{ "Contributors": "MIMIC", "Source": "MIMIC-IV", "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", "Categories": [ "Summarization" ], "Definition": [ "Summarize the MRI imaging diagnostics' detailed findings for the Spine into a concise conclusion." ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Medicine", "Clinical Reports", "MRI", "Spine" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMild levoscoliosis of lumbar spine. There is transitional anatomy partial\nsacralization L5. L4 and L5 endplate probable Schmorl's nodes are seen. \nVertebral body heights are preserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signalare preserved. There is congenital\nnarrowing of L3 and L4 pedicles. There is prominent epidural fat at L2-3 and\nL3-4.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal or neural foraminal narrowing. Nonspecific\nbilateral facet joint fluid is noted.\n\nAt L2-3 there is prominent epidural fat, disc bulge, facet joint hypertrophy,\nligamentum flavum hypertrophy, mild-to-moderatevertebral canal and no neural\nforaminal narrowing.\n\nAt L3-4 there is prominent epidural fat, congenitally short pedicles, disc\nbulge, facet joint hypertrophy, ligamentum flavum hypertrophy,\nmoderatevertebral canal and no neural foraminal narrowing.\n\nAt L4-5 there is congenitally short pedicles, disc bulge, ligamentum flavum\nhypertrophy, facet joint hypertrophy, moderate to severevertebral canal and\nmild bilateral neural foraminal narrowing. Nonspecific bilateral facet joint\nfluid is noted.\n\nAt L5-S1 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal and no neural foraminal narrowing. \nNonspecific bilateral facet joint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Right renal probable cysts are noted. \nNonspecific dorsal soft tissue probable dependent edema is noted.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel lumbar spondylosis, prominent epidural fat, and congenital\nnarrowing of the L3 through L5 pedicles as described, most pronounced at L4-5,\nwhere there is moderate to severe vertebral canal and mild bilateral neural\nforaminal narrowing.\n3. L3-4 prominent epidural fat, congenitally short pedicles, and spondylosis\nwith moderate vertebral canal narrowing.\n4. Limited imaging of kidneys suggest right renal probable cysts. If\nclinically indicated, consider dedicated renal ultrasound for further\nevaluation." }, { "input": "CERVICAL:\nThe cervical spine alignment is normal. Vertebral body heights and signal\nintensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of high-grade spinal canal or neural\nforaminal narrowing. There is no evidence of infection or neoplasm. There is\nno abnormal enhancement after contrast administration.\n\nTHORACIC:\nThe thoracic spine alignment is normal. Vertebral body heights and signal\nintensity appear unremarkable. There are degenerative endplates\nirregularities with small Schmorl's nodules more pronounced at superior\nendplate of T11, superior endplate of T12 and inferior endplate of T12. \nSclerotic area at the inferior posterior aspect of T12 vertebral body remains\nunchanged (4:11),the spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nThe lumbar spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear unremarkable.The conus medullaris and cauda equina\nfibers show normal shape and signal intensity. The conus medullaris ends at\nthe level of L1-L2.There is no evidence of high-grade spinal canal or neural\nforaminal narrowing.There is no evidence of infection or neoplasm.\n\nThere is a oval-shaped T2 hyperintense abnormality at the left retrocrural\nregion just superior to the left iliopsoas muscles measuring about 2.2 x 1.5\ncm (8:5). Its difficult to assess if this abnormality is enhancing or not\nsince the T1 pre contrast sequence does not cover this area. Also it is\ndifficult to appreciate this abnormality in the previous MR abdomen\nexamination. Overall appearance concerning for enlarged retrocrural lymph\nnode, however given the clinical history, metastatic disease is also\nconsideration.", "output": "1. Oval-shaped lesion identified at the left retrocrural region,\ndemonstrating T2 high-signal intensity, just superior to the left iliopsoas\nmuscles measuring about 2.2 x 1.5 cm (8:5); which may represent retrocrural\nenlarged lymph node, or retrocrural metastatic deposit.\n\n2. No abnormal intradural enhancement.\n\n3. No definite aggressive osseous process.\n\n4. There is no evidence of spinal canal stenosis or neural foraminal\nnarrowing throughout the cervicothoracic and lumbar spine.\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 impression and recommendation above was entered by Dr.\n___ on ___ at 12:11 hours into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lumbar spine: The vertebral body height and alignment is maintained. There is\na large region of T1 and T2 hyperintensity in the anterior aspect of the L4\nvertebral body which is not identified on STIR images and therefore most\nlikely represents a large region of focal fat. There is loss of normal\nintervertebral disc height and signal at L4-L5 and L5-S1 with vacuum disc\nphenomenon noted at this level.\n\n\nL2-L3: No disc herniation, spinal canal stenosis, or neural foraminal\nnarrowing.\n\nL3-L4: There is mild disc bulge asymmetric to the right. There is no\nsignificant spinal canal narrowing or neural foraminal stenosis.\n\nL4-L5: There is a broad-based disc protrusion with mild ligamentum flavum\nthickening and mild bilateral facet arthropathy resulting in narrowing of the\nbilateral subarticular zones and mass effect on the left greater than right\ntraversing L5 nerve roots. There is mild overall spinal canal stenosis\nwithout significant neural foraminal narrowing.\n\nL5-S1: There is a large right paracentral disc protrusion which is severely\ncompressing the right ventral thecal sac exerting mass effect on the right\ntraversing S1 nerve root. There is no significant neural foraminal stenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities.The conus medullaris terminates at the L1-L2 level.\n\nThe posterior elements and paraspinal soft tissues are normal.", "output": "1.. L5-S1 right paracentral disc protrusion compressing the right traversing\nS1 nerve root and severely narrowing the right ventral aspect of the thecal\nsac at this level.\n\n2. Broad-based disc protrusion L4-L5 narrowing the bilateral subarticular\nzones.\n\n3. Additional degenerative changes as detailed above" }, { "input": "There is no evidence of fracture or traumatic subluxation. There is no\nsignificant prevertebral soft tissue swelling. Moderate degenerative changes\nare seen throughout the cervical spine.\n\nC2/C3: There is no significant disc bulge, or neural foraminal or spinal\ncanal narrowing.\n\nC3/C4: There is mild right paracentral disc bulge, with possible contact of\nthe right exiting nerve root however no evidence of compression. There is no\nleft neural foraminal narrowing. Next\n\nC4/C5: No significant disc bulge, thecal sac or neural foraminal narrowing.\n\nC5/C6: There is a moderate disc bulge, with a focal left paracentral disc\nprotrusion. There is severe left neural foraminal narrowing with possible\ncontact of the exiting nerve root.\n\nC6/C7: There is a broad-based left paracentral disc bulge with moderate left\nneural foraminal narrowing and mild right neural foraminal narrowing. There\nis mild thecal sac narrowing.\n\nNo cord signal abnormalities are identified.", "output": "1. Interval progression of degenerative changes with severe left foraminal\nnarrowing at C5-6 and moderate left foraminal narrowing at C6-7 level. .\n2. No evidence of spinal stenosis or extrinsic spinal cord compression or\nintrinsic spinal cord signal abnormalities." }, { "input": "2 mm retrolisthesis of C5 on C6 is unchanged from prior examination. Cervical\nalignment is otherwise anatomic. Vertebral body heights are preserved. No\nfocal suspicious marrow lesion. There is moderate to severe degenerative loss\nof C5-C6 and C6-C7 disc height, similar to prior examination. The visualized\nposterior fossa is unremarkable. There is no cord signal abnormality.\n\nC2-C3 through C4-C5: No significant spinal canal or neural foraminal\nnarrowing.\n\nC5-C6: A left central disc protrusion and thickening ligamentum flavum results\nin mild to moderate spinal canal narrowing, remodeling the left ventral aspect\nof the cord without underlying cord signal change, overall similar to prior\nexamination. Uncovertebral and facet arthropathy results in moderate to\nsevere left and moderate right neural foraminal narrowing, also slightly\nprogressed from prior exam.\n\nC6-C7: A central protrusion results in mild spinal canal narrowing, overall\nsimilar to prior examination. Uncovertebral and facet arthropathy results in\nsevere left and moderate right neural foraminal narrowing, also progressed\nfrom prior examination.\n\nC7-T1: No significant spinal canal or neural foraminal.\n\nAsymmetric effacement of the left vallecula, potentially secondary to\nasymmetric lingual tonsil, overall similar to examination of ___. Of note,\nthis does not appear to be demonstrate increased metabolic uptake on recent\nPET-CT of ___. Otherwise, visualized prevertebral paraspinal soft\ntissues are unremarkable.", "output": "1. Cervical spondylosis most prominent at C5-C6 and C6-C7 where there is C5-C6\nmoderate to severe left and moderate right neural foraminal narrowing as well\nas C6-C7 severe left and moderate right neural foraminal narrowing, progressed\nfrom examination of ___.\n2. Spinal canal is most prominent at C5-C6 where it is mild-to-moderate,\nremodeling the left ventral aspect of the cord without underlying cord signal\nchange, overall similar to prior examination.\n3. There is no cord signal abnormality. No suspicious marrow lesions.\n4. Asymmetric fullness of the left vallecula, potentially secondary to\nasymmetric lingual tonsil, similar to examination of ___. This does not\ndemonstrate increased metabolic uptake on recent PET-CT of ___.\n5. Additional findings described above." }, { "input": "For the sake of numbering the lowest rib bearing level is denoted T12. \nalignment is normal. There is loss of signal of the discs on the T2 weighted\nimages due to degenerative disease. The spinal cord appears normal.\n\nImaging from T10 to T12 reveals no spinal canal or neural foraminal narrowing.\n\nAt T12-L1 there is a minimal disc bulge with no spinal canal or neural\nforaminal narrowing.\n\nAt L1-2 there is a minimal disc bulge with no spinal canal or neural foraminal\nnarrowing.\n\nAt L2-3 and L3-4 there are mild facet osteophytes and minimal disc bulging\nwith no spinal canal or neural foraminal narrowing.\n\nAt L4-5 there is a right sided extraforaminal disc protrusion that contacts\nthe exiting L4 root. There are large facet osteophytes bilaterally.\n\nThe L5 vertebral body is sacralized. There is no spinal canal or neural\nforaminal narrowing.", "output": "1. Mild degenerative disease." }, { "input": "CERVICAL:\nAlignment is normal. Mild multilevel degenerative changes with small anterior\nposterior osteophytes, and disc space narrowing at C5-C6. Vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration. No abnormal cord signal. No evidence of\ninfection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nC1 -C3: No spinal canal or neural foraminal narrowing.\nC3 -C4: Small posterior disc bulge with mild left uncovertebral and bilateral\nfacet hypertrophy is causing mild spinal canal narrowing and mild left neural\nforaminal narrowing.\nC4-C5: Small posterior disc bulge without significant spinal canal or neural\nforaminal narrowing.\nC5-C6: Bilateral uncovertebral hypertrophy causing mild left neural foraminal\nnarrowing. No spinal canal narrowing.\nC6-C7: Mild bilateral uncovertebral hypertrophy with small posterior disc\nbulge causing mild bilateral neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal.Mild multilevel degenerative changes with small anterior\nand posterior osteophytes. 0.5 x 0.5 cm stir hyperintense, T1 heterogeneous,\nperipherally enhancing lesion is seen within the mid to posterior T1 vertebral\nbody. Vertebral body and intervertebral disc signal intensity otherwise\nappear normal. The spinal cord appears normal in caliber and configuration. \nNo abnormal cord signal.No evidence of infection. There is no abnormal\nenhancement after contrast administration.\n\nC7-T9: No spinal canal or neural foraminal narrowing.\nT9-T10: Right facet hypertrophy with thickening of the ligamentum flavum is\ncausing mild spinal canal narrowing. No neural foraminal narrowing.\nT10-T12: No spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nAlignment is normal. Mild multilevel degenerative changes with small anterior\nand posterior osteophytes, disc space loss at L3-L4, and combination ___\ntype 1 and 2 changes along the endplates. Vertebral body and intervertebral\ndisc signal intensity are otherwise normal.From L2 through S1 there is a T1/T2\nhyperintense, stir hypo intense linear lesion within the thecal sac. Given\nthe inherent T1 hyperintensity assessment for enhancement is limited. \nHowever, there appears to be no enhancement of this structure. This is\ntypical of a lipoma of the filum terminale. No associated vascular flow\nvoids. No evidence of infection.\n\nT12-L2: No spinal canal or neural foraminal narrowing.\nL2-L3: Small asymmetric posterior disc bulge involving the left paramedian,\nforaminal, and extraforaminal regions with bilateral ligamentum flavum\nthickening and facet hypertrophy causing mild left neural foraminal narrowing\nand mild spinal canal narrowing.\nL3-L4: Moderate posterior disc bulge with thickening of ligamentum flavum and\nfacet hypertrophy causing crowding of nerve roots, moderate right and mild\nleft neural foraminal narrowing.\nL4-L5: Small posterior disc bulge with bilateral ligamentum flavum thickening\nand facet hypertrophy causing mild bilateral neural foraminal narrowing and\nspinal canal narrowing.\nL5-S1: Small posterior disc bulge causing mild spinal canal narrowing. No\nneural foraminal narrowing.\n\nOTHER: The partially visualized posterior fossa is unremarkable. The\nvisualized intra-abdominal solid organs as well as paraspinal soft tissues are\nwithin normal limits. No prevertebral edema.", "output": "1. Mildly thickened T1/T2 hyperintense, STIR hypointense lesion extending from\nL2 through S1 is consistent with a filum terminale lipoma.\n2. Mild multilevel degenerative changes throughout the spine with multilevel\nmild spinal canal and mild neural foraminal narrowing most prominent at L3-L4\nwith moderate spinal canal narrowing, crowding of nerve roots and moderate\nright with mild left neural foraminal narrowing at this level.\n3. No evidence of dural AV fistula.\n4. 0.5 cm T1 heterogenous minimally enhancing T1 vertebral body lesion likely\nrepresents an atypical hemangioma." }, { "input": "Mild presumed age-related kyphosis is identified. Otherwise, thoracic\nalignment is anatomic. Vertebral body heights are preserved. Oblique linear\nT2/STIR hyperintense signal extending through a anterior T6-T7 syndesmophyte\ninvolving the right anterior inferior margins the T6 vertebral body and with\nfracture plane extending in a oblique fashion through the T7 vertebral body\nfrom the superior to inferior endplate (series 5, image 9 through 14) is\nidentified. Given the fracture through the anterior syndesmophyte, there is\npresumed injury to the anterior longitudinal ligament at T6-T7. The posterior\nlongitudinal ligaments, ligamentum flavum, interspinous ligaments are intact. \nThere is no epidural collection. The cord is unremarkable in signal and\ncaliber.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nThe paraspinal muscles are intact. There is mild prevertebral edema. Mild\nbilateral pleural effusions identified.\n\nT2 hyperintense cystic lesions of both kidneys are statistically most\ncompatible with simple cysts. A large right extrarenal pelvis is noted.", "output": "1. T6-T7 anterior syndesmophyte fracture with minimal involvement of the\nanterior inferior T6 endplate. An oblique fracture line extends from the T7\nsuperior to inferior endplates. No bony retropulsion.\n2. Given the T6-T7 syndesmophyte fracture, it is presumed that the anterior\nlongitudinal ligament is obstructed at this level. The posterior longitudinal\nligament, ligamentum flavum and interspinous ligaments are intact.\n3. There is no cord signal abnormality. There is no epidural collection.\n4. There is no significant spinal canal or neural foraminal narrowing.\n5. Additional 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": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThe L2 vertebral body demonstrates compression deformity with approximately\n30% loss of vertebral body height with associated T2/STIR hyperintensity and\nT1 hypointensity, compatible with an acute fracture. There is no associated\nretropulsion component. There is edema within the L1-L2 intervertebral disc\nspace. There is mild prevertebral soft tissue edema. There is no definite\ninjury to the anterior longitudinal ligament or posterior longitudinal\nligament. The posterior paraspinal soft tissues appear unremarkable. The\nconus medullaris terminates at L2.\n\nT12-L1: There is a right paracentral disc protrusion causing mild right and no\nleft neural foraminal narrowing or spinal canal stenosis.\n\nL1-L2: There is a disc bulge with ligamentum flavum thickening causing mild\nbilateral neural foraminal narrowing without spinal canal stenosis.\n\nL2-L3: There is no spinal canal stenosis or neural foraminal narrowing.\n\nL3-L4: There is no spinal canal stenosis or neural foraminal narrowing.\n\nL4-L5: There is a disc extrusion with annular fissure (08:33) with ligamentum\nflavum thickening contacting the left traversing L5 nerve root without\ndisplacement. There is mild bilateral neural foraminal narrowing without\nspinal canal stenosis.\n\nL5-S1: There is a disc protrusion with mild facet arthropathy, without spinal\ncanal stenosis and mild bilateral neural foraminal narrowing.", "output": "1. Acute compression deformity of L2 vertebral body with approximately 30%\nloss of vertebral body height and L1-L2 intervertebral disc edema.\n2. Given the absence of adjacent inflammatory changes, findings are felt\nunlikely to represent discitis or osteomyelitis. No evidence of epidural\nabscess.\n3. No associated retropulsion component, cord compression, or ligamentous\ninjury.\n4. Mild degenerative changes of the lumbar spine with L4-L5 disc extrusion and\nannular fissure, as described above." }, { "input": "Motion artifact slightly limits evaluation.\n\nThere are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nAlignment is normal. No suspicious bone marrow signal abnormalities are seen.\nT1 hyperintense fat containing hemangioma is seen in the L2 vertebral body. \nDiscogenic bone marrow changes are present at multiple levels, mild but most\nprominent at L5-S1.\n\nEvaluation of distal spinal cord signal is limited by motion artifact. The\ndistal cord demonstrates normal morphology with the conus terminating at\nL1-L2. There is no evidence for pathologic contrast enhancement\n\nT12-L1: Mild disc bulge without spinal canal or neural foraminal narrowing.\n\nL1-L2: Broad-based left paracentral and foraminal disc protrusion and minimal\nbilateral facet arthropathy. No mass effect on the intrathecal nerve roots. \nNo clear evidence for mass effect on the traversing left L2 nerve root in\nsupine position. Minimal narrowing of the proximal left neural foramen\nwithout evidence for mass effect on the exiting L1 nerve root.\n\nL2-L3: Mild disc bulge, larger on the left than right. Minimal facet\narthropathy. No significant spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild disc bulge, larger on the left than right, with a possible small\nsuperimposed left foraminal disc protrusion. Mild facet arthropathy. No mass\neffect on the intrathecal nerve roots. Traversing left L4 nerve root is\ncontacted in the subarticular zone without evidence for frank compression. \nMild left neural foraminal narrowing without evidence for mass effect on the\nexiting L3 nerve root.\n\nL4-L5: Mild disc bulge and moderate facet arthropathy. No mass effect on the\nintrathecal nerve roots. Traversing L5 nerve roots are contacted in the\nsubarticular zones, left more than right, without evidence for frank\ncompression. Mild to moderate bilateral neural foraminal narrowing. Exiting\nL4 nerve roots may be contacted without evidence for frank compression.\n\nL5-S1: There is a disc bulge and a left paracentral disc herniation which\ndisplaces and deforms the traversing left S1 nerve root. Also mild to\nmoderate facet arthropathy. No significant mass effect on the intrathecal\nnerve roots. Mild right and moderate left neural foraminal narrowing with\nabutment of the exiting left L5 nerve root.", "output": "1. Multilevel lumbar degenerative disease.\n2. No significant narrowing of the thecal sac or mass effect on the\nintrathecal nerve roots.\n3. L3-L4: Traversing left L4 nerve root is contacted in the subarticular zone\nwithout evidence for frank compression.\n4. L4-L5: Traversing L5 nerve roots are contacted in the subarticular zones,\nleft more than right, without evidence for frank compression. \nMild-to-moderate bilateral neural foraminal narrowing with contact of the\nexiting L4 nerve roots, but no evidence for frank compression.\n5. L5-S1: Left paracentral disc herniation displaces and deforms the\ntraversing left S1 nerve root. Disc bulge and facet arthropathy cause\nmoderate left neural foraminal narrowing with abutment of the exiting left L5\nnerve root.\n\nNOTIFICATION: The following preliminary report in PACS was provided by Dr.\n___ on ___ at 12:55 AM:\nCord or cauda equina compression: no\nCord signal abnormality: no\nEpidural collection: no\nOther: Normal alignment. No significant spinal canal or neural foraminal\nstenosis.\n\nDr. ___ the additional findings in impression items 3 through 5 to\nthe ED QA nurses list on ___ at 09:03." }, { "input": "Study is mildly degraded by motion. There is new minimal C3 on C4\nanterolisthesis with no associated edema, prevertebral soft tissue swelling or\nepidural collection. Vertebral body heights are preserved. A stable C7\nvertebral body hemangioma is again noted. The visualized portion of the spinal\ncord is preserved in signal. There is remodeling of the cervical spinal cord\nwithout associated cord signal abnormality at C5-6 and C6-7.\n\nThere is loss of intervertebral disc height and signal at C2-3, C3-4, C4-5,\nC5-6, and C6-7.\n\nWithin 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. There is no abnormal enhancement on\npostcontrast imaging.\n\n At C2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is disc bulge with uncovertebral hypertrophy resulting in\nmoderate bilateral neural foraminal stenosiswith no vertebral canal stenosis,\nunchanged.\n\nAt C4-5 there is disc osteophyte complex with facet joint arthropathy\nresulting in severe right and moderate left neural foraminal and mild\nvertebral canal stenosis, progressed compared to prior exam.\n\nAt C5-6 there is disc bulge with uncovertebral hypertrophy resulting in severe\nspinal canal severe left and moderate right neural foraminal stenosis,\nprogressed compared to prior exam.\n\nAt C6-7 there is right paracentral disc protrusion with uncovertebral\nhypertrophy resulting in severe spinal canal and mild bilateral neural\nforaminal stenosis, which is new compared to prior exam.\n\nAt C7-T1 there is disc bulge with uncovertebral hypertrophy and facet joint\narthropathy resulting in mild left neural foraminal stenosis that is new with\nno vertebral canal stenosis.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no evidence of spinal cord lesion.\n3. Interval progression of multilevel degenerative changes as described, most\npronounced at C5-6 and C6-7 where there is severe vertebral canal stenosis\nwith remodeling of the cervical spinal cord, with no definite cord signal\nabnormality identified.\n4. C4-5 right and C5-6 left severe neural foraminal stenosis." }, { "input": "The cervical lordosis is preserved. There is no fracture or malalignment. The\nbone marrow signal is within normal limits. There are no degenerative\nchanges, nor spinal canal stenosis or neural foramina narrowing. There is no\nsignal abnormality in the spinal cord or enhancing lesion. The imaged portions\nof the posterior fossa are unremarkable.\n\nThere is no prevertebral soft tissue swelling or paraspinal abnormality. The\nvisualized aerodigestive tract is grossly unremarkable. There is no\nperitonsillar fluid collection or parotid anomaly. No cervical\nlymphadenopathy is identified.", "output": "1. Normal cervical spine MR examination.\n2. No cord signal abnormality.\n3. No abnormal enhancement on post-contrast imaging." }, { "input": "There is transitional anatomy at the lumbosacral junction. For the sake of\nthis study the numbering system is as described. Assuming the last\nrib-bearing vertebral body is T12, and at the renal artery is seen at the\nlower L1 level, there is partial sacralization of L5. Bone marrow signal is\nslightly heterogeneous though without focal suspicious marrow lesions\nidentified. Intervertebral disc desiccation is seen at L4-5. Conus\nterminates at L1 level, in normal anatomic position.\n\nAt T11-T12 through L1-2, there is no significant canal or foraminal narrowing.\n\nAt L2-3, there is a disc bulge and mild facet joint hypertrophy which\ncontribute to subarticular recess narrowing. No significant overall canal\nnarrowing or significant foraminal narrowing.\n\nAt L3-4, there is a disc bulge and facet joint hypertrophy contributing to\nsubarticular recess narrowing, crowding the traversing L4 nerve roots. No\nsignificant canal narrowing though there is moderate left and mild right\nforaminal narrowing. The exiting left L3 nerve root is seen to contact the\ndisc bulge laterally.\n\nAt L4-5, there is a disc bulge and facet joint hypertrophy with thickening of\nthe ligamentum flavum. There is secondary mild to moderate canal narrowing\nand subarticular recess narrowing crowding the traversing L5 nerve roots. \nThere is moderate left and mild right foraminal narrowing.\n\nAt L5-S1, there is facet joint hypertrophy. No significant canal or foraminal\nnarrowing.\n\nMultiple T2 hyperintensities within the kidneys bilaterally are likely cysts. \nOther included retroperitoneal paraspinal soft tissues are unremarkable.", "output": "Transitional anatomy at the lumbosacral junction as detailed above.\nDegenerative changes in the lower lumbar spine, specifically at L3-4 and L4-5\nresulting in up to mild to moderate canal narrowing at the latter level. \nSubarticular recess narrowing at these levels bilaterally crowding the\ntraversing L4 and L5 nerve roots. Moderate left foraminal narrowing at these\ntwo levels as well." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. \nCongenital partial fusion of C3-C4 is unchanged in appearance from prior\nexamination. There is no focal suspicious marrow lesion. Degenerative loss\nof disc height and signal at C4-C5 and C5-C6 is mild, similar to prior\nexamination. The visualized posterior fossa is unremarkable. There is no\ncord signal abnormality.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: A central protrusion results in moderate spinal canal narrowing,\nremodeling the ventral aspect of the cord, without underlying cord signal\nchange. Uncovertebral and facet arthropathy results in moderate left greater\nthan right neural foraminal narrowing, overall similar to prior examination.\n\nC5-C6: A central protrusion results in mild spinal canal narrowing. \nUncovertebral facet arthropathy results in mild bilateral neural foraminal\nnarrowing, overall similar to prior examination.\n\nC6-C7: A small central protrusion does not narrow the spinal canal. There is\nno significant neural foraminal narrowing.\n\nC7-T1: Unremarkable.\n\nThe adenoids are mildly prominent, slightly increased in size from examination\n___, potentially reactive. Clinical correlation is recommended.\n\nIncompletely characterized is a 1.5 cm T1 hyperintense focus in the right\nsubscapularis muscle on coronal localizer image (series 1e, image 13),\npotentially representing a lipoma.\n\nThe remainder of the visualize prevertebral paraspinal soft tissues are\nunremarkable.", "output": "1. Cervical spondylosis, most prominent at C4-C5 where a central protrusion\nremodels the ventral aspect of the cord without underlying cord signal change,\noverall similar to prior examination of ___. There is also moderate\nbilateral neural foraminal narrowing, left greater than right also similar to\nprior exam.\n2. Additional degenerative findings as described above.\n3. Incompletely characterized 1.5 cm T1 hyperintense focus in the right\nsubscapularis muscle, seen on a coronal localizer image. This could represent\na lipoma. Further evaluation with dedicated CT or MRI examination is\nrecommended.\n\nRECOMMENDATION(S): Dedicated right shoulder CT or MRI examination performed\nas clinically indicated for impression 3." }, { "input": "There is straightening of the cervical spine with multilevel loss of vertebral\nbody heights and disc desiccation, particularly at C5-C6 with ___ type 2\nendplate degenerative changes at multiple levels.\n\nC2-C3: There is no spinal canal or neural foraminal stenosis.\n\nC3-C4: There is progression of central disc bulge with spinal cord remodeling\nand moderate spinal canal stenosis. There is stable mild right and no left\nneural foraminal narrowing.\n\nC4-C5: There is interval progression of a disc bulge with mild spinal canal\nstenosis. There is stable mild bilateral neural foraminal narrowing.\n\nC5-C6: There is slight interval progression of a disc bulge with spinal cord\nremodeling and moderate spinal canal stenosis. There is stable severe right\nand mild left neural foraminal narrowing.\n\nC6-C7: There is a disc bulge with stable mild spinal canal stenosis, mild\nright and no left neural foraminal narrowing.\n\nThe prevertebral and paraspinal soft tissues appear unremarkable. The\ncraniocervical junction appears unremarkable. There is no evidence of\nmyelomalacia.", "output": "1. Interval progression of multilevel degenerative changes, most advanced and\nwith moderate spinal canal stenosis at C5-C6, with additional details as\nabove." }, { "input": "The alignment is normal. There is no evidence of spinal or neural foraminal\nstenosis. Diffusely T1 hypo intense bone marrow is seen throughout the lower\nthoracic and lumbar spine. The disc signal is normal. Minimal broad-based\nintervertebral disc bulge is seen at L5/S1.\n\nAt L4/L5 and L5/S1, a posterior epidural collection is seen which is T2\nheterogeneous as well as faintly T1 hyperintense however nonenhancing,\nconcerning for a hematoma, measuring approximately 5.2 cm in the craniocaudal\ndirection.\n\nNo acute fractures identified. No paraspinal or paravertebral soft tissue\nabnormalities identified. The nerve roots are thickened, faintly enhancing,\nalso concerning for arachnoiditis.", "output": "1. 5.2 cm posterior epidural heterogeneous T2 collection, likely secondary to\na hematoma spanning from L4 through S1, may be sequelae of prior intervention.\nFollow-up scan in ___ days is recommended for further evaluation.\n2. Thickened, faintly enhancing nerve roots, are also concerning for\narachnoiditis.\n3. Diffuse T1 hypo intense signal throughout the bone marrow, could be\nsecondary to anemia, or a systemic process, however a neoplastic diffuse\ninvolvement cannot be excluded.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 2:53 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "CERVICAL:\nVertebral body heights and alignment are preserved. At C7 vertebral body,\nthere is mild heterogeneous signal better seen on the sagittal STIR sequence\nas well as in the fat enhancing images (series 3, image 6, series 300, image\n6), there is suggestion of bone marrow neoplastic infiltration in the\nposterior aspect of C6 vertebral body (series 3, image 7, suggestive of bone\nmarrow infiltration from metastatic disease, the signal intensity throughout\nthe cervical spinal cord is normal with no evidence of cord expansion, focal\nor diffuse lesions. There is mild anterior indentation of the spinal cord at\nthe C4-C5 intervertebral disc, as below, without underlying signal\nabnormality. Minimal loss of intervertebral disc signal is suggestive of\ndegenerative change.\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 C2-3 there is mild left-sided facet arthropathy, which results in mild\nneural foraminal stenosis. There is no right neural foraminal or vertebral\ncanal stenosis..\n\nAt C3-4 there is mild right facet arthropathy, resulting in mild right neural\nforaminal stenosis. There is no vertebral canal or left neural foraminal\nstenosis..\n\nAt C4-5 there is mild posterior disc bulge, which indents the anterior thecal\nsac and contacts the anterior cord. Cord morphology is affected without\nabnormal cord signal. Overall vertebral canal stenosis remains to moderate. \nUncovertebral hypertrophy and facet arthropathy result in mild-to-moderate\nneural foraminal stenosis..\n\nAt C5-6 there is uncovertebral hypertrophy and facet arthropathy, left greater\nthan right, resulting in mild-to-moderate left and mild right neural foraminal\nstenosis. There is no vertebral canal stenosis..\n\nAt C6-7 there is mild posterior disc bulge, uncovertebral hypertrophy, and\nminimal bilateral facet arthropathy, which results in mild to moderate\nvertebral canal and moderate bilateral neural foraminal stenosis..\n\nAt C7-T1 there is right-sided uncovertebral hypertrophy and minimal posterior\ndisc bulge, which results in mild vertebral canal and right neural foraminal\nstenosis. There is no left neural foraminal stenosis..\n\nTHORACIC:\nRight hilar mass is only partially visualized and better assessed on dedicated\nCT chest from ___.\n\nVertebral body alignment is relatively preserved.\n\nThere is minimal loss of height at T2, with associated T1 weighted\nhypointensity and T2/IDEAL hyperintensity with enhancement, consistent with\nneoplastic infiltration. There is 5 mm of retropulsion. Multiple linear\nareas T1 hypointensity, which remain T2/IDEAL hypointense are suggestive of\npathologic fracture, which is likely chronic. Disease involvement appears to\nextend into the posterior elements and associated second rib on both sides. \nSoft tissue component, which enhances along signed major vertebral body\ncomponent, shows epidural involvement resulting in severe spinal canal\nnarrowing (series 25; image 3). There is resultant abnormal morphology of the\nspinal cord at this level without underlying cord signal abnormality. Anterior\nto the vertebral body on the left, there is T1 isointense, T2/IDEAL\nhyperintense, enhancing lesion, which is concerning for an additional site of\ndisease involvement.\n\nIn the posterior aspect of the T3 vertebral body, there is T1 hypointensity\nand associated T2/IDEAL hyperintensity with enhancement, consistent with\nneoplastic infiltration. Similar signal characteristics are seen in both\npedicles. There is no resultant height loss, retropulsion, or epidural\ninvolvement.\n\nIn the posterior aspect of the T4 vertebral body, there is T1 hypointensity\nand associated T2/IDEAL hyperintensity with enhancement, consistent with\nneoplastic infiltration. There is no resultant height loss, retropulsion, or\nepidural involvement.\n\nRemaining vertebral body heights and signal are normal. There is mild loss\nthoracic intervertebral disc height and signal, consistent with mild\ndegenerative change. Remaining thoracic spinal cord is within normal limits. \nThere is small posterior disc bulge at T6-7, which results in mild spinal\ncanal narrowing. Neural foramina appear patent throughout the thoracic spine,\nincluding at T2 through T5. No additional areas of abnormal contrast\nenhancement.\n\nLUMBAR:\nIn the right-side of the L2 vertebral body, there is T1 hypointensity and\nassociated IDEAL hyperintensity with enhancement, consistent with neoplastic\ninfiltration. Neoplastic infiltration extends into the right pedicle. There\nis no loss of height. There is extension outside of the vertebral body into\nthe right paraspinal fat as well as the subarticular and extraforaminal zones\n(series 22; image 28), with resultant moderate narrowing in these areas and\ncontact with the exiting L2 nerve root. Otherwise, there is no neural\nforaminal or spinal canal narrowing at L2-L3.\n\nAt T12-L1, there is mild posterior disc bulge, resulting in mild spinal canal\nnarrowing without bilateral neural foraminal narrowing.\n\nAt L1-L2, there is no neural foraminal or spinal canal narrowing.\n\nSee above for description of L2-L3.\n\nAt L3-L4, there is mild posterior disc bulge, resulting in mild-to-moderate\nspinal canal and bilateral neural foraminal narrowing.\n\nAt L4-L5, there is mild posterior disc bulge, which results in\nmild-to-moderate spinal canal and bilateral neural foraminal narrowing.\n\nAt L5-S1, there is mild posterior disc bulge, which results in\nmild-to-moderate spinal canal and bilateral neural foraminal narrowing.\n\nOTHER: See above for refer script shin of right hilar mass, which is more\ncompletely described on CT chest from ___.", "output": "1. Neoplastic infiltration of C7 vertebral body, better seen in the sagittal\nSTIR sequence towards the left (series 3, image 6). There is suggestion of\nneoplastic infiltration involving the posterior aspect of C6 (series 3, image\n7).\n2. Neoplastic infiltration at T2 vertebral body with minimal height loss and 5\nmm of retropulsion. Linear areas of T1 hypointensity throughout the T2\nvertebral body without associated edema are suggestive of chronic pathologic\nfracture. Disease extends into the posterior elements and adjacent ribs. \nSoft tissue component ___ is within the epidural space, resulting in severe\nspinal canal narrowing. There is abnormal cord morphology without underlying\ncord signal abnormality.\n3. Neoplastic infiltration of the T3 and T4 vertebral bodies without epidural\nextension, resultant pathologic fracture, or spinal canal/neural foraminal\ninvolvement.\n4. Disease involvement of the right side of the L2 vertebral body, with\nextension into the right pedicle. Tumor also extends outside of the vertebral\nbody into the right paraspinal fat as well as the subarticular and\nextraforaminal zones, contacting the exiting L2 nerve root.\n5. Partially visualized right hilar mass, which is more completely described\non chest CT from ___.\n6. Mild degenerative changes throughout the 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):115___\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": "CERVICAL:\nThere is reversal of the normal cervical lordosis. Otherwise, cervical\nalignment is anatomic. The marrow signal of the C2 through C6 vertebral\nbodies is heterogeneous, but without focal lesion. Re-identified is T1\nhypointense signal of the C7 vertebral body compatible with metastatic\ndisease, overall similar to prior examination. Cervical vertebral body\nheights are preserved. There is mild expansion of the left C7 vertebral body,\nmildly encroaching on the left epidural space slightly more prominent when\ncompared to prior exam. There is no abnormal signal or enhancement of the\ncervical cord.\n\nThere is edema of the bilateral cerebellar hemispheres secondary to known\nmetastatic disease. The enhancing left-sided cerebellar lesion is partially\nvisualized.\n\nC2-C3: There is no significant spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in mild left neural foraminal narrowing, unchanged\nfrom prior exam.\nC3-C4: There is no significant spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in severe right and mild left neural foraminal\nnarrowing, unchanged from prior exam.\nC4-C5: A central protrusion results in mild spinal canal narrowing, unchanged\nfrom prior exam. Uncovertebral facet arthropathy results in mild bilateral\nneural foraminal narrowing.\nC5-C6: There is no significant spinal canal narrowing. Uncovertebral facet\narthropathy results in mild right and moderate left neural foraminal\nnarrowing.\nC6-C7: There is no significant spinal canal narrowing. Left-sided vertebral\nbody lesion on C7 is slightly more prominent. Uncovertebral and facet\narthropathy results in moderate bilateral neural foraminal narrowing unchanged\nfrom prior exam.\nC7-T1: No significant spinal canal or neural foraminal narrowing\n\nThe remainder the visualized prevertebral paraspinal soft tissues are\nunremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic. There is interval mild less than 25% loss of\nT2 vertebral body height progressed from prior examination. The remainder of\nthe thoracic vertebral body heights are preserved. An expansile T2 osseous\nlesion with extension to the pedicles on examination of ___ is\nsmaller when compared to prior examination, with minimal effacement of the\nepidural fat. Re-identified are T3 and T4 vertebral body lesions, similar to\nprior examination. No definitive new thoracic lesions are identified. L1 and\nL2 vertebral body lesions have significantly increased in size when compared\nto prior exam. The L2 lesion now extends to the right pedicle.\n\nThere is no abnormal signal or enhancement of the thoracic cord.\n\nThere is no evidence of high-grade spinal canal or neural foraminal narrowing.\n\nRight apical infiltrative mass is partially visualized with obstructive\natelectasis. Re-identified is a necrotic 3 cm mass in the right renal upper\npole. Multiple T2 hyperintense simple renal cysts are also noted bilaterally.", "output": "1. Mild interval increase size of a C7 vertebral body lesion, with minimal\nremodeling into the left epidural space when compared to prior examination.\n2. A T2 expansile lesion is smaller when compared to prior examination. T3\nand T4 vertebral body lesions are similar.\n3. L1 and L2 vertebral body lesions are significantly increased in size when\ncompared to prior examination as described above.\n4. There is no evidence of abnormal signal or enhancement of the cervical or\nthoracic cord. Known left cerebellar metastatic disease is partially\nvisualized. Edema pattern from right-sided cerebellar metastatic disease is\nidentified although the lesion is beyond the field of view.\n5. Multilevel degenerative changes most prominent at C3-C4 where there is\nsevere right neural foraminal narrowing, unchanged from prior exam.\n6. Additional findings described above. Please refer to recent PET-CT of ___ for additional details.\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. \nAlignment is normal. There is no bone marrow edema, ligamentous edema, or\nparavertebral edema.\n\nThere are 2 small T1 and T2 hyperintense foci along the superior endplate of\nT12 to the right of midline, which suppresses signal on fat-suppressed T2\nweighted images, consistent with either focal fat deposits or predominantly\nfatty hemangiomas. These incidental findings.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at L1.\n\nT12-L1: Minimal left facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nL1-L2: Mild left facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nL2-L3: Minimal disc bulge and mild bilateral facet arthropathy. No spinal\ncanal or neural foraminal narrowing.\n\nL3-L4: Minimal disc bulge and mild bilateral facet arthropathy. No spinal\ncanal or neural foraminal narrowing.\n\nL4-L5: Mild disc bulge, left foraminal annular fissure without disc\nherniation, mild right and mild to moderate left facet arthropathy. No spinal\ncanal narrowing. Mild bilateral neural foraminal narrowing without nerve root\nimpingement.\n\nL5-S1: Moderate bilateral facet arthropathy. No significant disc bulge. No\nspinal canal or neural foraminal narrowing.\n\nVisualized upper sacrum (S1 through S4) appears unremarkable.\n\nA retroverted uterus is partially visualized. The endometrium appears to\nmeasure 5-6 mm.", "output": "1. Mild lumbar degenerative disease without evidence for neural impingement,\nas detailed above.\n2. Visualized upper sacrum, S1 through S4, appears unremarkable. A dedicated\nMRI of the pelvis would be required to evaluate the entire sacrum and coccyx.\n3. Within the partially visualized uterus, the endometrium appears to measure\n5-6 mm. This is not considered concerning even if the patient is\npostmenopausal, as long as there is no postmenopausal vaginal bleeding." }, { "input": "CERVICAL:\nAlignment is anatomic.Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Moderate multilevel degenerative change is noted, including\nmoderate posterior disc bulge contributing to flattening of the ventral thecal\nsac at the level of C3-C4, C5-C6, and C6-C7. Mild posterior disc bulge is\nnoted at the levels of C4-C5 and C7-T1. There is moderate left-sided neural\nforaminal narrowing at C3-C4, moderate right-sided neural foraminal narrowing\nat C4-C5, moderate to severe bilateral neural foraminal narrowing at C5-C6,\nand moderate left-sided neural foraminal narrowing at C6-C7. There is no\nabnormal enhancement of the cord or spinal canal after contrast\nadministration.\n\nTHORACIC:\nAlignment is anatomic.Vertebral body and intervertebral disc signal intensity\nappear normal. Probable bone island noted within the T8 vertebral body,\ncorresponding to a sclerotic focus on prior CT chest, abdomen and pelvis.. \nThe spinal cord appears normal in caliber and configuration.Mild to moderate\nposterior disc bulge at T7-T8, T9-T10, and T11-T12 contributes to flattening\nof the ventral thecal sac. There is no abnormal enhancement of the cord or\nspinal canal after contrast administration.\n\nA right lower lobe superior segment 1.1 cm pulmonary lesion (series 13, image\n12) is noted. There is also a 2.7 cm left adrenal lesion (series 14, image\n36). A T2 hyperintense cystic focus measuring approximately 5 mm in hepatic\nsegment ___ is also noted.", "output": "1. Moderate multilevel degenerative change within the cervicothoracic spine,\nincluding multilevel posterior disc bulging which contributes to posterior\nindentation and flattening of the ventral thecal sac as described above,\nhowever no evidence of cord compression or cord edema.\n2. No evidence of metastatic disease to the cervical or thoracic spine.\n3. Right lung 1.1 cm and left 2.7 cm adrenal lesions, concerning for\nmetastatic disease, although the adrenal lesion could potentially represent an\nadenoma.\n4. Additional findings described above." }, { "input": "THORACIC:\nThoracic alignment is anatomic. Re-identified is a T12 superior endplate\ncompression fracture without evidence of cortical bowing or soft tissue\nextension to suggest underlying lesion. There is minimal 2 mm retropulsion of\nthe superior endplate fracture fragment, which in combination with thickening\nof the ligamentum flavum results in mild spinal canal narrowing without\nimpingement of the cord. Minimal less than 10% loss of the T12 vertebral body\nheight is noted. The remainder of the body heights are preserved. Otherwise,\nno focal suspicious marrow lesion noting fatty rest/hemangioma at the T10\nlevel. Disc heights are preserved. No cord signal abnormality. There are\nmultilevel disc protrusions most prominent at T6-T7 and T9-T10 where left and\nright central protrusions respectively results in mild spinal canal narrowing,\nminimally remodeling the ventral aspect of the cord. There is no evidence for\nhigh-grade spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nDegenerative 3 mm retrolisthesis of L 2 on L3 is noted. Otherwise, lumbar\nalignment is anatomic. No STIR hyperintense marrow signal to suggest\nadditional acute lumbar spine fractures. There does appear to be STIR\nhyperintense marrow signal of the visualized portions of the S2 and S3\nvertebra (series 12, image 9 and 13, potentially representing small\nnondisplaced fractures. A L2 vertebral body hemangioma is noted. \nDegenerative loss of disc height and signal is moderate diffusely. The conus\nmedullaris terminates at the L1-L2 level, within expected limits. There is no\nsignal abnormality of the terminal cord.\n\nL1-L2: A disc protrusion results in mild spinal canal narrowing. There is no\nsignificant neural foraminal narrowing.\n\nL2-L3: A disc protrusion, retrolisthesis of L2 on L3 and thickening of the\nligamentum flavum results in mild spinal canal narrowing. In conjunction with\nfacet arthropathy, there is moderate bilateral neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing. There is crowding of the left greater than\nright subarticular zones likely impinging on the traversing left L4 nerve\nroot. In conjunction with facet arthropathy, there is moderate bilateral\nneural foraminal narrowing.\n\nL4-L5: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is moderate to severe right and\nmoderate left neural foraminal narrowing.\n\nL5-S1: A central protrusion with intervertebral osteophytes results in mild\nspinal canal narrowing. There appears to be possible impingement of the\ntraversing were of left S1 nerve root against the disc and facet osteophyte\n(series 14, image 46). In conjunction with facet arthropathy there is severe\nleft neural foraminal narrowing. Mild right neural foraminal narrowing. A\n\nOTHER: The visualized portions of the thoracic spine demonstrates a disc\nprotrusion and thickening of the ligamentum flavum at C5-C6 which results in\nat least moderate spinal canal narrowing. Atelectasis is noted at the lung\nbases. Small T2 hyperintense cystic lesions of both kidneys measuring up to 5\nmm are statistically most likely simple cysts.", "output": "1. Re-identified is acute compression fracture of T12 with less than 10% loss\nvertebral body height and minimal retropulsion of the superior endplate\nfracture fragment. This results in mild spinal canal narrowing without\nimpingement of the cord.\n2. There is mild STIR hyperintense signal visualized at the S2-S3 levels,\npotentially representing additional nondisplaced fractures. Clinical\ncorrelation is recommended.\n3. Otherwise, the remainder of the visualized thoracic and lumbar levels\ndemonstrates no signal abnormality to suggest additional fractures.\n4. There is no high-grade spinal canal or neural foraminal narrowing of the\nthoracic spine.\n5. Multilevel lumbar spondylosis, most prominent at L3-L4 where there is\nmoderate spinal canal narrowing and at L5-S1 where there appears to be severe\nleft neural foraminal narrowing.\n6. Additional findings as described above." }, { "input": "The patient is status post posterior fusion with pedicle screws extending from\nL3 at least as high is T11, the highest level included on these images. \nArtifacts from the hardware obscure images at these levels. Again seen is\nkyphosis at the level of the T12 compression fracture. The compression\nfracture signal intensity suggests a chronic lesion at this point. There is\nmild posterior subluxation of L2 upon L3.\n\nAt T11-12, the combination of retropulsed bone of the compression fracture,\ndisc bulging and facet osteophytes produces moderate spinal canal narrowing.\nAt T12-L1 there is no spinal canal.\nAt L1-2, disc bulging mildly narrows the spinal canal. The neural foramina\nappear normal.\nAt L3-4, bulging of the disc and prominent ligamentum flavum thickening\ncombine to produce severe spinal canal narrowing, unchanged since the prior\nstudy. There is narrowing of the neural foramina bilaterally.\nAt L4-5, disc bulging and facet osteophytes produce narrowing of the right\nside of the spinal canal and the proximal right neural foramen. The left\nneural foramina appears normal.\nAt L5-S1, there is a disc bulge and small midline protrusion. There is no\nnarrowing of the neural foramina. There is compression of the left S1 nerve\nroot between the disc bulge and the left-sided facet osteophytes.", "output": "1. The T12 compression fracture now appears chronic with no further loss of\nheight since ___.\n2. There has been interval posterior fusion with pedicle screws extending as\nlow as L3 and as high as T11, the highest level included.\n3. Severe spinal stenosis at L3-4." }, { "input": "There is a mild acute edematous changes along the inferior aspect of the right\nsacroiliac joint with small size joint effusion associated with small\ncollection at medial aspect of the right iliacus muscle communicating with\nright sacroiliac joint space. The collection measures about 12 x 19 mm on\nmaximum axial ___.\n\nThere is diffuse low T1 and low T2 bone marrow signal intensity which could\nrelate to red marrow reconversion however marrow infiltration by neoplastic\nprocess cannot be excluded.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. Please note that evaluation of cord signal is extremely limited\nsecondary to extensive artifact. There are bilateral mild neural foraminal\nnarrowing at the level of L5-S1. Otherwise; there is no spinal canal or other\nneural foraminal narrowing. Paraspinal edema could be seen in the setting of\nmyositis.", "output": "1. Right acute sacroiliitis with small collection/abscess in the medial aspect\nof the right iliacus muscle.\n2. There is diffuse low T1 and low T2 bone marrow signal intensity which could\nrelate to red marrow reconversion. However; marrow infiltration by neoplastic\nprocess cannot be excluded.\n3. Extremely limited evaluation of cord signal secondary to extensive\nartifact.\n4. Paraspinal edema could be seen in the setting of myositis.\n\nRECOMMENDATIONS: ___ pelvis MRI with and without contrast may be helpful for\nevaluation of the entirety of the SI joint as this is incompletely visualized\non the current exam..\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." }, { "input": "Levoconvex curvature of the lumbar spine with apex at L3 is more prominent\nwhen compared to prior examination. There is d approximately 8 mm left\nlateral listhesis of L3 on L4. Remainder of the lumbar alignment is anatomic.\nVertebral body heights are preserved. L3 vertebral body hemangioma and\ninferior L2 ___ type 2 endplate changes is noted. Otherwise, no suspicious\nmarrow signal. Degenerative loss of disc height is moderate spanning L2-L3\nthrough L5-S1, progressed from prior exam. The conus medullaris terminates at\nthe L2 level, within expected limits. There is no signal abnormality of the\nterminal cord.\n\nL1-L2: A small disc bulge does not significantly narrow the spinal canal. \nThere is mild bilateral neural foraminal narrowing secondary to facet\narthropathy.\n\nL2-L3: A disc bulge with thickening ligamentum flavum results in mild spinal\ncanal narrowing. Left-greater-than-right facet arthropathy with small facet\njoint effusions is noted. In combination with levoconvex curvature, there is\nmoderate right and mild left neural foraminal narrowing.\n\nL3-L4: A disc bulge with prominent left facet arthropathy results in moderate\nto severe spinal canal narrowing, progressed from prior examination. There is\npossible impingement of the traversing left L4 nerve root. There is moderate\nleft neural foraminal narrowing where a facet osteophyte remodels the exiting\nleft L3 nerve root there is moderate right neural foraminal narrowing.\n\nL4-L5: a disc bulge crowds the bilateral subarticular zones, posteriorly\ndisplacing the traversing left L5 nerve root (series 7, image 30). Prominent\nfacet arthropathy is noted resulting in moderate right and severe left neural\nforaminal narrowing, impinging on the exiting left L4 nerve root.\n\nL5-S1: A disc bulge crowds the bilateral subarticular zones contacting the\ntraversing S1 nerve roots without definitive posterior displacement. This\nresults in mild spinal canal narrowing. In conjunction with facet\narthropathy, there is moderate to severe right and severe left neural\nforaminal narrowing.\n\nThe above degenerative findings have all progressed from prior examination.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Multilevel lumbar spondylosis progressed from examination of ___. The\nfindings are most prominent at L3-L4 where there is new for to severe spinal\ncanal narrowing crowding the cord and at L4-L5 and L5-S1 where there is severe\nleft neural foraminal narrowing likely impinging on the exiting nerve roots.\n2. There is also moderate to severe right L5-S1 neural foraminal narrowing.\n3. Additional findings as described above." }, { "input": "There is levoconvex scoliosis of the lumbar spine. There is 8 mm of left\nlateral listhesis of L3 on L4, similar to prior. L1 and L3 vertebral body\nhemangiomas are again seen. There is abnormal increased T1 and T2 signal in\nthe inferior endplate of L2 consistent with ___ type 2 changes. There is\ndegenerative loss of disc height, most extensive at L2-3 and L3-4, similar to\nprior exam. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of infection or neoplasm. The scoliosis has slightly\nworsened compared to the prior study.\n\nT12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: Posterior disc bulge is seen. There is no spinal stenosis or foraminal\nnarrowing.\n\nL2-3: Posterior disc bulge and facet hypertrophy cause mild spinal canal\nnarrowing, and moderate right foraminal narrowing.\n\nL3-4: Posterior disc protrusion and facet hypertrophy cause moderate to severe\nspinal canal and right foraminal narrowing. A hemangioma in the L3 vertebral\nbodies unchanged.\n\nL4-5: Ligamentum flavum thickening and facet hypertrophy causes mild spinal\ncanal narrowing and moderate to severe left foraminal and mild right foraminal\nnarrowing. This finding is unchanged from the previous study.\n\nL5-S1: Posterior disc bulge and facet hypertrophy cause mild spinal canal\nnarrowing and severe left foraminal narrowing and moderate right foraminal\nnarrowing. This finding is unchanged from the previous study.", "output": "1. Scoliosis of lumbar spine convex to the left in the upper lumbar and to the\nright in the lower lumbar region. The scoliosis appears to have slightly\nworsened compared to the previous MRI study.\n2. Moderate-to-severe spinal stenosis at L3-4 and mild spinal stenosis at\nL2-3, L4-5 and L5-S1 levels not significantly changed.\n3. Moderate right foraminal narrowing at L2-3 moderate-to-severe right\nforaminal narrowing at L3-4, moderate-to-severe left foraminal narrowing at\nL4-5 and severe left foraminal narrowing at L5-S1 level are unchanged." }, { "input": "CERVICAL:\n\nThe examination is limited secondary to patient motion, allowing for this:\n\nThere is no evidence of vertebral body height loss. The cervical spinal\nalignment is within normal limits.\n\nMultilevel degenerative changes are as follows:\n\nC2-C3: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: There is a posterior disc bulge with superimposed central disc\nprotrusion which indents the ventral thecal sac and compresses the spinal cord\nwith moderate-severe canal stenosis at this level. Neural foraminal narrowing\nis severe on the left and moderate to severe on the right. There is increased\nT2 cord signal seen centered at C3-4 with mild inferior and superior\nextension. A left-sided facet joint effusion is noted at this level.\n\nC4-C5: Mild disc bulging indents the ventral thecal sac with only minimal\ncanal narrowing. Uncovertebral joint osteophytes contribute to moderate right\nand moderate-severe left neural foraminal narrowing. A left-sided facet joint\neffusion is noted at this level.\n\nC5-C6: There is no definite canal stenosis. Uncovertebral joint osteophytes\ncontribute to mild-to-moderate bilateral neural foraminal narrowing.\n\nC6-C7: No definite canal stenosis, with mild-to-moderate right and moderate\nleft neural foraminal narrowing.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\n\nTHORACIC:\nThe thoracic vertebral body heights are grossly maintained. Sagittal spinal\nalignment is maintained. There is no suspicious bone marrow signal identified.\n\nMild disc bulges are seen throughout the thoracic spine, most notably at T5-6,\nT6-7, T7-8, and T8-9. However, there is no evidence for moderate/severe canal\nstenosis. No abnormal cord signal is seen.\n\nIncidentally noted is a 1.7 x 1.4 cm cm left adrenal adenoma, better\ncharacterized on recent MRI abdomen. Additionally, the patient's known\ninferior right renal mass appears T2 heterogeneously hyperintense but is\nincompletely evaluated.\n\n\nLUMBAR:\nVertebral body heights are maintained. There is grade 1 anterolisthesis of L4\non L5, presumed degenerative in nature. The remainder of the sagittal spinal\nalignment is grossly maintained.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L1.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1: Posterior disc bulging with leftward asymmetry combines with facet\narthropathy and thickening of ligamentum flavum to result in moderate canal\nnarrowing at this level. Neural foraminal narrowing is moderate to severe on\nthe left and severe on the right with associated compression of bilateral\nexiting T12 nerve roots.\n\nL1-L2: Posterior disc bulging with leftward asymmetry combines with facet\narthropathy and thickening of ligamentum flavum to result in mild canal\nnarrowing with moderate severe left and moderate right neural foraminal\nnarrowing. There is compression of the exiting left and contact of the\nexiting right L1 nerve roots at this level.\n\nL2-L3: Posterior disc bulging is seen combining with facet arthropathy and\nthickening of ligamentum flavum to result in moderate canal narrowing with\ncrowding of the cauda equina nerve roots. Neural foraminal narrowing is\nmoderate severe on the right and moderate on the left.\n\nL3-L4: Posterior disc bulging flattens the ventral thecal sac combining with\nsevere thickening of ligamentum flavum and facet arthropathy to result in\nmoderate canal narrowing with crowding of the cauda equina nerve roots. \nNeural foraminal narrowing is moderate-severe bilaterally at this level with\ncontact of the exiting left L3 nerve root.\n\nL4-L5: There is uncovering of the intervertebral disc bulge at this level\nwhich combines with thickening of the ligamentum flavum and facet arthropathy\nto result in moderate canal narrowing with crowding of the cauda equina nerve\nroots. Neural foraminal narrowing is moderate-severe bilaterally with contact\nof the bilateral exiting L4 nerve roots.\n\nL5-S1: Posterior disc bulging is noted without definite canal narrowing. \nHowever, neural foraminal narrowing is moderate to severe on the right and\nmoderate on the left with a disc bulge contacting the bilateral exiting L5\nnerve roots.\n\nThere is no evidence for abnormal intramedullary, leptomeningeal, or epidural\nenhancement.", "output": "1. Multilevel cervical spondylosis most significant at C3-4 with\nmoderate-severe canal stenosis, severe left and moderate-severe right neural\nforaminal narrowing, spinal cord compression, and T2 hyperintensity within the\ncord which may reflect spondylotic myelomalacia.\n2. Additional known findings of inferior right renal mass and a left adrenal\nadenoma, better characterized on recent dedicated MRI abdomen examination\nperformed on ___.\n3. Multilevel spondylosis throughout the thoracic and lumbar spine, as above\nwith moderate canal stenosis at T12-L1 and L4-5 level. Multiple levels of\nmoderate-severe and severe neural foraminal narrowing within the lumbar spine\nare detailed above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:13 pm, 5 minutes after discovery of the\nfindings." }, { "input": "Lumbar spine numbering is established on prior examination. Based on this\nschema, there is lumbarization of S1. Lumbar alignment is anatomic. There is\nmarrow edema pattern of the T11 superior endplate with T1 hypointense\nserpiginous line, concerning for subacute compression fracture. The remainder\nof the vertebral body heights are preserved. ___ type 2 L2-L3 endplate\nchanges are identified. Degenerative loss of disc height is severe at L2-L3\nand L5-S1, moderate at L3-L4 and L4-L5. The conus medullaris terminates at\nthe L1 vertebral level, within expected limits. There is no signal\nabnormality of the terminal cord.\n\nL1-L2: Unremarkable.\n\nL2-L3: A disc bulge results in mild spinal canal narrowing in combination\nwith facet arthropathy there is mild bilateral neural foraminal narrowing,\ngreater on the right.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. \nThere is no neural foraminal narrowing.\n\nL4-L5: A disc bulge results in mild spinal canal narrowing, crowding the\nsubarticular zones. In combination with facet arthropathy there is moderate\nright and mild left neural foraminal narrowing.\n\nL5-S1: A disc bulge and epidural fat results in moderate spinal canal\nnarrowing, unchanged from prior examination. In combination with facet\narthropathy and loss of disc height there is moderate bilateral neural\nforaminal narrowing. These findings are similar appearance to examination of\n___.\n\nComplex left renal midpole cystic lesion, previously evaluated as compatible\nwith renal cell carcinoma on prior abdominal MRI is partially and incompletely\nvisualized. Superimposed T2 hyperintense cystic lesions of both kidneys are\nstatistically likely simple cysts. The remainder the visualized prevertebral\nand paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, similar in appearance to\nexamination of ___, most prominent at L5-S1 where a disc bulge\nepidural fat results in moderate spinal canal narrowing, with bilateral neural\nforaminal narrowing.\n2. Findings concerning for mild subacute compression fracture of T11 without\nsignificant loss of vertebral body height (series 4, image 7, series 5, image\n7 and 8). There is no apparent retropulsion. This could be further evaluated\nwith CT thoracic spine.\n3. Additional findings as described above.\n\nRECOMMENDATION(S): Probable mild subacute compression fracture of T11 without\nsignificant loss vertebral body height could be further evaluated with\nfollow-up CT thoracic spine.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Vertebral body alignment and height are preserved. Bone marrow signal is\nunremarkable. The conus demonstrates normal signal and morphology and\nterminates at the level of L1-L2. The cauda equina and nerve roots demonstrate\na normal morphology and distribution within the thecal sac.\n\nThere is minimal generalized intervertebral disc desiccation without\nsignificant intervertebral disc narrowing. There is severe facet arthropathy\nfrom L3-L4 through L5-S1, with small amount of fluid in the L4-L5 facet\njoints. Mildly prominent posterior epidural fat is also noted throughout the\nlumbar spine. However, there is no spinal canal or neural foraminal narrowing.\nFindings are not significantly changed compared to prior study of ___.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. No significant degenerative disk disease, spinal canal or neural foraminal\nnarrowing.\n2. Severe facet arthropathy from L3-L4 through L5-S1 with a small amount of\nfluid at the L4-5 facet joint." }, { "input": "The alignment of the lumbar spine is normal. The bone marrow is normal in\nsignal. The height of the vertebral bodies and intervertebral disc spaces are\nmaintained. The conus medullaris terminates at the mid L2 level. The spinal\ncord and nerve roots of the cauda equina are normal in signal. There is no\nabnormal enhancement. The dorsal epidural fat is prominent from L1-L2 to\nL4-5. The paraspinal soft tissues are normal. There are no fluid collections\nmild STIR hyperintense signal of the inferior left paraspinal muscles are\nnoted, which may be posttreatment in nature versus edema/strain.\n\nAt T9-T10, T10-T11, and T11-T12, there is no spinal canal or neural foraminal\nstenosis.\n\nAt T12-L1, there is disc bulge and bilateral facet arthropathy without spinal\ncanal or neural foraminal stenosis, unchanged from the prior examination.\n\nAt L1-L2, there is disc bulge and bilateral facet arthropathy without spinal\ncanal or neural foraminal stenosis, unchanged from the prior examination.\n\nAt L2-L3, there is disc bulge, ligamentum flavum thickening, and bilateral\nfacet arthropathy without spinal canal or neural foraminal stenosis, unchanged\nfrom the prior examination.\n\nAt L3-L4, there is disc bulge and bilateral facet arthropathy without spinal\ncanal or neural foraminal stenosis, unchanged from the prior examination.\n\nAt L4-5, there is disc bulge and bilateral facet arthropathy without spinal\ncanal or neural foraminal stenosis, unchanged from the prior examination.\n\nAt L5-S1, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis, unchanged from the prior examination.", "output": "1. No findings to account for the patient's symptoms. Stable, multilevel\ndegenerative changes of the lumbar spine without spinal canal or neural\nforaminal stenosis.\n2. Mild STIR hyperintense signal of the inferior left paraspinal muscles\ninferior to the L5 level, which may represent muscle edema/ strain versus\nposttreatment changes." }, { "input": "There is mild straightening of the normal cervical lordosis. There is no\nacute fracture or traumatic subluxation. No definite cord signal\nabnormalities are identified. No definite restricted diffusion is seen within\nthe cord.\n\nModerate degenerative changes are seen throughout the cervical spine.\n\nC2/C3: No significant degenerative changes. No evidence of thecal sac\nnarrowing or neural foraminal narrowing at this level.\n\nC3/C4: Minimal broad-based disc bulge however no significant thecal sac or\nneural foraminal narrowing.\n\nC4/C5: Mild central broad-based intervertebral disc bulge, with mild ventral\nthecal sac narrowing. Moderate left and mild right neural foraminal\nnarrowing.\n\nC5/C6: Mild broad-based intervertebral disc bulge, with a focal right\nparacentral disc protrusion resulting and moderate right neural foraminal and\nmild left neural foraminal narrowing.\n\nC6/C7: Mild broad-based intervertebral disc bulge with focal right disc\nprotrusion resulting in moderate right and mild left neural foraminal\nnarrowing.\n\nThere is no cervical lymphadenopathy. The thyroid gland is not seen on this\nexam. The vertebral artery flow voids appear to be symmetrically preserved.", "output": "1. No acute fracture or traumatic subluxation within the cervical spine.\n2. Moderate degenerative changes throughout the cervical spine as described\nabove.\n3. No evidence of restricted diffusion within the cervical spine." }, { "input": "CERVICAL:\nThere is 2 mm retrolisthesis of C3 on C4, as well as 2 mm retrolisthesis of C6\non C7. Otherwise, cervical spine alignment is within normal limits. \nVertebral body heights are preserved. ___ type 1 degenerative endplate\nchanges are most conspicuous at C6-7. Vertebral body heights preserved. \nCervical spinal cord is normal in caliber and signal intensity. No abnormal\nenhancement. No epidural collection. Cervical spine degenerative changes are\nmoderate. More specifically:\n\n-At C2-3, posterior intervertebral osteophytes mildly narrow the spinal canal\nand minimally abut the ventral spinal cord. There are uncovertebral and facet\nosteophytes without significant neural foraminal narrowing.\n-At C3-4, posterior intervertebral osteophytes and posterior ligamentous\nthickening cause mild to moderate spinal canal narrowing, without spinal cord\ncontact. Bilateral facet and uncovertebral osteophytes cause bilateral\nmoderate neural foraminal narrowing (11:10).\n-At C4-5, there is a posterior intervertebral osteophyte which touches the\nventral surface of the spinal cord without cord signal abnormality (11:15). \nThere are uncovertebral and facet osteophytes which cause moderate left and\nmild right neural foraminal narrowing.\n-At C5-6, there is minimal narrowing of the anterior spinal canal without cord\ncontact due to intervertebral osteophytes. Uncovertebral and facet\nosteophytes cause moderate left and mild right neural foraminal narrowing\n(11:18).\n-At C6-7, a combination of retrolisthesis, small posterior intervertebral\nosteophytes, and posterior ligamentous thickening cause moderate to severe\nspinal canal narrowing with effacement of the CSF space around the spinal cord\nand slight spinal cord flattening, however without cord signal abnormality\n(11:23). Uncovertebral and facet osteophytes cause moderate to severe\nbilateral neural foraminal narrowing (11:23).\n-At C7-T1, no spinal canal or neural foraminal narrowing.\nTHORACIC:\nThe imaged thoracic vertebral bodies demonstrate normal alignment. There is\nslight anterior height loss at T12 which is chronic and unchanged. Otherwise,\nvertebral body heights are preserved. There are ___ type 2 degenerative\nendplate changes at T12-L1. No worrisome focal marrow signal abnormalities. \nNo abnormal enhancement following administration of contrast. The thoracic\nspinal cord is normal in caliber and signal intensity. No epidural\ncollection. There are moderate multilevel thoracic spine degenerative\nchanges. More specifically:\n\n-At T1-2, there is posterior disc bulge does not cause significant spinal\nstenosis, however which causes mild bilateral neural foraminal stenosis (7:7\nand 7:14).\n-From T2-3 through T9-10 there is no significant spinal canal or neural\nforaminal narrowing.\n-At T10-11, there are prominent posterior intervertebral osteophytes which\ncause mild spinal canal narrowing due to attach the distal spinal cord. There\nis moderate right and mild-to-moderate left neural foraminal stenosis (10:16\nand 10).\n-At T11-12, there is posterior disc bulge but no significant spinal canal\nnarrowing. There is mild left and moderate to severe right (10:60) neural\nforaminal stenosis.\nLUMBAR:\nThere is 1-2 mm retrolisthesis of L5 on S1. Otherwise, alignment is normal. \nVertebral body heights are preserved. There are multilevel Schmorl's nodes,\nincluding posteriorly in the inferior endplate of L4, inferior endplate of L5,\nand elsewhere. The distal spinal cord and conus medullaris is unremarkable\nand terminates at T12-L1. The cauda equina nerve roots are within normal\nlimits. There is severe multilevel lumbar spine degenerative change including\nmultilevel disc height loss and multilevel degenerative endplate changes. \nMore specifically:\n\n-At T12-L1, there is no spinal stenosis, however there is moderate to severe\nleft neural foraminal stenosis and mild right neural foraminal stenosis due to\na mild posterior disc bulge and facet osteophytes.\n-At L1-2, there is a mild posterior disc bulge and ligamentum flavum\nthickening and facet osteophytes without significant spinal stenosis; there is\nmoderate bilateral neural foraminal stenosis.\n-At L2-3, there is a broad-based posterior disc bulge, ligamentum flavum\nthickening, and facet osteophytes which cause moderate spinal canal narrowing\nwith crowding of the cauda equina nerve roots, and contact of the descending\nbilateral L3 nerve roots (see series 14, image 18). There is mild left and\nmoderate right neural foraminal stenosis.\n-At L3-4 there is a posterior disc bulge, ligamentum flavum thickening, facet\nosteophytes which cause mild to moderate spinal canal narrowing and\nmild-to-moderate left and moderate to severe right neural foraminal stenosis.\n-L4-5, there is a posterior disc bulge, ligament flavum thickening, and facet\nosteophytes which cause mild spinal canal narrowing and moderate bilateral\nneural foraminal stenosis.\n-At L5-S1, there is posterior disc bulge ligamentum flavum thickening and\nfacet osteophytes which cause mild spinal canal narrowing. There is severe\nright and moderate severe left neural foraminal stenosis.\nOTHER: Although evaluation is difficult due to the degree of generalized\nedema, there is abnormal infiltrative T2 hyperintense, enhancing signal\nabnormality within the medial and posterior right psoas, likely also involving\nthe right iliacus muscle, partially visualized (series 20, image 34 and series\n14, image 29). T2 hyperintense renal foci and ascites are noted on localizer\nsequences. There are bilateral layering pleural effusions. The prevertebral\nand paraspinal soft tissues demonstrate diffuse edema likely related to a\ngeneralized edematous state. There is bilateral hydronephrosis.", "output": "1. Moderate to severe spinal stenosis at C6-7 where there is effacement of the\nCSF space around the spinal cord and slight cord flattening without cord\nsignal abnormality. No cord signal abnormality identified in the cervical,\nthoracic, or lumbar spine.\n2. No abnormal enhancement/evidence of spinal metastasis.\n3. Multilevel moderate to severe cervical, lower thoracic, and diffuse lumbar\nspine degenerative changes. Spinal stenosis is worst (moderate to severe) at\nC6-7 (as above) and L2-3 (moderate), and there is multilevel neural foraminal\nstenosis worst (severe) on the right at L5-S1, and moderate to severe\nbilaterally at C6-7, on the right at T11-12, on the left at T12-L1, and on the\nright at L3-4.\n4. Abnormal T2 hyperintense, enhancing signal abnormality in the posteromedial\nright iliopsoas. Given findings from same-day MRCP, findings are most\ncompatible with infiltrative tumor involvement of the right iliopsoas, overall\nbetter characterized on the MRCP.\n5. Incidentally noted bilateral layering pleural effusions, bilateral\nhydronephrosis, and generalized edema. Hydronephrosis is also better assessed\non same-day MRCP.\n\nNOTIFICATION: The findings above were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:26 am , initially\n5 minutes after discovery of the findings, and subsequently at 12:05 P.M.\nregarding impression point 4." }, { "input": "There is mild compression of the superior endplates of L1, L2 and L3 vertebral\nbodies with low T1 and slightly increased inversion recovery signal indicative\nof acute/subacute compression fractures. There is also mild compression of\nthe superior endplate of L5 vertebra with minimal decreased T1 signal\nindicative of late subacute to chronic compression.\n\nThere is no retropulsion of compressed vertebral bodies and there is no spinal\nstenosis.\n\nFrom T10-11 to L5-S1 levels disc degenerative changes and mild bulging seen\nwithout spinal stenosis. There is no evidence of high-grade foraminal\nnarrowing. The visualized sacrum demonstrates normal signal intensities.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild acute/subacute compressions of the superior endplates of L1, L2 and L3\nvertebral bodies and likely subacute to chronic compression of the superior\nendplate of L5 vertebra. No retropulsion or spinal stenosis.\n2. Mild multilevel degenerative changes without spinal stenosis or foraminal\nnarrowing." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is minimal dextroscoliosis of lumbar spine. Again is seen minimal\nexaggeration of the thoracic kyphosis at T12-L1.\n\nMinimal T11 and T12 anterior compression deformities are again seen. There\nhas been interval progression of Schmorl's nodes seen within superior\nendplates of T11 and T12. Minimal new edema is seen within the T11 superior\nendplate adjacent to the Schmorl's node.\n\nGrossly stable L1 through L3 anterior compression deformities are again seen,\nwith interval decreased associated linear STIR hyperintensity and T1\nhypointensity.\n\nNew L4 vertebral body compression deformity with linear T1 and stir\nhyperintensity is noted (see 101:13; 4, 05:10).\n\nThere has been interval progression of L5 compression deformity, with linear\nT2 and STIR hyperintensity noted to the L5 vertebral body (see 4, 05:10;\n101:13). The L5 vertebral body again demonstrates transitional anatomy.\n\nNo definite bony retropulsion of fractures is seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber, with conus at approximately L1-2 level.\n\nIntervertebral discheights are grossly preserved. There is loss of signal\nagain seen throughout the visualized thoracolumbar spine.\n\nAt T11-12 there is disc bulge, facet hypertrophy, ligamentum flavum\nthickening, with mild vertebral canal and no neural foraminal narrowing.\n\nAt T12-L1 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild vertebral canal and no neural foraminal\nnarrowing.\n\nAt L1-2 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild-to-moderatevertebral canal and no neural\nforaminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild-to-moderatevertebral canal and no neural\nforaminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild-to-moderatevertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with moderatevertebral canal and mild bilateral\nneural foraminal narrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nwith mild vertebral canal and mild bilateral neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. New acute to subacute L4 and L5 compression deformities without\nretropulsion of fracture fragments or perispinal hematoma.\n3. Grossly stable L1 through L3 compression deformities as described, with\ninterval minimal decrease of edema as described.\n4. Grossly stable T11 and T12 minimal anterior compression deformities, with\nnew probable acute to subacute Schmorl's node within T11 superior endplate as\ndescribed.\n5. Minimal interval progression of multilevel lumbar spondylosis and epidural\nfat as described, most pronounced at L4-5, where there is moderate vertebral\ncanal and mild bilateral neural foraminal narrowing\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:13 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Focus of signal abnormality at the posterior aspect of the spinal cord at C2-3\nis unchanged and demonstrates no abnormal enhancement. A subtle focus of\nhyperintensity within the right side of the spinal cord at C3-4 level is also\nunchanged. No definite new foci of signal abnormalities are seen within the\nspinal cord from skullbase to T3 level.\n\nAt C5-6 level disc and uncovertebral degenerative changes seen with severe\nleft and mild right foraminal narrowing and mild spinal stenosis slightly\nincreased from the prior study. At C6-7 level, moderate bilateral foraminal\nnarrowing and mild spinal stenosis is seen which is also slightly increased\nfrom the prior study. Mild degenerative changes at other levels are stable.", "output": "1. Unchanged signal abnormalities within the spinal cord. Without abnormal\nenhancement. No definite new abnormalities or enhancing lesions are seen.\n2. Degenerative changes at C5-6 and C6-7 levels have progressed since previous\nMRI." }, { "input": "Alignment is normal. There is disc desiccation at L2-L3 and L3-L4 with mild\nloss of intervertebral disc height. The remaining intervertebral disc signal\nintensity appears normal. Vertebral body height and signal intensity appears\nnormal. The spinal cord appears normal in caliber and configuration. The\nconus medullaris terminates at the level of L1. There is no evidence of\ninfection or neoplasm.\n\nT12-L1: Mild disc bulge without spinal canal or neural foraminal stenosis.\n\nL1-L2: Mild disc bulge without spinal canal or neural foraminal stenosis\n\nL2-L3: Disc bulge slightly eccentric to the left and facet arthropathy without\nspinal stenosis or foraminal narrowing.\n\nL3-L4: Diffuse disc bulge and facet arthropathy without spinal stenosis or\nforaminal narrowing.\n\nL4-L5: Mild disc bulge and facet hypertrophy resulting in mild bilateral\nneural foraminal narrowing.\n\nAt L5-S1 level, no significant disc bulge or disc herniation seen. There is\nno spinal stenosis or foraminal narrowing.", "output": "1. Multilevel lumbar mild degenerative changes without spinal stenosis or\nforaminal narrowing. No evidence of nerve root displacement." }, { "input": "5 non-rib-bearing, lumbar-type vertebrae are again demonstrated. Vertebral\nbody heights are preserved. No spondylolisthesis. Bone marrow signal remains\nheterogenous without evidence for suspicious focal lesions on fat-suppressed\nIDEAL images.\n\nAgain seen is a large Schmorl's node in the L3 superior endplate with\nsurrounding mixed discogenic bone marrow changes. Additional Schmorl's nodes\nare seen at other lumbar and lower thoracic levels. Moderate loss of disc\nheight at L2-L3 has increased since the ___ MRI.\n\nExtensive, predominantly ___ type 2 discogenic bone marrow changes at L5-S1\nhave progressed since the ___ MRI. Moderate to severe loss of disc\nheight at this level is unchanged.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity. \nThe conus medullaris terminates at L1-L2.\n\nT11-T12: Mild disc bulge and facet arthropathy without significant spinal\ncanal or neural foraminal narrowing. Nerve root sleeve diverticulum in the\nright neural foramen.\n\nT12-L1: Mild disc bulge, slightly larger on the left than right, without\nsignificant spinal canal or neural foraminal narrowing. Nerve root sleeve\ndiverticulum in the right neural foramen.\n\nL1-L2: Minimal disc bulge and mild facet arthropathy. No significant spinal\ncanal or neural foraminal narrowing. Nerve root sleeve diverticulum in the\nright neural foramen.\n\nL2-L3: Mild disc bulge, mild endplate osteophytes and mild facet arthropathy. \nNo significant spinal canal or neural foraminal narrowing.\n\nL3-L4: Disc bulge, moderate facet arthropathy, and infolding of the ligamentum\nflavum. Mild-to-moderate narrowing of the AP diameter of the thecal sac\nwithout intrathecal nerve root crowding, slightly progressed compared to ___. Subarticular zones are narrowed without compression of the traversing\nL4 nerve roots. Mild bilateral neural foraminal narrowing without mass effect\non the exiting L3 nerve roots.\n\nL4-L5: Mild disc bulge, larger on the left than right, and severe facet\narthropathy. Left greater than right subarticular zone narrowing with contact\nof the left greater than right traversing L5 nerve roots. Mild narrowing of\nthe thecal sac without intrathecal nerve root crowding. Mild-to-moderate\nbilateral neural foraminal narrowing. No significant change since the ___ MRI.\n\nL5-S1: Mild disc bulge with endplate osteophytes. Moderate to severe facet\narthropathy. Mild narrowing of the subarticular zones without compression of\nthe traversing S1 nerve roots. No significant mass effect on the thecal sac. \nMild to moderate bilateral neural foraminal narrowing. No change since the\nprior MRI.\n\nThere are degenerative changes of the bilateral sacroiliac joints. Large\nbilateral Tarlov cysts are again noted in the sacrum, 2.2 x 2.0 cm on the\nright and 1.8 x 1.3 cm on the left on image 200:76, stable in size compared to\nthe CT from ___ (and not fully included on the prior MRI).", "output": "1. Multilevel lumbar degenerative disease is again demonstrated.\n2. At L3-L4, mild-to-moderate narrowing of the AP diameter of the thecal sac\nhas slightly progressed compared to the ___ MRI. However, there is no\nassociated intrathecal nerve root crowding. No change in mild bilateral\nneural foraminal narrowing at this level.\n3. Unchanged appearance of the spinal canal and neural foramina at other\nlumbar levels. Slightly increased, moderate loss of disc height at L2-L3." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL:\nThere is straightening of cervical lordosis.\n\nVertebral body heights are grossly preserved. There is no definite focal\nmarrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nMild posterior disc bulges are noted at multiple levels, including C2-3, C3-4,\nC4-5, and C5-6. There is no definite spinal canal stenosis or neural\nforaminal narrowing identified at these levels.\n\nTHORACIC:\nVertebral body alignment is preserved.Vertebral body heights are preserved.\nThere is no definite focal marrow signal abnormality.The visualized portion of\nthe spinal cord is grossly preserved in signal and caliber. Intervertebral\ndischeightsandsignalare preserved. There is no definite evidence of spinal\ncanal or neural foraminal narrowing.\n\nLUMBAR:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no definite focal marrow signal abnormality.\n\nThe conus medullaris terminates at the level of L1. There is no definite\nspinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: There is a mild posterior disc bulge with facet hypertrophy and\nthickening of ligamentum flavum, resulting in mild vertebral canal and mild\nleft neural foraminal narrowing.\n\nL3-L4: Minimal posterior disc bulge and ligamentum flavum thickening is noted,\nwith minimal spinal canal stenosis. No definite neural foraminal narrowing at\nthis level.\n\nL4-L5: There is no significant spinal canal or neural foraminal stenosis. \nThere is nonspecific bilateral facet edema.\n\nL5-S1: A posterior left asymmetric disc bulge is noted with involvement of the\nsubarticular and foraminal zones with mild bilateral neural foraminal\nnarrowing. There is no definite spinal canal narrowing. There is nonspecific\nbilateral facet edema.\n\nOTHER:\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \nNonspecific minimal lumbar dorsal subcutaneous tissue dependent edema is noted\nat the L1-2 level.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of extradural cerebral spinal\nfluid collection.\n3. Multilevel cervical spondylosis without definite vertebral canal or neural\nforaminal narrowing.\n4. Mild multilevel lumbar spondylosis as described, most pronounced at L2-3,\nwhere there is mild vertebral canal narrowing.\n5. L2-3 left and L5-S1 bilateral mild neural foraminal narrowing." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is no marrow\nsignal abnormality. The visualized portion of the spinal cord is preserved in\nsignal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin 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.\n\nAt C2 through T1, there are minimal posterior disc bulges, which cause no\nvertebral canal or neural foraminal narrowing. Findings are most consistent\nwith minimal, multilevel cervical spondylosis, most notable at C5-6.", "output": "Essentially normal cervical spine MRI. Minimal multilevel spondylosis is\nunchanged compared to ___, most notable at C5-6. No vertebral canal or\nneural foraminal narrowing." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMild lumbar levoscoliosis is noted. Vertebral body alignment is preserved.\nVertebral body heights are preserved. Loss of intervertebral disc height with\ndesiccation is present multiple levels, most pronounced at L5-S1. \nHeterogeneous appearance of bone marrow at multiple levels, probably\nreflecting degeneration with fatty proliferation. Irregular T1/T2\nhyperintense focus in the vertebral body of L3, could represent a hemangioma.\n\nAt T10-T11 a broad posterior disc protrusion effacing the thecal sac\nanteriorly, combines with bilateral facet osteophytes resulting in\nseverespinal canal narrowing and moderate bilateralneural foraminal narrowing.\nThere is abnormal high signal in the spinal cord on the T2 weighted images at\nthis level. These findings are overall similar to the earliest study\navailable for comparison from ___.\n\nAt T11-T12 there is posterior disc bulging effacing the anterior thecal sac\nassociated with mildspinal canal narrowingThere is no significantneural\nforaminal narrowing.\n\nAt T12-L1 there is bulging of the disc and bilateral facet osteophytes. These\ndo not produce canal or neural foraminal narrowing..\n\nAt L1-L2 there is nospinal canalorneural foraminal narrowing.\n\nAt L2-L3 there is diffuse disc bulging and a left protrusion proximal to the\nleft neural foramen with a superiorly migrated fragment. The protrusion\neffaces the left aspect of the anterior thecal sac. Bilateral facet\nosteophytes are also present. There is moderate to severespinal canal\nnarrowing and moderate bilateralneural foraminal narrowing.\n\nAt L3-L4 there is diffuse disc bulging and a posterior protrusion right of\nmidline, facet osteophytes, and thickening of the ligamentum flavum associated\nseverespinal canal narrowing and moderate bilateralneural foraminal narrowing.\n\nAt L4-L5 there is disc bulging and a protrusion extending into the right\nneural foramen. There is effacement of the anterior thecal sac and\nmoderatespinal canal narrowing. The right protrusion compressing the exiting\nnerve root of L4. Bilateral facet osteophytes contribute to moderate left and\nsevere right neural foraminal narrowing\n\nAt L5-S1 there is posterior bulging and wide protrusion extending bilaterally\nto the distal foramen on the right and the proximal foramen on the left. The\nprotrusion abuts the anterior thecal sac. There is mild spinal canal\nnarrowing. Also present are facet osteophytes associated with moderate\nbilateralneural foraminal narrowing.\n\nOther than the abnormal cord signal at the T10-T11 level described above, the\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.", "output": "1. Interval progression of multilevel degenerative changes associated with\nspinal canal and neural foraminal narrowing, with most notable interval\nprogression at the L2-L3 through L4-L5 levels.\n2. Large posterior protrusion at T10-T11 associated with severe spinal canal\nnarrowing and abnormal cord signal, overall similar to the earliest study\navailable for comparison from ___.\n\nRECOMMENDATION(S): After attempts to reach the ordering provider at the time\nof the findings via phone and paging system, the impression and recommendation\nabove was entered by Dr. ___ on ___ at 15:55 into the\nDepartment of Radiology critical communications system for direct\ncommunication to the referring provider." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T11/ T12 and is\nunremarkable.\n\nAt T12/L1 level, there is mild disc desiccation with no evidence of neural\nforaminal narrowing or spinal canal stenosis.\n\nAt L1/L2 and L2/L3 levels, there is no evidence of neural foraminal narrowing\nor spinal canal stenosis\n\nAt L3/L4 level, there is mild disc desiccation and minimal posterior disc\nbulge, causing mild bilateral neural foraminal narrowing (6:5), contacting the\ntraversing nerve roots bilaterally, mild articular joint facet hypertrophy is\npresent\n\nAt L4/L5 level, there is minimal posterior disc bulge, causing mild left-sided\nneural foraminal narrowing (12:5), mild articular joint facet hypertrophy is\npresent.\n\nAt L5/S1 level, there is disc desiccation and posterior disc bulging with a\nsmall posterior annular tear, causing minimal bilateral neural foraminal\nnarrowing with no frank evidence of nerve compression or spinal canal\nstenosis, the sacroiliac joints are unremarkable.", "output": "Multilevel degenerative changes throughout the lumbar spine as described\nabove, more significant from L3/L4 through L5/S1 levels. A small posterior\nannular tear is noted at L4/L5." }, { "input": "Normal spinal alignment. Congenital narrowing spinal canal. Multilevel\ndegenerative changes, disc space narrowing, diffuse disc bulges, lumbar facet\narthritis. No worrisome osseous lesions. Normal visualized cord. \nFragmentation of the very inferior tips right L3, bilateral L4 articular\nfacets, chronic, no adjacent edema. No flow voids about the cord or conus. \nMild endplate edema T11, L 2, L3, L4, likely reactive, degenerative.\n\nMild central canal narrowing T11-T12 level.\n\nAt L1-L2, patent central canal, patent foramina.\n\nAt L2-L3 there is severe central canal narrowing. Small shallow central disc\nprotrusion measures 5 mm in AP diameter. Additional tiny superiorly extruded\nor free disc fragment. Undulation of the roots of cauda equina just above\nthis level consistent with severe stenosis at L2-L3 disc space level. Mild\nright, moderate left foraminal narrowing.\n\nAt L3-L4, moderate central canal narrowing, preserved CSF within thecal sac. \nMinimal mass effect on traversing right L4 nerve. Mild right, moderate left\nforaminal narrowing. Annular disc tear.\n\nAt L4-5 small shallow broad-based central disc protrusion. Moderate central\ncanal narrowing. Mass effect on both traversing L5 nerves. Suggestion of\nclumping of the nerve roots, possible arachnoiditis. Moderate bilateral\nforaminal narrowing, left greater than right.\n\nAt L5-S1 level, mild central canal narrowing. Minimal mass effect on both\ntraversing S1 nerve roots by diffuse disc bulge. Annular disc tear. Moderate\nright, mild-to-moderate left foraminal narrowing.", "output": "1. Advanced degenerative changes lumbar spine.\n2. Congenital narrowing spinal canal.\n3. Severe central canal narrowing L2-L3 level.\n4. Multilevel significant foraminal narrowing.\n5. Undulation of cauda equina at L2 level, most consistent with severe L2-L3\ncentral canal narrowing. Dural AV fistula is statistically very unlikely.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:00 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "CERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. There is no prevertebral soft tissue\nswelling.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is mild diffuse intervertebral disc desiccation within the cervical\nspine. Otherwise, intervertebral discheightsare preserved.\n\nAt C2-3 there is nospinal canaland no neural foraminal narrowing.\n\nAt C3-4 there is a diffuse disc bulge with indentation of the anterior thecal\nsac, causing mild spinal canaland no neural foraminal narrowing.\n\nAt C4-5 there is nospinal canaland no neural foraminal narrowing.\n\nAt C5-6 there is a minimal disc bulge without significant spinal canalorneural\nforaminal narrowing.\n\nAt C6-7 there is a right paracentral disc protrusion and mild ligamentum\nflavum thickening with mildspinal canaland mild rightneural foraminal\nnarrowing.\n\nAt C7-T1 there is a right paracentral disc protrusion with crowding of the\nright subarticular recess. Otherwise, there is no significant spinal\ncanalorneural foraminal narrowing.\n\nTHORACIC:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral discheightsandsignalare preserved.\n\nThere are no significant degenerative changes with nospinal canalorneural\nforaminal narrowing in the thoracic spine.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified.", "output": "1. No acute process in the cervical or thoracic spine. Specifically, no\nevidence of severe stenosis, cord compression, mass, abscess, or hematoma.\n2. Mild multilevel degenerative changes of the cervical spine, most prominent\nat C6-C7 where there right paracentral disc herniation indenting the thecal\nsac\n3. No significant degenerative changes or foraminal narrowing in the thoracic\nspine.\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. Vertebral disc heights are preserved. Decrease\nintervertebral disc space height and signal at the L2-3 and L3-4 levels with\nassociated high T2/IDEAL signal at the vertebral body endplates is compatible\nwith degenerative changes/Schmorl's node formation. In particular, a\nprominent L3 inferior endplate Schmorl's node with mild surrounding marrow\nedema pattern is noted. The cord is normal in caliber and configuration,\nwithout core signal abnormality.\n\nL3-4: There is mild disc bulge resulting in mild bilateral neural foraminal\nnarrowing, without significant spinal canal stenosis.\nL4-5: Disc bulging with right paracentral disc protrusion results in moderate\nspinal canal stenosis and bilateral neural foraminal narrowing,\nmoderate-to-severe on the right and moderate on the left. The disc\nposteriorly displaces the traversing right L5 nerve root as well as the S1\nnerve root (series 5, image 12).\nL5-S1: Disc bulging resultant moderate neural foraminal narrowing\nbilaterally, without significant spinal canal stenosis.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "Disc bulging with right paracentral disc protrusion at the L4-5 level result\nin moderate spinal canal stenosis and bilateral neural foraminal narrowing,\nright greater than left. The disc crowds subarticular zones, and likely\nimpinging on the traversing right L5 nerve root and posterior displaces the\nright S1 nerve root." }, { "input": "There is no significant change since the previous MRI examination.\n\nFrom T11-12 through L1-2 levels no abnormalities are seen.\n\nAt L2-3 and L3-4 levels disc bulging and degenerative disc disease seen with\nmild irregularity of the endplates and Schmorl's nodes. There is no spinal\nstenosis or foraminal narrowing seen.\n\nAt L4-5 a right paracentral disc herniation identified which slightly extends\ninferiorly. There is indentation and deformity of the thecal sac. The disc\nherniation could irritate the right L5 nerve root.\n\nAt L5-S1 level disc bulging is seen without spinal stenosis or foraminal\nnarrowing.\n\nThe conus is at a normal level. The paraspinal soft tissues are unremarkable.", "output": "Unchanged appearance of lumbar spine compared to the previous MRI of ___. Right-sided paracentral disc herniation indents the thecal sac\nand could result in irritation of right L5 nerve root. Degenerative changes\nat other levels as before." }, { "input": "At the site of the focal FDG avidity in the right L4 pedicle demonstrates no\nsignal abnormality, abnormal enhancement or soft tissue changes to suggest\nmetastatic disease from MRI appearances.\n\nFrom T11-12 through L2-3 levels disc degenerative changes and minimal bulging\nseen without spinal stenosis.\n\nAt L3-4 disc bulging is seen with mild narrowing of foramina without spinal\nstenosis.\n\nAt L4-5 level, disc and facet degenerative changes are seen. There is mild\nbilateral foraminal narrowing. An incidental hemangioma is seen in the\ninferior portion of the right side of the L4 vertebral body.\n\nAt L5-S1 level, disc bulging is seen without spinal stenosis with mild\nnarrowing of the foramina.\n\nAt rudimentary disc is seen between S1 and S2.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. \nPostcontrast images demonstrate no abnormal enhancement.", "output": "1. At the site of FDG avidity in the right pedicle of L4 no focal marrow\ninfiltrative process or soft tissue abnormality identified. Facet\ndegenerative changes are seen at this level.\n2. Multilevel mild degenerative changes without spinal stenosis with mild\nnarrowing of the foramina at from L3-4 to L5-S1 levels." }, { "input": "There is mild heterogeneity of the marrow signal on inversion recovery images\nin the upper thoracic spine without corresponding abnormalities on T1 weighted\nimages which may be artifactual or due to osteopenia. No focal abnormalities\nsuspicious for metastatic disease are seen.\n\nAt the craniocervical junction degenerative changes are seen without spinal\nstenosis. Mild thickening of the transverse ligament is seen. At C2-3 level\nmild degenerative change seen.\n\nAt C3-4 level, there is disc and facet degenerative changes mild antral\nlisthesis with moderate bilateral foraminal narrowing and mild spinal\nstenosis.\n\nAt C4-5 level, disc bulging and mild to moderate right-sided foraminal\nnarrowing without compromise of the left foramen. There is minimal deformity\nof the spinal cord on the anterior aspect by disc bulging.\n\nAt C5-6 level, disc bulging and the thickening of the ligament seen with the\nmoderate spinal stenosis and moderate to severe bilateral foraminal narrowing\nseen.\n\nAt C6-7 level, there is disc bulging and uncovertebral degenerative change. \nMild to moderate spinal stenosis seen. Mild to moderate bilateral foraminal\nnarrowing is identified.\n\nAt C7-T1 and inferiorly to T4-5 mild degenerative change seen.\n\nDue to mild kyphosis in the mid cervical region there is slight deformity of\nthe spinal cord by disc bulging at C5-6 and C6-7 levels. No intrinsic spinal\ncord signal abnormality is seen.", "output": "1. Changes of cervical spondylosis with moderate spinal stenosis at C5-6 and\nmild to moderate spinal stenosis at C6-7 level there is disc bulging and\nthickening of the ligaments resulting mild deformity of the spinal cord.\n2. Minimal deformity of the spinal cord anteriorly at C4-5 level by disc\nbulging.\n3. No abnormal signal within the spinal cord.\n4. Multilevel degenerative changes including foraminal changes most pronounced\nat C5-6 level.\n5. No abnormal enhancement." }, { "input": "From T11-12 through L3-4 levels no significant abnormalities are seen.\n\nAt L4-5 and L5-S1 levels mild disc bulging and early facet degenerative\nchanges are seen. No evidence of spinal stenosis or foraminal narrowing. No\nfocal disc herniation or nerve root displacement is seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Mild degenerative changes in the lower lumbar region without spinal stenosis\nor foraminal narrowing. No evidence of nerve root displacement." }, { "input": "Posterior fusion from L2-S1 levels, and intervertebral spacers from L3-S1\nlevels noted. There is 6 mm retrolisthesis of L2 on L3. Alignment is\notherwise normal. There are multilevel endplate degenerative changes from\nL2-S1. There is reduced intervertebral disc height at L2-L3 level. Vertebral\nbody and remaining intervertebral disc signal intensity appear otherwise\nnormal.\n\nT12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: There is a diffuse disc bulge and ligamentum flavum thickening not\ncausing significant spinal canal or neural foraminal narrowing. There is mild\nbilateral facet joint arthropathy.\n\nL2-L3: There is a diffuse disc bulge and 6 mm retrolisthesis of L2 on L3, not\ncausing significant spinal canal narrowing. There is moderate bilateral\nneural foraminal narrowing.\n\nL3-L4: Allowing for the susceptibility artifact from the fusion hardware,\nthere is no significant spinal canal or neural foraminal narrowing.\n\nL4-L5: Allowing for the susceptibility artifact from the fusion hardware,\nthere is no significant spinal canal or neural foraminal narrowing.\n\nL5-S1: Allowing for the susceptibility artifact from the fusion hardware,\nthere is no significant spinal canal or neural foraminal narrowing.\n\nThe imaged spinal cord appears normal in caliber and configuration. The conus\nends at L1 level. There is no evidence of infection or neoplasm.", "output": "-L2-S1 posterior fusion and L3-S1 intervertebral spacers.\n-No significant spinal canal or neural foraminal narrowing related to the\nfused L2-S1 levels.\n-Moderate bilateral neural foraminal narrowing at L2-L3 secondary to a diffuse\nposterior disc bulge and 6 mm retrolisthesis of L2 on L3." }, { "input": "There is mild retrolisthesis of L4 on L5. The vertebral body heights are\nmaintained. There are areas of focal fatty marrow and/ or hemangiomas in\nmultiple vertebral bodies. The bone marrow signal is otherwise unremarkable.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe L1-L2 level.\n\nThe paraspinal and prevertebral soft tissues appear unremarkable.\n\nAt the L2-L3 level, there is bilateral facet arthropathy and ligamentum flavum\nthickening. The spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge which cause mild spinal canal narrowing\nwith contact of the traversing right L4 nerve root, as well as moderate right\nand mild left neural foraminal narrowing.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge, and superimposed disc protrusion which cause\nmild spinal canal and lateral recess narrowing and moderate bilateral neural\nforaminal narrowing.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, diffuse disc bulge,\nand superimposed disc protrusion which indents the thecal sac and displaces\nthe right S1 nerve root. There is mild narrowing of both foramina.", "output": "1. Multilevel lumbar spondylosis with right-sided disk protrusion at L5-S1\nlevel displacing the right S1 nerve root. Other changes as described below\nincluding foraminal narrowing at L4-5 and L5-S1 levels." }, { "input": "4 mm retrolisthesis of L4 on L5 is unchanged from examination of ___. Lumbar alignment is otherwise anatomic. Vertebral body heights are\npreserved. There is no suspicious marrow signal. T12, L2, L3 and L5\nvertebral hemangiomas are unchanged from prior exam. There is\nmild-to-moderate loss of L3-L4 through L5-S1 disc height with associated loss\nof disc signal. The conus medullaris terminates at the L1 vertebral level,\nwithin expected limits. There is no signal abnormality of the visualized\ncord, conus medullaris or cauda equina.\n\nT12-L1 through L2-L3: There is no significant spinal canal or neural\nforaminal narrowing.\n\nL3-L4: There is a disc bulge and thickening of the ligamentum flavum\nresulting in very mild spinal canal narrowing. Facet arthropathy results in\nmild left greater than right neural foraminal narrowing.\n\nL4-L5: A mild disc bulge with central protrusion and annular fissure in\nconjunction with thickening of the ligamentum flavum and dorsal epidural fat\nresults in mild spinal canal narrowing with indentation of the ventral thecal\nsac. Facet arthropathy results in moderate left neural foraminal narrowing\nand severe right neural foraminal narrowing (series 2, image 7).\n\nL5-S1: A disc bulge with superimposed central protrusion and annular fissure\nwith thickening of the ligamentum flavum results in very mild spinal canal\nnarrowing. There is a small superimposed protrusion with annular fissure\ncrowding the right subarticular zone posteriorly displacing the traversing\nright S1 nerve root (series 5, image 23), slightly improved in appearance from\nexamination of ___. There is severe right neural foraminal narrowing (series\n2, image 7) and mild left neural foraminal narrowing secondary to facet\narthropathy.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. A disc protrusion at L5-S1 contacts and posteriorly displaces the\ntraversing right S1 nerve root. This appears slightly improved when compared\nto examination of ___.\n\n2. Additional multilevel multifactorial lumbar spondylosis, most prominent at\nL4-L5 where there is severe right neural foraminal narrowing and moderate left\nneural foraminal narrowing and at L5-S1 where there is severe right neural\nforaminal narrowing and mild left neural foraminal narrowing. These findings\nare similar in appearance to prior exam." }, { "input": "Examination is moderately motion degraded, especially on axial imaging.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere are postsurgical changes from L3 through L5 laminectomy and posterior\nfusion, with susceptibility artifact from hardware limiting localized\nevaluation. The posterior elements appear well fused. Minimal enhancing\ngranulation tissue is noted at the laminectomy defect, without epidural\nextension. No fluid collections are seen.\n\nGrade 1 anterolisthesis of L3 on L4, L4 on L5, and L5 and S1 appear unchanged.\nThere is minimal lumbar levoscoliosis. Vertebral body heights are preserved. \nThere is type ___ ___ endplate degenerative change at L5-S1 and type ___ ___\nendplate degenerative change at T12-L1. There is otherwise no marrow signal\nabnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the T12-L1 level. There is no epidural\ncollection or other abnormal focus of post contrast enhancement.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. Prominent anterior bridging osteophytes are noted\nat the L5-S1 level.\n\n 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 stenosis.\n\nAt L1-2 there is trace left-sided disc bulge without vertebral canal\nnarrowing. Facet and endplate osteophytes produce mild left neural foraminal\nnarrowing. The right neural foramen is patent.\n\nAt L2-3 there is trace disc bulge and facet osteophytes mildly narrow the\nspinal canal, similar to the prior study. Facet and endplate osteophytes\nproduce mild to moderate right greater than left neural foraminal narrowing.\n\nAt L3-4 there is no vertebral canal narrowing. Facet and endplate osteophytes\nproduce mild to moderate bilateral neural foraminal narrowing.\n\nAt L4-5 there is no vertebral canal narrowing. Anterolisthesis produces\nelongation of the bilateral neural foramina, with endplate osteophytes\nproducing minimal narrowing.\n\nAt L5-S1 there is mild disc bulge and facet osteophyte formation without\nsignificant spinal canal narrowing. Disc bulge contacts the traversing S1\nnerve roots without displacement. Facet and endplate osteophytes produce mild\nto moderate right and mild left neural foraminal narrowing.\n\nOverall degenerative changes appear minimally progressed since ___.\n\nLower lumbar paraspinal muscular edema is likely postsurgical.\n\nBone graft donor site is noted in the right iliac bone. 9 mm T2 hyperintense\nright interpolar renal lesion was not definitively seen on the prior at\nexamination, with an ill-defined T2 hyperintense area seen on the prior study.\nThis area does not appear definitively nonenhancing on the postcontrast series\n(09:11). The visualized retroperitoneum is otherwise grossly unremarkable.", "output": "1. Examination is moderately motion degraded and limited secondary fusion\nhardware artifact.\n2. Postsurgical changes from L3 through L5 laminectomy and posterior fusion.\n3. Multilevel lumbar spondylosis, as described, minimally progressed compared\nto ___, with most notable findings including mild spinal canal\nnarrowing at L2-L3, and up to moderate neural foraminal narrowing at\nbilateral L2-L3, bilateral L3-L4, and right L5-S1 levels.\n4. Within limits of study, no moderate or severe spinal canal or severe\nneural foraminal narrowing.\n5. Unchanged grade 1 anterolisthesis of L3 on L4, L4 on L5, and L5 on S1.\n6. Minimal lumbar scoliosis.\n7. 9 mm right interpolar lesion with possible enhancement, with prior\nexamination demonstrating ill-defined signal abnormality in this area. A\npossible solid component is questioned. Further evaluation with renal\nultrasound is advised.\n\nRECOMMENDATION(S): Renal ultrasound for evaluation of a questioned solid\nright interpolar renal lesion.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:04 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Posterior L3-L5 fusion with transpedicular screws, rods, laminectomies. Grade\n1 L3-L4, grade 1 L4-5, minimal L5-S1 anterolisthesis, stable since prior. No\npars defect. Mild thoracolumbar curve.. Mild edema inferior L2 endplate,\nlikely degenerative, new since prior. Stable mild disc space narrowing L3-L4,\nL4-5, L5-S1 levels benign T12 hemangioma. Normal cord. Prominent anterior\nL5-S1 osteophyte. Lumbar facet arthritis. Multilevel diffuse disc bulges.\n\nAt L1-L2, patent central canal, patent right foramen. Mild left foraminal\nnarrowing. No change.\n\nAt L2-L3, mild central canal narrowing. Moderate right, mild-to-moderate left\nforaminal narrowing. No change.\n\nAt L3-L4, patent central canal. Mild-to-moderate bilateral foraminal\nnarrowing, images are compromised by metal. Diffuse disc bulge contacts both\nexited L3 nerves, right greater than left, stable\n\nAt L4-5, patent central canal. Mild-to-moderate bilateral foraminal\nnarrowing, images are foramina are compromised by metal. No change.\n\nAt L5-S1, mild central canal narrowing, similar moderate bilateral foraminal\nnarrowing, similar.\n\nSmall benign simple cyst left kidney. 2.7 cm infrarenal aortic ectasia,\nmildly more prominent, compared to 2.4 cm on ___.", "output": "1. Advanced degenerative changes lumbar spine.\n2. L3-L5 postoperative changes, posterior fusion.\n3. Stable L3-L4, L4-5, L5-S1 anterolisthesis.\n4. Mild central canal narrowing L2-L3, L5-S1.\n5. Multilevel foraminal narrowing, as above.\n6. 2.7 cm infrarenal aortic ectasia, mild more prominent." }, { "input": "There is normal alignment. The vertebral body heights are preserved. The\nmarrow signal is heterogeneous with focal 1 cm T1 hypointense lesion within\nthe L5 vertebral body with questionable correlate STIR hyperintensity (these\n05:10; 04:10). The conus demonstrates normal signal morphology, terminating\nappropriately at the L1-L2 level. There is diffuse low intervertebral disc\nsignal without significant loss of height.\n\nAt T9-T10, T10-T11, and T11-T12, there are disc bulges causing mild spinal\ncanal narrowing, seen only on the sagittal sequences.\n\nAt T12-L1 there is disc bulge without significant neural foramina or spinal\ncanal stenosis.\n\nAt L1-L2 there is disc bulge and prominence of the dorsal epidural fat without\nsignificant neural foramina or spinal canal stenosis.\n\nAt L2-L3 there is disc bulge and prominence of the dorsal epidural fat causing\nmild to moderate spinal canal narrowing which crowds the nerve roots. There\nis no significant neural foraminal stenosis.\n\nAt L3-L4 there is disc bulge with a superimposed central annular fissure,\nfacet osteophytes, ligamentum flavum thickening, and prominence of dorsal\nepidural fat causing moderate spinal canal stenosis which contacts the\nbilateral traversing L4 nerve roots, right greater than left, within the\nsubarticular zones (7:5). There is mild bilateral neural foraminal stenosis.\n\nAt L4-L5 there is disc bulge with a superimposed right subarticular zone disc\nprotrusion in addition to facet osteophytes, ligamentum flavum thickening, and\nprominence of the dorsal epidural fat causing moderate central spinal canal\nstenosis and compressing the traversing right L5 nerve root within the\nsubarticular zone (07:10). There is mild bilateral neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge, facet osteophytes, ligamentum flavum thickening,\nand prominence of the epidural fat causing mild-to-moderate spinal canal\nstenosis and mild medial displacement of the traversing S1 nerve roots in the\nsubarticular zones (07:15). There is mild right and moderate left neural\nforaminal stenosis which contacts the undersurface of the exiting left L5\nnerve root (5:4).\n\nThere is a T2 hyperintense cystic structure at the sacral neural foramina\nmeasuring 1.2 x 1.8 cm, likely representing a Tarlov cyst (04:10).\n\nWithin the limitations of a noncontrast study, there is no evidence of\ninfection. There is prominent lobular T2 hyperintensity at the bilateral\nrenal pelvises, likely representing peripelvic cysts.", "output": "1. Multilevel degenerate changes of the lumbar spine, as described, greatest\nat L4-L5 where there is a right subarticular zone disc protrusion which\ncompresses the traversing right L5 nerve root.\n2. L3-L4 moderate spinal canal stenosis which contacts the bile traversing L4\nnerve roots within the subarticular zones.\n3. L5-S1 moderate left neural foraminal stenosis which contacts the\nundersurface of exiting left L5 nerve root.\n4. Heterogeneous marrow signal with 1 cm T1 hypo intense lesion within the L5\nvertebral body which demonstrates questionable STIR signal hyperintensity. If\nthere is no history of neoplasm, this likely represents focal hematopoietic\nmarrow. If there is clinical concern for metastatic disease, consider bone\nscan." }, { "input": "Study is moderately degraded by motion, especially on axial imaging. Within\nthese confines:\n\nThere is straightening of cervical lordosis. Vertebral body heights are\npreserved. Question linear defect of left C7 transverse process versus\nartifact (see 06:28; 07:23). Sagittal imaging, including STIR does not cover\nthis area.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is mild diffuse loss of height and normal T2 signal of the cervical\nintervertebral discs.\n\nAt C2-C3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is no spinal canal or neural foraminal narrowing.\n\nAt C4-C5, a posterior disc protrusion flattens the anterior cord. Spinal\ncanal narrowing is mild there is no neural foraminal narrowing.\n\nAt C5-C6, a posterior disc protrusion flattens the anterior cord. Spinal\ncanal narrowing is mild. There is mild right neural foraminal narrowing.\n\nAt C6-C7, a posterior disc protrusion flattens the anterior cord. Spinal\ncanal narrowing is mild. There is no neural foraminal narrowing.\n\nFrom C7-T1 through T5-T6, there is no disc herniation, spinal canal narrowing,\nor neural foraminal stenosis.\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 lung apicesare preserved. Patient's known Chiari 1\nmalformation is again visualized.", "output": "1. Study is moderately degraded by motion.\n2. Question finding corresponding to patient's suggested questioned left C7\ntransverse process fracture versus artifact, as described.\n3. Within limits of study, no definite evidence of ligamentous injury.\n4. Mild multilevel cervical spondylosis as described.\n5. Normal morphology and signal intensity of the visualized spinal cord." }, { "input": "From T10-L5 levels the vertebral bodies demonstrate heterogenous marrow\nsignal. There is focal decreased T1 and increased inversion recovery signal\ninvolving the S2 and S3 segments of the sacrum suggestive of metastatic\ndisease. There is no presacral mass identified on the sagittal images. \nHowever, this area is not covered on the axial images.\n\nThere is no evidence of spinal cord compression extending from T10 to the\nconus level. There is no evidence of cauda equina compression.\n\nMild degenerative disc disease is seen with disc bulging from L2-3 to L5-S1\nlevels without high-grade spinal stenosis with mild bilateral foraminal\nnarrowing from L3-4 to L5-S1 levels.\n\nHeterogenous signal is also seen in the partially visualized bilateral iliac\nbones.", "output": "1. Marrow infiltrative process involving S2 and S3 segments of the sacrum\nindicative of metastatic disease.\n2. Mild degenerative changes in the lumbar region.\n3. No evidence of distal spinal cord or cauda equina compression.\n4." }, { "input": "THORACIC SPINE:\n Alignment is normal. Vertebral body heights are maintained. There is an\nintraosseous hemangioma in T1. Probable additional intraosseous hemangiomas\nin the posterior aspect of T4, T9. marrow signal is otherwise unremarkable. \nThe thoracic spinal cord is normal in caliber and signal intensity. No\nabnormal enhancement. No epidural collection. Aside from mild signal loss of\nthe T11-12 disc, thoracic spine intervertebral discs demonstrate preserved\nheight and signal intensity. No spinal canal narrowing. Mild bilateral T1-2\nneural foraminal narrowing due to degenerative changes. No other neural\nforaminal narrowing in the thoracic spine.\n\nThoracic prevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR SPINE:\n Images from the current examination are interpreted in conjunction with\nimages of the lumbar spine from study performed ___ at 18:48:\n\nAlignment is normal. Vertebral body heights are maintained.\n\nThere is a 4.0 x 3.4 x 3.6 cm (AP by TV by SI) (11:47, 13:47, 10: 7, 12:7)\nexpansile T1 hypointense, diffusely enhancing, STIR hyperintense mass centered\nin the sacrum involving the S2, S3 vertebral bodies primarily on the left. \nThere is extension into the left S2-3 neural foramina to abut and likely\ninvolve the left S2 nerve root.\n\nMarrow signal elsewhere, within the lumbar spine, is normal. The distal\nspinal cord and conus medullaris appear within normal limits, terminating at\nL1-2. Note, however that sagittal and axial T2 weighted imaging of the lumbar\nspine could not be performed, as the patient could not tolerate the entire\nexamination. The cauda equina nerve roots appear normal, without abnormal\nenhancement. Note is made of prominent, enhancing linear foci both anterior\nand posterior to the distal spinal cord (for example 12:10), likely prominent\nveins. There is no evidence of epidural collection.\n\nSignal and height loss of lumbar spine intervertebral discs is consistent with\nmild degenerative change. At L2-3, there is a diffuse disc bulge, ligamentum\nflavum thickening, facet osteophytes, and trace bilateral facet joint\neffusions causing no spinal canal narrowing but mild bilateral neural\nforaminal narrowing. At L3-4, diffuse disc bulge, ligamentum flavum\nthickening, facet osteophytes cause mild spinal canal and mild bilateral\nneural foraminal narrowing. L4-5, there is diffuse disc bulge, ligamentum\nflavum thickening and facet osteophytes causing very mild spinal canal\nnarrowing, and mild-to-moderate bilateral neural foraminal narrowing. At\nL5-S1, there is diffuse disc bulge, ligamentum flavum thickening, without\nspinal canal narrowing however with mild moderate bilateral neural foraminal\nnarrowing.\n\nLumbar prevertebral and paraspinal soft tissues are unremarkable.\n\nOther:\n\nMediastinal adenopathy is partially visualized. Multiple bilateral lung\nnodules are noted, measuring up to 1.8 cm (for example, see series 8 image\n10).", "output": "1. Incomplete examination without sagittal and axial T2 weighted imaging of\nthe lumbar spine, due to the patient's inability to tolerate the entire study.\n2. 4.0 cm sacral osseous metastasis involving invading the left S2 neural\nforamina and likely involving the left S2 nerve root.\n3. No other thoracolumbar spine metastatic disease identified.\n4. Prominent dorsal and ventral perimedullary veins around the distal thoracic\nspinal cord, conus medullaris. No definite leptomeningeal enhancement.\n5. Mild lumbar spondylosis, causing mild spinal canal narrowing, worst at\nL3-4. Neural foraminal narrowing is worst (mild-to-moderate) bilaterally at\nL4-5 and L5-S1.\n6. Multifocal bilateral solid pulmonary nodules and mediastinal adenopathy." }, { "input": "Study is moderately degraded by motion, especially on postcontrast imaging. \nWithin these confines:\n\nCERVICAL, THORACIC AND LUMBAR SPINE\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nSchmorl's nodes are seen at multiple levels throughout the cervical, thoracic,\nlumbar spine. There is no prevertebral soft tissue swelling. T1, T4, T9, and\nL4 probable hemangiomas are again noted. Probable type ___ ___ changes are\nseen the T8 inferior endplate. Grossly stable nonspecific marrow\nheterogeneity is seen throughout the visualized osseous structures of the C4\nand inferior spinal levels.\n\nOn limited imaging of the sacrum, S2 and S3 fat-suppressed imaging\nhyperintensity, is partially seen with interval resolution of previously noted\nT1 hypointensity and postcontrast enhancement (see 7, 8, 9, 16:8 on current\nstudy, 4, 7:10 on ___ exam and 10, 12:8 on ___ exam).\n\nThe visualized portion of the spinal cord is grossly preserved in signal, with\nno definite evidence of abnormal enhancement. At C5-6 there is deformation of\nthe ventral thecal sac and spinal cord without definite associated cord signal\nabnormality.\n\nThere is loss of intervertebral disc height and signal at C5-6 and C6-7. \nThere is loss of intervertebral disc height at L3-4 and L4-5. Otherwise,\nintervertebral disc heights and signalare grossly preserved. Nonspecific facet\njoint fluid is noted at multiple levels of the lumbar spine.\n\nAt C2-3 there is uncovertebral hypertrophy, disc bulge, ligamentum flavum\nthickening, with no vertebral canaland no neural foraminal narrowing.\n\nAt C3-4 there is asymmetric right disc bulge, ligamentum flavum thickening,\nfacet joint hypertrophy, with mild vertebral canal, mild right and moderate\nleft neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, facet hypertrophy, ligamentum flavum thickening, \nwith mild vertebral canalmild left and moderate right neural foraminal\nnarrowing.\n\nAt C5-6 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\ndeformation of the ventral thecal sac and spinal cord without definite\nassociated cord signal abnormality, with mild-to-moderate vertebral canaland\nsevere bilateral neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nwith mild vertebral canaland moderate bilateral neural foraminal narrowing.\n\nMultilevel degenerative changes and epidural fat of the thoracic spine are\nnoted without definite evidence of moderate or severe vertebral canal or\nneural foraminal narrowing.\n\nAt T12-L1 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with no vertebral canaland no neural foraminal narrowing.\n\nAt L1-2 there is facet hypertrophy, ligamentum flavum thickening, epidural\nfat, with no vertebral canaland no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canaland mild bilateral neural foraminal\nnarrowing.\n\nAt L3-4 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild-to-moderate vertebral canaland mild bilateral neural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild-to-moderate vertebral canaland moderate bilateral \nneural foraminal narrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nwith mild vertebral canal and moderate bilateral neural foraminal\nnarrowing.\n\nOTHER:\nNonspecific bilateral mastoid fluid is present. Approximately 1 cm left\nmidline suboccipital soft tissue probable sebaceous cyst is noted (see 10,\n17:10).\n\nMultiple lung nodules, better assessed on CT chest dated ___.\nSuboccipital soft tissue midline probable sebaceous cyst is noted (see 4:5).", "output": "1. Study is degraded by motion.\n2. On limited imaging of the sacrum previously noted S2-3 area of enhancing\nmass now demonstrates minimal nonspecific probable edema, with interval\nresolution of previously seen T1 hypointensity. If concern for nondisplaced\nfracture or for other sacral mass, consider dedicated sacral MRI for further\nevaluation.\n3. Within limits of study, no definite evidence of paraspinal, paravertebral,\nor epidural enhancing spinal mass.\n4. Multilevel degenerative changes of the cervical, thoracic, and lumbar spine\nas described.\n5. Multiple lung nodules, better assessed on prior CT chest dated ___.\n6. Nonspecific bilateral mastoid fluid and suboccipital soft tissue probable\nsebaceous cyst.\n7. Nonspecific marrow heterogeneity as described. If concern for infiltrative\nprocess, consider bone scan for further evaluation.\n8. Please see same-day contrast brain MRI for description cranial findings.\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": "Study is moderately degraded by motion. Within these confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nC6 vertebral body probable hemangioma is noted.\n\nNonspecific water ideal hyperintensity is noted at the C3-4 through C5-6\ninterspinous ligament spaces and within overlying dorsal cervical soft tissues\n(see 3: ___.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber, with no definite evidence of syrinx.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine. Nonspecific facet joint fluid is noted in multiple levels of the\ncervical spine.\n\nC2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: There is disc bulge, no spinal canal, and no foraminal narrowing.\n\nC4-C5: There is disc osteophyte complex, facet and uncovertebral hypertrophy,\nmild spinal canal, mild right and moderate left neural foraminal narrowing.\n\nC5-C6: There is disc osteophyte complex, facet joint hypertrophy, ligamentum\nflavum hypertrophy, uncovertebral hypertrophy, moderate spinal canal and\nsevere bilateral foraminal narrowing.\n\nC6-C7: There is disc bulge, facet joint hypertrophy, uncovertebral\nhypertrophy, mild spinal canal, and moderate bilateral neural foraminal\nnarrowing.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\nOTHER:\n\nThere is no definite evidence of paravertebral or paraspinal mass. There is\nno abnormal enhancement. Limiting of the posterior fossa again demonstrates\npatient's previously noted probable Chiari 1 malformation.", "output": "1. Study is moderately degraded by motion.\n2. Findings suggestive of Chiari malformation, grossly similar compared to ___ contrast brain MRI, with no definite evidence of syrinx.\n3. Cervical spondylosis, worst at C5-6, with moderate spinal canal narrowing\nand severe bilateral foraminal narrowing.\n4. C3-4 through C5-6 findings concerning for interspinous ligament injury.\n5. Within limits of study, no definite evidence of cervical spinal cord lesion\nor abnormal enhancement.\n\nNOTIFICATION: The findings were discussed with Dr. ___. of the ED by\n___, M.D. on the telephone on ___ at 10:51 am." }, { "input": "CERVICAL:\nAlignment is anatomic.Vertebral body heights and signal intensity appear\nunremarkable. There are multilevel mild disc desiccation with preserved disc\nheights. At C5-C6 level; there is right central disc bulge mildly effacing\nright ventrolateral subarachnoid CSF space with mild spinal canal stenosis and\nmild-to-moderate right neural foraminal narrowing. At C6-C7 level; small disc\nbulge with no significant spinal canal stenosis and mild bilateral neural\nforaminal narrowing. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of significant spinal canal stenosis.There\nis no evidence of infection or neoplasm. There is no abnormal enhancement\nafter contrast administration.\n\nLUMBAR:\nAlignment is anatomic.Vertebral body heights and signal intensity appear\nunremarkable. There are multilevel mild disc desiccation at L2-L3, L3-L5 and\nL5-L4 levels. A small disc bulge at L4-L5 demonstrates a small central\nannular fissure. The lower spinal cord, conus medullaris and cauda equina\nfibers appear normal in caliber and configuration. Mild neural foraminal\nnarrowing at bilateral L5-S1. There is no evidence of other significant\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.", "output": "1. No findings concerning for metastatic lesions at cervical and lumbar spine.\n2. Mild degenerative changes of the cervical spine more pronounced at C5-C6\nlevel with underlying mild spinal canal stenosis.\n3. Mild-to-moderate right C5-C6 and mild bilateral C6-C7 neural foraminal\nnarrowing.\n4. Mild neural foraminal narrowing at bilateral L5-S1 neural foramina.\n5. Additional findings 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": "Please note that the patient was in extreme pain and only T1 and T2 sagittal\nimaging of the thoracic spine was obtained. Please note that spinal numbering\nwas done of scout imaging.\n\nThere is diffuse metastatic disease involving the thoracic, lumbar spine and\nsternum with multiple pathological fractures.\n\nIn comparison with prior CT T-spine the multiple thoracic pathological\nwedge-type compression fractures appear similar. no new fracture identified. \nPlease note that there is no STIR imaging available to assess for acute\nfracture/vertebral body edema.\n\nPathological fracture of the L1 vertebral body with retropulsion of a bony\nfragment into the spinal canal by 8 mm result in moderate severe spinal canal\nstenosis with the thecal sac measuring 7 mm in AP diameter and crowding of the\nnerve roots.\nPathological fracture of the L2 vertebral body with retropulsion of a bony\nfragment into the spinal canal by 7 mm results in moderate severe spinal canal\nstenosis and crowding of the nerve roots with the thecal sac measuring 6 mm in\nAP diameter.\n\nPathological fractures of the T5 through T7 vertebral bodies result in\nmoderate spinal canal stenosis. No abnormal cord signal intensity at this\nlevel.\n\nSuspected multilevel mid thoracic neural foraminal stenosis, but this is\nsuboptimally assessed on isolated sagittal imaging and dedicated axial imaging\nis advised.", "output": "1. Please note that the patient was in extreme pain and only T1 and T2\nsagittal imaging of the thoracic spine was obtained. Please note that spinal\nnumbering was done of scout imaging.\n2. There is diffuse metastatic disease involving the thoracic, lumbar spine\nand sternum with multiple pathological fractures.\n3. In comparison with prior CT T-spine the pathological fractures of the\nthoracic spine appears relatively similar compared to prior imaging. Please\nnote that there is no STIR imaging to assess for acute fractures/bone marrow\nedema.\n4. Pathological fractures of the L1 and L2 vertebral bodies with associated\nretropulsion of bony fragments into the spinal canal results in moderate\nsevere spinal canal stenosis with crowding of the nerve roots and dedicated\naxial imaging is advised to better assess this.\n5. Mid thoracic neural foraminal narrowing could also be better assessed on\naxial imaging." }, { "input": "Patient motion degrades the diagnostic quality of the imaging.\n\nTHORACIC SPINE:\nNoted is diffuse osseous metastatic disease with multiple pathological wedge\ntype compression deformity fractures from T5 through T11 vertebral bodies,\nmost severe from T6 through T11 levels. The T10 fracture is new compared to\nprior MR dated ___, but was present on prior CT L-spine done on ___. There is increased T2 and STIR signal in the anterior aspect\nof the T7 vertebral body which also demonstrates enhancement postcontrast and\nmay represent active myelomatous involvement or an acute on chronic fracture. \nNo paraspinal collections.\n\nNo thoracic cord masses or abnormal signal intensity. The apparent abnormal\nsignal intensity in the left aspect of the upper and mid thoracic cord is\nthought to be artifactual in nature. There is extensive moderate spinal canal\nnarrowing secondary to degenerative disease with superimposed posterior\nepidural lipomatosis in the mid and lower thoracic spine. There is areas of\neffacement of CSF surrounding the thoracic cord at these levels, but there is\nno abnormal cord signal intensity to suggest cord compromise. There is\nmultilevel mid thoracic severe neural foraminal narrowing which appears\nslightly progressed compared to prior thoracic MR done ___.\n\n\nLUMBAR SPINE:\nExtensive myelomatous involvement of the lumbar spine with associated\npathological wedge-type compression fractures with almost complete loss of\nheight of the L1 and L2 vertebral bodies. This appears similar compared to\nprior CT L-spine done ___. No STIR hyperintense edema to suggest\nacute fracture.\n\nL1: Almost complete loss of height of the L1 vertebral body with retropulsion\nof bony fragments into the spinal canal by 9 mm. This with associated\nepidural lipomatosis and degenerative changes effaces the CSF space\nsurrounding the conus/proximal nerve roots. Nerve root compromise is\nsuspected.\n\nL2: Almost complete loss of height of the L2 vertebral body with retropulsion\nof bony fragments into the spinal canal by 7 mm and this together with\ndegenerative changes and epidural lipomatosis almost completely efface the CSF\nspace surrounding the nerve roots. Nerve root compromise is suspected\n\nThere is moderate narrowing of the L1-2 neural foramina bilateral.\n\nL2-3: Degenerative changes and epidural lipomatosis completely efface the CSF\nspace surrounding the nerve roots with crowding of the nerve roots. Moderate\nnarrowing of the neural foramina bilateral.\n\nL3-4: Degenerative changes and epidural lipomatosis almost completely effaces\nCSF space around the nerve roots. Mild neural foraminal narrowing bilateral.\n\nL4-5: Mild subarticular zone narrowing. No compromise of the nerve roots in\nthe central aspect of the spinal canal. Moderate neural foraminal narrowing\nbilateral.\n\nL5-S1: No compromise of the nerve roots in the central aspect of the spinal\ncanal. Severe left and moderate severe right neural foraminal narrowing.\n\nExtra-spinal: Myelomatous involvement of the right iliac bone. Mediastinal\nlipomatosis. Simple appearing right renal cysts.", "output": "1. Limited examination due to patient motion.\n2. Extensive myelomatous involvement of the thoracic and lumbar spine with\nmultiple pathologic fractures as described above.\n3. There is almost complete loss of height of the L1 and L2 vertebral bodies\n(these are chronic fracture), with retropulsion of bony fragments into the\nspinal canal and this associated with degenerative changes and epidural\nlipomatosis results in severe spinal canal narrowing with effacement of the\nCSF surrounding the conus and nerve roots at these levels.\n4. There is also moderate severe narrowing of the spinal canal at the L2-3 and\nL3-4 levels predominantly secondary to epidural lipomatosis.\n5. There is increased T2 and STIR signal in the anterior aspect of the T7\nvertebral body which also demonstrates enhancement postcontrast and may\nrepresent active myelomatous involvement or an acute on chronic fracture.\n6. Extensive moderate spinal canal narrowing of the mid and lower thoracic\nspine secondary to degenerative disease and epidural lipomatosis.\n7. Severe mid and lower thoracic and L5-S1 neural foraminal narrowing as\ndescribed above." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\nThere is redemonstration of diffuse osseous metastatic disease with multiple\nsevere wedge-shaped compression fracture deformities of the thoracic and\nlumbar vertebral bodies, mildly progressed in the upper thoracic spine\ncompared to prior exam dated ___.\n\nSevere compression deformities are noted from T4 through L2 with slightly\nexaggerated kyphotic deformity of the upper thoracic spine.\n\nThere is suggested new areas of edema within the T2, T5 and T6 vertebral\nbodies (see 4:8 on current study and 6: 9; 11:8 on prior exam).\n\nSimilar to prior exam, there is prominent epidural fat extending from T3-T4\nthrough L3-L4.\n\nThere is multilevel spinal canal narrowing, most pronounced at T5-T6 due to\nposterior retropulsion and prominent epidural fat. There are no underlying\ncord signal abnormalities. Otherwise there is moderate extensive spinal canal\nnarrowing due to degenerative changes and prominent epidural fat.\n\nThere is no evidence of thoracic spinal cord signal abnormality.\n\nThere is severe multilevel neural foraminal narrowing, mildly progressed from\nprior exam in the upper thoracic spine.\n\nLUMBAR SPINE:\n\nThere is redemonstration of extensive myeloma involvement of the lumbar spine\nwith severe compression fracture deformities of the L1 and L2 vertebral bodies\nand moderate deformities of the L3 through L5 vertebral bodies, similar to\nprior exam.\n\nThere is grossly stable retropulsion of the posterior cortices of L1 and L2\nwith grossly stable severe spinal canal stenosis and probable compression of\nthe descending nerve roots from L1 through L3 levels.\n\nThere is mild-to-moderate spinal canal narrowing from L3-L4 through L5,\nunchanged from prior exam.\n\nOTHER:\nThere are incompletely characterized T2 hyperintense lesions in the kidneys\nbilaterally. Nonspecific facet joint fluid is noted at multiple levels of the\nthoracic and lumbar spine.", "output": "1. Examination is moderately degraded by motion.\n2. Extensive myelomatous involvement of the thoracic and lumbar spine with\nmultiple severe wedge-shaped compression fracture deformities, notably from T4\nthrough L2, mildly progressed in the upper thoracic spine from prior exam,\nsome which demonstrate probable minimal new edema compared to ___\nprior exam, as described.\n3. Severe spinal canal narrowing at T5-T6 due to prominent epidural fat and\nposterior retropulsion of the T6 cortex, worsened from prior.\n4. Severe spinal canal narrowing with probable compression of the descending\nnerve roots from L1 through L3 due to grossly stable retropulsion of the L1\nand L2 posterior cortices from severe compression deformities.\n5. Otherwise, moderate multifocal spinal canal narrowing of the thoracic and\nlumbar spine.\n6. Grossly stable multilevel severe neural foraminal narrowing of the thoracic\nspine, as described." }, { "input": "Thoracic spine:\n\nThe moderate compression fractures of the T3, T4, T5, and T11 vertebral bodies\nand severe compression fractures of the T6-T6, T7, T8, T9, and T10 vertebral\nbodies are unchanged from the CT chest ___. The patient is status\npost vertebroplasty of T11. The bone marrow is heterogeneous in signal. The\nparaspinal soft tissues are normal.\n\nThe spinal cord is normal in signal.\n\nAt T4-T5 and from T6-T7 to T9-T10, prominent dorsal epidural fat causes\nmoderate to severe spinal canal stenosis. Prominent dorsal epidural fat and\nretropulsion of the posterior and superior cortex of the T6 vertebral body\nflattens and remodels the spinal cord, causing severe spinal canal stenosis at\nT5-T6.\n\nLumbar spine:\n\nA 4 mm retrolisthesis of L4 on L5 is unchanged. Mild loss of height with\npatchy marrow edema in the L1 vertebral body and cortical regularity of the L1\ninferior endplate are new from the prior examination. The remainder of the\nbone marrow is heterogeneous, related to degenerative endplate changes and\nfatty marrow deposition. The intervertebral discs are diffusely desiccated. \nThe L4-L5 and L5-S1 intervertebral discs are moderately to severely narrowed. \nThe conus medullaris terminates at T12-L1. The spinal cord is normal in\nsignal. No fluid collections or masses are identified.\n\nAt L1-L2, bulge and bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis, unchanged from prior.\n\nAt L2-L3, disc bulge, bilateral facet arthropathy and prominent dorsal\nepidural fat cause mild spinal canal stenosis, improved from the prior\nexamination. There is no neural foraminal stenosis.\n\nAt L3-L4, disc bulge, bilateral facet arthropathy, and prominent dorsal\nepidural fat cause mild spinal canal stenosis, improved from the prior\nexamination. There is no neural foraminal stenosis.\n\nAt L4-L5, disc bulge and bilateral facet arthropathy cause mild bilateral\nneural foraminal stenosis, unchanged from prior. There is no spinal canal\nstenosis.\n\nAt L5-S1, disc bulge and bilateral facet arthropathy cause severe bilateral\nneural foraminal stenosis, unchanged from prior. There is no spinal canal\nstenosis.\n\nThe kidneys contain multiple T2 hyperintense lesions, most likely representing\ncysts.", "output": "1. New, acute to subacute compression fracture of the L1 vertebral body.\n2. Unchanged compression fractures of the T3-T11 vertebral bodies.\n3. Multilevel degenerate changes of the thoracolumbar spine, most advanced at\nT5-T6, where there is severe spinal canal stenosis and L5-S1, where there is\nsevere bilateral neural foraminal stenosis.\n4. Thoracic epidural lipomatosis\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 1:12 ___, 15 minutes after discovery\nof the findings." }, { "input": "Alignment is normal. There are mild degenerative changes in the lumbar spine.\nThere is lower lumbar facet arthritis. Small area of anterior endplate edema\nT12, likely degenerative. Disc desiccation, mild narrowing L5-S1 level. The\nspinal cord appears normal in caliber and configuration. There is no pars\ninterarticularis defect. There is no evidence of infection or neoplasm. \nThere are small benign perineural cysts at the S3 level.\nAt L1-L2, L2-L3, L3-L4, L4-5 levels, central canal and foramina are patent.\nL5-S1 level: There is annular disc tear and shallow central tiny broad-based\ndisc protrusion. Mild effacement of the ventral thecal sac, left S1 nerve\nroot sleeve origin. Mild central canal narrowing. . There is moderate left,\nand mild to moderate right foraminal narrowing, sagittal image 13, 4\nrespectively.", "output": "1. There is small disc protrusion at L5-S1 level, with mild central canal\nnarrowing, moderate left and mild to moderate right foraminal narrowing.\n2. There is no pars interarticularis defect.\n3. Mild degenerative changes elsewhere lumbar spine." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nVertebral body heights are preserved. C4 and C6 inferior endplate type ___ ___\nchanges are noted. Multiple Schmorl's nodes are seen throughout cervical\nspine. Vertebral body heights are grossly preserved. Limited imaging of\nthoracic spine suggests presence of T3 vertebral body probable hemangioma.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc signal throughout the cervical spine. \nThere is loss of intervertebral disc height at C4-5, C5-6, and C6-7.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is disc bulge, novertebral canal and no neural foraminal\nnarrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy, central protrusion,\nfacet joint hypertrophy, deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality, mildvertebral canal and\nno neural foraminal narrowing.\n\nAt C4-5 there is asymmetric left disc bulge, uncovertebral hypertrophy, facet\njoint hypertrophy, ligamentum flavum hypertrophy, deformation of ventral\nthecal sac and spinal cord without definite associated cord signal\nabnormality, mild to moderatevertebral canal, moderate right and severe\nleftneural foraminal narrowing.\n\nAt C5-6 there is disc bulge, left paracentral disc protrusion, uncovertebral\nhypertrophy, ligamentum flavum hypertrophy, facet joint hypertrophy,\ndeformation of ventral thecal sac and spinal cord without definite associated\ncord signal abnormality, mild to moderatevertebral canal, mild left and\nmoderate rightneural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, deformation of ventral thecal sac, mildvertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt C7-T1 there is disc bulge and central disc protrusion, mildvertebral canal\nand no neural foraminal narrowing.\n\nLimited imaging of thoracic spine suggests T1-2 and T2-3 disc bulges with mild\nvertebral canal narrowing.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical spondylosis as described, most pronounced at C4-5,\nwhere there is deformation of ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, mild-to-moderate vertebral canal,\nmoderate right and severe left neural foraminal narrowing.\n3. C5-6 deformation of ventral thecal sac and spinal cord without definite\nassociated cord signal abnormality, mild to moderate vertebral canal, mild\nleft and moderate right neural foraminal narrowing.\n4. Limited imaging of thoracic spine demonstrates mild vertebral canal\nnarrowing as described." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is transitional anatomy with partial sacralization of L5 and partial\nlumbarization of S1. Vertebral body heights are preserved. Multiple\nvertebral body hemangiomas are present. Endplate degenerative changes\nincluding multiple Schmorl's nodes, with no definite epidural or paravertebral\ncollection, are noted at the anterior T12-L1 intervertebral disc space. The\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. 1 cm right\nrenal probable cyst is noted (see 05:27). 6 x 5 mm partially visualized at\nleast partially cystic left renal lesion is noted (see 05:24). Partially\nvisualized hiatal hernia is noted (see 5:1).\n\nAt T12-L1 there is facet joint arthropathy withno vertebral canal or neural\nforaminal stenosis.\n\nAt L1-2 there is facet joint arthropathy withno vertebral canal or neural\nforaminal stenosis.\n\nAt L2-3 there is facet joint arthropathy and ligamentum flavum hypertrophy\nwithno vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is ligamentum flavum hypertrophy withno vertebral canal or\nneural foraminal stenosis.\n\nAt L4-5 there is a disc bulge which contacts bilateral L5 nerve roots within\nthe less in right subarticular zones, ligamentum flavum hypertrophy and facet\njoint arthropathy resulting in moderate vertebral canal and no neural\nforaminal stenosis.\n\nAt L5-S1 there is facet joint arthropathy ligamentum flavum hypertrophy and\ndisc bulge which contacts bilateral S1 nerve roots within the left in right\nsubarticular zones, resulting in mild vertebral canal and no neural foraminal\nstenosis.", "output": "1. Multilevel degenerative changes as described, most pronounced at L4-5,\nwhere disc bulge contacts bilateral L5 nerve roots within the subarticular\nzones, and there is moderate vertebral canal stenosis.\n2. No definite acute vertebral body fracture identified.\n3. T12-L1 level anterior intervertebral disc space degenerative changes as\ndescribed.\n4. Right probable renal cyst and partially visualized left renal cystic\nlesion, which may represent a cyst, as described. If clinically indicated,\nrenal ultrasound may be obtained for further evaluation.\n5. Partially visualized hiatal hernia." }, { "input": "There is a transitional vertebra at the thoracolumbar junction, labeled T12\nfor the purposes of this report, and a transitional vertebra at the lumbar\nsacral junction, labeled a partially sacralized L5 for the purposes of this\nreport. Bone marrow signal is diffusely heterogenous with multiple\nhemangiomas again noted vertebral body heights are preserved. Minimal grade 1\nanterolisthesis of L4 on L5 is unchanged. The distal spinal cord appears\nunremarkable. The conus medullaris terminates at L1-L 2.\n\nT11-T12: Minimal disc bulge and mild facet arthropathy without significant\nspinal canal or neural foraminal narrowing.\n\nT12-L1: Minimal disc bulge and mild facet arthropathy without significant\nspinal canal or neural foraminal narrowing.\n\nL1-L2: Minimal disc bulge and moderate facet arthropathy. No significant\nspinal canal narrowing. Mild left neural foraminal narrowing. No change\nsince the prior MRI.\n\nL2-L3: Mild disc bulge, thickening of the ligamentum flavum, and moderate\nfacet arthropathy. No significant mass effect on the thecal sac. Mild\nnarrowing of the subarticular zones without frank compression of the\ntraversing L3 nerve roots. Mild, left greater than right neural foraminal\nnarrowing. No change since the prior MRI.\n\nL3-L4: There is a disc bulge, small broad-based central disc protrusion,\nthickening of the ligamentum flavum, and moderate to severe facet arthropathy\nwith right facet joint effusion. Mild to moderate narrowing of the thecal sac\nwith mild crowding of the intrathecal nerve roots. Abutment of bilateral\ntraversing L4 nerve roots in the subarticular zones. Moderate bilateral\nneural foraminal narrowing with abutment of the exiting L3 nerve roots. The\nabove findings are unchanged. 6-7 mm synovial cyst projecting from the\nposterior aspect of the right facet joint into the posterior paravertebral\nmuscles, images 201:23 and 200:43, is new.\n\nL4-L5: There is a grade 1 anterolisthesis, a mild disc bulge, thickening of\nthe ligamentum flavum, and severe facet arthropathy with bilateral facet joint\neffusions. There is mild narrowing of the thecal sac with mild crowding of\nthe intrathecal nerve roots, and mild narrowing of the subarticular zones\nwithout frank compression of the traversing L5 nerve roots. The neural\nforamina are foreshortened with mild to moderate right and moderate left\nneural foraminal narrowing. The exiting left L4 nerve root is contacted by\nfacet osteophytes. No significant interval change.\n\nL5-S1: The disc is underdeveloped due to partial sacralization of L5. No\nspinal canal or neural foraminal narrowing.\n\nThere are degenerative changes of the sacroiliac joints.\n\nThe localizer sequence, image 1:13, demonstrates a partially visualized, at\nleast 14 mm hyperintense focus in the lower pole of the right kidney, also\nseen on the axial T2 weighted images of the prior MRI, statistically likely a\ncyst.", "output": "1. Transitional vertebra at the thoracolumbar junction, labeled T12, and\ntransitional vertebra at the lumbar sacral junction, labeled a partially\nsacralized L5.\n2. Multilevel degenerative disease. Mild to moderate narrowing of the thecal\nsac at L3-L4 and mild narrowing of the thecal sac at L4-L5 with mild crowding\nof the intrathecal nerve roots at these levels, unchanged compared to the ___ MRI. Mass effect on multiple traversing and exiting nerve roots,\nas detailed above, also unchanged.\n3. New 6-7 mm synovial cyst projects from the posterior aspect of the right\nL3-L4 facet joint into the posterior paravertebral muscles compared to ___." }, { "input": "Vertebral body heights are preserved. Minimal retrolisthesis of C3 on C4 is\nunchanged. Minimal anterolisthesis of C4 on C5 appears slightly less\nconspicuous compared to ___. Minimal retrolisthesis of C5 on C6 is\nunchanged. Minimal anterolisthesis of T1 and T2 has increased in conspicuity.\nNo suspicious bone marrow signal abnormalities are seen. Scattered\nhemangiomas are again noted, for example within C7, T1, and T2 vertebral\nbodies. There are multilevel discogenic bone marrow changes in the endplates,\nwhich have increased in severity at C5-C6 and C6-C7 since ___.\n\nThe cerebellar tonsils are normally positioned. No significant change in a\nprominent extra-axial spaces in the posterior fossa, likely due to parenchymal\nvolume loss.\n\nEvaluation of spinal cord signal is limited by artifacts. There is apparent\nfaint hyperintensity projecting over the cord at near the C6 superior endplate\non the sagittal images, not clearly confirmed on the axial images, and not\nseen on the ___ MRI, possibly artifactual.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: Unchanged minimal retrolisthesis. Right paracentral disc protrusion\nwith endplate osteophytes mildly remodels the right ventral spinal cord, with\nmoderate right and mild left spinal canal narrowing. Also severe right and\nmild left neural foraminal narrowing by uncovertebral and facet osteophytes. \nNo significant change since the prior MRI.\n\nC4-C5: Minimal anterolisthesis, decreased compared to the ___ MRI. \nBroad-based central disc protrusion, with the left-sided component slightly\nsmaller than on the ___ MRI. The protrusion Indents the ventral thecal sac\nwithout definite spinal cord contact or remodeling, only mildly narrowing the\nspinal canal. Mild bilateral neural foraminal narrowing by uncovertebral and\nfacet osteophytes is similar to prior.\n\nC5-C6: Motion artifact limits evaluation on axial images. Unchanged minimal\nretrolisthesis. Broad-based central disc protrusion with overlying endplate\nosteophytes moderately narrow the spinal canal with ventral spinal cord\nremodeling, increased compared to ___. Moderate to severe bilateral neural\nforaminal narrowing is unchanged.\n\nC6-C7: Small central disc protrusion minimally indents the ventral thecal sac\nwithout significant spinal canal narrowing. Mild right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes, not\nsignificantly changed.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nT1-T2: Increased minimal anterolisthesis. Infolding of the ligamentum flavum.\nNo significant spinal canal narrowing.\n\nRight thyroid nodule is again partially visualized, last assessed by\nultrasound on ___.", "output": "1. At C4-C5, minimal anterolisthesis appears decreased compared to ___, raising the question of mild dynamic instability. Left-sided component\nof the broad-based central disc protrusion has decreased in size since ___. \nMild residual spinal canal narrowing.\n2. At C5-C6, broad-based central disc protrusion and endplate osteophytes\nmoderately narrow the spinal canal with ventral spinal cord remodeling,\nincreased compared to ___. Faint hyperintensity projecting over the spinal\ncord near the superior endplate of C6 on sagittal images is not confirmed on\naxial images and may represent artifact, but mild cord signal abnormality\ncannot be excluded definitively.\n3. At T1-T2, minimal anterolisthesis appears slightly increased in size since\n___.\n4. No significant change in degenerative disease at other cervical levels.\n5. Partially visualized right thyroid nodule, last assessed by ultrasound on\n___.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 13:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere are small foci of hyperintense marrow signal abnormality within the C6\nvertebral body which represents venous flow. There is no prevertebral soft\ntissue swelling.\n\nThe spinal cord at the levels C4-C7 has heterogeneous linear signal\nabnormalities which represents CSF pulsation artifact. The visualized portion\nof the remainder of the spinal cord is preserved in signal and caliber.\n\nMild degenerative changes are seen along the spine. There is intervertebral\ndisc space height loss at C5-C6. Otherwise, the intervertebral disc heights\nand signal are preserved.\n\nAt C2-3 there is posterior central disc protrusion causing anterior thecal sac\ndeformity with no vertebral canaland no neural foraminal narrowing.\n\nAt C3-4 there is uncovertebral hypertrophy, posterior central disc protrusion\ncausing anterior thecal sac deformity with no vertebral canaland no neural\nforaminal narrowing.\n\nAt C4-5 there is posterior central disc protrusion causing anterior thecal sac\ndeformity with no vertebral canaland no neural foraminal narrowing.\n\nAt C5-6 there is bilateral uncovertebral hypertrophy, posterior central disc\nprotrusion, slightly more pronounced towards the left causing anterior thecal\nsac deformity with mild vertebral canaland mild bilateral neural foraminal\nnarrowing.\n\nAt C6-7 there is no vertebral canaland no neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canaland no neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. The patient is status post thyroidectomy.", "output": "1. No evidence of cord compression or severe neural foraminal stenosis.\n2. Mild multilevel degenerative disease along the cervical spine, most\nsignificant at the level of C5-C6 level." }, { "input": "There is redemonstration of retropharyngeal hematoma (06:24). There is linear\nSTIR hyperintensity extending through anterior C4 vertebral body through the\nanterior osteophyte extending into the intervertebral disc space, with mild\nintervertebral disc edema. There is mild prevertebral soft tissue edema with\nquestionable injury to the anterior longitudinal ligament. There is also\nedema along the inter spinous process and ligamentum nuchae, more significant\nat C4/C5 level, there is fluid within the C6-C7 intervertebral disc space with\nSTIR hyperintensity of the superior C7 vertebral body endplate without\ndefinite T1 hypointensity, possibly related to marrow edema. Patient is\nintubated with presence of an enteric tube.\n\nThere is 5 mm retrolisthesis of C4 on C5 and 2 mm anterolisthesis of C 2 on\nC3. There is loss of intervertebral disc space at C4-C5 through C6-C7 levels\nwith disc desiccation related to degenerative process.\n\nC2-C3: There is no spinal canal stenosis or neural foraminal narrowing.\n\nC3-C4: There is a disc bulge with facet and uncovertebral joint arthropathy\nresulting in moderate left and mild right neural foraminal narrowing without\nspinal canal stenosis or cord edema.\n\nC4-C5: There is a disc bulge with facet and uncovertebral joint arthropathy\ncausing moderate spinal canal stenosis with remodeling of spinal cord without\ncord edema. There is moderate to severe right and mild left neural foraminal\nnarrowing.\n\nC5-C6: There is a disc bulge with facet and uncovertebral joint arthropathy\nresulting in moderate spinal canal stenosis with remodeling of the ventral\nwith remodeling and flattening of the spinal cord (07:27) with moderate\nbilateral neural foraminal narrowing.\n\nC6-C7: There is a disc bulge with facet and uncovertebral joint arthropathy\nresulting in moderate spinal canal stenosis with remodeling of the ventral\nspinal cord without cord edema. There is moderate left and no right neural\nforaminal narrowing.\n\nC7-T1: There is no spinal canal stenosis or neural foraminal narrowing.", "output": "1. Acute fracture involving the anterior C4 vertebral body with prevertebral\nsoft tissue edema and probable injury to the anterior longitudinal ligament as\nwell the as the interspinous ligament.\n2. Edema within the C6-C7 intervertebral disc space with probable osseous\nedema of the superior C7 vertebral body.\n3. Redemonstration of retropharyngeal hematoma.\n4. Retrolisthesis of C4 on C5 and anterolisthesis of C2 on C3.\n5. Multilevel degenerative changes as detailed above, with moderate spinal\ncanal stenosis at C4-C5 through C6-C7 levels with spinal cord remodeling,\nwithout definite cord edema." }, { "input": "Study is severely degraded by motion. Within these confines:\n\n There is reversal of cervical lordosis. Vertebral body heights are grossly\npreserved. Schmorl's nodes are 6 tested throughout the cervical spine. C4-5\nprobable type ___ ___ changes are noted.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nPlease note study is nondiagnostic for evaluation of cervical spinal cord\nlesions.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C2-3 there is uncovertebral hypertrophy, mildvertebral canal and no neural\nforaminal narrowing.\n\nAt C3-4 there is uncovertebral hypertrophy, ligamentum flavum hypertrophy,\nfacet joint hypertrophy mildvertebral canaland question moderate rightneural\nforaminal narrowing.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, ligamentum flavum hypertrophy, deformation of ventral thecal sac\nand spinal cord, moderatevertebral canaland question severe rightneural\nforaminal narrowing.\n\nAt C5-6 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, ligamentum flavum hypertrophy, deformation of ventral thecal sac\nand spinal cord, moderatevertebral canaland question moderate rightneural\nforaminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, ligamentum flavum hypertrophy, mild-to-moderatevertebral canaland\nquestion moderate leftneural foraminal narrowing.\n\nAt C7-T1 there is nodefinite vertebral canal or neural foraminal narrowing.\n\nOTHER:\n Within the limits of this noncontrast study there is no definite\nparavertebral or paraspinal mass identified.", "output": "1. Study is severely degraded by motion. Please note study is nondiagnostic\nfor evaluation of cervical spinal cord lesions. If concern for cervical\nspinal cord lesion, consider repeat study when patient can tolerate\nexamination.\n2. Multilevel cervical spondylosis as described, with suggested moderate\nvertebral canal narrowing at C4-5 and C5-6 with deformation of ventral thecal\nsac and spinal cord.\n3. C6-7 mild-to-moderate vertebral canal narrowing.\n4. Question C3-4 moderate right, C4-5 severe right, C5-6 moderate right, and\nC6-7 moderate left neural foraminal narrowing." }, { "input": "Patient motion moderately compromises exam.\n\nIncreased T2 signal involving right sacral ala is stable since prior, likely\nrepresents meningioma, no corresponding decreased T1 signal. Multilevel\nadvanced degenerative changes lumbar spine. Congenital narrowing spinal\ncanal. Multilevel disc space narrowing, diffuse disc bulges, endplate\nhypertrophic changes, facet arthritis. Normal visualized cord. Minimal\nretrolisthesis L5-S1, new.\n\nAt L1-L2 level there is moderate central canal narrowing, worsened. Mild\nbilateral foraminal narrowing.\n\nAt L2-L3 level there is moderate central canal narrowing, stable, preserved\nCSF. Mild-to-moderate bilateral foraminal narrowing, stable.\n\nAt L3-L4 level there is moderate to severe central canal narrowing, preserved\nCSF, mildly worsened since prior. Moderate bilateral foraminal narrowing,\nstable.\n\nAt L4-5 level there is mild central canal narrowing, similar. Moderate\nbilateral foraminal narrowing, similar.\n\nAt L5-S1 level there is mild central canal narrowing. Small shallow central\ndisc protrusion, stable. Severe bilateral foraminal narrowing, stable.\n\n2.4 cm right adrenal nodule, stable since ___ CT abdomen pelvis,\nlikely benign adenoma.", "output": "1. Advanced degenerative changes lumbar spine, mildly worsened.\n2. Congenital narrowing spinal canal.\n3. Significant central canal narrowing L1-L 2, L2-L3, L3-L4.\n4. Multilevel foraminal narrowing, as above." }, { "input": "The exam is severely limited by patient motion.\n\nAn approximately 2.2 x 1.4 cm area of increased T2 signal in the right S2\nvertebral body has been present since at least ___. There is diffuse disc\nheight loss and disc desiccation, most pronounced at L2-3. Vertebral body\nheights are grossly preserved. There is no gross malalignment. The bone\nmarrow demonstrates diffuse heterogeneous signal. The canal and neural\nforamina cannot be accurately assessed despite repeated attempts at imaging.", "output": "Despite repeated attempts, the study remains nondiagnostic secondary to\npatient motion." }, { "input": "At T2-3 level there is slight anterior displacement of the spinal cord\nidentified the indentation on the cord and slight flattening of the cord. This\nfinding is unchanged from the prior study. In the posterior subarachnoid space\nat this level pulsation artifacts are identified indicating of patency of\nsubarachnoid space. There is no syringohydromyelia identified. Although the\nCSF flow imaging is somewhat limited by respiration artifacts, there is CSF\npulsation seen in this region. The findings suggest that there is likely a\ncontinuous subarachnoid space in this region without evidence of an arachnoid\ncyst.\n\nMild multilevel degenerative changes identified. There is no spinal stenosis\nand extrinsic spinal cord compression", "output": "Deformity of the spinal cord at the T2 level is again identified but there is\nno evidence of arachnoid cyst in this region. There is no syringohydromyelia.\nMild multilevel degenerative changes are seen." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. There is focal fatty marrow in the T12\nvertebral body. The visualized portion of the spinal cord is preserved in\nsignal and caliber. The conus terminates at the T1 level. There is no\nprevertebral soft tissue swelling.\n\nThere is diffuse degenerative disc signal with mild loss of disc height at\nL3-4 and L5-S1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is there is a small disc bulgecausing mild left neuroforamen\nnarrowing. There is no significant vertebral canal narrowing.\n\nAt L2-3 there is there is a disc bulge causing mild left neuroforamen\nnarrowing, progressed from prior.\n\nAt L3-4 there is a disc bulge and mild facet arthropathy cause minimal spinal\ncanal and mild right neuroforamen narrowing, progressed from prior.\n\nAt L4-5 there is a new left disc herniation indenting the left thecal sac and\ndisplacing the left L5 nerve root (series 5, image 25).\n\nAt L5-S1 there is a disc protrusion and mild facet arthropathy causing\nmoderate right neural foramen narrowing and minimal spinal canal narrowing.", "output": "1. New leftward disc herniation at L4-5 displacing the left L5 nerve root.\n2. Progression of multilevel degenerative disease at the remainder of the\nlumbar spine levels, as described above." }, { "input": "There is mild retrolisthesis of C4 on C5, likely degenerative and unchanged\nfrom prior. Vertebral body heights are preserved. Vertebral body signal\nintensity appear normal. There is mild loss of intervertebral disc signal and\nloss of disc height, most prominent at C4-C5. There is no abnormal signal or\nenhancement of the spinal cord.\n\nC2-3: There is a mild central disc protrusion without narrowing of the spinal\ncanal. Facet hypertrophy causes mild left neural foraminal narrowing.\nC3-4: There is a central disc protrusion which mildly indents the thecal sac. \nThere is no evidence of neural foraminal narrowing.\nC4-5: There is a disc bulge and ligamentum flavum hypertrophy flattening the\nthecal sac and causing moderate to severe spinal canal stenosis. \nUncovertebral and facet hypertrophy cause moderate to severe bilateral neural\nforaminal narrowing.\nC5-6. Central disc protrusion with mild narrowing of the spinal canal. Facet\nhypertrophy causes mild to moderate left neural foraminal narrowing.\nC6-7: A disc bulge causes moderate spinal canal narrowing. Uncovertebral and\nfacet hypertrophy causes moderate left and severe right neural foraminal\nnarrowing.\nC7-T1: There is evidence of disc protrusion without evidence of spinal canal\nnarrowing. Facet hypertrophy causes mild neural foraminal narrowing.\n\nVisualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes. There is moderate to severe spinal canal\nnarrowing at C4-5 and moderate spinal canal narrowing at C6-7. There is\nevidence of multilevel neural foraminal narrowing, which is moderate to severe\nbilaterally at C4-5, mild-to-moderate of the left foramina of C5-6, moderate\nof the left foramen of C6-7 and severe of the right foramen.\n2. Additional findings described above." }, { "input": "Grade 1 anterolisthesis L4-5, degenerative in etiology, more prominent since\nprior exam. More prominent L4-5 disc space narrowing. Mild narrowing L5-S1\ndisc space, similar. Lumbar facet arthritis, most prominent at L4-5 level,\nwhere there is mild reactive edema of the posterior elements and paraspinal\nsoft tissues. Fluid within bilateral L4-5, L5-S1 facet joints, most prominent\nat the left L5-S1 facet joint. Multilevel diffuse disc bulges. Vertebral body\nsignal intensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm.\nT11-T12 level: Diffuse disc bulge. Right anterolateral shallow disc\nprotrusion into paraspinal soft tissues, endplate hypertrophic changes,\nsimilar. Mild central canal narrowing, similar. Mild bilateral foraminal\nnarrowing, similar.\nT12-L1 level: Patent central canal, patent foramina.\nL1-L2 level: Patent central canal, similar. Patent foramina, similar.\nL2-L3 level: Patent central canal. Annular disc tear, broad-based left\nforaminal, far lateral shallow disc protrusion, prominent endplate\nhypertrophic change, contacting the exited left L2 nerve, similar. Mild to\nmoderate left foraminal narrowing, similar. Patent right foramen.\nL3-L4 level: Patent central canal. Left foraminal shallow broad-based disc\nprotrusion, annular disc tear, contacts exited left L3 nerve, similar. Mild\nto moderate left foraminal narrowing, similar. Mild right foraminal\nnarrowing, similar.\nL4-5 level: Diffuse disc bulge, prominent thickening ligamentum flavum,\nworsened. Moderate central canal narrowing, worsened. Preserved CSF signal\nwithin thecal sac. New narrowed right lateral recess, encroachment on\ntraversing right L5 nerve, new finding. Marked left facet arthritis, with\nsynovial thickening partially encroaching into the left foramen, worsened. \nModerate to severe left foraminal narrowing with flattening of the left L4\nnerve within foramen, worsened. Severe right foraminal narrowing, worsened.\nL5-S1 level: Annular disc tear, similar. Patent central canal. . Moderate\nright foraminal narrowing, worsened. Moderate to severe left foraminal\nnarrowing, worsened.\nRemainder normal.", "output": "1. Interval worsening of degenerative changes in the lower lumbar spine.\n2. Grade 1 anterolisthesis, moderate central canal narrowing L4-L5 level,\nworsened; new encroachment on traversing right L5 nerve in the lateral recess.\n3. Significant bilateral L4-5, L5-S1 foraminal narrowing.\n4. Similar findings at L3-L4 level." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nMild degenerative changes are seen throughout the cervical spine, most notably\nat the C5-C6 and C6-C7 vertebral levels.\n\nWithin 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.\n\nAt C2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is a mild posterior disc bulge which narrows the ventral CSF\nspace without significant vertebral canal or neural foraminal stenosis.\n\nAt C4-5 there is mild predominantly left-sided posterior disc bulge and\nuncovertebral hypertrophy which causes narrowing of the ventral CSF space and\nmild left neural foraminal stenosis. There is no significant right neural\nforaminal stenosis.\n\nAt C5-6 there is mild predominantly left-sided posterior disc bulge and\nuncovertebral hypertrophy which contacts the ventral thecal sac and causes\nmild deformation of the spinal cord, along with left mild to moderate neural\nforaminal narrowing with contact on the traversing nerve root. There is no\nsignificant right neural foraminal stenosis.\n\nAt C6-7 there is a posterior disc protrusion with disc material seen extruding\nsuperiorly which contacts the ventral thecal sac and causes mild deformation\nof the spinal cord. There is mild uncovertebral and facet joint hypertrophy\nwith resultant bilateral neural foraminal narrowing, left greater than right.\n\nAt C7-T1 there is no vertebral canal or neural foraminal stenosis.", "output": "1. Mild degenerative changes seen throughout the cervical spine, most notably\nat the C5-C6 and C6-C7 vertebral levels.\n2. At C5-6 there is a small predominantly left-sided posterior disc bulge and\nuncovertebral hypertrophy which contacts the ventral thecal sac and left mild\nto moderate neural foraminal narrowing with contact on the traversing nerve\nroot. There is no significant right neural foraminal stenosis.\n3. At C6-7 there is a posterior disc protrusion with disc material seen\nextruding superiorly, which contacts the ventral thecal sac and causes mild\ndeformation of the spinal cord. There is mild uncovertebral and facet joint\nhypertrophy with resultant bilateral neural foraminal narrowing, left greater\nthan right." }, { "input": "There is mild kyphosis seen in the mid cervical region. At the craniocervical\njunction and C2-3 mild degenerative change seen. C3-4 moderate to severe\nright-sided and moderate left-sided foraminal narrowing seen due to\nuncovertebral and facet degenerative changes.\n\nAt C4-5 moderate to severe bilateral foraminal narrowing identified due to\nuncovertebral degenerative change.\n\nAt C5-6 mild to moderate bilateral foraminal narrowing identified. No spinal\nstenosis seen.\n\nAt C6-7 disk and uncovertebral degenerative change seen. There is severe\nright-sided and moderate left-sided foraminal narrowing.\n\nAt C7-T1 moderate-to-severe bilateral foraminal narrowing and disc bulging\nidentified. At T1-2 disk bulging and a small central osteophyte seen. \nModerate to severe right-sided and mild left-sided foraminal narrowing seen.\n\nAt T2-3 and T3-4 disk degenerative change seen. Spinal cord shows normal\nintrinsic signal. At C4-5 disc bulging contacts the spinal cord without\ndeformity", "output": "Progression of degenerative changes since the previous MRI of ___. \nMultilevel degenerative changes and mild cervical kyphosis seen. Disc bulging\nindents the thecal sac at multiple levels and contacts the spinal cord at C4-5\nlevel. Foraminal changes at multiple levels as described above." }, { "input": "There are diffuse osseous metastases throughout the cervical, thoracic, and\nlumbar spine. Osseous metastases involve both the anterior and posterior\nelements numerous vertebrae. There is no pathologic fracture. There are no\nspinal cord metastases. There is a 1.0 x 1.3 x 3.4 cm (AP x TV x SI) enhancing\nextradural metastasis at L2-3 that is superimposed on a diffuse disc bulge\nresulting in between 50 and 75% narrowing of the spinal canal at this level .\nThe conus medullaris is normal in appearance and position, terminating at L2. \nThere does not appear to be compression of the conus.\n\nThere is degenerative disc and joint disease throughout the cervical spine.\nThere are small disc protrusions at C3-4, C5-6, and C6-7. There are\nuncovertebral and facet osteophytes causing neural foraminal stenosis at\nmultiple that is severe bilaterally at C3-4, severe on the right at C4-5,\nsevere on the left at C5-6, and severe on the left at C6-7. There is a mild\ndisc bulge at L1-2 that does not cause significant spinal canal stenosis.\nThere is degenerative facet arthropathy at multiple levels.\n\nThere is a right cerebellar metastasis, as seen on MRI from ___.\nThere are multiple right upper lobe lung masses, a large right hilar mass, and\nmediastinal lymphadenopathy, as seen on CT from ___. There are\nmultiple liver metastases, as seen on CT.", "output": "1. Diffuse osseous metastases throughout the cervical, thoracic, and lumbar\nspine. No pathologic fracture.\n2. Epidural 3.4 cm metastasis at L2-3 superimposed on a diffuse disc bulge\nwith 50-75% narrowing of the spinal canal at this level and compression of the\nthecal sac.\n3. Additional metastases in the right cerebellum, right lung, mediastinum,\nand liver.\n4. Degenerative joint disease of the cervical spine causes severe neural\nforaminal stenosis at C3-4, right C4-5, left C5-6, and left C6-7.\n\n\nNOTIFICATION: Preliminary findings discussed by Dr. ___ of\nradiology with Dr. ___ at 09:05 ___." }, { "input": "The thoracic spine has normal curvature vertebral body height. Multiple\nenhancing metastases are identified throughout the T spine which are not\nsignificantly changed in size or appearance compared with the previous exam\nfrom ___. No new lesions are identified. No enhancing mass is seen\nin the thecal sac, spinal cord or nerve roots.\n\nThe intervertebral disc have normal height and signal intensities. There is no\ndisc herniation, or spinal canal or neural foraminal stenosis. The thoracic\nspinal cord and conus medullaris have normal morphology and signal\nintensities. The posterior elements and paraspinal soft tissues are normal.\n\nThe study is limited for the assessment of the mediastinum or lungs.", "output": "1. Unchanged burden of metastatic disease to the thoracic spine. No\npathological fractures or degenerative changes. No cord compression.\n\n2. No enhancing mass identified in the thecal sac, spinal cord or nerve\nroots." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The conus terminates at L1.\n\nAt T11-T12, T12-L1, L1-L2, L2-L3, and L3-L4, there is no significant spinal\ncanal or neural foraminal narrowing.\n\nAt L4-L5, there is a larger disc bulge which narrows the subarticular zone,\nwith resultant right moderate neural foraminal narrowing.\n\nAt L5-S1, there is a mild disc bulge without significant spinal canal\nnarrowing. Mild facet arthropathy results in mild to moderate left neural\nforaminal narrowing and mild right neural foraminal narrowing.\n\nA simple cyst in the posterior right lobe of the liver is present. A simple\ncyst in the right kidney is also noted.", "output": "Multilevel degenerative changes, most severe at L4-L5 with moderate right\nneural foraminal narrowing." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere are mild degenerative endplate signal changes at the inferior endplate\nof the L3 vertebral body.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L1-L2.\n\nThere is mild multilevel intervertebral disc height/signal loss,\nmanifestations of degenerative change.\n\nAt L2-L3 there is eccentric right disc bulging with mild right neural\nforaminal narrowing. No significant spinal canal or left neural foraminal\nnarrowing. Similar to prior.\n\nAt L3-L4 there is eccentric left disc bulging with moderate left (slightly\nprogressed) and mild right neural foraminal narrowing. No significant spinal\ncanal narrowing.\n\nAt L4-L5 there is a right foraminal disc protrusion resulting in moderate to\nsevere right neural foraminal narrowing and compression of the exiting L4\nnerve and moderate left neural foraminal narrowing. Neural foraminal\nnarrowing appears slightly progressed from prior. No significant spinal canal\nnarrowing.\n\nAt L5-S1 there is no significant spinal canal or neural foraminal narrowing.", "output": "Degenerative changes of the lumbar spine most significant at L4-L5 level,\nwhere there is moderate to severe right neural foraminal narrowing, and\ncompression of the exiting L4 nerve root and moderate left neural foraminal\nnarrowing. Findings are slightly progressed from prior MRI examination." }, { "input": "The study is moderately limited by motion artifact.\n\nThere is extensive prevertebral edema from the craniocervical junction through\nthe T3-T4 level.\n\nThere is a minimally displaced fracture of the C4 anterior superior corner, as\nseen on the preceding CT, with marrow edema parallel to the anterior superior\nendplate of C4. Disruption of the anterior longitudinal ligament is suspected\nat this level, though evaluation is limited by motion artifact. There is\nedema between the laminae of C3 and C4 bilaterally, extending to the margins\nof the facet joints, but without extension into the interspinous ligament or\nspinous process. The facet joints remain well aligned. Cervical vertebral\nbodies are also well aligned.\n\nThere is a small nondisplaced fracture of the C7 anterior superior corner, as\nseen on the preceding CT, with associated disruption of the anterior\nlongitudinal ligament. There is also marrow edema parallel to the anterior\nsuperior endplate of C7 and extending in a parasagittal plane into the central\nvertebral body, with central disruption of the superior endplate demonstrate\non the preceding CT, consistent with a nondisplaced fracture.\n\nThere is minimal edema in the anterior aspect of the C4-C5 disc, which may be\neither posttraumatic or degenerative, as there is loss of disc height and\nendplate degenerative changes.\n\nC2-C3: Small disc protrusion does not contact the spinal cord or\nsignificantly narrow the spinal canal. No significant neural foraminal\nnarrowing.\n\nC3-C4: Small disc protrusion indents the ventral thecal sac and mildly\nremodels the ventral spinal cord with mild to moderate spinal canal narrowing.\nNeural foramina are not well assessed due to motion artifact.\n\nC4-C5: Broad-based central endplate osteophyte ridge moderately narrows the\nspinal canal with ventral spinal cord flattening. At least moderate bilateral\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC5-C6: Central broad-based disc protrusion with endplate osteophytes, larger\non the right than left, contact the right ventral spinal cord. Spinal canal\nnarrowing is only mild. At least moderate right neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nC7-T1: Posterior endplate osteophyte ridge, larger on the left than right,\nindents the ventral thecal sac without spinal cord contact. At least moderate\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC7-T1: Minimal anterolisthesis. Small central disc protrusion without spinal\ncanal or neural foraminal narrowing.\n\nEvaluation of spinal cord signal on sagittal T2 weighted images is limited by\nmotion artifact. No cord signal abnormalities are seen on axial T2 weighted\nimages. Diffusion-weighted images demonstrate no evidence for cord contusion\nor infarction.\n\nThe cerebellar tonsils are normally positioned. Axial T2 weighted images\ndemonstrate volume loss in bilateral cerebellar hemispheres was prominent\nfissures, and a small chronic infarction a left cerebellar hemisphere, as seen\non the ___ CT head.", "output": "1. Motion limited exam.\n2. C4 anterior superior corner fracture with disruption of the anterior\nlongitudinal ligament. Edema between the laminae of C3 and C4 bilaterally,\nabutting the posterior aspects of the facet joints, without facet joint\ndisruption or extension into the spinous processes/interspinous ligament. No\nspondylolisthesis.\n3. C7 anterior superior corner fracture extending into the central vertebral\nbody, with disruption of the anterior longitudinal ligament.\n4. Edema in the anterior aspect of the C4-C5 disc may be posttraumatic or\ndegenerative.\n5. Prevertebral edema from the craniocervical junction through T3-T4.\n6. No evidence for spinal cord signal abnormalities.\n7. Multilevel cervical degenerative disease." }, { "input": "The patient is status post posterior fusion of L1-L2, anterior fusion of L2\nthrough S1, placement of intervertebral body spacers from L1-2 through L5-S1,\nand laminectomy extending from L1-L5. Enhancing granulation tissue is seen\nposterior to the L4 and L5 vertebral bodies (7; 11). A collection is seen\nwithin the postsurgical bed tracking along the posterior elements of the\nvertebral bodies spanning L3-S1 measuring approximately 4.5 x 4.8 x 11.4 cm. \nAt the level of L5-S1 there is a small possible defect (2, 44-47). This\ncollection may also communicate with a 2.8 x 11.7 x 14 x 1 cm subcutaneous\nsoft tissue fluid collection (2; 50).\n\nT1 and T2 signal is seen surrounding multiple intervertebral discs in the\nlumbar spine consistent with ___ type 2 changes. The spinal cord appears\nnormal in caliber and configuration.\n\nT12-L1: Ligamentum flavum thickening, posterior disc bulge, and facet\nhypertrophy cause mild spinal canal and mild left neural foraminal narrowing.\nL1-2: Facet hypertrophy and posterior osteophytes cause moderate right and\nmild to moderate left neural foraminal narrowing without significant spinal\ncanal narrowing.\nL2-3: Ligamentum flavum thickening and facet hypertrophy cause moderate spinal\ncanal and mild bilateral neural foraminal narrowing.\nL3-4: Posterior osteophytes and facet hypertrophy cause moderate spinal canal\nnarrowing and moderate right and mild left neural foraminal narrowing.\nL4-5: Posterior osteophytes and facet hypertrophy cause mild-to-moderate\nspinal canal and moderate bilateral neural foraminal narrowing. Granulation\ntissue posterior to the L5 vertebral body causes moderate spinal canal\nnarrowing (2; 43).\nL5-S1: Posterior osteophytes and facet hypertrophy causes mild spinal canal\nand moderate left neural foraminal narrowing.", "output": "1. Possible small defect at the level of L5-S1 connecting the spinal canal to\na posterior fluid collection, concerning for CSF leak.\n2. Multilevel degenerative changes of the lumbar spine with moderate spinal\ncanal narrowing at L2-3, L3-4, and posterior to the L5 vertebral body due to\ngranulation tissue.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:34 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "The patient is status post posterior fusion of L1-2, anterior fusion of L2\nthrough S1, placement of L1-2 through L5-S1 intervertebral spacers, and\nlaminectomy from L1 through L5. Re-demonstration of the fluid collection\nextending from L3 through S1 posteriorly, measuring up to 5.7 x 2.6 x 9.8 cm,\npreviously 4.8 x 4.5 x 11.4 cm (05:28, 02:49). As before, there is enhancing\ngranulation tissue posterior to the L4-5. The previously seen defect at L5-S1\ncommunicating with the thecal sac is re-demonstrated (02:42). The large\nsubcutaneous fluid collection has essentially resolved.\n\nT12-L1: As before, ligamentum flavum thickening, posterior disc bulge and\nfacet hypertrophy result in mild canal narrowing and mild left neural\nforaminal narrowing.\nL1-2: Facet hypertrophy and posterior osteophytes result in mild canal and\nmild left neural foraminal narrowing.\nL2-3: Posterior osteophytes, ligamentum flavum thickening, and facet\nosteophytes result in moderate canal narrowing and mild bilateral neural\nforaminal narrowing.\nL3-4: Posterior osteophytes and facet hypertrophy result in moderate canal\nnarrowing, as well as moderate right and mild left neural foraminal narrowing.\nL4-5: Posterior osteophytes and facet hypertrophy as well as posterior\ngranulation tissue result in moderate canal narrowing. There is moderate\nright and mild left neural foraminal narrowing.\nL5-S1: Posterior osteophytes as well as facet hypertrophy results in mild\ncanal narrowing. There is moderate left neural foraminal narrowing.\n\nOther: T2 hyperintense left renal cysts are re-demonstrated.", "output": "1. Overall similar appearance of the fluid collection extending from L3\nthrough S1 posteriorly, measuring up to 5.7 x 2.6 x 9.8 cm previously 4.8 x\n4.5 x 11.4 cm. Communication with the thecal sac is re-demonstrated L5-S1.\n2. Similar multilevel degenerative changes." }, { "input": "FINDINGS:\nTaking in consideration underlying extensive metal artifact which may limit\ndiagnostic quality of the study;\n\nThe patient is status post posterior fusion of L1-2, anterior fusion of L2\nthrough S1, placement of L1-2\nThrough L5-S1 intervertebral disc spacers, and laminectomy from L1 through L5.\n\nThere is mild further interval decrease of posterior paraspinal fluid\ncollection extending from L3 through S1 posteriorly, measuring up to 3.3 cm x\n4.5 cm x 7.5 cm compare to 4 x 5.5 X 9.8 cm (AP,TV and SI directions;\nrespectively).\n\nRedemonstration of previously identified defect at anterior inferior aspect of\nthe collection at L5-S1 level communicating with the thecal sac (series 7,\nimage 11).\n\nRedemonstration of extensive surgical date lower lumbar posterior and\nparaspinal edematous changes as well as, enhancing locoregional, epidural and\nsurgical bed enhancing tissue which could be reactive in nature or related to\ngranulation tissue formation. There is also adjacent small locules of micro\ncollections.\n\n\nT12-L1: As before, ligamentum flavum thickening, posterior disc protrusion and\nfacet hypertrophy result in mild canal narrowing and mild left neural\nforaminal narrowing.\n\nL1-2: Facet hypertrophy and posterior osteophytes result in mild canal and\nbilateral mild neural foraminal narrowing.\n\nL2-3: Posterior osteophytes, ligamentum flavum thickening, and facet\nosteophytes result in mild to moderate canal narrowing and mild bilateral\nneural foraminal narrowing.\n\nL3-4: Posterior osteophytes and facet hypertrophy result in mild to moderate\ncanal narrowing, as well as moderate right and mild left neural foraminal\nnarrowing.\n\nL4-5: Posterior osteophytes and facet hypertrophy as well as posterior\ngranulation tissue result in mild spinal canal narrowing. There is moderate\nleft and mild right neural foraminal narrowing.\n\nL5-S1: Posterior osteophytes as well as facet hypertrophy results in mild\ncanal narrowing. There is moderate left neural foraminal narrowing.\n\nOther: T2 hyperintense left renal cysts are re-demonstrated.", "output": "1. There is further interval decrease of lower lumbar posterior paraspinal\nfluid collection extending from L3 through S1.\n2. Redemonstration of suggested communication with the thecal sac at L5-S1" }, { "input": "Limited examination due to patient motion, no contrast was administered,\nwithin this limitations:\n\nThe patient is status post posterior fusion of L1-2, anterior fusion of L2\nthrough S1, placement of L1-2 through L5-S1 intervertebral disc spacers, and\nlaminectomy from L1 through L5.\n\nThere is mild interval increase in size of posterior paraspinal surgical bed\nfluid collection extending from L3 through S1 posteriorly, measuring up to 2.9\nx 5.2 x 6.2 cm compare to 2.3 x 4.6 x 6.2 cm (AP,TV and SI directions;\nrespectively). There is interval development of intralesional air fluid\nlevels as well as fluid fluid level; which could be related to recent\nintervention.\n\nRedemonstration of previously identified defect at anterior inferior aspect of\nthe collection at L5-S1 level with questionable communicating with the thecal\nsac (series 6, image 10).\n\nRedemonstration of extensive surgical date lower lumbar posterior and\nparaspinal edematous changes.\n\nConsidering extensive metal and motion and metal artifact; it is difficult to\nassess the underlying disc degenerative disease. However, there is no severe\ndegree spinal canal stenosis.", "output": "1. There is mild interval increase in size of lower lumbar posterior\nparaspinal fluid collection extending from L3 through S1 with new development\nof fluid fluid levels as well as air-fluid levels; could be related to post\ntherapeutic changes.\n2. Redemonstration of suggested communication with the thecal sac at L5-S1.\n3. Relatively stable postsurgical changes, the patient is status post\nposterior fusion of L1-2, anterior fusion of L2 through S1, placement of L1-2\nthrough L5-S1 intervertebral disc spacers, and laminectomy from L1 through L5." }, { "input": "Vertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nThere is no concerning focal bone marrow signal abnormality. Mild, ___ type\n1 degenerative endplate changes are noted at L3-L4. The conus medullaris\nterminates at the level of L1-L2.\n\nMild loss of intrinsic T2 signal within the intervertebral discs is most\nnotable at L2-L3 and L3-L4, compatible with disc desiccation. There is\nminimal disc bulging at L4-L5 without canal stenosis or neural foraminal\nnarrowing. Otherwise, there is only minimal background lumbar spondylosis and\nno evidence for significant canal stenosis or neural foraminal narrowing.\n\nThere is no evidence for abnormal intramedullary, leptomeningeal, or epidural\nenhancement. No epidural fluid collection. The urinary bladder is\nsignificantly distended. There is edema like signal in the subcutaneous soft\ntissue of the posterior lumbar spine (for example image 6, series 3, and image\n22, series 5), although this finding is nonspecific has been described in\npatients with overweight.", "output": "1. No evidence for suspicious bone marrow lesion, intraspinal mass, or\nabnormal enhancement.\n2. Minimal spondylosis of the lumbar spine, without significant canal stenosis\nor neural foraminal narrowing.\n3. There is edema like signal in the subcutaneous soft tissue of the posterior\nlumbar spine." }, { "input": "Please note that only scout images were performed as the patient did not\ntolerate the confines of the MRI scanner.\n\nOn scout imaging there bilateral pleural effusions as noted on prior CT chest\ndone ___.\n\nReferring physician ___.", "output": "1. Patient unable to tolerate the confines of the MRI scanner.\n2. Referring team (Dr ___ informed.\n3. Limited imaging of lungs again demonstrate patient's known bilateral\npleural effusions." }, { "input": "3-4 mm retrolisthesis of L5 on S1 is unchanged since CT examination of ___. \nOtherwise, lumbar alignment is anatomic. Vertebral body heights are\npreserved. There is no focal suspicious marrow lesion. ___ type 1 L5-S1\nendplate changes are noted. Degenerative loss of disc height and signal is\nmild at L1-L2 through L4-L5 and moderate to severe at L5-S1. The conus\nmedullaris terminates at the inferior endplate of L1, within expected limits. \nThere is no abnormal signal of the terminal cord.\n\nT11-T12 through L3-L4: Mild degenerative changes not result in significant\nspinal canal or neural foraminal narrowing.\n\nL4-L5: A central protrusion minimally crowds the subarticular zones without\nposterior displacement of the traversing nerve roots. There is no significant\nspinal canal narrowing. In conjunction with facet arthropathy, there is mild\nbilateral neural foraminal narrowing.\n\nL5-S1: A small disc bulge does not narrow the spinal canal. In conjunction\nwith facet arthropathy and loss of disc height there is severe right neural\nforaminal narrowing, flattening the exiting right L5 nerve root (series 2,\nimage 15). Degenerative changes results in mild left neural foraminal\nnarrowing.\n\nThere are multiple T2 hypointense cystic lesions in both kidneys measuring up\nto 7 mm, statistically likely simple cysts. There is also an apparent 8-9 mm\nT2 hypointense rounded focus in the left superior renal pole (series 5, image\n7), which may represent hemorrhagic cyst versus volume averaging artifact\nsecondary to patient motion. The remainder the visualized prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. Lumbar spondylosis most prominent at L5-S1 where there is severe right\nneural foraminal narrowing, flattening the exiting right L5 nerve root.\n2. There is no significant spinal canal or other high-grade neural foraminal\nnarrowing.\n3. An apparent 8-9 mm T2 hypointense rounded focus in the left superior renal\npole, which may represent a hemorrhagic cyst versus artifact secondary to\npatient motion and volume averaging. Further evaluation with renal ultrasound\nconfirm the finding is recommended." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T12 and is\nunremarkable. At T11/T12, there is a Schmorl's node, partially evaluated in\nthis examination.\n\nAt T12/L1 level, there is disc desiccation with no evidence of neural\nforaminal narrowing or spinal canal stenosis.\n\nAt L1/L2 level, the intervertebral disc space appears maintained with no\nevidence of neural foraminal narrowing or spinal canal stenosis there is\nminimal articular joint facet hypertrophy.\n\nAt L2/L3 level, appears maintained with no evidence of neural foraminal\nnarrowing or spinal canal stenosis, mild articular joint facet hypertrophy is\npresent\n\nAt L3/L4 level, there is minimal posterior disc bulge with no evidence of\nnerve root compression, articular joint facet hypertrophy and ligamentum\nflavum thickening are identified at this level.\n\nAt L4/L5 level, there is disc desiccation and mild posterior disc bulge,\ncontacting the traversing nerve roots bilaterally, mild articular joint facet\nhypertrophy and ligamentum flavum thickening are present resulting in mild\nspinal canal narrowing (image number 25, series 5).\n\nAt L5/S1 level, there is disc desiccation and minimal posterior disc bulge,\napparently contacting the traversing nerve root on the right (31:5). Mild\narticular joint facet hypertrophy is present, there is no evidence of spinal\ncanal stenosis\n\nThe sacroiliac joints are unremarkable.", "output": "1. Schmorl's node identified at T11/T12, partially evaluated in this\nexamination.\n\n2. Mild multilevel disc degenerative changes throughout the lumbar spine as\ndescribed in detail above with no evidence of significant spinal canal\nnarrowing.\n\nNOTIFICATION: Apreliminary report was provided by Dr. ___, on ___." }, { "input": "The alignment is normal. There is mild straightening of the normal cervical\nlordosis. A T1 hypo intense, STIR hyper intense and T2 hyperintense signal is\nseen along the superior aspect of the C6 vertebral body, corresponding to the\nfracture seen on the prior CT. Subtle increased STIR signal involving the C5\nvertebral body may be secondary to a contusion however no definite fracture\nthe C5 vertebral bodies identified. No other fracture is identified. Subtle\nincreased fluid is seen along the anterior longitudinal ligament at C5/C6. \nThere is a small amount of prevertebral soft tissue fluid. No underlying cord\nsignal abnormalities are identified. Mild degenerative changes are seen\nthroughout the cervical spine.\n\nC2/C3: No evidence of an intervertebral disc bulge. No spinal canal or\nneural foraminal narrowing.\n\nC3/C4: Mild broad-based intervertebral disc bulge. No significant neural\nforaminal or spinal canal narrowing.\n\nC4/C5: No significant degenerative changes seen.\n\nC5/C6: Mild broad-based intervertebral disc bulge. No significant neural\nforaminal or spinal canal narrowing.\n\nC6/C7: Mild broad-based intervertebral disc bulge with mild bilateral neural\nforaminal narrowing. Minimal thecal sac narrowing is identified.\n\nNo other soft tissue abnormality is identified. No diffusion abnormalities\nare identified throughout the cord.", "output": "1. Acute mild compression fracture involving the C6 vertebral body, without\nevidence of retropulsion of fragments. No underlying cord signal\nabnormalities or cord diffusion abnormalities are identified.\n2. Possible subtle contusion of the C5 vertebral body. Subtle increased fluid\nsignal along the anterior longitudinal ligament at C5/C6 is concerning for\ninjury.\n3. Mild degenerative changes of the cervical spine." }, { "input": "Cervical spine: There is motion artifact which degrades spatial resolution. \nThere is normal cervical alignment. The vertebral body heights are preserved.\nThere is diffuse heterogeneous marrow signal with areas of focal marrow fat\nosseous hemangiomas. There is diffuse background mild marrow T1\nhypointensity. There is diffuse low intervertebral disc signal.\n\nThere is central disc protrusion and intervertebral uncovertebral osteophytes\ncausing mild spinal canal narrowing and mild-to-moderate bilateral neural\nforaminal stenosis.\nAt C4-C5 there is left paracentral disc protrusion in addition to\nuncovertebral and intervertebral osteophytes causing asymmetric left severe\nspinal canal stenosis which mildly deforms the spinal cord without intrinsic\ncord signal abnormality. There is severe left and moderate right neural\nforaminal stenosis.\nAt C5-C6 there is near complete loss of intervertebral disc height with bulky\nintervertebral uncovertebral osteophytes causing severe left spinal canal\nstenosis which deforms the traversing spinal cord, without associated\nintrinsic cord signal abnormality. There is severe left and mild right neural\nforaminal stenosis.\nAt C6-C7 there is mild spinal canal narrowing and mild bilateral neural\nforaminal stenosis secondary to central disc protrusion and uncovertebral\nosteophytes.\n\n\nThere is marked enlargement of the right palatine tonsil which measures up to\n2.8 cm TV x 2.8 cm AP (11:2). There is heterogeneous the T2 hyperintense\nenlargement of the left thyroid lobe which measures 5.7 cm SI x 3.8 cm AP\n(05:17). There are additional nodules within the right thyroid lobe measuring\nup to 1.5 cm (22:18). There is extensive cervical lymph node enlargement\npredominant involving the right jugular and spinal accessory chains with\nadditional partially visualized large right suboccipital, submandibular, and\nsupraclavicular lymph nodes. There is an enlarged right axillary lymph node\nmeasuring 2.0 x 1.2 cm (22:23). There is an enlarged left cervical chain\nlymph node measuring up to 2.1 cm (11:19) and a partially visualized enlarged\nleft intra parotid lymph node measuring 1.9 cm (11:6).\n\nThoracic spine: There is motion artifact which degrades spatial resolution. \nThere is normal thoracic alignment. There is mild central loss of height at\nthe T11 vertebral body without marrow edema, likely representing a remote mild\ncompression fracture. There is heterogeneous marrow signal with multiple\nareas of focal fat and osseous hemangiomas. There is diffuse low\nintervertebral disc signal. There is no significant spinal canal or neural\nforaminal stenosis.\n\nThere is a 3.0 x 4.2 cm right subcutaneous soft tissue chest wall mass (4:6).\n\nLumbar spine: There is motion artifact which degrades spatial resolution. \nThere is normal lumbar alignment. There is mild loss of vertebral body height\nat L2 and L3 without marrow edema, consistent with chronic compression. There\nis heterogeneous marrow signal with enlarging osseous hemangioma within the L4\nvertebral body. There is diffuse low intervertebral disc signal, without\nsignificant loss of height.\n\nAt T12-L1 there is disc bulge and facet osteophytes without significant neural\nforamina or spinal canal stenosis.\nAt L1-L2 there is a central disc protrusion with bulky intervertebral\nosteophytes in addition to facet osteophytes and ligamentum flavum thickening\ncausing moderate to severe central spinal canal stenosis which crowds the\ntraversing nerve roots (14:9). There is moderate bilateral neural foraminal\nstenosis.\nAt L2-L3 there is disc bulge and facet osteophytes causing mild spinal canal\nnarrowing and mild bilateral neural foraminal stenosis.\nAt L3-L4 there is disc bulge and intervertebral and facet osteophytes, and\nligamentum flavum thickening causing mild spinal canal narrowing which\ncontacts the traversing L4 nerve roots in the subarticular zones (14:23). \nThere is mild bilateral neural foraminal stenosis.\nAt L4-L5 there is disc bulge, ligamentum flavum thickening, and intervertebral\nand facet osteophytes causing mild spinal canal narrowing which compresses the\ntraversing left L5 nerve root in the subarticular zone (15:13). There is\nmoderate left and mild right neural foraminal stenosis.\nAt L5-S1 there is no significant neural foramina or spinal canal stenosis.\n\nThere are osteophytes at the bilateral sacroiliac joints. There are enlarged\nretroperitoneal lymph nodes as follows: There is a 2.1 x 1.9 cm right\npericaval node at the level of the left renal vein (13:32). There is a 1.7 x\n3.1 cm right pericaval lymph node at the L1 level (8:5). There are enlarged\nleft periaortic low measuring 1.2 and 1.3 cm respectively (14:11). There is\nlayering sludge versus gallstones within the gallbladder.", "output": "1. Extensive cervical lymphadenopathy, as described, predominantly involving\nthe right jugular and spinal accessory chains. Marked enlargement of the\nright palatine tonsil. Enlarged right axillary lymph nodes with a right\nanterior chest wall subcutaneous mass which may represent a lymph node.\nScattered retroperitoneal lymphadenopathy, as described. Findings are highly\nsuspicious for a lymphoproliferative of process such as lymphoma with\ndifferential including other neoplasm or systemic infectious/inflammatory\nprocess.\n2. Marked heterogeneous T2 hyperintense enlargement of the left thyroid lobe,\nwhich could be further characterized with dedicated thyroid ultrasound.\n3. Multilevel degenerative changes of the cervical spine with severe stenosis\nsecondary to osteophytes and disc protrusions at C4-C5 and C5-C6 which deforms\nthe cord without cord edema or myelomalacia. Severe left neural foraminal\nstenosis at C4-C5 and C5-C6.\n4. No significant neural foramina or spinal canal stenosis within the thoracic\nspine.\n5. Multilevel degenerative changes of the lumbar spine, as described, with\nsevere spinal canal stenosis at L1-L2 secondary to intervertebral osteophytes\nand disc protrusion which crowds the traversing nerve roots.\n6. L3-L4 subarticular zone stenosis which contacts the traversing L4 nerve\nroots.\n7. L4-L5 left subarticular zone stenosis which compresses the traversing left\nL5 nerve root.\n8. Heterogeneity of bone marrow in the cervical thoracic and lumbar vertebral\nbodies low signal which could be related to anemia but diffuse infiltrative\nprocess could have similar appearance.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:16 AM, 15 minutes after\ndiscovery of the findings." }, { "input": "Cervical spine: There is no abnormal enhancement within the cervical spine. \nThere is no abnormal enhancement within the spinal canal or involving the\nspine. There is re- demonstration of extensive enhancing lymphadenopathy\nprobably involving the right jugular and spinal accessory chains with\nadditional enlarged lymph nodes within the left parotid, left submandibular,\nright axillary, right suboccipital, and right supraclavicular spaces. There\nis partial visualization of an a large right palatine tonsil.\n\nThoracic spine: There are no enhancing lesions within the thoracic spine,\nspinal canal, or spinal cord. There is an enhancing large right peritracheal\nlymph node measuring 1.0 centimeter (7:11). There is linear signal intensity\nwithin the dependent aspects of the lungs which may represent atelectasis\nversus scarring.\n\nLumbar spine: There is no abnormal postcontrast enhancement within the lumbar\nspine, spinal canal, conus medullaris, or cauda equina nerve roots.\n\nThere is redemonstration of enhancing enlarged retroperitoneal lymph nodes\nwithin the retrocrural (8:23), pericaval (11:11), left periaortic (11:14), and\nparailiac spaces (10:26). The partially visualized parailiac disease measures\nup to 2.9 x 2.4 centimeters on the right and 2.2 x 1.6 centimeters on the left\n(10:26). There sub centimeter right renal cortical cysts.", "output": "1. No abnormal enhancement within the spine, spinal canal, or involving the\nspinal cord or nerve roots.\n2. Redemonstration of extensive lymphadenopathy, above and below the\ndiaphragm, highly suspicious for a lymphoproliferative process such as\nlymphoma. Differential considerations includes of the neoplasm with nodal\ndisease or systemic infectious/inflammatory process.\n3. Please refer to prior noncontrast MR of the spine performed earlier today\nwhich detailed description of multilevel degenerative changes levels of up to\nsevere stenosis" }, { "input": "There is T2 hyperintensity involving the dorsal columns of the imaged cord\nbilaterally from C2 to C6/C7 levels. There is no abnormal enhancement. The\nimaged cord is normal in caliber.\n\nAlignment is normal. Vertebral body heights are normal. Vertebral body and\nintervertebral disk signal intensity appear normal. Normal craniocervical\njunction.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.", "output": "T2 hyperintensity involving the dorsal columns of the imaged spinal cord\nbilaterally from C2 to C6/C7 levels. Findings are consistent with subacute\ncombined degeneration." }, { "input": "Alignment is normal. Reversal of the cervical lordosis is noted which could\nbe related to patient positioning. Vertebral body and intervertebral disc\nsignal intensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.\n\nA mucous retention cyst is noted in the left maxillary sinus.", "output": "1. Normal cervical spine MRI." }, { "input": "Overall there has been no significant change since the previous MRI. Mild\nscoliosis of the lumbar spine seen convex to the right in the upper lumbar\nregion.\n\nFrom T11-12 through L2-3 levels mild degenerative disc disease identified.\n\nAt L3-4 level, there is a right-sided broad-based protrusion with moderate\nnarrowing of the right foramen. The spinal canal and the neural foramina are\nnormal in appearance.\n\nAt L4-5 level, disc bulging and facet degenerative changes are identified. \nThere is minimal to mild left foraminal narrowing.\n\nAt L5-S1 level, the neural foramina and spinal canal are normal in appearance.\n\nThe distal spinal cord paraspinal soft tissues are unremarkable. The CSF\nintensity is extending to the lower sacral region on the MRI of ___ are no\nlonger visible likely related to surgery. These areas not fully evaluated.", "output": "Overall no significant interval change in multilevel mild-to-moderate\ndegenerative changes. Moderate right foraminal narrowing is again seen at\nL3-4 level." }, { "input": "There is mild scoliosis of lumbar spine convex to the right.\n\nFrom T11-12 through L2-3 levels mild degenerative change seen.\n\nAt L3-4 disc bulging is seen without spinal stenosis. There is a right-sided\nforaminal and next intraforaminal disc protrusion more predominantly in the\nextraforaminal region. This appears to be minimally more prominent from the\nprior study. This could affect the exiting right L3 nerve root. Clinical\ncorrelation recommended to determine the significance. The left foramen is\npatent.\n\nAt L4-5 level, mild disc bulging and facet degenerative changes seen with mild\nsubarticular recess narrowing and mild left foraminal narrowing.\n\nAt L5-S1 level, there is no significant disc bulge or herniation. There is no\nforaminal narrowing.\n\nWithin the sacral spinal canal at S3 level presumed postoperative changes are\nidentified which are unchanged from the recent MRI. The previously seen intra\nsacral cyst is no longer visible likely related to prior surgery although\nthese area is partially evaluated on this lumbar spine MRI.\n\nThe distal spinal cord shows normal signal intensities.", "output": "1. The right-sided foraminal and extraforaminal disc protrusion at L3-4 level\nappears slightly more prominent and could affect the right L3 exiting nerve\nroot. Clinical correlation recommended to determine the significance of this\nfinding.\n2. Otherwise previously seen degenerative changes on the MRI of ___ are\nstable.\n3. Postoperative changes are seen in the distal sacral region" }, { "input": "The vertebral body height, alignment, and marrow signal are normal.\n\nThe conus medullaris is normal in signal and morphology in terminates at the\nL1-L2 level.\n\nAt the T12-L1 level, the spinal canal neural foramina appear normal.\n\nAt the L1-L2 level, the spinal canal and neural foramina appear normal.\n\nAt the L2-L3 level, there is ligamentum flavum thickening. The spinal canal\nand neural foramina appear normal.\n\nAt the L3-L4 level, there is ligamentum flavum thickening and a right\nforaminal disc protrusion which causes moderate right neural foraminal\nnarrowing. The spinal canal and left neural foramen appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge causing minimal left neural foraminal\nnarrowing. The spinal canal and right neural foramen appear normal.\n\nAt the L5-S1 level, the spinal canal neural foramina appear normal.", "output": "1. Mild lower lumbar spondylosis including degenerative disc disease which\ncauses moderate neural foraminal narrowing at on the right at the L3-L4 level\nand mild on the left at the L4-L5 level." }, { "input": "Please note the study is mildly degraded by motion.\n\nTHORACIC:\nAlignment is normal. Scattered T1 and T2 hypo intense lesions are seen\nthroughout the vertebral bodies, likely representing bone islands. Vertebral\nbody and intervertebral disc signal intensity appear normal. The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing.\n\nLUMBAR:\nAlignment is normal. ___ type 1 changes are noted a the inferior endplate\nof L4. Vertebral body signal intensity appears normal. The spinal cord\nappears normal in caliber and configuration. Decreased signal is noted in the\nL4-L5 and L5-S1 discs. There is mild facet arthropathy at L2-3, L3-4, L4-5\nand L5-S1. A broad-based disc bulge is seen at L3-4 with no significant\nspinal canal or neural foraminal stenosis. A broad-based disc bulge is also\nseen at L ___ with moderate spinal canal, subarticular zone and mild left\nneural foraminal stenosis. Broad-based disc bulge at L5-S1 results in mild\nleft neural foraminal stenosis and abuts but does not displace the transiting\nS1 nerve root.\n\nOTHER: There is enlargement of the spleen measuring up to 16 cm in SI\ndimension. There is low insertion of the cystic duct. The common bile duct\nis prominent measuring approximately 1 cm.", "output": "1. Multilevel degenerative changes, predominantly in the lumbar spine,\nresulting in moderate spinal canal, subarticular zone and mild left neural\nforaminal stenosis at L4-5. Facet arthropathy and disc bulge at L5-S1 results\nin mild left neural foraminal stenosis and the disc abuts but does not\ndisplace the transiting left S1 nerve root.\n2. Splenomegaly. Recommend correlation with physical exam.\n3. There is low insertion of the cystic duct. The common bile duct is\nprominent measuring approximately 1 cm in diameter. Clinical correlation with\npossible further evaluation with ultrasound or MRCP as indicated.\n\nRECOMMENDATION(S):\n1. Splenomegaly. Recommend correlation with physical exam.\n2. Low insertion of the cystic duct with prominent common bile duct measuring\napproximately 1 cm. Clinical correlation with possible further evaluation\nwith ultrasound or MRCP is indicated." }, { "input": "There is a new exspansile metastatic lesion in the L2 vertebral\nbody, with posterior bowing of the posterior veertebral body wall. This\nprocess abuts the traversing nerve roots in the subarticular zone and lateral\nrecess. This process extends into the bilateral L2-L3 foramina as well. The\nmedial aspects of these foramina are obliterated, and the exiting L2 nerve\nroots are compressed. There is mild wedging of the vertebral body as well.\n\nThere is a well-defined T1/T2 hyperintense focus in the right posterior aspect\nof the L3 vertebral body which most likely represents a hemangioma or a focus\nof fat. This is similar in size to the prior CT and radiograph.\n\nThe following metastases are partially visualized:\n\nThe left ilac metastases have markedly increased in sizefrom 2.8 to 5.4 cm in\nAP dimention. There are new metastases in the adjacent left sacral ala. A new\nmetastasis in the right S3 segment likley involes exiting right sacral nerve\nroots. \n\nOtherwise, the patient has heterogeneous marrow signal and endplate\ndegenerative changes, most prominent at L4-5 and L5-S1. \n\nThe conus medullaris terminates at the level of the L1 superior endplate with\nnormal contour and signal.\n\nUnderlying degenerative changes include: \n\nAt T12-L1, there is mild bilateral facet arthropathy but no significant\nnarrowing. At L1-L2, there are similar findings.\n\nAt L2-L3, the metastatic lesion in L2 as described above.\n\nAt L3-L4, there is a small disc protrusion and mild facet arthropathy but no\nevidence of nerve root impingement. At L4-L5, there is a moderate disc bulge\nand moderate bilateral facet arthropathy with abutment of traversing nerve\nroots in the subarticular zones.\n\nAt L5-S1, there is a disc bulge and mild facet arthropathy but no spinal canal\nnarrowing. Disc and vertebral body and facet osteophytes mildly narrow the\nforamina bilaterally as well.", "output": "1. New metastasis within the L2 vertebral body with abnormal posterior\nexpansion of the vertebral body compressing the right greater than left\nexiting L2 nerve roots in the foraminal zones.\n\n2. New left sacral ala and right S3 segment sacral metastases, partially\nvisualized.\n\n3. Marked interval enlargement of destructive, exspansile left iliac\nmetastases.\n\n4. The previously described L3 lesion is liklely a hemanioma.\n\nPlease note that the examination was performed to assess for spinal stenosis,\nand that no gadolinium was administered. This limits sensitivity for small\nmetastases. If clinically warranted, the patient could return for post\ngadolinium and STIR images. \n\nFindings discussed with Dr. ___, medicine, at 12:30 pm on\n___." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no focal marrow signal abnormality. The visualized portion of the\nspinal cord is preserved in signal and caliber. There is no definite cord\nsignal abnormality within motion limitation.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nThere is no definite focus of abnormal contrast enhancement. There is no\nevidence of infection or neoplasm. There is no prevertebral soft tissue\nswelling.. There are postsurgical changes from Chiari decompression. The\nvisualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare otherwise preserved.\n\n At C2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt C4-5 there is trace disc bulge without significant vertebral canal or\nneural foraminal stenosis.\n\nAt C5-6 there is minimal disc bulge indenting the ventral thecal sac without\nsignificant vertebral canal or neural foraminal stenosis.\n\nAt C6-7 there is trace disc bulge without significant vertebral canal or\nneural foraminal stenosis.\n\nAt C7-T1 there is no vertebral canal or neural foraminal stenosis.\n\nSagittal view of the T1-T2, T2-T3, T3-T4 levels demonstrate no significant\nspinal canal or neural foraminal narrowing.", "output": "1. Study is moderately degraded by motion.\n2. Within limitations of examination, no definite cervical spinal cord lesion\nidentified.\n3. Postsurgical changes related to Chiari decompression.\n4. Mild cervical degenerative disc disease without definite moderate to severe\nspinal canal or neural foraminal narrowing." }, { "input": "There is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. Multiple T1 and T2 bright lesions are noted\nwithin the vertebral bodies, most notable at the level of L3 in compatible\nwith hemangiomas. The background bone marrow signal is heterogeneous without\nfocal suspicious lesion. There is diffuse disc desiccation and partial loss of\ndisc height. The conus medullaris terminates at the level of L1-L2. There is\nno spinal cord signal abnormality detected. The prevertebral and paraspinal\nsoft tissues are unremarkable.\n\nAt the levels of T11-T12 and T12-L1, there is no significant spinal canal or\nneural foraminal narrowing.\n\nL1-L2: A mild posterior disc bulge and bilateral facet hypertrophy is noted\nwithout appreciable spinal canal or neural foraminal narrowing.\n\nL2-L3: A disc bulge, ligamentum flavum hypertrophy, and facet degenerative\nchanges cause mild canal narrowing, with mild right and minimal left neural\nforaminal narrowing.\n\nL3-L4: A disc bulge with facet hypertrophy and ligamentum flavum hypertrophy\ncauses moderate to severe spinal canal narrowing, and mild bilateral neural\nforaminal narrowing. The disc bulge contacts the bilateral traversing nerve\nroots at this level.\n\nL4-L5: A disc bulge, and bilateral facet and ligamentum flavum hypertrophy\ncause severe spinal canal stenosis with mild bilateral neural foraminal\nstenosis. At this level, the posterior disc bulge contacts the bilateral\ntraversing nerve roots.\n\nL5-S1: A central disc protrusion indents the thecal sac and combines with\nbilateral facet hypertrophy to cause mild canal narrowing and mild bilateral\nneural foraminal narrowing.", "output": "Multilevel degenerative changes of the lumbar spine, as described above, most\nsevere at the level of L4-L5 with moderate to severe spinal canal and mild\nbilateral neural foraminal stenosis." }, { "input": "Evaluation of the lower axial T2 weighted images is moderately degraded by\npatient motion artifact. The alignment of the lumbar spine is maintained. \nThe vertebral body heights and intervertebral disc spaces are preserved. \nThere is slight loss of intervertebral disc T2 signal at L3-L4 and L4-L5\nrelated to degenerative process. The conus medullaris terminates at L1-L2 and\nis unremarkable.\n\nL1-L2: There is no spinal canal stenosis or neural foraminal.\n\nL2-L3: There is a stable mild disc bulge with ligamentum flavum thickening\ncausing indentation of the ventral thecal sac without spinal canal stenosis,\nand mild bilateral neural foraminal narrowing, similar to the prior study.\n\nL3-L4: Motion degraded evaluation with suggestion of disc bulge, ligamentum\nflavum thickening and bilateral facet arthropathy contributing to\nmoderate-to-severe spinal canal stenosis, possibly progressed in the interim,\nwith crowding of the cauda equina nerve roots. There is narrowing of\nbilateral subarticular recess with the traversing nerve roots impingement to\nthe disc bulge and the facet osteophytes. There is stable mild-to-moderate\nbilateral neural foraminal narrowing.\n\nL4-L5: Motion degraded evaluation with suggestion of disc bulge with new\nannular fissure, ligamentum flavum thickening and bilateral facet arthropathy\ncontributing to severe spinal canal stenosis, progressively progressed in the\ninterim, with crowding of the cauda equina nerve roots. There is narrowing of\nbilateral subarticular zones with the traversing nerve roots impinged between\nthe disc bulge and facet osteophytes. There is stable mild-to-moderate\nbilateral neural foraminal narrowing.\n\nL5-S1: There is a disc bulge with ligamentum flavum thickening bilateral facet\narthropathy causing mild spinal canal stenosis with mild bilateral neural\nforaminal narrowing.", "output": "1. Limited examination due to patient motion, within this limitation in the\nlower lumbar spine, there is suggestion of progression of the lumbar\nspondylosis, with moderate-to-severe L3-L4 and severe L4-L5 spinal canal\nsterogressivenosis, as detailed above." }, { "input": "Partial L3, and L4, L5 laminectomy has been performed since prior. Stable T10\nvertebral body 0.7 cm lesion, suggestion of fatty component on T1 weighted\nimages, favoring benign etiology such as hemangioma. Grade 1 anterolisthesis\nL3-L4, similar to prior. Grade 1 anterolisthesis L4-5, more prominent. No\npars defect pre multilevel degenerative changes. Narrowed L3-L4, L4-5, L5-S1\ndisc spaces. Multilevel diffuse disc bulges. Lumbar facet arthritis. Normal\nvisualized cord.\n\nAt L1-L2 level, central canal, foramina are patent.\n\nAt L2-L3 level central canal is patent. Mild bilateral foraminal narrowing,\nstable.\n\nAt L3-L4 level there is mild-to-moderate central canal narrowing, improved,\npreserved CSF. Mild mass effect on traversing both L4 nerves if. Moderate\nbilateral foraminal narrowing, stable. Annular disc tear.\n\nAt L4-5 level there is annular disc tear. There is mild central canal\nnarrowing, interval decompression, improved since prior. Moderate bilateral\nforaminal narrowing, more prominent since prior. Grade 1 anterolisthesis is\nminimally more prominent.\n\nAt L5-S1 level central canal is patent. Mild left foraminal narrowing,\nmoderate right foraminal narrowing, stable.\n\nNo abnormal spine enhancement. No evidence of arachnoiditis.\nMild volume free pelvic fluid, more prominent since prior.\n2.9 cm left adrenal nodule, similar to ___, consistent with benign adenoma. \nLeft pelvic kidney.", "output": "1. Interval laminectomy, central canal decompression L3-L5..\n2. Grade 1 L4-5 anterolisthesis, mildly worsened since prior, moderate\nbilateral foraminal narrowing at this level has mildly worsened.\n3. Degenerative changes lumbar spine, as above.\n4. Indeterminate 0.7 cm lesion at T10, stable since prior, favor benign\netiology such as hemangioma.\n5. Mild volume free pelvic fluid." }, { "input": "CERVICAL:\nThere is hypo intensity on the T1 weighted images of the vertebral bodies\nadjacent to the C4-5 and C5-6 interspaces. These areas are mildly\nhyperintense on the STIR images. These findings raise a concern of infection.\nHowever, the signal intensity of the intervertebral discs is markedly reduced\non the STIR images. This suggests the changes are more likely due to\ndegenerative disease.\n\nThere is mild anterior subluxation of C3 on C4 and mild canal narrowing due to\nthis and a disc bulge at this level.\n\nAt C4-5, intervertebral osteophytes narrow the spinal canal and flattens the\nanterior surface of the spinal cord. A midline disc protrusion or\nossification of the posterior longitudinal ligament deforms the anterior\nsurface of the spinal cord.\n\nAt C5-6, intervertebral osteophytes narrow the spinal canal and slightly\nflatten the anterior surface of the spinal cord.\n\nAt C6-7 comment intervertebral osteophytes slightly narrow the spinal canal\nbut do not contact the spinal cord.\n\n\nTHORACIC:\nAlignment is normal there is loss of signal of the title discs on the T2\nweighted images, a manifestation of degenerative disc disease. There is a\nmidline disc protrusion at T 3 4 indenting the anterior surface of the spinal\ncord. There is a small midline and right-sided disc protrusion at T6-7 that\nflattens the anterior surface of the spinal cord. There is a small midline\ndisc protrusion at T10-11 that touches the anterior surface of the spinal\ncord. There is a small disc protrusion at T11-12 that touches the anterior\nsurface of the spinal cord.\n\n\nLUMBAR:\nThere is mild anterior subluxation of L5 upon S1. Otherwise, alignment is\nnormal.There is mild high signal intensity in the L1 and L2 vertebral bodies\non the STIR images as well as high signal intensity in the intervertebral\ndisc. The endplates but not the disc enhance after contrast administration. \nImages of these areas are heavily degraded by motion artifact. However, the\nfindings raise some concern of possible infection with osteomyelitis and\ndiscitis. The absence of pathologic disc enhancement argues against\ninfection. There is a bulge of the L2-3 intervertebral disc with mild canal\nnarrowing.\n\nThere is bulging of the L3-4 intervertebral disc and thickening of the\nligamentum flavum. Together, these produce mild canal narrowing.\n\nThere is bulging of the L4-5 intervertebral disc with no significant canal or\nforaminal compromise.\n\nThere is a bulge of the L5-S1 intervertebral disc that extends into the right\nneural foramen. There is bilateral severe neural foraminal narrowing.\n\nThere is no evidence of an abnormal fluid collection.\n\nThere is no evidence of abnormal enhancement after contrast administration. \nHowever, images are limited by motion artifact and only cervical axial imaging\nwas obtained after contrast", "output": "1. No evidence of abnormal fluid collections.\n2. Possible degenerative or infectious changes at L2-3, incompletely imaged\ndue to motion artifact and lack of axial T1 weighted post contrast images. \nSome of findings are suggestive of infection, but the is appearances could be\nproduced by degenerative disease.\n3. No evidence of all fluid collections." }, { "input": "The study is somewhat limited secondary to patient motion artifact.\n\n\nCERVICAL:\nThere is overall straightening of the normal cervical lordosis, with mild\nanterolisthesis of C3 on 4 and C4 on 5, not significantly changed since the\nprior study. Vertebral body heights are maintained. There is no evidence of\nacute fracture. Degenerative vertebral body endplate changes are again noted\nat multiple levels, and there is diffuse intervertebral disc height loss\nthroughout the cervical spine, with associated decreased fluid sensitive\nsignal intensity, compatible with desiccation. The cervical spinal cord is\nnormal in intrinsic signal intensity throughout There is no evidence of\ninfection or neoplasm.There is no pathologic postcontrast enhancement.\n\nFrom the craniocervical junction through C2-3, there is no significant spinal\ncanal or neural foraminal narrowing.\n\nAt C3-4, a posterior disc bulge and posterior osteophytic ridge contribute to\nmild spinal canal narrowing. Left greater than right uncovertebral\nhypertrophy and facet arthropathy contribute to mild to moderate left neural\nforaminal narrowing.\n\nAt C4-5, a large posterior osteophyte and central disc protrusion cause\nmoderate spinal canal narrowing with remodeling of the anterior spinal cord\n(07:11). There is bilateral facet arthropathy and uncovertebral joint\nhypertrophy, resulting in right greater than left mild neural foraminal\nnarrowing.\n\nAt C5-6, posterior osteophytic ridge mildly narrows the spinal canal, without\ncontacting the spinal cord.\n\nAt C6-7 and C7-T1, posterior intervertebral osteophytes minimally narrow the\nspinal canal, without contacting the spinal cord.\n\nTHORACIC:\nThere is slight dextroconvex scoliotic curvature of the upper thoracic spine,\nunchanged from the prior study. Vertebral body heights are maintained. There\nis no evidence of acute fracture. Multilevel intervertebral disc height loss\nand decreased fluid sensitive signal intensity within the discs is compatible\nwith desiccation. T2/T1 hyperintense foci in the T5, T6, and T10 vertebral\nbodies are compatible with osseous hemangiomas. A tiny T2 hyperintense focus\nin the central T11 vertebral body is T1 hypo intense and enhances on\npostcontrast images (13:6, 15:7, 18:7), unchanged compared to the prior study\nand likely an atypical osseous hemangioma. The spinal cord appears normal in\ncaliber and configuration.No suspicious enhancing lesions are identified.\n\nAt T1-2 and T2-3, small posterior intervertebral osteophytes and mild disc\nbulges cause no significant spinal canal or neural foraminal narrowing.\n\nAt T3-4, a central disc protrusion causes mild spinal canal narrowing, and\nremodels the anterior spinal cord (16:13).\n\nAt T4-5 and T5-6, there is no significant spinal canal or neural foraminal\nnarrowing.\n\nAt T6-7, and intervertebral posterior osteophyte and central disc protrusion\nindenting the anterior thecal sac and remodeling the anterior spinal cord\n(16:26).\n\nAt T8-9 and T9-10, there is no significant neural foraminal or spinal canal\nnarrowing.\n\nAt T10-11, a central disc protrusion, posterior intervertebral osteophyte and\nligamentum flavum thickening mildly narrow the spinal canal and re- mottled\nthe anterior surface of the spinal cord (17:18).\n\nAt T11-12, a diffuse disc bulge, posterior osteophytic ridge, and ligamentum\nflavum thickening results an minimal spinal canal narrowing, with indentation\nof the anterior thecal sac and remodeling of the anterior spinal cord (17:25).\n\nOTHER: A previously described moderate-sized loculated right pleural effusion\nis again noted posteriorly.", "output": "1. Slightly motion limited exam.\n2. Within these limitations, there is no evidence of enhancing lesion\nsuspicious for malignancy.\n3. Mild to moderate multilevel cervical and thoracic spondylosis, as described\nabove. There is no underlying spinal cord signal abnormality or nerve root\nimpingement." }, { "input": "From T11-12 through L3-4 levels disc degenerative changes and mild bulging\nseen.\n\nAt L4-5 level, mild disc bulging and facet degenerative changes seen with\nminimal narrowing of the foramina without spinal stenosis.\n\nAt L5-S1 level, mild disc bulging and facet degenerative changes seen. There\nis a synovial cyst in the lateral portion of the left foramen which contacts\nthe exiting left L5 nerve root. There is moderate to severe narrowing of the\nleft foramen. There is also moderate narrowing of the right foramen without\ndeformity or compression of the exiting nerve root. There is no spinal\nstenosis seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Degenerative changes most pronounced at L5-S1 level where\nmoderate-to-severe left and moderate right foraminal narrowing seen.\n2. Mild degenerative changes at other levels." }, { "input": "Thoracic Spine: There is a compression fracture of the T8 superior endplate\nwith mild height loss. Signal abnormality at the T8 endplate demonstrates T1\nhypointensity and STIR hyperintensity, indicating that the fracture could be\nacute to a few months old. There is no evidence to suggest that this is a\npathologic fracture due to underlying malignancy. There is a chronic Schmorl's\nnode at the inferior endplate of T12. Vertebrae are otherwise normal in\nconfiguration. There is no suspicious marrow signal abnormality. Alignment is\nnormal.\n\nAt T8-9, there is a tiny midline disc protrusion. There is no contact with the\nspinal cord. There is no spinal canal or foraminal stenosis at any level. The\nthoracic spinal cord is normal in course, caliber, and signal.\n\nThe posterior elements and paraspinal soft tissues are normal.\n\nLumbar spine: Schmorl's nodes causing focal convexity of the superior and\ninferior endplates of L5 are unchanged. Vertebrae are normal in alignment. The\nbone marrow has a normal signal intensity. The intervertebral discs have\nnormal height and signal intensities.\n\nT12-L1:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nL1-L2:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nL2-L3:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nL3-L4:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nL4-L5:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nL5-S1:There is no disc herniation, or spinal canal or neural foraminal\nstenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1 level.\n\nThe posterior elements and paraspinal soft tissues are normal.\n\nIn the left lower lobe of the lung, there is a 1.4 x 1.6 cm ill-defined,\npossibly spiculated nodule (series 7, image 13). Redemonstrated is an\nabdominal aortic aneurysm that is not significantly changed in size from MRI\nof the lumbar spine on ___, measuring approximately 4.5 cm. It is\nlarger than on CT from ___, at which time it measured approximately\n3.4 x 3.1 cm.", "output": "1. No cord compression. Tiny T8-9 central disc protrusion does not contact the\nspinal cord.\n2. Compression fracture of the T8 superior endplate with signal\ncharacteristics suggesting that it is anywhere from acute to a few months old.\n(This level was not imaged on the prior MRI from 11 days ago).\n3. Left lower lobe 1.6 cm pulmonary irregular nodule, possibly spiculated.\nThis is incompletely imaged and is suspicious for malignancy. Dedicated CT\nchest recommended for further evaluation.\n4. Abdominal aortic aneurysm, unchanged in size from MRI 11 days ago but\nincreased from prior CT in ___. Current size is approximately 4.5 cm in\ndiameter.\n\nThe above findings were discussed with Dr. ___ at 15:40 ___." }, { "input": "There are 12 rib-bearing vertebrae. The numbering is documented on images 2:6\nand 3:7.\n\nT6 vertebral body is essentially entirely replaced by a trabeculated lesion,\nwhich appears characteristics of a hemangioma on the CT portion of the ___ PET-CT, and which does not demonstrate FDG uptake. The present\nMRI demonstrates no appreciable fat signal within this lesion on T1 weighted\nor fat sensitive IDEAL images. The lesion demonstrates mildly low signal on\nT1 weighted images with high signal on fluid sensitive IDEAL images. There is\nno associated loss of vertebral body height.\n\nThe tip of the T5 spinous process, which demonstrated FDG uptake on the recent\nPET-CT, appears mildly irregular with low signal, corresponding to cortical\nremodeling. The CT portion of the recent PET-CT suggests a fracture in this\nlocation. No marrow edema is clearly demonstrated on the present MRI, likely\ndue to mostly cortical involvement by the abnormality. No underlying\nmetastatic lesion is definitively demonstrated.\n\nThere is no evidence for osseous, epidural, or leptomeningeal metastases\nelsewhere in the thoracic spine.\n\nFor multiple Schmorl's nodes. There are small disc bulges and protrusions at\nseveral levels, the largest being a central disc protrusion at T1-T2 which\nmildly narrows the spinal canal. No spinal canal narrowing is seen at other\nlevels. Allowing for the large field of view, no definite spinal cord signal\nabnormalities are seen. The conus medullaris terminates at L1.\n\nThe included extra-spinal soft tissues were better assessed on the recent\nPET-CT.", "output": "1. Cortical irregularity at the tip of the T5 spinous process with an\napparent small fracture on the CT portion of the recent PET-CT. No definite\nmarrow edema is demonstrated, likely due to mostly cortical involvement. No\nunderlying metastatic lesion is definitively demonstrated. It is not entirely\nclear whether this represents a benign a pathologic fracture.\n\n2. T6 vertebral body contains a trabeculated lesion with classic features of\nthe hemangioma on the CT portion of the recent PET-CT, and without FDG uptake.\nAbsence of fat signal on the present MRI is likely related to atypical nature\nof the hemangioma with paucity of fat. However, follow up MRI with and\nwithout contrast would be helpful to exclude a developing superimposed\nmetastasis.\n\nRECOMMENDATION(S): Thoracic spine MRI with and without contrast is\nrecommended in a few months for reassessment of the abnormalities at T5 and\nT6." }, { "input": "There is no evidence of bony or ligamentous injury. Note ligamentous\ndisruption identified.\n\nAt the craniocervical junction and C2-3 and C3-4 no abnormalities are seen.\n\nAt C4-5, C5-6 and C6-7 levels mild disc bulging identified. There is mild\nnarrowing of the foramina at C5-6 and C6-7 levels. There is no abnormal\nsignal within the spinal cord or extrinsic spinal cord compression. The\nprevertebral soft tissue thickness maintained. The small area of\nhyperintensity within the pons may represent a chronic infarct.", "output": "Mild degenerative changes. No evidence of spinal stenosis or high-grade\nforaminal narrowing. No evidence of bony or ligamentous injury." }, { "input": "For the purposes of numbering, the vertebral bodies were counted from the\nlevel of C2 based on the localizer images.\n\nAlignment is normal. Vertebral body heights are preserved. There is no marrow\nsignal abnormality. The visualized portion of the spinal cord is preserved in\nsignal and caliber. There is no marrow signal abnormality. Intervertebral\ndisc signal and heights are preserved. There is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \nNo neural foramina or spinal canal stenosis at any level. There is no\nabnormal enhancement on postcontrast imaging.", "output": "1. No evidence of spinal canal or neural foraminal stenosis of thoracic spine.\n2. No abnormal enhancement on postcontrast images." }, { "input": "THORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious focal marrow lesion. Disc height and signal are maintained. \nThere is no signal abnormality of the thoracic cord. There is no significant\nspinal canal or neural foraminal narrowing. There are trace bilateral pleural\neffusions.\n\nLUMBAR:\n2 mm retrolisthesis of L5 on S1 is unchanged. There is transitional anatomy\nof S1 with a rudimentary S1-S2 disc. Otherwise, lumbar alignment is anatomic.\nVertebral body heights are preserved. ___ type 1 L4-L5 endplate changes are\nidentified as well as a L5 vertebral body hemangioma and L3 vertebral body\nfatty rest. There is no focal suspicious marrow lesion. Degenerative loss of\ndisc height and signal is moderate at L4-L5 and mild at L5-S1. The conus\nmedullaris terminates at the inferior endplate of T12, within expected limits.\nThere is no signal abnormality of the terminal cord or conus.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: A disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In combination with facet arthropathy, there is mild\nright greater than left neural foraminal narrowing.\n\nL5-S1: A left eccentric disc bulge crowds the left-greater-than-right\nsubarticular zones, contacting both traversing nerve roots but likely\ndisplacing the left S1 nerve root (series 17, image 25). In combination with\nfacet arthropathy, there is moderate right and moderate to severe left neural\nforaminal narrowing. Small bilateral facet joint effusions as well as a\nprominent 7 mm left facet synovial cyst is identified.\n\nOTHER: There are T2 hyperintense cystic lesions of the left kidney measuring\napproximately 6 mm as well as a partially imaged T2 hyperintense cystic lesion\nof the hepatic segment ___ (series 11, image 20) compatible with a simple cyst\nand hemangioma respectively, essentially unchanged from prior CT torso of ___. The common bile duct is prominent measuring up to 6-7 mm, also\nunchanged from prior examination of ___. Otherwise, the remainder the\nprevertebral paraspinal soft tissues are unremarkable.", "output": "1. Lumbar spondylosis, most prominent at L5-S1 where a left eccentric disc\nbulge crowds the bilateral subarticular zones, but posteriorly displacing the\nleft S1 nerve root. In combination with facet arthropathy there is moderate\nright and moderate to severe left neural foraminal narrowing.\n2. No spinal canal or neural foraminal narrowing of the thoracic spine.\n3. There is no cord signal abnormality.\n4. Additional findings described above." }, { "input": "The visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.\n\nThe cervical spine alignment is maintained. Vertebral body heights and disc\nspaces are preserved. The bone marrow signal is normal.\n\nThe cervical cord is normal in morphology and signal intensity.\n\nC2-C3: There is a mild left asymmetric disc protrusion which indents the\nthecal sac but does not contact the spinal cord. There is mild to moderate\nleft and no significant right neural foraminal narrowing secondary to facet\nand uncovertebral arthropathy. This is overall similar to prior exam.\n\nC3-C4: There is a small disc protrusion without significant spinal canal\nnarrowing. Uncovertebral facet arthropathy results in mild bilateral neural\nforaminal narrowing, similar to prior exam.\n\nC4-C5: There is no significant spinal canal narrowing. Uncovertebral facet\narthropathy results in mild to moderate bilateral neural foraminal narrowing,\nsimilar to prior exam.\n\nC5-C6: There is a posterior disc protrusion, which in combination with\nuncovertebral facet arthropathy appears to result in at least moderate\nbilateral neural foraminal narrowing, progressed from prior examination. \nThere is mild spinal canal narrowing..\n\nC6-C7: Mild to moderate, asymmetric leftward disc bulge with superimposed\nprotrusion, indenting the thecal sac and almost contacting the spinal cord. \nNo underlying spinal cord abnormality. Mild canal stenosis at this level. \nThere is mild to moderate associated left neural foraminal narrowing.\n\nC7-T1: A left eccentric disc protrusion results in mild spinal canal narrowing\nalong the left aspect of the spinal canal, minimally remodeling the cord\nwithout underlying cord signal change. Uncovertebral facet arthropathy\nresults in moderate left and no significant right neural foraminal narrowing. \nThis is overall similar to prior exam.\n\nVisualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Degenerative changes as described above, most prominent at C5-C6 where a\nposterior disc protrusion in combination with uncovertebral and facet\narthropathy appears to results in at least moderate bilateral neural foraminal\nnarrowing, progressed from prior examination.\n2. There is no high-grade spinal canal narrowing.\n3. The remainder of the above described degenerative changes are similar to\nexamination of ___." }, { "input": "1-2 mm retrolisthesis of L3 on L4 is unchanged from prior exam. Otherwise,\nlumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. Degenerative loss of disc height is moderate to\nsevere at L2-L3 and mild spanning L3-L4 through L5-S1. The conus medullaris\nterminates at the L1-L2 level, within expected limits. There is buckling of\nthe cauda equina superior to the L3-L4 level secondary to severe spinal canal\nnarrowing. Minimal cauda equina postcontrast enhancement at the level of the\nL3-L4 is felt to be secondary to inflammatory change and crowding of the cauda\nequina nerve roots. Otherwise, there is no abnormal signal or enhancement of\nthe terminal cord, conus medullaris or cauda equina.\n\nT10-T11 through L1-L2: Mild degenerative changes include small disc\nprotrusions without significant spinal canal or neural foraminal narrowing.\n\nL2-L3: A small disc bulge with thickening of ligamentum flavum and epidural\nfat results in mild spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nL3-L4: A right eccentric disc bulge with prominent thickening of the\nligamentum flavum results in severe spinal canal narrowing, compressing the\ncauda equina. In conjunction with facet arthropathy, there is mild to\nmoderate right and mild left neural foraminal narrowing.\n\nL4-L5: A small disc bulge and thickening ligamentum flavum results in mild\nspinal canal narrowing. In conjunction with facet arthropathy there is mild\nbilateral neural foraminal narrowing with remodeling of the under surfaces of\nthe exiting nerve root secondary to the disc bulge.\n\nL5-S1: There is no significant spinal canal narrowing. In conjunction with\nfacet arthropathy, there is mild-to-moderate left neural foraminal narrowing.\n\nA 3.5 cm right renal simple cyst is identified. There is ectasia of the\ninfrarenal abdominal aorta and iliac vessels measuring up to 2.2 and 1.4 cm\nrespectively.", "output": "1. There is severe spinal canal narrowing at L3-L4 secondary to a disc bulge\nand thickening of the ligamentum flavum, compressing the cauda equina. \nMinimal postcontrast enhancement this level of the cauda equina is felt to be\nsecondary to inflammatory change and crowding. The remainder of the cauda\nequina, conus medullaris and terminal cord demonstrates no abnormal signal or\nenhancement.\n2. There is ectasia of the infrarenal abdominal aorta and iliac vessels\nmeasuring up to 2.2 and 1.4 cm respectively.\n3. Additional findings 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.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. Vertebral body height is maintained. There is diffuse\nloss of normal T1 and T2 bone marrow signal. There is loss of normal T2 disc\nsignal throughout the lumbar spine. There is loss of disc height at L4-L5\nwith associated adjacent ___ type 2 endplate changes. The spinal cord\nappears normal in caliber and configuration. The conus terminates at the L1\nlevel.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-L3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, a small posterior disc bulge does not result in any significant\nspinal canal or neural foraminal narrowing.\n\nAt L4-L5, a small posterior disc bulge results in mild spinal canal and mild\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is a posterior disc herniation as well is a sequestered disc\nfragment inferior and posterior to the left S1 vertebral body, measuring\napproximately 9 mm (3:90; 06:36). This causes canal narrowing with\ndeformation of the left-sided thecal sac. The disc fragment contacts and\ndisplaces the exiting left S1 nerve root nerve root posteriorly. There is\nmoderate bilateral neural foraminal narrowing.\n\nOnly the tip of the spleen is visualized, however appears slightly low in\nsignal on the T2 weighted images. The visualized portion of the liver does\nnot appear abnormally dark on the T2 weighted images.", "output": "1. Posterior disc herniation at L5-S1 and 9 mm sequestered disc fragment\ninferiorly along the left side of the posterior aspect of the S1 vertebral\nbody, causing canal narrowing with deformation of the left sided thecal sac\nand posterior displacement of the left S1 nerve root.\n2. Diffuse loss of normal bone marrow signal, may be due to bone marrow\nhyperplasia, a marrow infiltrative process, or hemochromatosis. Correlation\nwith laboratory values is recommended.\n3. Only the tip of the spleen is visualized, however it appears slightly low\nin signal on the T2 weighted images, possibly due to iron deposition. \nCorrelate with labs.\n\nRECOMMENDATION(S): Correlation with laboratory values.\n\nNOTIFICATION: The updated findings and recommendations were emailed by Dr.\n___ to the ___ QA nurses on ___ at 11:38." }, { "input": "The patient is status post L4 and L5 bilateral laminectomies, with complete\ninterval resolution of previously seen postoperative seroma within the\nposterior aspect of the surgical bed. Lumbar alignment is anatomic. \nVertebral body heights are preserved. There is no suspicious marrow signal,\nnoting mild type 1 L3-L4 ___ endplate changes. Loss of disc height and\nsignal is severe at L4-L5 and and moderate at L5-S1. The conus medullaris\nterminates at the L1-L2 level, within expected limits. There is no abnormal\nsignal were enhancement of the visualized cord, conus or cauda equina.\n\nT11-T12 and T12-L1: Mild degenerative changes do not significantly narrow the\nspinal canal or neural foramen.\n\nL1-L2: A disc bulge thickening of the ligamentum flavum minimally narrows the\nspinal canal. There is no significant neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum and epidural fat\nresults in moderate spinal canal narrowing, minimally crowding the cauda\nequina. Facet arthropathy results in mild bilateral neural foraminal\nnarrowing. This is similar appearance to prior examination.\n\nL3-L4: A prominent disc bulge with superimposed central protrusion, increased\nin size from prior exam, with thickening of the ligamentum flavum results in\nmild to moderate spinal canal narrowing. There is crowding of the bilateral\nsubarticular zones which contacts but does not posteriorly displace the\ntraversing nerve roots. In combination with facet arthropathy, there is\nmoderate to severe left, which appears to live for progressed from prior\nexamination. Moderate right neural foraminal narrowing appears essentially\nunchanged.\n\nL4-L5: The patient is decompressed secondary to bilateral laminectomies. \nEnhancing granulation tissue contacts the dorsal and of right lateral epidural\nspace without spinal canal narrowing. Enhancement contacts the posterior\naspects of the right traversing L5 nerve root without encasement. Facet\narthropathy results in moderate bilateral neural foraminal narrowing, likely\ncontacting the under surfaces of the exiting nerve roots, unchanged from\npostoperative examination.\n\nL5-S1: The patient is decompressed secondary to bilateral laminectomies. No\nsignificant enhancing granulation tissue encroaches on the spinal canal or\nneural foramina. A disc bulge with annular fissure does not result in\nsignificant spinal canal narrowing. In combination with facet arthropathy,\nthere is moderate to severe bilateral neural foraminal narrowing, similar in\nappearance to prior exam.\n\nAllowing for postsurgical findings, the visualized prevertebral and paraspinal\nsoft tissues are unremarkable.", "output": "1. The patient is status post L4 through L5 bilateral laminectomies. Complete\nresolution of previously seen prominent postoperative seroma in the posterior\naspect of the operative bed, compressing the thecal sac.\n2. Interval worsening of a L3-L4 disc bulge with superimposed central\nprotrusion, which results in mild to moderate spinal canal narrowing. In\ncombination with facet arthropathy, there appears to be worsening of left\nL3-L4 neural foraminal narrowing, which is now moderate to severe, potentially\nimpinging on the exiting nerve root. Clinical correlation with patient's\nsymptoms is recommended.\n3. Additional degenerative changes as described above, similar in appearance\nto prior exam most prominent at L5-S1 where there is moderate to severe\nbilateral neural foraminal narrowing.\n4. Enhancing granulation tissue at L4-L5 does not significantly narrow the\nspinal canal and contacts the posterior aspect of the exiting right L4 nerve\nroot without evidence of encasement." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nAdvanced degenerative changes in the lumbar spine. L4-5 laminectomies. \nModerate endplate edema L3-L4 level, more prominent on the left, worsened\nsince prior, most likely degenerative. Multilevel endplate hypertrophic\nchanges, diffuse disc bulges, disc space narrowing. Disc space narrowing has\nworsened at L3-L4 level since ___. Lumbar facet arthritis\n\nCongenital narrowing upper lumbar spinal canal.\n\nAt L1-L2 level mild central canal narrowing, stable. Patent foramina.\n\nAt L2-L3 level there is moderate central canal narrowing, mildly worsened\nsince prior, preserved CSF within thecal sac. The left subarticular recess is\nmore narrowed compared to prior. Mild bilateral foraminal narrowing, worsened\nsince prior.\n\nAt L3-L4 level prominent endplate hypertrophic changes. Probable small\nbroad-based central disc protrusion, new since prior moderate central canal\nnarrowing, worsened since prior. Worsened bilateral subarticular narrowing on\nboth sides, mass effect on bilateral L4 nerve root origins. There is new\ncomponent of inferior left foraminal disc protrusion, sagittal image 6, axial\nimage 24, causing moderate to severe foraminal narrowing, worsened.. Moderate\nright foraminal narrowing, worsened.\n\nAt L4-5 level central canal is decompressed. Moderate bilateral foraminal\nnarrowing, stable.\n\nAt L5-S1 level central canal is decompressed. Moderate to severe bilateral\nforaminal narrowing, stable since prior", "output": "1. Advanced degenerative changes lumbar spine.\n2. Congenitally narrow upper lumbar spinal canal.\n3. Moderate central canal narrowing L2-L3 level.\n4. Worsened degenerative changes at L3-L4 level, with moderate central canal\nnarrowing, associated small central disc protrusion. Left L3-L4 foraminal\ndisc protrusion is of intermediate T2 signal, suggesting it is subacute,\ncontributing to moderate to severe foraminal narrowing" }, { "input": "Heterogenous the marrow signal is identified in T12 vertebral body. Foci of\nlow T1 and high inversion recovery signal seen from L1-2 L5 vertebral bodies\nand within the sacrum with predominant involvement in L2, L4 and L5 vertebral\nbodies consistent with metastatic disease. There is no pathologic fracture\nseen except for minimal 2 depression of the superior endplate of L4 vertebra. \nSubtle epidural enhancement is seen at the posterior aspect of T12 and L4\nvertebral bodies. There is no evidence of intraspinal mass or high-grade\nthecal sac compression seen.\n\nMild multilevel degenerative changes identified. There is a small protrusion\nwith moderate narrowing of the right foramen at L4-5 level.\n\nThe distal spinal cord is normal in appearance. Prominent lymph nodes are\nseen in the retroperitoneum most pronounced in the left para-aortic region at\nL4 level.", "output": "Bony metastatic disease involving the T12 vertebra, lumbar spine and sacrum\nwith mild anterior epidural soft tissue changes at T12 and L4 levels. No\npathologic fracture or high-grade thecal sac compression seen. \nRetroperitoneal lymphadenopathy." }, { "input": "Cervical spine:\n\nMild heterogeneity of the marrow is identified in C4-C7 vertebral body is\nsuspicious for infiltrative process. There is no epidural soft tissue\nabnormality seen or intraspinal mass identified. There is no evidence of\nneoplastic spinal cord compression seen in the cervical region. From C3-4 to\nC6-7 mild disc bulging identified. Mild to moderate bilateral foraminal\nnarrowing is seen from C3-4 to C6-7 levels. There is no spinal cord\ncompression seen or abnormal signal within the spinal cord.\n\nThoracic spine:\n\nFoci of low T1 and high inversion recovery signal are identified in multiple\nthoracic vertebral bodies but most predominant changes in T3 5 T11 and T12\nvertebral bodies as well as in the anterior portion of T9 vertebral body\nconsistent with bony metastatic disease. There is no pathologic fracture\nseen. Mild anterior epidural soft tissue changes are seen at T12 level\nwithout thecal sac compression. No epidural masses seen otherwise or spinal\ncord compression identified. No abnormal signal seen within the spinal cord. \nMild multilevel degenerative changes are seen.", "output": "Bony metastatic disease in the cervical and thoracic spine with more\npredominant changes in the thoracic spine involving T3-T5-T9-T11 and T12\nvertebral bodies. Minimal epidural soft tissue changes are seen at T12 level.\nNo cord compression is seen. Mild multilevel degenerative changes." }, { "input": "In comparison to the recent examination of ___, redemonstrated is\ndiffuse metastatic disease to the spine and pelvis. Pathologic compression\ndeformity of the L4 vertebral body with approximately 20% loss of height\ncentrally has slightly progressed compared to prior examination. There is no\nretropulsion. The remaining vertebral body heights are maintained. Alignment\nis normal. There is no spinal canal narrowing. A diffuse disc bulge results\nin mild left and moderate right neural foraminal narrowing at L4-5 level. The\nvisualized spinal cord is normal in caliber and signal intensity. Nerve roots\nof the cauda equina are within normal limits. There is no epidural or\nparaspinal mass or fluid collection. Multiple renal cysts are noted. An\nenlarged retroperitoneal is unchanged.", "output": "1. Diffuse metastatic disease to the visualized spine and pelvis, similar to\nprior examination.\n\n2. Pathologic compression fracture of the L4 vertebral body with\napproximately 20% loss of height centrally has slightly progressed since the\nprior examination. No retropulsion or canal compromise.\n\n3. No spinal canal narrowing. Moderate right neural foraminal narrowing at\nL4-5 as a result of a disc bulge.\n\n4. Unchanged retroperitoneal lymphadenopathy." }, { "input": "Vertebral body heights are grossly preserved throughout the visualized spine. \nNo evidence of fracture. Anterolisthesis of L4 on L5 is mild, similar to the\nprior CT without evidence of spondylolysis.\n\nAt L3-L4, there is a minimal broad-based disc bulge with mild bilateral neural\nforaminal narrowing. The spinal canal is patent without stenosis.\n\nAt L4-L5, an asymmetric left, broad-based disc herniation with extension by\nthat 6 mm superiorly and 2 mm inferiorly has progressed since the prior CT\n(series 2, image 9; series 6, image 27). The disc herniation along with facet\narthropathy and ligamentum flavum hypertrophy results in moderate-to-severe\nnarrowing of the spinal canal. There is moderate-to-severe left and severe\nright neural foraminal narrowing, likely compressing the traversing and\nexiting nerve roots. Facet joint effusions are noted.\n\nAt L5-S1, no abnormalities are seen.\n\nRemaining levels from T12 through L3 are normal without spinal canal stenosis\nor significant neural foraminal narrowing.\n\nNo osseous lesions suspicious for malignancy or infection. The spinal cord\nappears normal in caliber and configuration. The paravertebral muscles are\nwithin normal limits. No prevertebral soft tissue swelling.\n\nAlthough this exam is not dedicated for imaging of the abdomen or pelvis, the\nimaged portions of these regions is unremarkable.", "output": "1. Asymmetric, predominantly left paracentral disc herniation extending 6 mm\nsuperiorly and 2 mm inferiorly, progressed since prior CT with degenerative\nchanges resulting in moderate to severe spinal canal stenosis and moderate\nleft and severe right neural foraminal narrowing.\n2. Anterolisthesis of L4 on L5, unchanged from ___ CT.\n3. Mild, broad-based disc bulges at L3-L4 with mild neural foraminal narrowing\nand no significant spinal canal stenosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:39 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Sagittal IDEAL and T1 weighted images are limited by motion artifact. \nSagittal T2 weighted images provide good diagnostic quality.\n\nVertebral body heights are preserved. No suspicious bone marrow signal\nabnormalities are seen. Alignment appears preserved allowing for probable\nossification of the posterior longitudinal ligament from C3 through C6. There\nare superimposed disc herniations plus/minus endplate osteophytes from C3-C4\nthrough C6-C7, causing severe spinal canal stenosis from C3-C4 through C5-C6\nwith cord compression, and moderate spinal canal stenosis at C6-C7. Mild\nassociated cord edema at C5-C6 cannot be excluded. There is cord expansion\nand T2 hyperintensity from mid C2 through C3-C4 levels. There is a\ndiscontinuous linear focus of T2 hyperintensity in the cord at the level of\nC1-C2, and discontinuous T2 hyperintensity in the medulla as seen on the\npreceding brain MRI.", "output": "1. Incomplete examination. Some of the obtained images are motion-limited.\n2. Disc herniations plus/minus endplate osteophytes from C3-C4 through C6-C7\nand probable ossification of the posterior longitudinal ligament from C3\nthrough C6, causing severe spinal canal stenosis from C3-C4 through C5-C6 with\ncord compression, and moderate spinal canal stenosis at C6-C7. Mild\nassociated cord edema at C5-C6 cannot be excluded.\n3. Expansile T2 hyperintensity in the cord from mid C2 through C3-C4. \nDiscontinuous linear T2 hyperintensity in the cord at C1-C2. Discontinuous T2\nhyperintensity in the medulla, as seen on the preceding brain MRI. These\nfindings do not appear to be related to cord compression. Diagnostic\nconsiderations include demyelinating disease and sequela of\ninfection/inflammation. A paraneoplastic syndrome may be considered, in an\nappropriate clinical context. Primary neoplasm is less likely given the\ndiscontinuity of the cord and medullary signal abnormalities.\n\nRECOMMENDATION(S):\n1. Neuro surgery evaluation.\n2. Complete cervical spine MRI with and without contrast, when it may be\ntolerated by the patient.\n3. Cervical spine CT may be considered to confirm the suspected ossification\nof the posterior longitudinal ligament.\n\nNOTIFICATION: The preliminary report, including the presence of cord\ncompression and cord signal abnormalities, and recommendation items 1 and 2,\nwere discussed with ___, M.D. by ___, M.D. on the telephone\non ___ at 5:27 pm, 10 minutes after discovery of the findings." }, { "input": "Study is moderately degraded by motion, especially on axial imaging. Sagittal\npostcontrast imaging is severely motion degraded. Within these confines:\n\nCERVICAL:\nThere is 1-2 mm retrolisthesis of C2 on C3, C4 on C5, and C5 on C6. Cervical\nvertebral body height is preserved. No focal bone marrow lesions are \nidentified.\n\nThere is patchy abnormal hyperintense signal on T2 weighted images in the\nmedulla and upper cervical cord to the C3 level, with expansion of the cord,\nmost conspicuous at the C2 level, unchanged compared to exam from 1 day\nprevious. There is suggested abnormal enhancement within the cord at C2 and\nC3 (see ___. The signal abnormality within the medulla appears\nworse from the ___ MRI head exam.\n\nThe abnormal hyperintense signal within the cord at C4-6 appears similar to\nthe ___ MRI and most likely reflects myelomalacia related to\ncervical disc disease.\n\nGrossly stable loss of intervertebral disc height and signal are again noted\nat C3-4, C4-5, C5-6, and C6-7.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, there is a central disc protrusion that results in severe spinal\ncanal narrowing. Uncovertebral joint hypertrophy results in mild bilateral\nneural foraminal narrowing.\n\nAt C4-5, there is a disc protrusion that results in severe spinal canal\nnarrowing. Uncovertebral joint hypertrophy and the broad-based disc\nprotrusion results in severe right and moderate left neural foraminal\nnarrowing.\n\nAt C5-6, there is a broad-based disc protrusion that results in severe spinal\ncanal narrowing. Uncovertebral joint hypertrophy and the broad-based disc\nprotrusion results in severe bilateral neural foraminal narrowing.\n\nAt C6-7, there is a left paracentral disc protrusion results in moderate\nspinal canal narrowing, not appreciably changed from the ___ MRI. \nUncovertebral joint hypertrophy results in mild right and moderate left neural\nforaminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing. F there is\nno prevertebral and paraspinal soft tissue abnormality.\n\nTHORACIC:\nThoracic vertebral body height and alignment are preserved. There is mild\nthoracic degenerative disc disease without definite spinal canal or neural\nforaminal narrowing. No focal marrow signal abnormality is identified.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nLUMBAR:\nThere is 2 mm anterolisthesis of L4-L5. Lumbar vertebral body height is\npreserved. Partially visualized is patient's known right bone island (see 12,\n18:40 on current study and 02:45; 602:29 on ___ abdomen pelvis CT).\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThe conus medullaris terminates at the L2-3 intervertebral disc level.\n\nThere is loss of intervertebral disc height and signal at L4-5. Otherwise\nintervertebral discheightsandsignalare preserved.\n\nAt L4-5, there is a disc extrusion with superior migration, ligamentum flavum\nthickening, and facet hypertrophy that result in mild spinal canal narrowing. \nThe degree of subarticular zone narrowing is improved from the ___\nexam there is mild bilateral neural foraminal narrowing. The disc extrusion\ncontacts, but does not compress the traversing L5 nerve roots. There is\nmoderate left and severe right neural foraminal narrowing due to the disc\nextrusion and facet hypertrophy, slightly improved on the right. There are\nbilateral facet joint effusions.\n\nOtherwise, there is no lumbar spinal canal or neural foraminal narrowing.\n\nOTHER:\n\nThere is a joint effusion and probable degenerative change at the left\nsacroiliac joint. This is incompletely imaged.\n\nThere is a simple cyst within hepatic segment 7. There is a 2 cm rounded\nlesion lateral to the ascending colon (series 12, image 15) likely a benign\ncyst given the stability from the ___ CT. No definite enhancement is\nidentified, however this is incompletely imaged on the T1 postcontrast images.\nThe prevertebral and paraspinal soft tissues are otherwise unremarkable.", "output": "1. Motion degraded examination, as described..\n2. Patchy signal abnormality within the medulla and C1-3 levels, with\nexpansion of the cord at the C2 level, and suggested abnormal enhancement at\nC2. The medullary signal abnormality appears worse from the ___ MRI\nhead exam. Differential considerations include infection, demyelinating\ndisease including neuromyelitis optica, systemic autoimmune disease,\nparaneoplastic disease, or neoplasm including lymphoma, astrocytoma, and\nependymoma. If clinically indicated, consider repeat contrast cervical spine\nMRI exam when patient can tolerate examination.\n3. Cervical spondylosis, worse from the ___ cervical spine MRI at\nthe C3-4, C4-5, and C5-6 levels with severe spinal canal narrowing.\n4. Grossly stable C6-7 moderate spinal canal narrowing compared to ___ prior exam.\n5. Grossly stable C4-6 cervical spinal cord signal abnormality at compared to\n___ MRI, suggestive of myelomalacia.\n6. L4-5 disc extrusion with superior migration, improved from the ___\nMR lumbar spine exam, as detailed above, with continued mild vertebral canal,\nmoderate left and severe right neural foraminal narrowing.\n7. Minimal thoracic spondylosis as described, without definite moderate or\nsevere vertebral canal neural foraminal narrowing.\n8. Numerous probable hepatic cysts better visualized on ___ prior\nabdomen and pelvis CT. If clinically indicated, consider hepatic ultrasound\nfor further evaluation.\n9. Partially imaged cystic left adnexal structure, better visualized on ___ prior abdomen and pelvis CT exam. If clinically indicated, consider\nrepeat abdomen CT for further evaluation.\n\nRECOMMENDATION(S): Neurosurgical consultation." }, { "input": "The hyperintense signal changes involving the medulla and C1-C3 levels appear\nfairly similar compared to prior in terms of distribution, but demonstrates\nincreased enhancement compared to prior. There is mild swelling of the cord\nat the C1-C3 level. There is more extensive myelopathic signal changes now\nextending inferior to the level of T7/T1 with associated enhancement.\n\nCervical spondylosis appears fairly similar compared to prior imaging.\n\nAt the levels C3-4 - C6-7 there is broad-based disc osteophyte complexes\nresulting in moderate spinal canal stenosis as evidenced by effacement of the\nCSF anterior to the cord as well as deformation of the cord. Stenosis at the\nC5-6 level is most severe and there is complete loss of CSF outlining the\ncord.\n\nAt the level C3-4: Central disc osteophyte complex indenting the anterior\naspect of the cord. Mild foraminal narrowing bilateral.\n\nAt the level C4-5: Broad-based disc osteophyte complex indenting the cord\nanteriorly. There is moderate severe bilateral neural foraminal narrowing.\n\nAt the level C5-6: Broad-based disc osteophyte complex with a superimposed\nmore focal central posterior protrusion indenting the anterior aspect of the\ncord. No residual CSF posterior to the cord at this level which is concerning\nfor moderate severe spinal stenosis. There is moderate severe neural\nforaminal narrowing bilateral.\n\nAt the level C6-7: Broad-based disc osteophyte complex indents the anterior\naspect of the cord. There is moderate neural foraminal narrowing bilateral.", "output": "The patchy signal changes extending from the medulla to the C3 level appears\nfairly similar in distribution compared to prior, but there is more avid\nenhancement at this stage.\n\nThere is also more extensive myelopathic signal changes (in retrospect\npreviously probably extending to the C5 level) now extending down to the T7-T1\nlevel with associated enhancement suggesting disease progression.\n\nA demyelinating condition is considered most likely and correlation with in\nNMO antibody is advised. In the differential diagnosis consider other\ndemyelinating conditions. Infection or conditions such as sarcoidosis are\nconsidered less likely, but may be correlated with CSF if clinically\nindicated.\n\nMarked cervical spondylosis resulting in at least moderate severe spinal canal\nstenosis at the C5-6 level as described above. Multilevel moderate cervical\nspinal canal stenosis and neural foraminal stenosis as described above. This\nappears fairly similar compared to prior." }, { "input": "CERVICAL:\nUnchanged 1-2 mm retrolisthesis of C2 on C3, C4 on C5 and C5 on C6.Vertebral\nbody signal intensities appears normal. No significant change in loss of\nintervertebral disc height and signal at C3-C4 through C6-C7. There has been\nslight interval improvement in the patchy abnormal hyperintense signal on T2\nweighted images of the medulla and cervical cord to the level of C6 with\nassociated stable expansion of the cord most prominent at C2. Subtle\npostcontrast enhancement within the cord has also improved, with residual\ncontrast enhancement at C2 and C3.\n\nC2-C3: Patent canal and neural foramina.\nC3-C4: Unchanged central disc protrusion resulting in severe spinal canal\nstenosis. Uncovertebral osteophytes result in mild bilateral neural foraminal\nnarrow neuro radiology gel ing, unchanged.\nC4-C5: Disc protrusion and uncovertebral osteophytes results in severe spinal\ncanal stenosis, severe right and moderate left neural foraminal narrowing,\nunchanged.\nC5-C6: Disc protrusion and uncovertebral osteophytes result in severe spinal\ncanal stenosis and severe bilateral neural foraminal narrowing, unchanged.\nC6-C7: Left paracentral disc protrusion and uncovertebral osteophytes result\nin moderate spinal canal stenosis, mild right and moderate left neural\nforaminal narrowing.\nC7-T1: Patent canal and neural foramina.\n\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nThere is no evidence of infection or neoplasm.\n\nOTHER:\n\nAgain seen are a few right hepatic lobe T2 hyperintense lesions that are\nincompletely characterized but favored to represent cysts, measuring up to 1.2\ncm. The previously described 2 cm rounded lesion lateral to the ascending\ncolon is unchanged and likely represents benign cysts given stability since ___.", "output": "1. Interval improvement of patchy signal abnormality within the medulla and\nC1-C6 levels with associated expansion and subtle contrast enhancement of the\ncord at C2. These findings in combination with the described findings on the\nconcurrently performed MRI head study are again suspicious for neuromyelitis\noptica.\n2. Unchanged evidence of cervical cord myelomalacia extending from C4 through\nC6.\n3. No significant abnormality of the thoracic spine.\n4. Unchanged few right hepatic lobe T2 hyperintense lesions that are\nincompletely characterized but favored to represent cysts.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:16 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "Study is mildly degraded by motion.\n\nStable reversal of cervical lordosis again noted.\n\n Vertebral body heights are preserved. There is no definite focal marrow\nsignal abnormality.\n\nMild T2 hyperintensity in the spinal cord at C2 level and C3-5 level is less\ncompared to ___, and enhances on postcontrast imaging. T2\nhyperintensity in the spinal cord at C2-3 level is similar to before and\ndemonstrates persistent enhancement. T2 hyperintensity in the spinal cord at\nC5-6 level is unchanged. Additional areas of nonenhancing T2 hyperintensity\nextending from C2 through C6 level are noted, less pronounced compared to ___\nprior exam.\n\nThere is loss of intervertebral disc height and signal at C3-4, C4-5, C5-6,\nand C6-7, grossly unchanged.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4, disc protrusion causes mild-to-moderate spinal canal narrowing and\ndeforms ventral thecal sac and spinal cord. Bilateral neural foraminal\nnarrowing is mild.\n\nAt C4-5, disc osteophyte complex mildly narrows the spinal canal and contacts\nthe anterior surface of the spinal cord. Bilateral neural foraminal narrowing\nis moderate.\n\nAt C5-6, disc osteophyte complex causes severe spinal canal narrowing which\ndeforms the spinal cord and almost completely effaces the surrounding CSF\nspace. Bilateral neural foraminal narrowing is severe.\n\nAt C6-7, disc osteophyte complex causes moderate to severe spinal canal\nnarrowing which contacts the anterior posterior surface of the spinal cord. \nBilateral neural foraminal narrowing is severe.", "output": "1. Study is mildly degraded by motion.\n2. C2 level and C3-5 level spinal cord lesions, less conspicuous compared to\n___ prior exam, minimally enhancing on current examination,\nconcerning for active demyelinating process.\n3. Additional areas of nonenhancing cervical spinal cord signal abnormality\nextending from C2 through C6, overall decreased compared to ___ prior exam.\n4. Enhancing suspected demyelinating lesion in the spinal cord at C2-3 level\nis not significantly changed.\n5. Unchanged cord signal abnormality at C5-6 is nonspecific and may reflect\nmyelomalacia in the setting of severe spinal canal narrowing secondary to\ndegenerative changes.\n6. Additional multilevel cervical spondylosis as described above.\n7. Please see concurrently obtained contrast brain MRI for description of\ncranial structures." }, { "input": "2 mm anterolisthesis of C4 on C5 and 2 mm retrolisthesis of C6 on C7 is\nunchanged from prior exam. The remainder of the cervical alignment is\nanatomic. Vertebral body heights are preserved. Prominent C5-C6 and C6-C7\nmixed ___ type 1 and 2 endplate changes are identified. Loss of disc height\nand signal at C5-C6 and C6-7 is mild. There is no focal suspicious marrow\nlesion. The visualized posterior fossa is unremarkable. There is no cord\nsignal abnormality.\n\nC2-C3 through C4-C5: No significant spinal canal or neural foraminal\nnarrowing.\n\nC5-C6: A disc protrusion does not significantly narrow the spinal canal. \nUncovertebral and facet arthropathy results in severe left and moderate right\nneural foraminal narrowing.\n\nC6-C7: A central protrusion does not significantly narrow the spinal canal. \nUncovertebral and facet arthropathy results in severe right and moderate left\nneural foraminal narrowing.\n\nC7-T1: A a central protrusion does not significantly narrow the spinal canal. \nThere is no neural foraminal narrowing.\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial cervical spondylosis, most prominent at C5-C6\nwhere there is severe left and moderate right neural foraminal narrowing and\nat C6-C7 where there is severe right and moderate left neural foraminal\nnarrowing.\n2. Additional findings as described above." }, { "input": "The vertebral body heights and alignment are maintained. There is severe loss\nof height and endplate degenerative changes at L3-L4, L4-L5, L5-S1. \nApproximately 1 cm T2 hyperintense lesions in the L1, S1, and S3 vertebral\nbodies are incompletely evaluated in the absence of T1 weighted images. \nEvaluation of degenerative changes is limited by lack of axial T2 weighted\nimages. Within this limitation,\n\nFrom T12-L1 through L2-L3, there is no appreciable spinal canal or neural\nforaminal stenosis.\n\nAt L3-L4, there is a disc bulge with accompanying osteophytes, ligamentum\nflavum thickening, and moderate to severe degenerative changes of bilateral\nfacet joints. Spinal canal narrowing is mild. Neural foraminal narrowing is\nmoderate to severe on the left and mild on the right.\n\nAt L4-L5, there is a disc bulge with accompanying osteophytes, ligamentum\nflavum thickening, and mild degenerative changes bilateral facet joints. \nSpinal canal narrowing is mild. Neural foraminal narrowing is at least\nmoderate on the right and mild on the left.\n\nAt L5-S1, there is a disc bulge and moderate degenerative changes of bilateral\nfacet joints. Spinal canal narrowing is mild. Neural foraminal narrowing is\nmoderate bilaterally.\n\nThe paraspinal soft tissues are grossly unremarkable. Evaluation for edema in\nthe bone marrow or adjacent soft tissues is very limited due to lack of fat\nsuppressed images.", "output": "1. Incomplete study due to severe claustrophobia with only sagittal T2\nweighted images available for interpretation.\n2. T2 hyperintense lesions in the L1, S1, and S3 vertebral bodies are\nincompletely evaluated. These could represent hemangiomas, but more\naggressive lesions cannot be excluded.\n3. Moderate to severe narrowing of the left L3-L4 and moderate narrowing of\nthe right L4-L5 neural foramina.\n4. Multilevel degenerative changes as described above without significant\ncentral spinal canal narrowing." }, { "input": "Advanced degenerative changes lumbar spine. Lumbar epidural lipomatosis. \nMultilevel disc space narrowing, diffuse disc bulges, lumbar facet arthritis. \nNormal spinal alignment. No worrisome osseous lesions. Normal visualized\ncord. Few Schmorl's nodes.\n\nAt L1-L 2, patent central canal, patent foramina.\n\nAt L2-L3, small free disc fragment at the level of mid left paramedian L2\nvertebral body, mild canal narrowing, new since prior. Patent right foramina.\nMild-to-moderate left foraminal narrowing, with small disc protrusion, new\nsince prior.\n\nAt L3-L4, mild central canal narrowing. Moderate to severe left, mild right\nforaminal narrowing, similar.\n\nAt L4-5, mild central canal narrowing. Mild left, moderate right foraminal\nnarrowing, similar.\n\nAt L5-S1, patent central canal. Moderate to severe left foraminal narrowing,\nwith disc osteophyte complex, similar. Moderate right foraminal narrowing,\nsimilar.", "output": "1. Degenerative changes lumbar spine.\n2. Epidural lipomatosis.\n3. Small free disc fragment at mid L2 level, mild canal narrowing.\n4. Multilevel significant foraminal narrowing." }, { "input": "The examination is mildly degraded by motion.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignated the T1 level. There are 12 rib-bearing thoracic vertebral bodies. \nT12 has short ribs.\n\nThe alignment of the thoracic spine is normal. The bone marrow is\nheterogeneous with mixed T2/STIR hyperintense and hypointense signal and T1\nhypointense signal at T11-T12, representing degenerative endplate changes and\nunchanged from the prior examinations. T2/STIR and T1 hypointense signal at\nthe endplates of T1-T2 also represent degenerative endplate changes. The T1\nand T2 hyperintense round, well-circumscribed lesion in the T9 vertebral body,\nmeasuring 1.6 cm, suppresses on the STIR sequence and represents an\nintraosseous hemangioma, unchanged from the prior examination. The spinal\ncord is normal in signal. The intervertebral discs are diffusely desiccated. \nThe intervertebral disc spaces at T1-T2, T5-T6, T6-C7, T7-T8, and T11-T12 are\nnarrowed. The paraspinal soft tissues are normal.\n\nAt T1-T2, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet arthropathy cause severe bilateral neural foraminal stenosis, progressed\nfrom the ___ cervical spine MRI. There is no spinal canal\nstenosis.\n\nAt T2-T3, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet arthropathy cause mild bilateral neural foraminal stenosis, progressed\nfrom the ___ cervical spine MRI. There is no spinal canal\nstenosis.\n\nAt T3-T4, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis, unchanged from the prior examinations.\n\nAt T4-T5, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis, unchanged from the prior examinations.\n\nAt T5-T6, there is diffuse disc bulge with superimposed central disc\nprotrusion and bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis. The central disc protrusion has progressed from the ___ thoracic spine MRI.\n\nAt T6-T7, diffuse disc bulge with superimposed central disc extrusion and\nsuperior migration as well as bilateral facet arthropathy indents and slightly\ndeforms the anterior thecal sac, causing mild spinal canal stenosis, slightly\nimproved from the ___ thoracic spine MRI. There is no neural\nforaminal stenosis.\n\nAt T7-T8, diffuse disc bulge with central disc extrusion, superior migration,\nand annular fissure as well as bilateral facet arthropathy abuts and deforms\nthe anterior thecal sac, causing mild spinal canal stenosis, mild left neural\nforaminal stenosis, and moderate right neural foraminal stenosis, progressed\nfrom the ___ thoracic spine MRI.\n\nAt T8-T9, diffuse disc bulge and bilateral arthropathy cause mild right neural\nforaminal stenosis. There is no spinal canal stenosis.\n\nAt T9-T10, there is right central disc protrusion and bilateral facet\nhypertrophy without spinal canal or neural foraminal stenosis, unchanged from\nthe prior examinations.\n\nAt T10-T11, diffuse disc bulge and bilateral facet arthropathy cause mild\nright neural foraminal stenosis, unchanged from the ___ lumbar spine\nMRI. There is no spinal canal stenosis.\n\nAt T11-T12, diffuse disc bulge with superimposed left paracentral disc\nprotrusion indents and deforms the anterior thecal sac, causing mild spinal\ncanal stenosis and moderate to severe left neural foraminal stenosis,\nunchanged from the ___ lumbar spine MRI.\n\nAt T12-L1, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom the prior examination.\n\nOn the localizer sequences, there are degenerative changes in the cervical\nspine with disc bulges abutting the spinal cord at multiple levels, most\nadvanced at C5-C6, grossly similar in appearance to the prior examination.\n\nThere is an azygos lobe and fissure in the chest.", "output": "1. The study is mildly degraded by motion.\n2. Overall, progressive multilevel degenerative changes of the thoracic spine\nas detailed above, most pronounced at T7-T8 with mild spinal canal, mild left\nneural foraminal, and moderate right neural foraminal stenosis.\n3. Unchanged mild spinal canal and moderate to severe left neural foraminal\nstenosis at T11-T12." }, { "input": "There is normal lumbar alignment. The vertebral body heights are preserved. \nThere is an osseous hemangioma within the T10 vertebral body. There\nmultilevel heterogeneous degenerative endplate changes with significant\nanterior type 3 and diffuse type ___ ___ changes at T12-L1, which is\nrelatively unchanged comparison to prior study. There is unchanged near\ncomplete loss of intervertebral disc height at T12-L1, L3-L4, and L5-S1. \nThere is diffuse low intervertebral disc signal. The conus demonstrates\nnormal signal morphology, terminating appropriately at the mid L2 level.\n\nAt T12-L1 there is disc bulge and facet osteophytes without significant spinal\ncanal stenosis. There is moderate to severe left neural foraminal stenosis\n(04:14).\n\nAt L1-L2 there is no significant neural foramina or spinal canal stenosis.\nThere is no significant neural foraminal spinal canal stenosis.\n\nAt L3-L4 there is a 0.7 cm AP x 0.9 cm TV x 1.6 cm SI T1 isointense, mildly T2\nhyperintense, lesion within the right subarticular zone, which demonstrates\nheterogeneous peripheral enhancement and is new in comparison to prior study\n(09:11; 07:11). This compresses the traversing right L3 nerve root in the\nlateral recess. There is disc bulge, facet osteophytes, ligamentum flavum\nthickening, and intervertebral osteophytes causing moderate to severe spinal\ncanal stenosis which compresses the bilateral traversing L4 nerve roots in the\nsubarticular zones and crowds the central nerve roots. There is mild\nbilateral neural foraminal stenosis.\n\nAt L4-L5 there is disc bulge, facet osteophytes, and ligamentum flavum\nthickening causing mild spinal canal narrowing and contact of the traversing\nleft L5 nerve root in the subarticular zone (08:11). There is moderate right\nand mild left neural foraminal stenosis. There is a left-sided synovial cyst\n(08:10 )which narrows the left subarticular recess.\n\nAt L5-S1 there is central disc protrusion and intervertebral and facet\nosteophytes causing mild spinal canal narrowing and subarticular recess\nnarrowing disc contacting the right S1 nerve root within the subarticular\nzone.\nThere is lipoatrophy of the paraspinal musculature. The paraspinal soft\ntissues are otherwise unremarkable.", "output": "1. New sequestered disc fragment at the right L3-L4 lateral recess with\nsignificant peripheral inflammatory changes, which compresses the traversing\nL4 nerve root. This is unlikely to represent an enhancing mass, as it was not\npresent on prior study.\n2. Additional relatively unchanged multilevel degenerate changes of the lumbar\nspine, as described, most severe at L3-L4 where there is moderate to severe\nspinal canal stenosis.\n3. L3-L4 subarticular zone stenosis which compresses the bilateral traversing\nL4 nerve roots.\n4. L4-L5 left subarticular zone stenosis due to degenerative changes and a\nsynovial cyst which contacts the traversing L5 nerve root.\n5. L5-S1 subarticular zone stenosis with disc protrusion contacting the right\nS1 nerve root." }, { "input": "The limited sagittal sequences provided are degraded by motion.\n\nThe vertebral body heights and alignment are maintained. Evaluation of the\nbone marrow signal is suboptimal as no T1 weighted images are provided and the\nwater and fat IDEAL images are moderately motion degraded. Within this\nlimitation, no definitive marrow signal abnormality is identified. The\nintervertebral discs demonstrate relatively preserved height and signal\nintensity.\n\nThe cervicomedullary junction is within normal limits. The visualized spinal\ncord is normal in caliber. Evaluation of cord signal is somewhat limited by\nstreak artifact and lack of axial images, but no gross abnormalities are\nidentified.\n\nThere is no gross evidence of disc herniation. There is no spinal canal\nnarrowing. The cervical neural foramina cannot be adequately assessed in the\nabsence of axial images.", "output": "1. The study is suboptimal due to presence of motion artifact and lack of\nsagittal T1 and axial T2 weighted images as well as lack of intravenous\ncontrast.\n\n2. The cervical spinal cord is normal in caliber. Evaluation of the cord\nsignal is suboptimal, but no obvious signal abnormality is identified on the\nsagittal T2 weighted images. There is no evidence of cord compression." }, { "input": "The craniocervical junction and C2-3 level mild degenerative changes are\nidentified. At C3-4 level, disk degenerative changes are seen with right-sided\nuncovertebral degenerative change with mild narrowing of the right foramen\nwithout compromise of the left foramen.\n\nAt C4-5 mild disk bulging seen without spinal stenosis or foraminal narrowing.\n\nC5-6 level: Mild disk and uncovertebral degenerative changes seen with minimal\nnarrowing of both foramina without spinal stenosis.\n\nFrom C6-7 and inferiorly to T4-5 mild degenerative changes seen.\n\nThe spinal cord shows abnormal intrinsic signal without extrinsic compression.", "output": "Mild changes of cervical spondylosis without spinal stenosis or high-grade\nforaminal narrowing. Minimal to mild foraminal changes as described above." }, { "input": "Thoracic spine:\nT6 vertebral body edema, with linear, horizontal component on T1 weighted\nimages, highly suggestive of acute/subacute fracture. 1 cm rounded focus of\ndecreased T1 signal posterior T6 vertebral body measuring 1 cm is\nindeterminate, may represent reactive change more likely than underlying\nmetastasis. Follow-up recommended.\nMild edema involving anterior margin of inferior T5 endplate may represent\nreactive change or subacute compression fracture.\nMild edema superior margin of T7 endplate are likely reactive.\nSubtle chronic fracture superior T8 endplate.\nAccentuated marrow signal in these vertebral bodies may be from prior\nradiation therapy, clinically correlate. Mild paravertebral edema is likely\nreactive. Mild height loss T6 vertebral body. No retropulsion.\nNo cord T2 signal abnormality.\nDegenerative changes lumbar spine. Mild diffuse disc bulges at T5-T6, T6-T7,\nT7-T8 levels, contribute to minimal central canal narrowing, and abut the\nventral cord at T6-T7, T7-T8, without cord deformity or edema. Central canal\nis patent at other levels.\nNo foraminal narrowing at any levels in the thoracic spine.\n\nLumbar spine:\nNormal alignment. No worrisome osseous lesions. Normal visualized cord.\nMultilevel degenerative changes, mild diffuse disc bulges, lumbar facet\narthritis.\n\nAt L1-L2, L2-L3, L3-L4 levels there is mild central canal narrowing, patent\nforamina.\n\nAt L4-5 level central canal is patent. Mild bilateral foraminal narrowing.\n\nAt L5-S1 level if central canal is patent. Mild right foraminal narrowing. \nPatent left foramen.\n\nOther:\nCerebellar abnormality is better evaluated on MRI brain ___.\nAbnormal lung findings are suboptimally evaluated, may represent tumor or\nposttreatment change. Small bilateral pleural effusions.\nIndeterminate 1.7 cm left adrenal nodule, similar compared with ___\nTrace free pelvic fluid.", "output": "1. Findings consistent with acute to subacute mild compression fracture T6. \nSmall nodular component of abnormal signal along posterior T6 vertebral body\nis indeterminate, is more likely reactive that metastasis, follow-up\nrecommended to ensure resolution.\n2. Small area of subacute compression fracture inferior T5 vertebral body\nversus reactive change.\n3. Abnormal findings left lung, may represent posttreatment change, tumor or\ncombination. Small pleural effusions.\n4. Mild degenerative changes thoracic, lumbar spine." }, { "input": "There is STIR hyperintense signal of the L1, L3 and L4 superior endplates\ncorresponding to anterior compression wedge fracture deformities. Minimally\ndistracted superior endplate fracture fragments at L3-L4 is re-identified. \nThese findings results in less than 30% loss of anterior vertebral body\nheight. There is disc desiccation and mild loss of L5-S1 disc height. The\nconus medullaris terminates at the L1 vertebral level, within expected limits.\nThere is no signal abnormality of the visualized cord, conus medullaris and\ncauda equina.\n\nT11-T12 through L2-L3: There are mild degenerative changes without\nsignificant spinal canal or neural foraminal narrowing.\n\nL3-L4: A disc protrusion and thickening of the ligamentum flavum does not\nresult in significant spinal canal narrowing. There is facet arthropathy\nwhich results in mild left neural foraminal narrowing and no significant right\nneural foraminal narrowing.\n\nL4-L5: A disc protrusion and thickening ligament flavum does not result in\nsignificant spinal canal narrowing. There is bilateral facet arthropathy\nwhich results in mild left neural foraminal narrowing and moderate right\nneural foraminal narrowing.\n\nL5-S1: A central disc protrusion with annular fissure and thickening of the\nligamentum flavum results in mild spinal canal narrowing. Bilateral facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nThere is mild attenuation of the L3-L4 anterior longitudinal ligament (series\n6, image 11) suggestive of strain without without frank disruption. The\nposterior longitudinal ligament and ligamentum flavum appear intact. The\ninterspinous and supraspinous ligaments appear intact.\n\nThere are fusiform aneurysms of the bilateral common iliac arteries measuring\nup to 3 cm in diameter (series 8, image 19) demonstrating eccentric mural\nplaque/thrombus.\n\nOn sagittal views there are incompletely characterize focal dilatation of the\ninfrarenal abdominal aorta.\n\nCystic lesions of the right kidney measuring up to 3 mm, statistically most\nlikely represent simple cysts. The remainder of the prevertebral and\nparaspinal soft tissues are unremarkable.", "output": "1. Anterior wedge compression deformities of L1, L3 and L4 with less than 30%\nloss of vertebral body height. There are minimally distracted anterior\nteardrop fractures of L3 and L4.\n2. There is mild attenuation in signal of the L3-L4 anterior longitudinal\nligament suggestive of ligamentous injury without frank disruption. There is\nno other evidence of ligamentous injury.\n3. Superimposed multilevel degenerative changes, most prominent at L4-L5 where\nthere is moderate right neural foraminal narrowing.\n4. There are incompletely characterize fusiform aneurysms of the bilateral\ncommon iliac arteries measuring up to 3 cm demonstrating eccentric\nthrombus/plaque.\n\nRECOMMENDATION(S): Point 4: Further evaluation with abdominal and pelvic CTA\nor MRA as clinically indicated.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:52 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nNo worrisome osseous abnormalities. Degenerative changes lumbar spine. \nNarrowed L4-5 disc space, similar to prior, with endplate degenerative\nchanges. Lower lumbar facet arthritis. Multilevel mild diffuse disc bulges.\n\nAt T12-L1, L1-L2 level central canal, foramina are patent.\n\nAt L2-L3 level there is mild central canal, mild bilateral foraminal\nnarrowing, similar to prior..\n\nAt L3-L4 level there is mild central canal narrowing, stable.. Mild left\nforaminal narrowing, stable. Patent right foramen. Annular disc tear, new\nsince prior.\n\nAt L4-5 level central canal is patent.. Mild bilateral foraminal narrowing,\nstable.\n\nAt L5-S1 level there is early termination of the thecal sac with prominent\nepidural fat, stable since prior. No degenerative contribution to thecal sac\neffacement. No nerve root compromise.. Mild left foraminal narrowing,\nstable. Patent right foramen.\n\nExophytic 2 cysts left kidney, are larger since prior, no worrisome features,\nappear benign.", "output": "1. Degenerative changes lumbar spine, essentially stable.\n2. Multilevel mild foraminal narrowing." }, { "input": "There is no evidence of vertebral body height loss. The cervical spinal\nalignment is within normal limits. The bone marrow signal is normal.\n\nThe cervical spinal cord is normal in morphology and signal intensity.\n\nMinimal multilevel degenerative changes are seen throughout the cervical\nspine, without evidence for appreciable canal or neural foraminal narrowing. \nThere are minimal bulges of the C5-6 and C6-7 intervertebral discs with no\nencroachment on the spinal cord or neural foramina.\n\nThere is no evidence for abnormal intramedullary, leptomeningeal, or epidural\nenhancement. The prevertebral and paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Minimal degenerative disease without spinal cord or nerve root compromise. \nOtherwise norm cervical spine MRI." }, { "input": "For again seen, the patient is status post anterior fusion at C4-5. There is\nthere is narrowing of the spinal canal due to degenerative disc disease at\nmultiple levels. This is most marked at C3-4 where a disc protrusion\ncompresses the anterior surface of the spinal cord and there is increased\nsignal intensity of the cord on the T2 weighted images.\n\nAxial images at C2-3 demonstrate a small midline disc protrusion at does not\nquite contact the anterior surface of the cord.\n\nAt C3-4,. There is a large disc protrusion extending across the entire\nanterior margin of the spinal canal, flattening the spinal cord, and extending\ninto the proximal neural foramina bilaterally. Uncovertebral osteophytes.\nProduces moderate hyphen severe bilateral neural foraminal narrowing. The disc\nprotrusion is larger than on ___ and the spinal canal and spinal\ncord encroachment are more severe.\n\nAt C4-5, there are no degenerative changes and the neural foramina appear\nnormal.\n\nAt C5-6, there are no degenerative changes and the neural foramina appear\nnormal.\n\nAt C6-7, a broad-based bulge of the disc encroaches on the spinal canal and\nslightly flattens the anterior surface of the spinal cord. Uncovertebral\nosteophytes produces moderate right and moderate-severe left neural foraminal\nnarrowing.\n\nAt C7-T1, a broad bulging of the disc encroaches on the spinal canal but does\nnot contact the spinal cord. The neural foramina appear normal.", "output": "For degenerative disc disease progressing since ___. There is a\nlarge disc protrusion at C3-4 that compresses the spinal cord and causes\nabnormal high signal intensity in the cord on T2 weighted images." }, { "input": "Study is mildly degraded by motion.\n\nAlignment is normal. Mild loss of intervertebral disc height and endplate\nosteophyte formation noted at C5-C6 and C6-C7 levels. Diffuse loss of T2\nsignal in the intervertebral discs. Vertebral body and intervertebral disc\nsignal intensity otherwise appear normal. The spinal cord is normal in\ncaliber and grossly normal in signal within the confines of motion artifact. \nPlease refer to the separate brain MRI for description of the intracranial\nfindings.\n\nThe paraspinal and prevertebral soft tissues are grossly unremarkable.\n\nAt C2-C3, there is no spinal canal or neural foraminal stenosis.\n\nAt C3-C4, there is no spinal canal stenosis. Uncovertebral joint osteophytes\ncause mild-to-moderate right and mild left neural foraminal narrowing.\n\nAt C4-C5, posterior disc osteophyte complex causes minimal spinal canal\nnarrowing. There are uncovertebral joint osteophytes causing mild left and no\nright neural foraminal narrowing.\n\nAt C5-C6, there is a central to left paracentral disc protrusion with endplate\nosteophyte formation causing mild narrowing of the spinal canal. Facet and\nuncovertebral joint osteophytes cause moderate left and mild right neural\nforaminal narrowing.\n\nAt C6-C7, central disc protrusion causes mild narrowing of the spinal canal. \nUncovertebral joint osteophytes cause mild-to-moderate left and mild right\nneural foraminal narrowing.\n\nAt C7-T1, there is a central disc protrusion, but no spinal canal or neural\nforaminal stenosis is demonstrated.\n\n There is no evidence of infection or neoplasm.", "output": "1. No acute findings.\n2. Multilevel degenerative changes of the cervical spine with no evidence of\nspinal cord compression. There is mild spinal canal narrowing at the C5-C6\nand C6-C7 levels as well as mild-to-moderate neural foraminal narrowing as\ndescribed above." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL, THORACIC, AND LUMBAR SPINE:\n\nCervical and lumbar vertebral body alignment is preserved. There is\nlevoscoliosis of the thoracic spine. There is transitional anatomy with\npartial sacralization of L5. Minimal T7 through T9 anterior compression\ndeformities are again seen, grossly unchanged compared to ___ thoracic spine\nprior exam. Schmorl's nodes are seen at multiple levels throughout the\ncervical, thoracic, lumbar spine. Otherwise, vertebral body heights are\npreserved. S1 superior endplate probable type ___ ___ changes seen. Patchy\ntype ___ ___ changes seen at multiple levels throughout the cervical, thoracic\nand lumbar spine. There is no prevertebral soft tissue swelling.\n\nThe visualized portion of the spinal cord is grossly preserved in signal,\nwithout definite abnormal enhancement on postcontrast imaging.\n\nThere is loss of intervertebral disc height and signal throughout the\ncervical, thoracic, and lumbar spine.\n\nDisc bulges, facet joint hypertrophy, ligamentum flavum thickening, and facet\njoint hypertrophy is noted at multiple levels throughout the cervical,\nthoracic, and lumbar spine, without definite evidence of moderate or severe\nvertebral canal or neural foraminal narrowing.\n\nOTHER:\n There is no paravertebral or paraspinal mass identified.\n\nNonspecific perineural cysts are noted at multiple levels throughout the\ncervical, thoracic and lumbar spine. Nonspecific probable dependent edema is\nnoted in the dorsal lumbar soft tissues.\n\nLimited imaging of the pelvis on scout imaging demonstrates urine filled\nbladder.\n\nLimiting the parotid glands demonstrate left parotid multiple subcentimeter\nnonspecific subcentimeter structures, which may represent lymph nodes.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical, thoracic, and lumbar spondylosis as described without\ndefinite evidence of moderate or severe vertebral canal or neural foraminal\nnarrowing.\n3. Grossly stable T7 through T9 minimal anterior compression deformities\ncompared to ___ prior thoracic spine MRI.\n4. Nonspecific probable nerve root sleeve cysts throughout cervical, thoracic,\nlumbar spine without definite evidence of spinal hygromas. If continued\nconcern for CSF leak, consider radionuclide cisternography study.\n5. Please see concurrently obtained contrast brain MRI for description of\ncranial findings.\n6. Limited imaging of the pelvis on scout imaging demonstrates urine filled\nbladder." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of the lumbar spine. Multiple Schmorl's nodes are seen\nthroughout the thoracolumbar spine. There is transitional anatomy with\npartial sacralization of L5. Vertebral body heights are otherwise grossly\npreserved. L5-S1 type ___ ___ changes are seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal throughout lumbar\nspine. Nonspecific facet joint fluid is noted at multiple levels of the\nlumbar spine.\n\nAt T11-12 there is facet joint hypertrophy, epidural fat, mild vertebral canal\nno neural foraminal narrowing.\n\nAt T12-L1 there is disc bulge, facet joint hypertrophy, epidural fat,\nmildvertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is epidural fat, mildvertebral canal and no neural foraminal\nnarrowing.\n\nAt L2-3 there is disc bulge, left paracentral disc extrusion with inferior\nmigration and intraforaminal extension into the left L3-4 neural foramen,\nmoderate to severevertebral canaland mild rightneural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet hypertrophy, epidural fat, extension of\nL2-3 left paracentral disc extrusion into left L3 neural foramen,\nmoderatevertebral canaland severe leftneural foraminal narrowing.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, epidural fat,\nseverevertebral canal and mild bilateral neural foraminal narrowing. \nLeft-sided facet joint probable synovial cyst is noted (see 4:8).\n\nAt L5-S1 there is disc bulge which contacts bilateral exiting L5 nerve roots,\ncentral disc protrusion, facet joint hypertrophy, epidural fat, mildvertebral\ncanal and moderate bilateral neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Nonspecific probable dependent edema is noted in\nthe lumbar dorsal soft tissues.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel lumbar spondylosis and epidural fat as described, most\npronounced at L4-5, where there is severe vertebral canal and mild bilateral\nneural foraminal narrowing.\n3. L2-3 left paracentral probable disc extrusion which extends inferiorly into\nleft L3-4 neural foramen, with differential consideration of nerve sheath\ntumor. If concern for tumor, consider contrast lumbar spine MRI for further\nevaluation.\n4. L2-3 moderate to severe vertebral canal narrowing.\n5. L3-4 moderate vertebral canal and severe left neural foraminal narrowing.\n6. L5-S1 disc bulge contacts bilateral exiting L5 nerve roots with mild\nvertebral canal and moderate bilateral neural foraminal narrowing.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:07 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. Degenerative loss of disc height is moderate\nspanning L2-L3 through L5-S1 with associated loss of disc signal. There is no\nabnormal signal or enhancement of the terminal cord, conus medullaris or cauda\nequina.\n\nT11-T12 through L1-L2: Small central protrusions do not significantly narrow\nthe spinal canal or neural foramina. This is unchanged from prior exam.\n\nL2-L3: A disc bulge with prominent epidural fat results in moderate to severe\nspinal canal narrowing, mildly crowding the cauda equina with severe crowding\nof the left subarticular zone, posteriorly displacing the traversing nerve\nroot. Interval resolution of previously seen inferiorly migrating extrusion. \nLoss of disc height and facet arthropathy results in mild right and no\nsignificant left neural foraminal narrowing.\n\nL3-L4: There is mild spinal canal narrowing secondary to a small disc bulge\nand prominent epidural fat. Mild bilateral neural foraminal narrowing is\nidentified.\n\nL4-L5: A central protrusion and prominent epidural fat results in moderate to\nsevere spinal canal narrowing, similar to slightly more prominent compared to\nprior examination. There is crowding of the subarticular zones contacting but\nnot definitively posterior displacing the traversing nerve roots. Loss of\ndisc height and facet arthropathy results in mild bilateral neural foraminal\nnarrowing. Unchanged right-sided posteriorly oriented synovial cyst.\n\nL5-S1: A central protrusion does not significantly narrow the spinal canal. \nLoss of disc height with facet arthropathy results in moderate to severe\nbilateral neural foraminal narrowing remodeling the bilateral exiting nerve\nroots, unchanged from prior exam. A\n\nVisualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Interval resolution of the inferiorly migrating disc extrusion at L2-L3. \nThere remains a large disc bulge with prominent epidural fat which results in\nmoderate to severe spinal canal narrowing, with severe crowding of the left\nsubarticular zone which posteriorly displaces the traversing left L3 nerve\nroot.\n2. Additional degenerative changes most prominent at L5-S1 where there is\nmoderate to severe bilateral neural foraminal narrowing, remodeling the\nexiting L5 nerve roots, unchanged from prior exam.\n3. No evidence of nerve sheath tumor. No abnormal enhancement of the terminal\ncord, conus medullaris or cauda equina.\n4. Additional findings as described above." }, { "input": "Spine Numbering used for the present study shown on series 4, image 5.\n\nScoliosis on the localizing images.\nThe vertebral body height and alignment within the lumbar spine are normal.\nThere are degenerative endplate changes at the L5-S1 level. There is a\nprobable L3 vertebral body hemangioma.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe T12-L1 level.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the T11-T12 level, the spinal canal and neural foramina appear normal.\n\nAt the T12-L1 level, the spinal canal and neural foramina appear normal.\n\nAt the L1-L2 level, there is bilateral facet arthropathy. The spinal canal and\nneural foramina appear normal.\n\nAt the L2-L3 level, there is bilateral facet arthropathy and a diffuse disc\nbulge. The spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, there is bilateral facet arthropathy and a diffuse disc\nbulge. The spinal canal and neural foramina appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy and a diffuse disc\nbulge with a left foraminal disc protrusion which causes mild left neural\nforaminal narrowing.\n\nAt the L5-S1 level, there is bilateral facet arthropathy and a diffuse disc\nbulge with left foraminal disc protrusion which causes mild to moderate left\nneural foraminal narrowing. Mild edemal around the facets, likely reactive.\n\nProminent posterior epidural fat noted in the lumbar region, in particular\nfrom L3- S1 levels, contributing to mild canal narrowing.\nFatty infiltration of the paraspinous muscles noted.\nT2 hyperintense lesion in the right kidney measuring approximately 3.2 times\n4.4 cm, anda small 0.7cm slightly heterogeneous lesion in left kidney, (se 10,\nim 22) inadequately assessed on the present study.", "output": "1. Multilevel, multifactorial lumbar spondylosis without evidence of\nsignificant spinal canal narrowing or neural impingement. Moderate facet\ndegenerative changes at L4-5 and L5-S1 levels in particular.,\nLeft foraminal narrowing at L4-5 and L5-S1 levels from disc and facet changes.\nProminent epidural fat in the lower lumbar region, contributing to canal\nnarrowing.\n2. T2 hyperintense lesion in the right kidney measuring approximately 3.2x 4.4\ncm, is inadequately assessed on the present study. Recommend correlation with\nultrasound for better assessment." }, { "input": "There is a focus of hyperintensity within the spinal cord at C4 -5 level on\nthe right side demonstrates enhancement indicative of lesion from multiple\nsclerosis. There are no other foci of signal abnormalities within the cervical\nspinal cord from skullbase to T4 level. There is normal evidence of extrinsic\nspinal cord compression. No evidence of significant disc bulge or herniation\nseen.", "output": "No prior studies for comparison. T2 hyperintensity seen within the right side\nof the spinal cord at C4-5 level demonstrated enhancement indicative of a\nMultiple sclerosis plaque." }, { "input": "THORACIC SPINE: Thoracic spine alignment is preserved. Vertebral body heights\nand disc spaces are maintained. No significant spinal canal or neural\nforaminal narrowing is present. A small disc protrusion present at C6-C7 is\nbetter evaluate on the recent cervical spine CT. The thoracic cord is normal\nin morphology and signal intensity. The lack of contrast decreases the\nsensitivity for detection of demyelinating lesions.\n\nWithin the T4 vertebral body, there is an ovoid T2 and STIR hyperintense\nlesion which measures 1.5 cm in CC dimension. An additional small T2 and STIR\nhyperintense lesion is seen within the spinous process of T5.\n\nNo abnormality is seen within the paraspinal musculature.\n\nLUMBAR SPINE: Lumbar spine alignment is preserved. Vertebral body heights and\ndisc spaces are maintained. Bone marrow signal is normal. The conus medullaris\nis normal in morphology and signal intensity and terminates at the level of\nL1. The cauda equina demonstrates normal morphology is well.\n\nMild facet degenerative changes are present at L3-L4, L4-L5 and L5-S1 without\nsignificant spinal canal or neural foraminal narrowing.\n\nNo signal abnormality is seen within the visualized paraspinal musculature.\nNonspecific subcutaneous edema overlies the upper lumbar spine.", "output": "1. No evidence for thoracic or lumbar spinal fracture.\n2. No cord compression or signal abnormality. N.B. The lack of intravenous\ncontrast decreases the sensitivity for detection of demyelinating disease.\n3. T4 and T5 STIR-hyperintense lesions compatible with \"atypical\" slow-flow\nvenous malformations (formerly \"atypical hemangiomas\")." }, { "input": "Redemonstrated is a hyperintense focus within the right aspect of the cervical\nspinal cord at the level of C4-C5, with more sharply defined margins than on ___. This lesion no longer demonstrates contrast enhancement. No new\nT2 hyperintense lesion or abnormal enhancement is detected in the spinal cord.\nThere is no evidence for cord swelling or atrophy.\n\nThe vertebral body heights and alignment are maintained. No concerning bone\nmarrow signal abnormalities are seen. The intervertebral disc have normal\nheight and signal intensities. There is no disc herniation, and no spinal\ncanal or neural foraminal stenosis.", "output": "Demyelinating plaque in the right aspect of the cervical spinal cord at the\nlevel C4-C5 no longer demonstrates contrast enhancement. No evidence for new\nlesions in the cervical or visualized upper thoracic cord." }, { "input": "THORACIC:\nThoracic vertebral body height and alignment are preserved. No suspicious\nbone marrow signal abnormalities identified.\n\nThe thoracic spinal cord appears normal in morphology and signal intensity.\n\nThere is mild degenerative disc disease, with several small disc protrusions\nas follows:\n\nAt T6-T7 level, there is disc bulge slightly more pronounced towards the left\n(image 28, series 7).\n\nAt T7-T8 level, there is disc bulge, more pronounced towards the left, causing\nmild anterior thecal sac deformity (Image 7, series 8).\n\nDisc bulge is noted at T11-T12 level, causing anterior thecal sac deformity,\nmore significant on the right (image 28, series 8).\n\nThe prevertebral and paraspinal soft tissues are unremarkable. Incidental\nnote is made of a 14 mm simple left renal cyst.\n\nLUMBAR:\nLumbar vertebral body height and alignment are preserved. No suspicious bone\nmarrow signal abnormalities identified.\n\nThe conus medullaris terminates at the L1 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nAt L3-4, there is a disc bulge, ligamentum flavum thickening, and facet\nhypertrophy result in mild spinal canal and bilateral neural foraminal\nnarrowing.\n\nAt L4-5, there is a disc bulge with superimposed right paracentral disc\nextrusion with inferior migration that displaces the traversing right L5 nerve\nroot. The disc bulge/extrusion, ligamentum flavum thickening, and facet\nresult in mild spinal canal and mild right neural foraminal narrowing. There\nis moderate left neural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge, ligamentum flavum thickening, and facet\nhypertrophy without spinal canal narrowing. There is mild bilateral neural\nforaminal narrowing.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Mild thoracic degenerative disc disease as described above, more pronounced\nat T6-T7, T7-T8 and T11-T12 levels.\n2. No focal or diffuse lesions are visualized throughout the thoracic spinal\ncord.\n3. Lumbar degenerative disc disease, with mild spinal canal narrowing at L3-4\nand L4-5 and moderate left neural foraminal narrowing at L4-5. There is a\nsuperimposed right paracentral disc extrusion with inferior migration L4-5\nthat results in posterior displacement of the traversing right L5 nerve root." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThe conus medullaris terminates at L1-L2\n\nAlignment is normal. There is loss of normal intervertebral disc signal from\nL1-L2 through L3-L4 likely secondary to degenerative changes. Vertebral body\nbone marrow signal is normal.\n\nFrom L1-L2 through L5-S1 levels, there is no spinal canal stenosis or neural\nforaminal stenosis.\n\nUnchanged perineural cysts (Tarlov cysts), are identified in the sacrum\nbilaterally at S1 and S2 levels.\n\nThere is moderate to severe bilateral hydroureteronephrosis. Left total hip\narthroplasty is partially visualized. The visualized paraspinal muscles are\nnormal.", "output": "1. No spinal canal or neural foraminal stenosis.\n2. Moderate to severe bilateral hydroureteronephrosis which is new as compared\nto CT colonography ___." }, { "input": "Study is mildly degraded by motion. Vertebral body alignment is preserved. \nVertebral body heights are preserved. There is no focal marrow signal\nabnormality. Multiple Schmorl's nodes are noted throughout cervical spine The\nvisualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc signal at C3-4, C4-5, and C5-6.\n\nWithin 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.\n\n At C2-3 there is there is a central disc protrusion and disc withno vertebral\ncanal or neural foraminal stenosis.\n\nAt C3-4 there is disc bulge withno vertebral canal or neural foraminal\nstenosis.\n\nAt C4-5 there is no vertebral canal or neural foraminal stenosis.\n\nAt C5-6 there is disc bulge withno vertebral canal or 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. A\nright-sided perineural cysts is noted.", "output": "1. Study is mildly degraded by motion.\n2. Mild multilevel degenerative changes as described, with no definite\nvertebral canal or neural foraminal stenosis." }, { "input": "From T10-11 through L3-4 no abnormalities are identified.\n\nAt L4-5 level, disc degenerative changes and central disc herniation seen\nindenting the thecal sac with moderate left-sided and mild right-sided\nsubarticular recess narrowing. There is no spinal stenosis. There is no\nforaminal narrowing.\n\nAt L5-S1 level: No significant abnormalities are seen.\n\nDistal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Central disc herniation at L4-5 level resulting in moderate left-sided and\nmild right-sided subarticular recess narrowing. No other significant\nabnormalities." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nLevoscoliosis with apex at L2-3 level is again noted. Grade 1 L3 on L4\nanterolisthesis is present. Vertebral body heights are preserved. T11, L2, L3\nand S1 vertebral body probable hemangioma are again noted. The visualized\nportion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal at L1-2, L2-3, L3-4,\nand L4-5.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is disc bulge and central disc protrusion which deforms the\nventral thecal sac, with no associated cord signal abnormality, andno neural\nforaminal stenosis.\n\nAt L1-2 there is facet joint arthropathy, ligamentum flavum hypertrophy and\ndisc bulge withno vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is a right paracentral disc protrusion, ligamentum flavum\nhypertrophy and facet joint arthropathy resulting in right subarticular zone\nstenosis contacting the right L3 nerve root, moderate to severe vertebral\ncanal stenosis and no neural foraminal stenosis.\n\nAt L3-4 there is disc bulge withno vertebral canal or neural foraminal\nstenosis.\n\nAt L4-5 there is disc bulge which contacts the left L5 nerve roots within the\nleft subarticular zone, ligamentum flavum hypertrophy and facet joint\narthropathy resulting in moderate to severe vertebral canal and no neural\nforaminal stenosis.\n\nAt L5-S1 there is a disc bulge which contacts the right S1 nerve root within\nthe right subarticular zone withno vertebral canal or neural foraminal\nstenosis.", "output": "1. Lumbar spine levoscoliosis with apex at L2-3 level.\n2. Multilevel degenerative changes as described, most pronounced at L2-3 and\nL4-5 levels, where there is moderate to severe vertebral canal stenosis.\n3. L2-3 disc protrusion contacts right L3 nerve root, L4-5 disc bulge contacts\nleft L5 nerve root, and L5-S1 disc bulge contacts right S1 nerve root." }, { "input": "Lumbar vertebral body height is preserved. 2 mm retrolisthesis of L2 on L3\nand of L3 on L4 is likely related to facet arthropathy. Vertebral body\nalignment is otherwise preserved. The bone marrow signal appears mildly\nheterogeneous, without a suspicious abnormality. There is scoliosis of lumbar\nspine convex to the right in the lower lumbar and to the left in the upper\nlumbar region.\n\nThe conus medullaris terminates at the L1-L2 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nAt L1-L2, there is intervertebral disc height loss. There is a disc bulge\nwithout spinal canal or neural foraminal narrowing. There are small bilateral\nfacet joint effusions.\n\nAt L2-L3, there is intervertebral disc height loss and abnormal fluid signal\nwithin the disc. There is a disc bulge and ligamentum flavum thickening\nwithout spinal canal narrowing facet arthropathy results in mild right neural\nforaminal narrowing. There is no left neural foraminal narrowing. There are\nsmall bilateral facet joint effusions.\n\nAt L3-L4, there is intervertebral disc height loss. There is a disc bulge,\nligamentum flavum thickening, and facet arthropathy with mild spinal canal\nnarrowing. There is narrowing of the right subarticular zone with contact,\nbut no displacement of the traversing right L4 nerve root. Facet arthropathy\nresults in mild right and moderate left neural foraminal narrowing. There are\nsmall bilateral facet joint effusions.\n\nAt L4-L5, there is intervertebral disc height loss. There is a disc bulge,\nligamentum flavum thickening, and facet arthropathy result in moderate spinal\ncanal narrowing the disc bulge and facet arthropathy result in narrowing of\nthe bilateral subarticular zones with contact, left worse than right. The\nextraforaminal component of the disc displaces the exiting left L4 nerve root.\nFacet arthropathy results in mild right and severe left neural foraminal\nnarrowing. There are small bilateral facet joint effusions.\n\nAt L5-S1, there is intervertebral desiccation. There is a disc bulge,\nligamentum flavum thickening, and facet arthropathy without spinal canal\nnarrowing. Facet arthropathy results in mild right and moderate left neural\nforaminal narrowing.\n\nThere is a small perineural root sleeve cyst associated with the left S2 nerve\nroot.\n\nThe right kidney is asymmetrically enlarged, there is perirenal free fluid,\nand the right ureter is dilated.", "output": "1. Lumbar degenerative changes as detailed above, with moderate spinal\nstenosis at L4-5 level due to disc and facet degenerative changes.\n2. Degenerative changes are most advanced at L4-L5 with subarticular zone\nnarrowing that results in contact of the traversing L5 nerve roots and\ndisplacement of the exiting left L4 nerve root due to the extraforaminal disc\ncomponent. Facet arthropathy results in severe neural foraminal narrowing at\nleft L4. There are small facet joint effusions throughout most of the lumbar\nspine.\n3. Asymmetric enlargement of the right kidney with perirenal free-fluid and\ndilation of the right ureter. Please refer to the CT abdomen pelvis dated ___ for further details.\n\nRECOMMENDATION(S): Refer to CT abdomen pelvis dated ___ for details\nregarding the right kidney." }, { "input": "The examination is moderately degraded by patient motion. Allowing for this\nconfine:\n\nThe patient's known, mildly displaced and distracted type 2 odontoid fracture\nis seen. There is associated prevertebral soft tissue swelling and edema. \nThere is fluid about see 0 C1, C1-C2 lateral masses, without widening of the\narticulation CT to suggest distraction.\n\nApparent discontinuity of the anterior longitudinal ligament is seen at the\nlevel of the C2 body (8:8). 3 membrane, anterior atlantoaxial ligament are\nintact. Apical ligament of dense is not well seen. Posterior longitudinal\nligament is intact. The posterior longitudinal ligament and ligamentum flavum\nappear intact. Increased STIR/T2 signal within the intraspinous ligaments\nfrom C1-C5 are suggestive of posterior ligamentous complex injury.\nFluid within right C2-C3, C3-C4 facet joint, and left C2-C3 facet joint, mild\nposterior element edema, may be degenerative or posttraumatic. No associated\nfracture is seen on CT scan, and there are advanced degenerative changes at\nthe levels.\nFluid within left L4-5 facet joint is likely a degenerative basis given severe\narthropathy seen within the joint on CT scan.\nMinimal anterolisthesis C4-C5, similar to CT scan.\nThere is millimetric retrolisthesis of C6 on C7, most likely degenerative in\nnature.\n\nMultilevel degenerative changes cervical spine, multilevel disc osteophyte\ncomplexes, disc space narrowing, posterior element hypertrophic changes. No\ncord T2 signal abnormality.\n\nAt C2-C3 level central canal is patent. Probably moderate bilateral foraminal\nnarrowing.\n\nAt C3-C4 level there is mild central canal narrowing, minimal effacement of\nthe posterior cord by posterior element hypertrophic changes. Moderate\nbilateral foraminal narrowing.\n\nAt C4-C5 level there is mild central canal narrowing.. Moderate to severe\nleft, moderate right foraminal narrowing.\n\nAt C5-C6 level there is mild central canal narrowing. Severe right and\nmoderate left foraminal narrowing.\n\nAt C6-C7 level there is mild-to-moderate central canal narrow. Severe\nbilateral foraminal narrowing.\n\nAt C7-T1 level central canal is patent. Minimal bilateral foraminal\nnarrowing.\n\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.", "output": "1. Moderately motion degraded examination.\n2. Type 2 odontoid fracture stable, surrounding edema. Edema about C 0 - C1,\nC1-C2 articulation, this area was better seen on CT scan. No evidence of\ndistraction at C 0 C1. Subluxation C1-C2 cannot be excluded.\n3. Posterior ligamentous complex injury C1-C5..\n4. Upper cervical spine multilevel facet joint fluid, without distraction or\nsubluxation at CT scan, most likely degenerative.\n5. Multilevel degenerative changes, mild-to-moderate central canal narrowing\nC6-C7 level, and multilevel significant foraminal narrowing, as above.\n6. No cord edema." }, { "input": "Study is mildly degraded by motion.\n\nLevels were established by counting down from the C2 level using series 1,\nimage 2; series 5, image 9; series 12, image 9.\n\nTHORACIC AND LUMBAR SPINE MRI:\n\nThoracic spine vertebral line is preserved. There is mild levoscoliosis of\nlumbar spine. Vertebral body heights are preserved. A subcentimeter T1/T2\nhyperintense lesion is seen in right posterior-lateral aspect of the T4\nvertebral body, most consistent with a hemangioma. L5 vertebral body probable\nhemangioma is also noted. T7-T8, T8-9, and T9-10 type ___ ___ changes are\nseen.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nMild disc desiccation is seen involving the L3-4 disc. Otherwise,\nintervertebral disc heights and signal are preserved.\n\nL3-L4: There is a disc bulge, facet joint hypertrophy, epidural fat, mild\nvertebral canal and no neural foraminal narrowing. Nonspecific bilateral\nfacet joint fluid is noted.\n\nOtherwise, there is no definite evidence of thoracic or lumbar spine vertebral\ncanal or neural foraminal narrowing.\n\nOTHER:\n There is no paravertebral or paraspinal mass identified. There is no\nabnormal enhancement after contrast administration. Limiting the kidneys\nsuggests and at least 1.1 cm right renal at least partially cystic lesion,\nincompletely characterized (see 14, 15, 17:9).\n\nLimited imaging of the abdomen suggests irregularity of hepatic contour,\ncompatible with patient's known history of hepatic cirrhosis.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no definite evidence of abnormal enhancing thoracic\nor lumbar spinal lesion.\n3. Mild multilevel thoracic and lumbar spondylosis as described, without\ndefinite evidence of moderate or severe vertebral canal or neural foraminal\nnarrowing.\n4. 1.1 cm right renal at least partially cystic incompletely characterized\nlesion." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc heights are\nnormal. No concerning marrow signal abnormalities. The visualized posterior\nfossa is normal. The spinal cord appears normal in contour and signal\nintensity. There is no evidence of spinal canal or neural foraminal narrowing.\n\nThere is a heterogeneously T2 hyperintense nodule within the left lobe of the\nthyroid gland, not entirely imaged on the current study and better seen on the\nprior MRI from ___ and thyroid ultrasound from ___.", "output": "Normal appearance of the cervical spine on noncontrast MRI." }, { "input": "CERVICAL:\nThere is a slightly expansile enhancing C4 spinal cord lesion measuring 0.9 cm\nTV x 0.7 cm AP x 1.6 cm SI (3:8, 13:8) demonstrating T2/STIR hyperintensity. \nThere is no additional spinal cord lesion. The alignment of the cervical\nspine is maintained. The vertebral body heights and intervertebral disc\nspaces are preserved. The prevertebral and paraspinal soft tissues appear\nunremarkable. There is no evidence of epidural hematoma or abscess.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. There is a T1 and T2\nhyperintense T8 vertebral body lesion corresponding to a hemangioma. The\nvertebral body heights and intervertebral disc space and signal are preserved.\nThe spinal cord is normal in caliber morphology without abnormal signal\nintensity or enhancement. There are mild disc protrusions at T3-T4, T5-T6,\nand T7-T8 levels indenting the ventral thecal sac without spinal cord\ncompression or neural foraminal narrowing.\n\nLUMBAR:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand intervertebral disc space and signal are preserved. There is no epidural\nabscess or abnormal enhancement. The conus medullaris terminates at L1. There\nis no spinal canal stenosis or neural foraminal narrowing.\n\nOTHER: There is right pelvicaliectasis without evidence of hydronephrosis.", "output": "1. Slightly expansile enhancing C4 spinal cord lesion as described above. \nFinding may reflect demyelinating lesion. Alternative differential\nconsiderations include infectious or inflammatory process or, far less likely,\nintrinsic spinal cord neoplasm." }, { "input": "Re-identified is 1.1 cm segment of C4 central T2 hyperintense cord signal,\nslightly less conspicuous and decreased in size when compared to examination\nof ___, with resolution of previously seen enhancement. No new cord\nsignal abnormality or lesions. The visualized posterior fossa is\nunremarkable.\n\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc height and signal are maintained. \nNo significant spinal canal or neural foraminal narrowing.\n\nVisualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Interval decrease size of a C4 central T2 hyperintense lesion now measuring\napproximately 1.1 cm, with resolution of previously described enhancement. \nGiven resolution of enhancement as well as decreased size, the findings are\nmost consistent with demyelinating process such as transverse myelitis rather\nthan neoplasm.\n2. No new lesions.\n3. Additional findings as described above." }, { "input": "The exam was terminated early due to patient discomfort. Axial postcontrast\nsequence of the lower thoracic spine was obtained.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\n\nL5-S1: A disc bulge is seen with bilateral facet arthropathy. There is\nmoderate left foraminal narrowing.\n\nOtherwise, there is no evidence of spinal canal or neural foraminal narrowing.\nThere is no evidence of infection or neoplasm.", "output": "1. No evidence of infection or neoplasm.\n2. Mild degenerative changes of the lumbar spine, worse at L5-S1, as above." }, { "input": "Study is mildly degraded by motion.\n\nThere is straightening of the cervical lordosis. A Schmorl's node is seen\ninvolving the inferior endplate of C6. Vertebral body heights are preserved. \nSuperior C5 and C5-6 mixed type 1 and type ___ ___ changes are suggested.\n\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is multilevel disc desiccation and mild loss of height. Nonspecific\nfacet joint fluid is noted at multiple levels of the cervical spine.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: A small right uncovertebral osteophyte is seen, no spinal canal\nnarrowing with mild right neural foraminal narrowing.\n\nC4-C5: A disc bulge is seen with bilateral facet and uncovertebral\nhypertrophy, mild spinal canal narrowing, moderate right and mild left neural\nforaminal narrowing.\n\nC5-C6: A disc bulge is seen with bilateral facet and uncovertebral\nhypertrophy, deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, mild-to-moderate spinal canal\nnarrowing, moderate right and mild left neural foraminal narrowing.\n\nC6-C7: A left-sided disc protrusion is seen, effacing the left ventrolateral\nthecal sac and spinal cord without definite associated cord signal\nabnormality, mild spinal canal narrowing, moderate right and no left neural\nforaminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\n OTHER:\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Scout imaging demonstrates patient is intubated. \nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by size criteria.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel cervical spondylosis as described, most pronounced at C5-6,\nwhere there is mild-to-moderate vertebral canal, mild left and moderate right\nneural foraminal narrowing.\n3. Subcentimeter nonspecific lymph nodes as described, which may be reactive.\n4. Right C4-5 and C6-7 moderate neural foraminal narrowing.\n5. C5-6 and C6-7 deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality." }, { "input": "THORACIC:\nThere is exaggerated kyphotic angulation of the thoracic spine. Alignment is\notherwise preserved.Vertebral body heights are preserved. There is mild loss\nof T2 signal within the intervertebral discs at T3-T4 and from the T5-T6\nthrough T9-T10 levels with mild intervertebral disc space narrowing at these\nlevels.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nepidural collection.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nThere are 5 non rib-bearing lumbar type vertebral bodies. Alignment is\npreserved.Vertebral body heights are preserved. There is loss of disc T2\nsignal along with mild disc height narrowing at the L4-L5 and L5-S1 levels.\n\nThe terminal spinal cord appears normal in caliber and configuration. The\nconus medullaris terminates at the T12-L1 level. There is no epidural\ncollection.\n\nFrom the levels of T12 level on through L3-L4, there is no significant spinal\ncanal or neural foraminal narrowing.\n\nAt L4-L5, the posterior disc bulge effaces the subarticular recesses, greater\non the left than right, and indents the ventral thecal sac without significant\nspinal canal narrowing. The neural foramina are patent.\n\nAt L5-S1, posterior disc bulge with left paracentral protrusion indents the\nventral thecal sac without significant spinal canal narrowing. There is\nmoderate effacement of the left subarticular recess. The neural foramina are\npatent.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nOTHER: 7 mm T2 hyperintense lesion in the right hepatic lobe was also seen on\nthe prior CT examination, and is hyperintense on the postcontrast T1 images,\nlikely representing an hemangioma (12:21, 9v:19). There is splenomegaly. \nAgain noted is a peripheral wedge-shaped hypo enhancing focus of the lateral\nspleen as well as partial visualization of a large, rounded area of expansile\nhypo enhancement in the lower pole the spleen measuring roughly 74 x 43 mm,\nwith surrounding inflammatory fat stranding (8u:24), better characterized on\nprior CT examination, corresponding to known splenic infarcts. At the lateral\nmargin of the right lower pole kidney, there is a small wedge-shaped area of\nT2 hypo intensity (13:9), as seen on the prior CT, which may represent\nadditional infarct.\n\nThere are degenerative changes of the bilateral sacroiliac joints, greater on\nthe right.", "output": "1. No evidence of epidural collection, or discitis osteomyelitis.\n2. Mild thoracolumbar spondylosis, as described. No significant spinal canal\nor neural foraminal narrowing.\n3. There is splenomegaly. Partial visualization of a 74 x 43 mm acute left\ninferior splenic infarct with surrounding inflammatory change, better\ncharacterized on prior CT. Additional chronic appearing infarct of the mid\nsplenic body.\n4. Subcentimeter wedge-shaped area of signal abnormality in the right lower\npole kidney, as seen on prior CT, which may represent additional infarct.\n5. Probable hepatic hemangioma." }, { "input": "The cervical and thoracic spine images are moderately degraded by motion\nartifact.\n\nVertebral body heights and alignment are maintained. There is no definite\nbone marrow signal abnormality. The spinal cord is normal in caliber and\nthere is no gross signal abnormality on sagittal T2 weighted images however\npresence of motion artifact and lack of axial images limits evaluation. \nDegenerative disc disease at L4-5 and L5-S1 does not result in significant\nspinal canal or neural foraminal narrowing.\n\nThe scout images are notable for hepatosplenomegaly, small bilateral pleural\neffusions and pulmonary parenchymal abnormalities, as seen on prior studies. \nThe scout images also demonstrate free fluid in the pelvis surrounding the\nuterus and the ovaries. This may be physiologic in a young female, but is\nincompletely evaluated", "output": "1. The study is limited by motion artifact and lack of axial and postcontrast\nsequences. Within these confines, there is no gross evidence of discitis-\nosteomyelitis or cord compression.\n2. Known hepatosplenomegaly and small bilateral pleural effusions and\npulmonary parenchymal abnormalities are not adequately evaluated on this\nstudy.\n3. The scout images are notable for free fluid in the pelvis surrounding the\nuterus and the ovaries which may be physiologic, but is incompletely\nevaluated." }, { "input": "Limited views of the sinuses, cervicomedullary junction, and skull base are\nunremarkable. The visualized paravertebral soft tissues and lung apices are\nunremarkable.\n\nThere is normal cervical alignment. The vertebral body heights are preserved.\nThere is T2 hyperintensity at the posterior articulating endplates of C4-C5\nand C5-C6. There is T2 hyperintensity within the left C4-C5 facets. There is\nlow signal throughout the cervical spine intervertebral disc spaces with\nposterior loss of height at C4-C5 and C5-C6. The spinal cord demonstrates\nnormal signal morphology without evidence of abnormal postcontrast\nenhancement. There is no abnormal postcontrast enhancement.\n\nAt C2-C3 there is no neural foramina or spinal canal stenosis.\nAt C3-C4 there is uncovertebral arthropathy causing mild left neural foraminal\nstenosis and mild spinal canal stenosis.\nAt C4-C5 there is mild spinal canal stenosis and no neural foraminal stenosis.\nAt C5-C6 there is uncovertebral arthropathy causing mild left neural foraminal\nstenosis and mild spinal canal stenosis.\nAt C6-C7 there is no neural foramina or spinal canal stenosis.\nAt C7-T1 there is no neural foraminal spinal canal stenosis.", "output": "1. Mild degenerative changes of the cervical spine with mild C3-C6 spinal\ncanal stenosis and mild left neural foraminal stenosis at C3-C4 and C5-C6.\n2. T2 hyperintensity at the articulating endplates and left facets of C4-C5\nlikely representing ___ type 1 degenerative change." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is low\nsingle throughout all cervical intervertebral discs and T2 hyperintensity\nadjacent to the posterior articulating endplates of C4-C5 and C6-C7, relating\nto mild degenerative disc disease, unchanged since compared to the prior exam.\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm.\n\nAt C2-3, there is no spinal canal or neural foraminal stenosis.\nAt C3-4, there is no significant spinal canal stenosis. There is mild neural\nforaminal stenosis on the left due to uncovertebral hypertrophy.\nAt C4-5, there is mild spinal canal stenosis. There is no evidence of neural\nforaminal stenosis.\nAt C5-6, there is mild spinal canal stenosis. There is also moderate left and\nmild to moderate right neural foraminal stenosis, due to uncovertebral\nhypertrophy, unchanged from prior.\nAt C6-7, there is no spinal canal or neural foraminal stenosis.\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.", "output": "1. Mild to moderate neural foraminal stenosis at multiple levels, most at C5-6\nlevel on the left, unchanged from prior.\n2. Mild multilevel degenerative disc disease." }, { "input": "At the craniocervical junction and C2-3 levels mild degenerative change seen. \nAt C3-4 central disc osteophyte and disc bulging result in moderate-to-severe\nspinal stenosis and deformity of the spinal cord. There is moderate-to-severe\nbilateral foraminal narrowing.\n\nAt C4-5 level, disc bulging results in mild spinal stenosis and mild narrowing\nof the foramina.\n\nAt C5-6 disc bulging and posterior osteophytes result in moderate spinal\nstenosis and mild deformity of the spinal cord with moderate left and mild\nright foraminal narrowing.\n\nAt C6-7 disc bulging results in mild spinal canal narrowing with\nmild-to-moderate bilateral foraminal narrowing.\n\nAt C7-T1 and inferiorly to T3-4 mild degenerative changes are seen.\n\nThere is subtle increased signal seen within the spinal cord at C3-4 level\nindicating myelomalacia.", "output": "1. Moderate-to-severe spinal stenosis at C3-4, moderate spinal stenosis at\nC5-6, and mild spinal stenosis at C4-5 and C6-7 levels due to disc osteophytes\nand ligamentous thickening.\n2. Multilevel foraminal changes as described most pronounced at C3-4 level.\n3. Extrinsic deformity of the spinal cord at C3-4 level due to spinal stenosis\nwith subtle increased signal within the spinal cord indicating myelomalacia." }, { "input": "CERVICAL:\nThere is STIR hyperintensity within the interspinous ligament at C1-C2 and\nthroughout the cervical spine. No other ligamentous injury is seen in the\ncervical spine. There is STIR/T2 hyperintensity within the right lateral mass\nof C1 involving the right transverse foramen compatible with known fracture,\nbetter visualized on the prior CT. There is increased T2 signal intensity\nwithin the spinous process of C7 compatible with the previously seen mildly\ndisplaced fracture. There is diffuse multilevel disc desiccation with loss of\nintervertebral disc height and mixed ___ type 1 and type 2 marrow changes\nalong the endplates at C3-C4. There is similar mild retrolisthesis of C3 on\nC4. Alignment is otherwise normal. The ligaments are grossly intact. The\nspinal cord appears normal in caliber and configuration.\n\nC2-C3: No significant spinal canal or neural foraminal stenosis.\nC3-C4: Posterior disc osteophyte complex, retrolisthesis and ligamentum flavum\nthickening results in mild to moderate spinal canal stenosis with flattening\nof the ventral spinal cord.\nC4-C5: Diffuse disc bulge uncovertebral spondylosis without spinal canal\nstenosis results in mild bilateral neural foraminal narrowing.\nC5-C6: Diffuse disc bulge and uncovertebral spondylosis without spinal canal\nstenosis results in moderate left neural foraminal narrowing.\nC6-C7: Diffuse disc bulge and uncovertebral spondylosis without significant\nspinal canal or neural foraminal stenosis.\nC7-T1: Mild diffuse disc bulge without significant spinal canal or neural\nforaminal stenosis.\n\nTHORACIC:\nThere is increased STIR/T2 signal intensity along the superior endplate of T2,\nthrough the T3 vertebral body and the superior endplate of T4 with associated\nanterior wedge compression deformity of T3 and prevertebral soft tissue edema\ncompatible with acute fractures. There is marrow edema within the spinous\nprocess and lamina of T1, T2 and T3 as well as the right transverse process of\nT2 and T3 compatible with known displaced fractures seen on CT. Alignment is\nnormal.There is diffuse disc desiccation with loss of intervertebral disc\nheight and scattered fatty deposits. The conus medullaris terminates at the\nlevel of T12-L1. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nThere is prevertebral edema/hematoma extending from T1-T4 with extensive STIR\nhyperintensity in the interspinous ligament and paraspinal soft tissues\npredominately extending from C7-T1 to T3-T4.\n\nOTHER:", "output": "1. Right lateral mass fracture of C1 extending to the right transverse foramen\nand spinous process/lamina fracture at C7, better characterized on the prior\nCT. Edema within the interspinous ligament predominately at C1-C2 and C7-T1\nsuggestive of intraspinous ligament injury. No other cervical ligamentous\ninjuries or disruption.\n2. Acute anterior compression fracture of T3 and superior endplate fracture of\nT2 and T4 with involvement of the right transverse process and bilateral\nlamina/spinous process with possible focal disruption of the ligamentum flavum\nat the level of T3 and interspinous ligaments from C7-T1 to T3-T4. Otherwise\nintact anterior and posterior longitudinal ligaments.\n3. Acute right transverse process fracture of T5 is not well visualized and\nbetter evaluated on the dedicated CT.\n4. Prevertebral hematoma extending from T1-T4 with extensive interspinous and\nparaspinal soft tissue edema.\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": "From T10-T11 through L2-3 levels, no significant abnormalities identified.\nAt L3-4 level, mild disc degenerative changes seen. There is a disc protrusion\nin the left foramen which moderate to severely narrows the foramen and deforms\nthe left L3 nerve root . This is a new finding since the previous MRI\nexamination. Is no spinal stenosis.\n\nAt L4-5 level, disc bulging identified. The previously seen left-sided disk\nherniation has considerably decreased in size. There is a small disc\nprotrusion remains at this level which minimally narrows the left subarticular\nrecess with mild disk bulging without spinal stenosis. There is\nmild-to-moderate narrowing of the neural foramen as before.\n\nAt L5-S1 level disk bulging and annular tear identified. Mild narrowing of the\nforamina seen.\n\nThe distal Cord and paraspinal soft tissues are unremarkable.", "output": "1. New left foraminal disc herniation at L3-4 level compressing the exiting\nleft L3 nerve root.\n2. Decrease in size of left-sided disc herniation at L4-5 level." }, { "input": "Vertebral body heights are preserved. Minimal retrolisthesis of C5 on C6 was\nnot seen in ___. There is discogenic bone marrow change along the C5 inferior\nendplate. No concerning bone marrow signal abnormalities are seen.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa is unremarkable. No signal abnormalities are seen in the\ncervical or visualized upper thoracic spinal cord.\n\nAt C2-3, there is a tiny right paracentral disc osteophyte complex without\nsignificant spinal canal narrowing. There is mild to moderate right and\nmoderate left neural foraminal narrowing by right greater than left\nuncovertebral osteophytes and left greater than right facet osteophytes.\n\nAt C3-4, there is no spinal canal narrowing. There is severe right and\nmoderate left neural foraminal narrowing by uncovertebral osteophytes.\n\nAt C4-5, there is a tiny central disc protrusion which indents the ventral\nthecal sac but does not significantly narrow the spinal canal. There is severe\nbilateral neural foraminal narrowing, primarily by uncovertebral osteophytes,\nthough mild facet arthropathy is also present.\n\nAt C5-6, there is a small central disc extrusion with slight inferior\nextension, which indents the ventral thecal sac with minimal spinal canal\nnarrowing, but does not contact the spinal cord. There is mild bilateral\nneural foraminal narrowing by uncovertebral osteophytes.\n\nAt C6-7, there is no spinal canal narrowing. There is mild bilateral neural\nforaminal narrowing by uncovertebral osteophytes.\n\nAt C7-T1, the left neural foramen is moderately narrowed by endplate\nosteophytes. There is no spinal canal or right neural foraminal narrowing.\n\nAt T1-T2, there is a tiny central disc protrusion without spinal canal\nnarrowing. There is no neural foraminal narrowing.", "output": "Multilevel degenerative disease. No significant spinal canal narrowing.\nMultilevel bilateral neural foraminal narrowing, as detailed above." }, { "input": "Disc and vertebral body heights are maintained. Presumed hemangiomas at T8 and\nL1 are noted. There is no suspicious marrow signal or cord signal abnormality.\nThe conus terminates at the T12-L1 level, within expected limits.\n\nAt the left T5-6 level there is prominent thickening of the ligamentum flavum\n(series 6, image 22). Otherwise, there is no significant spinal canal or\nneural foraminal narrowing of the thoracic spine. Prevertebral and paraspinal\nare unremarkable.", "output": "There is no significant spinal canal or neural foraminal narrowing of the\nthoracic spine." }, { "input": "The alignment is normal. No concerning bone marrow signal abnormalities are\nidentified. No concerning cord signal abnormalities are seen. Normal T2\nsignal seen within the intervertebral discs of the cervical spine. \nRe-demonstrated is 8 mm cerebellar tonsillar herniation overall unchanged\ncompared to the MRI of the cervical spine from ___.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: Mild disc bulge is seen resulting in minimal spinal canal narrowing\nunchanged compared to the prior exam. There is no significant neural\nforaminal narrowing.\n\nC4-C5: There is no spinal canal or neural foraminal narrowing.\n\nC5-C6: Minimal disc bulge is seen however there is no significant spinal canal\nor neural foraminal narrowing.\n\nC6-C7: Minimal disc bulge is seen however there is no significant spinal canal\nor neural foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. No significant spinal canal or neural foraminal narrowing. Similar\nappearance of mild multilevel degenerative changes compared to the exam from\n___.\n2. Similar appearance of cerebellar tonsillar herniation 8 mm below the\nforamen magnum suggestive of Chiari 1 malformation." }, { "input": "Accurate vertebral numbering cannot be established because the lower thoracic\nspine is not adequately penetrated on the prior chest radiographs, and there\nis no other prior thoracic spine imaging available. There is a transitional\nvertebra at the thoracolumbar junction with short ribs, labeled T12 for the\npurposes of this report. There are 4 lumbar-type vertebrae, labeled L1\nthrough L4, since the iliolumbar ligament is not visualized at the most caudal\nlumbar-type vertebra. L5 is presumed to be completely sacralized. The\nnumbering is documented on image 02:11.\n\nUsing the above numbering, the conus medullaris terminates at T12-L1. The\ndistal spinal cord demonstrates normal morphology and signal intensity without\nabnormal contrast enhancement.\n\nSagittal images demonstrate apparent contrast enhancement throughout the\nvisualized intrathecal course of the right L1 nerve root on postcontrast T1\nweighted sequence (image 7:10) compared to the precontrast T1 weighted\nsequence (image 4:10). However, on axial images, the visualized intrathecal\nportion of the L1 nerve root demonstrates mild hyperintensity on precontrast\nas well as postcontrast images, for example precontrast image 6:2 and\npostcontrast image 8:2. There is no evidence for nerve root thickening or\nnodularity.\n\nVertebral body heights are preserved. There are multiple hemangiomas and\nfocal fat deposits in the included upper sacrum, as well as in the L2\nvertebral body. No concerning bone marrow signal abnormalities are seen. \nAlignment is preserved.\n\nT11-T12: Sagittal images demonstrate a a tiny disc bulge without spinal canal\nnarrowing or spinal cord contact. No axial images through this level.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: There is a disc bulge, a central annular tear with a shallow\nbroad-based central disc protrusion, and mild facet arthropathy. Subarticular\nzones are narrowed with apparent abutment of bilateral traversing L4 nerve\nroots. No mass effect on the intrathecal nerve roots. Minimal bilateral\nneural foraminal narrowing without exiting L3 nerve root impingement.\n\nL4-L5: There is a disc bulge, a central disc protrusion, and mild bilateral\nfacet arthropathy. Bilateral traversing L5 nerve roots are abutted in the\nsubarticular zones. The thecal sac is slightly indented without mass effect\non the intrathecal nerve roots. The neural foramina are mildly narrowed\nwithout mass effect on the exiting L4 nerve roots.\n\nL5-S1: Underdeveloped disc and facet joints due to sacralization of L5. No\nspinal canal or neural foraminal narrowing.", "output": "1. Accurate vertebral numbering cannot be established in the absence of prior\nthoracic spine imaging. Transitional vertebra with short ribs at the\nthoracolumbar junction is labeled T12 for the purposes of this report. There\nare 4 lumbar-type vertebrae, labeled L1 through L4 in this report, and a\nsacralized L5.\n2. Normal appearance of the visualized distal spinal cord and conus\nmedullaris, without contrast enhancement.\n3. Possible mild contrast enhancement of the intrathecal course of the right\nL1 nerve root without thickening or nodularity, a nonspecific finding which\nmay be seen in the setting of Lyme disease or other infectious/inflammatory\nprocesses.\n4. L3-L4: The subarticular zones are narrowed with apparent abutment of\nbilateral traversing L4 nerve roots.\n5. L4-L5: Subarticular zones are narrowed with abutment of bilateral\ntraversing L5 nerve roots.\n\nRECOMMENDATION(S):\n1. If accurate vertebral numbering is needed in the future, then radiographs\nof the thoracic spine should be obtained.\n2. Consider correlation with CSF testing for Lyme disease and other\ninfectious/ inflammatory etiologies.\n\nNOTIFICATION: The impression items 1 and 2 were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:16 AM. The\nfollowing preliminary report was provided overnight by radiology resident Dr.\n___: \"No evidence of abnormal nerve root enhancement. Small central disc\nbulge at L5-S1 causes mild-to-moderate bilateral neural foraminal stenosis at\nL5-S1.\"" }, { "input": "From T11-12 through L3-4 levels, disc degenerative change and mild bulging\nseen. At L3-4 mild bilateral foraminal narrowing is seen.\n\nAt L4-5 level, there is been previous spinal fusion with pedicle screws. Disc\nbulging and mild narrowing of the foramina seen with laminectomy. The\nlaminectomy is also seen at L3-4 level.\n\nAt L5-S1 level disc degenerative change and mild bulging seen with mild\nnarrowing of the subarticular recesses and foramina.\n\nOverall there has been no significant change since the previous MRI\nexamination.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. No\nabnormal intraspinal enhancement seen. There are no MRI signs of\narachnoiditis seen.", "output": "Stable appearance of lumbar spine. Degenerative changes and postoperative\nchanges since previous MRI of ___. No significant new\nabnormalities are seen." }, { "input": "Cervical vertebral body heights are maintained and there is no evidence of\nfracture. Intervertebral disc heights are preserved. Cervical alignment is\nnormal. The spinal cord appears normal in caliber and signal throughout.\n\nThere are minimal disc bulges from C3-4 through C6-7 with minimal\nuncovertebral hypertrophy, but no significant spinal canal stenosis or neural\nforamen narrowing. No evidence of prevertebral soft tissue abnormality or\nligamentous injury.", "output": "1. No acute findings. No evidence of ligamentous injury.\n\n2. Minimal disc bulges from C3-4 through C6-7, without nerve root compression\nor spinal canal stenosis." }, { "input": "CERVICAL:\nPatchy T2 hyperintensity in the cervical spinal cord only seen on the sagittal\nimages appears artifactual. There are no definite lesions in the cervical\nspinal cord to suggest demyelination. No enhancing lesions to indicate active\ndemyelination.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nTHORACIC:\nSubtle T2 hyperintensity in the right dorsal spinal cord at the T8-T9 level\nagain demonstrated, less prominent than on the previous exam. T2\nhyperintensity in the left dorsal spinal cord at the T9-T10 level appears less\nprominent as well. Otherwise, the thoracic spinal cord is normal in caliber\nand in signal, and there are no enhancing lesions to suggest active\ndemyelination.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nOTHER: The paraspinal and prevertebral soft tissues are normal.", "output": "1. Foci of increased T2 signal in the spinal cord at the T8-T9 and T9-T10\nlevels consistent with demyelinating disease, somewhat less prominent than on\nthe previous examination.\n2. No new lesions or enhancing lesions in the cervical or thoracic spinal cord\nto indicate active demyelination.\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": "From T11-L2 L3-4 level disc degenerative changes and mild bulging seen. On the\nsagittal images no evidence of high-grade spinal stenosis or foraminal\nnarrowing seen.\n\nAt L4-5 level, there is mild anterolisthesis of L4 over L5. There is bulging\nand uncovering of the disc and thickening of the ligaments resulting in what\nappears to be moderate to severe spinal stenosis on the sagittal images. There\nis moderate narrowing of the foramina. This can be further characterized with\naxial images if clinically indicated.\nAt L5-S1 level mild degenerative change is seen. The distal spinal cord shows\nnormal signal intensity.", "output": "1. Limited study secondary to motion. Axial images could not be obtained as\npatient was unable to continue.\n2. Grade 1 spondylolisthesis of L4 over L5 with moderate to severe spinal\nstenosis and moderate foraminal narrowing. This can be further characterized\nwith axial images on repeat examination with sedation if clinically indicated." }, { "input": "From T11-12 to L4-5 no evidence of disk bulge or disk herniation identified.\n\nAt L5-S1 level previous left-sided hemilaminectomy is identified. There are\nsoft tissue changes on the left side of the spinal canal redemonstrated\nenhancement indicating or epidural scarring. There is no evidence of recurrent\ndisc herniation. Compared to the previous MRI of the enhancement in the\nepidural soft tissue has slightly decreased. There is an incidental conjoin \nnerve root identified on the left side.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "No evidence of recurrent disc herniation seen. Epidural scarring is seen in\nthe left-sided L5-S1 level. No evidence of new disc herniation seen on over\ndisplacement identified." }, { "input": "There are 4 lumbar-type vertebrae and L5 which is partially sacralized on the\nright. The iliolumbar ligament at L5 is only visualized on the left.\n\nThe localizer sequence again demonstrates a levoconvex scoliosis centered at\nL3-4. Minimal retrolisthesis of L3 on L4 is similar to the ___ CT. At L4-5,\nthe present MRI shows a minimal anterolisthesis, but the ___ CT showed a\nminimal retrolisthesis. Vertebral body heights are within normal limits. No\nsuspicious bone marrow signal abnormalities are seen.\n\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating near the T12 lower endplate.\n\nAt T12-L1, there is a minimal disc bulge and minimal facet arthropathy without\nspinal canal or neural foraminal narrowing.\n\nAt L1-2, there is a minimal disc bulge with a tiny left paracentral disc\nprotrusion, and mild bilateral facet arthropathy. There is no spinal canal\nnarrowing. There is mild bilateral neural foraminal narrowing.\n\nAt L2-3, there is a disc bulge, moderate to severe right and mild left facet\narthropathy. The traversing right L3 nerve root is compressed in the\nsubarticular zone, and the traversing left L3 nerve root is abutted in the\nsubarticular zone. The remainder of the spinal canal is mildly narrowed\nwithout crowding of the intrathecal nerve roots. There is severe right neural\nforaminal narrowing with impingement of the exiting right L2 nerve root, and\nmild left neural foraminal narrowing without neural impingement.\n\nAt L3-4, there is a disc bulge and a central disc protrusion, as well as\nsevere right and moderate to severe left facet arthropathy and thickening of\nthe ligamentum flavum. The traversing right L4 nerve root is compressed in the\nsubarticular zone. The traversing left L4 nerve root is partially compressed\nin the subarticular zone. The remainder of the spinal canal is severely\nnarrowed with crowding of the intrathecal nerve roots. There is also severe\nright and moderate to severe left neural foraminal narrowing with compression\nof the exiting right L3 nerve root and impingement of the exiting left L3\nnerve root.\n\nAt L4-5, there is a disc bulge, a central disc protrusion, and severe\nbilateral facet arthropathy, as well as slight thickening of the ligamentum\nflavum. Bilateral traversing L5 nerve roots are compressed in the subarticular\nzones. There is severe spinal canal stenosis with crowding of the intrathecal\nnerve roots. There is also moderate to severe bilateral neural foraminal\nnarrowing with impingement of bilateral exiting L4 nerve roots.\n\nAt L5-S1, there is a minimal disc bulge and moderate left facet arthropathy.\nThe right facet joint is underdeveloped due to partial right-sided\nsacralization of L5. There is no significant spinal canal or neural foraminal\nnarrowing.\n\nThere is a partially visualized exophytic T2 hyperintense lesion arising from\nthe posterior aspect of the right kidney and measuring at least 5.4 cm. It\nmeasured 3.9 cm on the ___ abdominal CT and 2.9 cm on the ___ abdominal CT.\nSmaller T2 hyperintense foci are also noted in the visualized portions of both\nkidneys, not fully characterized, but likely cysts.", "output": "1. L5 is partially sacralized on the right.\n2. Scoliosis and multilevel degenerative disease. Severe spinal stenosis at\nL3-4 and L4-5.\n3. At L4-5, the present MRI demonstrates a mild anterolisthesis, but the ___\nCT demonstrated a mild retrolisthesis, suggesting dynamic instability.\n4. Partially visualized cystic lesion in the posterior aspect of the right\nkidney demonstrates progressive interim enlargement compared to ___ in ___\nabdominal CTs. This could still represent a simple cyst, but is incompletely\nevaluated.\n\nRECOMMENDATION(S):\n\n1. If clinically warranted, flexion/extension lumbar spine radiographs could\nbe considered for further evaluation of suspected dynamic instability at ___. Renal ultrasound should be considered for further evaluation of the left\nrenal cystic lesion.\n\nNOTIFICATION: The recommendation for renal ultrasound above was entered by\nDr. ___ on ___ at approximately 10:45 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." }, { "input": "Thoracic: Mild dextrocurvature of the thoracic spine is noted.\nAt C7-T1, posterior disc bulge causes mild spinal canal narrowing.\nThere is a small right-sided disc protrusion at T3-4 that slightly flattens\nthe right anterior aspect of the spinal cord.\nOtherwise, degenerative changes of the thoracic spine are minimal without\nsignificant spinal canal or neural foraminal narrowing.\n\nLumbar: L5 is partially sacralized on the right. Levoscoliosis of the lumbar\nspine is centered at L4-5 level.\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\nAt L1-L2, evaluation is limited due to technical difficulties in image plane\nselection. Within the limitation, no significant spinal canal or neural\nforaminal narrowing is identified.\nAt L2-3, posterior disc bulge and ligamentum flavum thickening cause mild\nspinal canal narrowing and moderate right and mild left neural foraminal\nnarrowing.\nAt L3-4 and L4-5, posterior disc bulge and ligamentum flavum thickening cause\nsevere spinal canal narrowing and severe right and moderate left neural\nforaminal narrowing. There is crowding of the nerve roots at these levels but\nwith preservation of trace amount of CSF around the nerve roots in the spinal\ncanal.\nAt L5-S1, there is no significant spinal canal or neural foraminal narrowing.\n\n\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm. Vertebral body signal intensity appear\nnormal.\n1.6 cm cyst in the upper pole right kidney and 6.7 cm lobulated cyst in the\nlower pole of left kidney are again noted. Mild edema in the posterior lumbar\nsubcutaneous fat is nonspecific.", "output": "1. Severe degenerative changes of the lumbar spine is identified, including\nsevere spinal canal narrowing and neural foraminal narrowing, right worse than\nleft, at L3-4 and L4-5. Within the limits of suboptimal plane selection,\nfindings of the lumbar spine appear similar compared to ___.\n2. Right L5 partial sacralization.\n3. Minimal degenerative changes of thoracic spine without spinal canal or\nneural foraminal narrowing." }, { "input": "The alignment of the lumbar spine is well maintained. There is no evidence of\ncompression fracture or subluxation. There is disc desiccation at L5-S1\nlevel. There is heterogeneous marrow signal changes related to degenerative\nprocess. There is a stable ovoid focus of hypointense T1 and T2 signal within\nthe superior endplate of L4 vertebral body, with questionable enhancement\n(4:9, 9:7).\n\nThe conus terminates at L1 level. There is no abnormal cord enhancement.\n\nL1-L2 and L2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: There is a broad-based disc bulge with bilateral facet arthropathy and\nligamentum flavum hypertrophy resulting in mild effacement of the thecal sac\nwithout spinal canal stenosis or significant neural foraminal narrowing.\n\nL4-L5: There is a broad-based disc bulge with bilateral facet arthropathy and\nligamentum flavum hypertrophy resulting in mild spinal canal stenosis. There\nis mild left neural foraminal narrowing and no significant right neural\nforaminal narrowing.\n\nL5-S1: There is a central disc protrusion with stable annular tear resulting\nin mild spinal canal stenosis. In conjunction with bilateral facet\narthropathy and ligamentum flavum hypertrophy, there is mild left and no\nsignificant right neural foraminal narrowing.\n\nThere is redemonstration of parapelvic cysts within bilateral kidneys.", "output": "1. Stable ovoid focus within the superior endplate of L4 vertebral body\ndemonstrating hypointense T1 and T2 signal with questionable enhancement. \nThis finding is felt to most likely represent atypical hemangioma. However,\nin the setting of reported multiple myeloma, close attention on follow-up is\nrecommended. Otherwise, no new lesions are identified.\n2. Mild lumbar spine spondylosis, most advanced at L4-L5 and L5-S1 levels as\nabove." }, { "input": "There is a transitional vertebra at the lumbosacral junction with rudimentary\ndisc between S1 and S 2.\n\nPostoperative changes with pedicle screws are identified from L3-S1 level with\nlaminectomy in the lower lumbar region at L4 and L5 level.\n\nFrom T11-12 through L2-3 levels mild degenerative disc disease seen.\n\nFrom L3-4 to L5-S1 levels the spinal canal is patent. Disc degenerative\nchanges are identified.\n\nAt L5-S1 level soft tissue changes are seen within the left side (8:6 and 4:6)\nwhich appear to narrow the left neural foramen (09:37). This area does not\ndemonstrate postcontrast enhancement and likely represent a disc herniation.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Spinal fusion from L3-S1 level.\n2. Likely recurrent disc herniation on the left side at L5-S1 level narrowing\nthe left neural foramen which could affect the exiting left L5 nerve root. \nCorrelation with patient's symptomatology is recommended. Correlation with\nany prior imaging would also be helpful." }, { "input": "3 mm anterolisthesis C4 on C5. 1-2 mm anterolisthesis C7-T1. Anterior fusion\nC5-C6 with hardware in place, and solid fusion across vertebral bodies.. \nMultilevel degenerative changes, disc osteophyte complex C3-C4 through C7-T1\nlevels. Posterior element degenerative changes.\n\nAt C2-C3 level there is mild central canal narrowing. Moderate left, mild\nright foraminal narrowing.\n\nAt C3-C4 level there is broad-based shallow central disc bulge. Severe\ncentral canal narrowing. Cord flattening. Subtle central cord T2 signal\nabnormality. Severe bilateral foraminal narrowing.\n\nAt C4-C5 level there is moderate central canal narrowing, nearly completely\neffaced CSF about cord, minimal cord flattening. Moderate left, severe right\nforaminal narrowing.\n\nAt C5-C6 level there is mild central canal narrowing, preserved CSF about\ncord. Subtle right paramedian cord T2 signal abnormality versus artifact. \nMild-to-moderate bilateral foraminal narrowing.\n\nAt C6-C7 level there is severe central canal narrowing. Cord flattening, cord\nT2 signal abnormality. Contribution to central canal narrowing from posterior\nelement ligamentous thickening or calcification exerting mass effect on the\nleft posterior column. Severe left, moderate right foraminal narrowing.\n\nAt C7-T1 level there is mild-to-moderate central canal narrowing, preserved\nCSF about cord. Moderate bilateral foraminal narrowing.\n\nAt T1-T2 level there is small shallow central disc protrusion,\nmild-to-moderate central canal narrowing, minimal remottling of the ventral\ncord and preserved CSF about cord. Mild to moderate right, severe left\nforaminal narrowing", "output": "1. Advanced degenerative changes cervical spine.\n2. Anterior fusion C5-C6.\n3. Severe central canal narrowing at C3-C4, C6-C7 levels, with cord\nflattening, cord T2 signal abnormality at both levels, more prominent at C6-C7\nlevel.\n4. Multilevel significant foraminal narrowing, as above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:13 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "CERVICAL:\nThere are extensive vertebral metastases. Alignment is normal.the spinal cord\nappears normal in caliber and configuration.There is no evidence of infection.\nNormal craniocervical junction. Heterogeneous enhancement in the vertebral\nbodies after contrast administration is consistent with bone metastatic\ndisease.\n\nThere is mild loss of intervertebral disc height from C4-C7 levels.\n\nC3-C4: Posterior disc bulge and ligamentum flavum thickening causing moderate\nspinal canal narrowing. There is no cord compression. Uncovertebral\nhypertrophy on the left causes moderate to severe left-sided neural foraminal\nnarrowing (series 10, image 18).\n\nC4-C5: Posterior disc bulge and ligamentum flavum thickening causing mild\nspinal canal narrowing. There is bilateral uncovertebral hypertrophy causing\nmoderate bilateral neural foraminal narrowing, there is no evidence of central\nspinal canal stenosis (series 10, image 16).\n\nC5-C6: Posterior disc bulge and ligamentum flavum thickening causing mild\nspinal canal narrowing. No cord compression. No neural foraminal narrowing.\n\nC6-C7: Posterior disc bulge and ligamentum flavum thickening causing moderate\nspinal canal narrowing. There is no cord compression. No neural foraminal\nnarrowing.\n\nTHORACIC:\nThere are extensive vertebral metastases. Alignment is normal. Vertebral body\nand intervertebral disc signal intensity appear normal. The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing. There is no evidence of infection. There\nis no abnormal enhancement after contrast administration. Note is made of\nbilateral pleural effusions, moderate on the right and mild on the left.\n\nLUMBAR:\nThere are extensive vertebral metastases. The spinal cord appears normal in\ncaliber and configuration.There is no evidence of infection .There is\nleptomeningeal enhancement of the lumbosacral cord and conus. This is\nsuspicious for leptomeningeal metastases, however the differential also\nincludes infection and inflammation. The conus medullaris terminates at the\nlevel of L1 and is unremarkable.\n\nThere is loss of intervertebral disc height and hydration from L2-S1 levels.\n\nL1-2: Right paracentral disc bulge causing mild spinal canal and mild right\nneural foramina narrowing.\n\nL2-L3: Diffuse disc bulge not causing significant spinal canal narrowing. \nMild bilateral neural foraminal narrowing.\n\nL3-L4: Diffuse disc bulge not causing significant spinal canal narrowing. \nMild bilateral neural foraminal narrowing.\n\nL4-L5: Diffuse disc bulge causing mild spinal canal narrowing. Mild bilateral\nneural foraminal narrowing.\n\nL5-S1: Mild loss of disc height, no spinal canal or neural foraminal\nnarrowing.\n\nNote is made of left-sided simple renal cysts.", "output": "1. Extensive vertebral metastases.\n2. No evidence of cord compression.\n3. There is leptomeningeal enhancement of the lumbosacral cord and conus.\nThis is suspicious for leptomeningeal metastases, however the differential\nalso includes infection and inflammation.\n4. Mild moderate spondylosis of the cervical, and lumbosacral spine, as\ndescribed.\n5. Bilateral pleural effusions, moderate on the right and mild on the left\nside." }, { "input": "THORACIC:\nThe thoracic vertebral body heights are grossly maintained. Sagittal spinal\nalignment is maintained. There is no suspicious bone marrow signal identified.\n\nThere is no evidence for appreciable canal stenosis or neural foraminal\nnarrowing within the thoracic spine.\n\n\nLUMBAR:\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation. There is no concerning focal\nbone marrow signal abnormality. The conus medullaris terminates at the level\nof L1.\n\nMinimal disc bulging is seen at L1-L2 without definite canal or neural\nforaminal narrowing. There is no appreciable spinal canal or neural foraminal\nnarrowing.\n\nThere is no evidence for abnormal intramedullary, leptomeningeal, or epidural\nenhancement. The visualized spinal cord is normal in morphology and signal\nintensity.", "output": "1. Essentially normal contrast enhanced MRI of the thoracic and lumbar spine. \nSpecifically, no abnormal enhancement or cord signal. No significant canal or\nneural foraminal narrowing." }, { "input": "Axial T2 gradient echo sequences are mildly to moderately motion degraded,\ndespite repeat acquisition.\n\nThere is mild degenerative spondylolisthesis at C4-5, C5-6, and C6-7. There\nis mild loss of vertebral body height at C5 and C6, likely secondary to\ndegenerative disc disease. There is degenerative endplate change throughout\nthe cervical spine, most severe at the C3-6 levels.\n\nThe cervical spinal cord appears normal in morphology and signal intensity.\n\nAt C2-3, uncovertebral and facet joint osteophytes result in mild left neural\nforaminal narrowing. There is no right neural foraminal or spinal canal\nnarrowing.\n\nAt C3-4, there is mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint osteophytes result in\nmoderate bilateral neural foraminal narrowing.\n\nAt C4-5, there is mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint osteophytes result in\nmoderate right and severe left neural foraminal narrowing.\n\nAt C5-6, there moderate spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint osteophytes result in\nsevere right and moderate left neural foraminal narrowing.\n\nAt C6-7, there is mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint osteophytes result in\nmoderate bilateral neural foraminal narrowing.\n\nAt C7-T1, there is mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint osteophytes result in mild\nbilateral neural foraminal narrowing.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.", "output": "Axial T2 and gradient echo sequences are mildly to moderately motion degraded\ndespite repeat acquisition. Within this confines:\n\n1. No acute malalignment or findings to suggest ligamentous injury.\n2. Cervical degenerative disc disease as detailed above, with moderate spinal\ncanal narrowing and severe right neural foraminal narrowing at C5-C6.\n3. Additional findings as described above." }, { "input": "The dissection of the distal thoracic and upper abdominal aorta is partially\nvisualized and grossly unchanged. The alignment of the thoracic spine is\nnormal. The bone marrow is heterogeneous, likely related to degenerative\nendplate changes. The spinal cord is normal in signal and caliber. The\nheight of the vertebral bodies are maintained. A Schmorl's node involves the\nsuperior endplate of T5, unchanged from the prior examination. The\nintervertebral discs are diffusely desiccated.\n\nAt T1-T2, there is a left central disc protrusion without spinal canal or\nneural foraminal stenosis.\n\nAt T2-T3, there is symmetric disc bulge without spinal canal or neural\nforaminal stenosis.\n\nAt T3-T4, there is no spinal canal or neural foraminal stenosis.\n\nAt T4-T5, there is central disc bulge without spinal canal or neural foraminal\nstenosis.\n\nAt T5-T6 and T6-T7, there is no spinal canal or neural foraminal stenosis. \nThere is a small right T5-T6 3 mm neural foraminal perineural cyst.\n\nAt T7-T8 and T8-T9, there is symmetric disc bulge without spinal canal or\nneural foraminal stenosis.\n\nAt T9-T10 and T10-T11, there is no spinal canal or neural foraminal stenosis.\n\nAt T11-T12 and T12-T11, there is disc bulge without spinal canal or neural\nforaminal stenosis.\n\nA large exophytic cyst in the upper pole of the right kidney is partially\nvisualized. A 0.5 cm T2 hypointense lesion in the right interpolar kidney on\n7:1 is unchanged in size in comparison to the CTA torso ___ and was\nT1 hyperintense on the MRA abdomen ___, likely representing a\nhemorrhagic or proteinaceous cyst.", "output": "1. Multilevel degenerative changes of the thoracic spine without spinal canal\nor neural foraminal stenosis.\n\n2. Unchanged dissection of the distal descending thoracic and upper abdominal\naorta." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThe vertebral body height, alignment, and marrow signal within the lumbar\nspine are normal.\n\nThe conus medullaris is normal in signal and morphology in terminates at the\nL1-L2 level.\n\nThere is a soft tissue density within the left T11-T12 neural foramen, with\nassociated expansion of the neural foramen, the appearance of which is\nconcerning for a peripheral nerve sheath tumor such as schwannoma or neural\nfor coronal. Central T2 hypointensity suggests the appearance of a schwannoma.\nDedicated thoracic spine MRI with and without contrast is recommended.\n\nAt the L2-L3 level, the spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, the spinal canal and neural foramina appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge, and right foraminal disc protrusion with\nannular fissure which causes minimal spinal canal narrowing and severe right\nneural foraminal narrowing with compression of the exiting right L4 nerve\nroot.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, diffuse disc bulge,\nintervertebral osteophytes, and disc protrusion causing mild spinal canal\nnarrowing and mild to moderate bilateral neural foraminal narrowing, possibly\ncontacting the exiting bilateral L5 nerve roots.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. The right\nkidney is atrophic.", "output": "1. Abnormal soft tissue mass within the left T11-T12 neural foramen, with\nassociated expansion of the neural foramen, which could represent peripheral\nnerve sheath tumor and is felt to most likely represent a schwannoma, as\ndescribed above. Recommend clinical correlation, and dedicated thoracic spine\nMRI with and without contrast.\n2. Multilevel lumbar spondylosis as described, including disc protrusion at\nthe L4-L5 which causes severe right neural foraminal narrowing and compression\nthe exiting right L4 nerve root.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr.\n___ by telephone on ___ at 9:10 AM, minutes after discovery of the\nfindings." }, { "input": "Thoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Previously described hemangiomas are\nunchanged. Disc height and signal are preserved. There is no abnormal cord\nsignal or enhancement. The conus medullaris terminates at the L1-L2 vertebral\nlevel, within expected limits.\n\nThe patient is status post T11 bilateral laminectomy and left facetectomy for\nresection of the T11-T12 mass with neural foraminal extension. When compared\nto the prior exam, there is interval decrease size of a postoperative seroma\nwithin the resection bed, now measuring approximately 2.1 x 1.5 x 1.5 cm (AP,\nTRV, SI). There is now enhancing granulation tissue within the resection site\nwith extension along the left epidural space and left neural foramina. There\nis no significant spinal canal narrowing secondary to the granulation tissue. \nNo evidence of nodular enhancement to suggest disease recurrence.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: The right kidney is atrophic with compensatory hypertrophy of the left\nkidney. Allowing for postsurgical changes, there remainder the prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. Interval decrease size of a postoperative seroma within the T11-T12\nlaminectomy and resection site. There is interval development of enhancing\ngranulation tissue along the dorsal and lateral epidural space with extension\ninto the left T11-T12 neural foramina.\n2. No significant spinal canal or neural foraminal narrowing.\n3. No definitive nodular masslike enhancement to suggest recurrent disease. \nClose attention on followup is recommended." }, { "input": "Thoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Osseous T10 and L1 hemangiomas are noted. \nDisc height and signal are maintained. There is no cord signal abnormality. \nThe conus medullaris terminates at the L1-L2 level, within expected limits.\n\nThe patient is status post T11 bilateral laminectomy and left facetectomy for\nresection of a T11-T12 mass with left neural foraminal extension. There is a\nnonenhanced postoperative 2.7 x 1.4 x 2.8 cm (TRV, AP, SI) seroma in the\nresection bed, exerting minimal mass effect on the posterior left lateral\naspect of the thecal sac resulting in mild spinal canal narrowing. There is\nno compression of the cord. The degree of ventral epidural enhancement\nadjacent to the T11 and T12 posterior vertebral bodies seen on the\npreoperative MRI is less conspicuous (series 11, image 10). No nodular\nenhancement to suggest residual lesion.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nThere are bibasilar small pleural effusions with associated compressive\natelectasis. The right kidney is atrophic with compensatory hypertrophy of\nthe left kidney, unchanged from prior exam.", "output": "1. The patient is status post T11 bilateral laminectomy and left facetectomy\nand resection of a left T11-T12 mass with left neural foraminal extension. No\nnodular enhancement to suggest residual lesion.\n\n2. Nonenhancing postoperative 2.8 cm seroma is noted, minimally effacing the\nposterior aspect of thecal sac. Interval improvement in degree of anterior\nepidural thickening and enhancement adjacent to the T11 and T12 vertebral\nbodies." }, { "input": "The patient is status dose post resection of neoplasm in the left neural\nforamen at T11-12 level. Postoperative changes are identified. Laminectomy\nis seen at this level. There are soft tissue changes on the left side of the\nthecal sac extending to neural foramen which demonstrate enhancement following\ngadolinium administration indicative of epidural scarring. The previously\nseen nodular area of enhancement is no longer visible. There is no\ncompression of the thecal sac seen. No spinal cord compression identified. \nNo other areas of abnormal enhancement seen. Subtle signal abnormalities\nwithin the adjacent vertebral bodies are again identified.\n\nThe remaining vertebral bodies and discs in the thoracic region are normal in\nappearance. There is no spinal cord compression or intrinsic spinal cord\nsignal abnormalities.", "output": "Postoperative changes seen at T11-12 level. Enhancing soft tissues are\nidentified which may be postoperative change. No nodular area of enhancement\nseen. Followup as clinically indicated." }, { "input": "Study is severely degraded by motion. Within these confines:\n\nCERVICAL:\n\nAlignment is anatomic. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nAt the C2-C3 level, there is no disc herniation, spinal canal stenosis or\nneural foraminal narrowing.\n\nAt the C3-C4 level, there is mild disc bulge with no significant spinal canal\nstenosis. There is no neural foraminal narrowing.\n\nAt the C4-C5 level, there is minimal disc bulge with no significant spinal\ncanal stenosis. There is no neural foraminal narrowing.\n\nAt the C5-C6 level, there is right central disc protrusion causing mild spinal\ncanal stenosis. There is effacement of the right subarticular recess and at\nleast mild right neural foraminal narrowing. There is no left neural\nforaminal narrowing.\n\nAt the C6-C7 level, there is left central disc protrusion causing mild spinal\ncanal stenosis. There is effacement of the subarticular recess on the left\nand at least mild left neural foraminal narrowing. There is no right neural\nforaminal narrowing.\n\nAt the C7-T1 level, there is no spinal canal stenosis. There is no neural\nforaminal narrowing.\n\nTHORACIC:\n\nLimited examination secondary to patient motion artifact, particularly the\naxial post contrast sequences. Within these confines:\n\nAlignment is anatomic. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration. There is no spinal canal\nstenosis or neural foraminal narrowing.\n\nLUMBAR:\n\nSeverely limited examination secondary to patient motion artifact,\nparticularly the axial and sagittal postcontrast sequences.\nWithin these confines:\n\nAlignment is anatomic. Vertebral body and intervertebral disc signal\nintensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no abnormal enhancement after contrast administration.\nThe SI joints are unremarkable. The visualized portions of the\nretroperitoneum and the paraspinal musculature are grossly unremarkable.\n\nAt the L1-L2 level, there is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nAt the L2-L3 level, there is minimal disc bulge and thickening of the\nligamentum flavum. There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nAt the L3-L4 level, there is thickening of the ligamentum flavum and mild\nfacet hypertrophy. There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nAt the L4-L5 level, there is mild facet hypertrophy resulting in mild\nbilateral neural foraminal narrowing. There is no spinal canal stenosis.\n\nAt the L5-S1 level, there is minimal disc bulge with no significant spinal\ncanal stenosis or neural foraminal narrowing.\n\nOTHER: There are probable small bilateral pleural effusions with associated\natelectasis. Incidentally noted is a 3.1 x 1.2 cm lipoma within the\nsubcutaneous tissues of the lower back. Visualized portions of the urinary\nbladder appear moderately distended.", "output": "1. Study severely degraded by motion.\n2. Within limits of study, no definite evidence of metastatic disease within\nthe cervical, thoracic or lumbar spine. If continued concern for metastatic\ndisease, consider repeat study when patient can tolerate exam.\n3. Multilevel degenerative changes involving the cervical spine, most severe\nat C5-C6 and C6-C7 with mild spinal canal stenosis at these levels.\n4. Mild multilevel degenerative changes involving the lumbar spine.\n5. Probable bilateral small pleural effusions with associated atelectasis." }, { "input": "Mild 2 mm anterolisthesis of C5 on C6 is unchanged from prior examination. \nThe remainder of the cervical alignment is anatomic. Vertebral body heights\nare preserved. Vertebral body and intervertebral disk signal intensity are\nunremarkable. The visualized portion of the spinal cord appears normal. There\nis no evidence of infection or neoplasm. There is no abnormal enhancement\nafter contrast administration. Visualized prevertebral and paraspinal soft\ntissues are unremarkable.\n\nAt C2-3, there is no spinal canal or neural foraminal stenosis.\nAt C3-4, there is an mild disc protrusion without significant spinal canal\nstenosis. No significant neural foraminal stenosis.\nAt C4-5, there is a mild central disc protrusion without significant spinal\ncanal stenosis. No evidence of neural foraminal stenosis.\nAt C5-6, there is a right central disc protrusion causing mild spinal canal\nstenosis, remodeling the right ventral aspect of the cord. No evidence of\nneural foraminal stenosis.\nAt C6-7, there is a left central disc protrusion and intervertebral\nosteophytes causing mild spinal canal stenosis. Uncovertebral and facet\narthropathy results in mild to moderate left neural foraminal narrowing. No\nevidence of neural foraminal stenosis on the right.\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.", "output": "1. No evidence of abnormal enhancement within the cervical spine to suggest\nmetastatic disease.\n2. Multilevel degenerative change is with mild spinal canal stenosis at C5-6,\nand C6-7." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nThere is levoscoliosis of the lumbar spine with the apex at L2. There is\nstable grade 1 anterolisthesis of L2-L3 by 2 mm, L3-L4 by 1 mm, L4-L5 by 5 mm,\nand L5-S1 by 3 mm. There are ___ type 1 changes at L1-L2 and L2-L3 without\ndefinite associated epidural collection, and ___ type 2 changes at the\nremaining levels. There is interval progression of endplate irregularity at\nL1-L2 and L2-L3 levels with increase in hypointense T1 marrow signal at these\nlevels. There is multilevel loss of intervertebral disc height and disc\ndesiccation related to degenerative process. The conus terminates at L2\nlevel.\n\nT12-L1: There is no spinal canal stenosis or neural foraminal stenosis. \nThere is bilateral facet osteophytes and ligamentum flavum thickening.\n\nL1-L2: There is a disc bulge with interval increase in ligamentum flavum\nthickening resulting in progression of moderate spinal canal stenosis. \nCombined with bilateral facet osteophytes, there is slight progression of\nsevere right neural foraminal stenosis compressing the exiting nerve root, and\nmoderate left neural foraminal stenosis.\n\nL2-L3: There is a disc bulge with bilateral ligamentum flavum thickening\nresulting in minimal increase in severe spinal canal stenosis with deformity\nof the thecal sac again seen. Combined with bilateral endplate and facet\nosteophytes, there is stable severe left neural foraminal stenosis with\ncompression of the exiting nerve roots, and moderate right neural foraminal\nstenosis.\n\nL3-L4: There is a disc bulge with bilateral ligamentum flavum thickening,\nresulting in stable moderate spinal canal stenosis with deformity of the\nthecal sac again seen. Combined with bilateral facet and endplate\nosteophytes, there is stable severe right with compression of the exiting\nnerve root and moderate left neural foraminal stenosis.\n\nL4-L5: There is a disc bulge with bilateral ligamentum flavum thickening,\nresulting in stable severe of spinal canal stenosis with compression of the\nthecal sac and near complete effacement of the CSF. Combined with facet\nosteophytes, there is stable mild right and severe left neural foraminal\nstenosis with compression of the exiting nerve root.\n\nL5-S1: There is a disc bulge with bilateral ligamentum flavum thickening\nresulting in slight interval progression of severe spinal canal stenosis with\nnear complete effacement of the CSF signal and compression of the thecal sac. \nCombined with bilateral osteophytes, there is slight interval progression of\nsevere left neural foraminal stenosis with compression of the exiting nerve\nroots and mild-to-moderate right neural foraminal stenosis.\n\nAgain seen are multiple bilateral T2 hyperintense cystic structures within\nbilateral kidneys, with stable appearance of a thin internal septation within\nthe upper pole of the right kidney, which may represent two adjacent cysts. \nThere is atrophy of the posterior paraspinal musculature. Limited imaging of\nthe bladder on scout imaging suggests a distended bladder (see 1c: 6).", "output": "1. Levoscoliosis and stable spondylolisthesis with increase in degenerative\nmarrow signal changes at L1-L2 and L2-L3.\n2. Multilevel degenerative changes of the lumbar spine, with slight interval\nprogression of multilevel severe spinal canal and neural foraminal stenosis,\nas detailed above.\n3. Limited imaging of the bladder on scout imaging suggests a distended\nbladder." }, { "input": "CERVICAL: Mild retrolisthesis is seen involving C3 on C4, C4 on C5, and C5 on\nC6. The alignment is otherwise unremarkable. The bone marrow is\nheterogeneous, consistent with patient's known metastatic prostate cancer. No\ncord signal abnormalities are identified. Diffuse degenerative disc\ndesiccation is seen throughout the cervical spine.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3-C4: Central disc bulge with a central disc protrusion results in\nmild-to-moderate spinal canal narrowing. Uncovertebral and facet joint\narthropathy contributes to severe left and moderate right neural foraminal\nnarrowing.\n\nC4-C5: Central disc protrusion contributes to mild-to-moderate spinal canal\nnarrowing. Uncovertebral and facet joint arthropathy contributes to severe\nleft and moderate right neural foraminal narrowing.\n\nC5-C6: All broad-based disc bulge, with a central disc protrusion is seen\nresulting in mild canal narrowing. Facet joint and uncovertebral arthropathy\ncontributes to severe bilateral neural foraminal narrowing, right greater than\nleft.\n\nC6-C7: Left central disc bulge is seen, resulting in mild-to-moderate canal\nnarrowing. Facet joint and uncovertebral arthropathy contributes to severe\nleft and moderate right neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nNo other paraspinal or paravertebral soft tissue abnormalities are identified.\n\nTHORACIC: The alignment is normal. Re demonstrated is heterogeneity and\nenhancement of the bone marrow consistent with diffuse prostate cancer\nmetastases. The cord signal is normal. Diffuse disc degenerative disease is\nseen throughout the thoracic spine.\n\nNo significant spinal canal or neural foraminal narrowing is seen throughout\nthe thoracic spine. No paraspinal or paravertebral soft tissue abnormalities\nare identified.\n\nLUMBAR:\n\nThe alignment is normal. Diffuse heterogeneity and enhancement of the bone\nmarrow is consistent with diffuse prostate cancer metastases. No cord signal\nabnormalities are identified, with the conus terminating at L1.\n\nL1-L2: There is no significant spinal canal or neural foraminal narrowing.\n\nL2-L3: There is no significant spinal canal or neural foraminal narrowing.\n\nL3-L4: Central broad-based disc bulge is seen resulting in bilateral\nsubarticular zone narrowing. Facet joint osteophytes and ligamentum flavum\nhypertrophy contributes to mild canal narrowing at this level. Mild bilateral\nneural foraminal narrowing is seen.\n\nL4-L5: Central disc bulge is seen, resulting in mild canal narrowing facet\njoint osteophytes and ligamentum flavum hypertrophy is seen, contributing to\nbilateral subarticular zone narrowing. Mild left neural foraminal narrowing\nis seen. The right neural foramen appears to be patent.\n\nL5-S1: Central disc bulge is seen, however there is no significant spinal\ncanal or neural foraminal narrowing.\n\nNo other paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Diffuse heterogeneity enhancement of the bone marrow is consistent with\ndiffuse prostate cancer metastases throughout the spine.\n2. No cord signal abnormalities identified. No cord compression.\n3. Cervical spondylosis, most pronounced at C4-C5 and C5-C6.\n4. Lumbar spondylosis, most pronounced at L3-L4 and L4-L5." }, { "input": "Again seen is diffuse heterogeneity of the visualized osseous structures, with\npredominantly T1 hypointense component, with diffuse areas of patchy T2\nhyperintensity and enhancement, compatible with known diffuse osseous\nmetastatic disease. The alignment and the vertebral body heights are\npreserved. There is no evidence of fracture. Schmorl's nodes are seen at\nmultiple levels. There is no definite associated pathologic fracture or\nextra cortical soft tissue extension. There is no prevertebral soft tissue\nedema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nThe visualized distal spinal cord is preserved in signal and caliber. There\nis no epidural collection or other areas of abnormal postcontrast enhancement.\n\nAt T12-L1, L1-L2, and L2-L3, there is no significant spinal canal or neural\nforaminal narrowing.\n\nAt L3-L4, mild disc bulge and facet osteophytes mildly narrow the spinal\ncanal. There is effacement of the subarticular zones without traversing nerve\nroot impingement. Facet and endplate osteophytes produce mild bilateral\nneural foraminal narrowing.\n\nAt L4-L5, disc bulge and facet osteophytes mildly narrow the spinal canal. \nThere is effacement of the subarticular zones with contact of the traversing\nnerve roots without compression. Facet and endplate osteophytes produce mild\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is trace disc bulge without significant spinal canal\nnarrowing. The neural foramina are patent.\n\nThere is prominence of the epidural fat seen at the L4-L5 and L5-S1 levels.\n\nModerate facet degenerative changes are seen at multiple levels. Areas of\ninterspinous edema are noted diffusely throughout the lumbar spine, with areas\nof adjacent paraspinal muscular edema, which may be related to strain.\n\nDegenerative changes appears similar to the ___ examination.\n\nThere is diffuse heterogeneity of the bone marrow with patchy areas of\nenhancement within the visualized sacrum and pelvis, consistent with osseous\nmetastatic disease. The visualized retroperitoneum is grossly unremarkable.", "output": "1. Re-demonstration of diffuse osseous metastatic disease without pathologic\nfracture or definite extra cortical soft tissue extension.\n2. Diffuse areas of interspinous edema and mild adjacent paraspinal muscular\nedema, which may be related to strain.\n3. Multilevel lumbar spondylosis, as described, similar to ___\nexamination, with most notable findings including mild spinal canal narrowing\nat L3-L4 and L4-L5, and mild neural foraminal narrowing at multiple levels. \nNo high-grade spinal canal or neural foraminal narrowing.\n4. Patchy areas of enhancement throughout the vertebral bodies, sacrum and\npelvis, consistent with osseus metastatic disease." }, { "input": "Images are substantial limited by motion artifact.\n\nThere are 7 cervical, 13 rib-bearing, and 5 lumbar-type vertebrae, as seen on\nprior studies. L5 is partially sacralized the numbering is documented on\nimages 6:7, 12:12.\n\nAll of the visualized bones are diffusely infiltrated by metastases, as seen\npreviously.\n\nCERVICAL:\nThere is no significant change in vertebral body heights compared to ___. There is mild retrolisthesis of C3 on C4, C4 on C5, and C6 on C7,\nunchanged. Postcontrast axial T1 weighted images through the cervical spine\nare nondiagnostic due to insufficient signal to noise ratio, in addition to\nmotion artifact. There is otherwise no evidence for epidural metastatic\ndisease. Evaluation of spinal cord signal is limited by motion artifacts on\nsagittal and axial T2 weighted images. No abnormal intrathecal contrast\nenhancement is seen on postcontrast sagittal T1 weighted images. The\ncerebellar tonsils are normally positioned, and the visualized portion of the\nposterior fossa appears unremarkable.\n\nEvaluation of multilevel degenerative disease is limited by extensive motion\nartifact. Mild retrolisthesis, disc protrusions, and endplate osteophytes\nindent the ventral thecal sac from C3-C4 through C6-C7 with mild to moderate\nspinal canal narrowing, not significantly changed compared to ___. \nThe neural foramina are not well assessed.\n\nTHORACIC:\nSmall depressions in superior endplates of T4, T6, T11, and T12 vertebral\nbodies are new since the ___ total spine MRI, without significant\nloss of vertebral body height. T13 superior endplate deformity is new\ncompared to the ___ lumbar spine MRI. A mildly expansile lesion in\nthe lower posterior aspect of the T4 vertebral body (15:20) and a mildly\nexpansile lesion in the lower posterior aspect of the T6 vertebral body\n(15:27) minimally indent the left ventral thecal sac without significant\nspinal canal narrowing, similar to the ___ chest CT. An erosive\nlesion in the central posterior aspect of the T5 vertebral body minimally\nindents the ventral thecal sac, image 6:7, also unchanged since the prior CT. \nTiny bilateral anterior epidural lesions at T7 and T8 are also unchanged since\nthe prior CT, images 6:9, 15:32 15:37. Similarly, tiny bilateral anterior\nepidural lesions at T10 (images 12:11, 12:13, 16:15), and at T11 in the\nmidline (16:11, 12:12) are unchanged since the prior CT. Overall there is\nonly mild spinal canal narrowing in the thoracic spine, without mass effect on\nthe spinal cord. No definite cord signal abnormalities are seen allowing for\nmotion artifact.\n\nLUMBAR:\nMild L1 superior endplate deformity is unchanged compared to the ___\nlumbar spine MRI. There is no significant loss of vertebral body height. \nAlignment is preserved. There is no compression of the conus medullaris,\nwhich terminates at L1, or the intrathecal nerve roots. Multilevel\ndegenerative disease is not well assessed due to motion artifact, but does not\nappear significantly changed compared to the ___ MRI. Mild spinal\ncanal narrowing is again seen at L3-L4. Subarticular zone narrowing is again\nseen at L3-L4 and L4-L5. Neural foraminal narrowing is again seen at L3-L4\nand L4-L5.\n\nOTHER:\n\nBilateral posterior rib metastases with subpleural components are again\npartially visualized.", "output": "1. Substantially motion limited exam.\n2. 7 cervical, 13 rib-bearing, and 5 lumbar-type vertebrae with partial\nsacralization of L5 are again demonstrated.\n3. All of the visualized bones are diffusely infiltrated by metastases, as\nseen previously. Small depressions in superior endplates of T4, T6, T11, and\nT12 vertebral bodies are new since ___. Small depression in the T13\nsuperior endplate is new since ___. No significant loss of vertebral\nbody height in the cervical, thoracic, or lumbar spine.\n4. No compression of the spinal cord or cauda equina nerve roots.\n5. Multiple tiny foci of anterior epidural extension of osseous metastases in\nthe thoracic spine are similar to the ___ chest CT. There is no\nassociated mass effect on the spinal cord.\n6. Multilevel degenerative disease is not well assessed due to extensive\nmotion artifact, but does not appear significantly changed compared to prior\nstudies.\n7. Bilateral posterior rib metastases with subpleural components are again\npartially visualized." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Degenerative loss of disc height is mild at\nC4-C5 and C5-C6. The visualized posterior fossa is unremarkable. There is no\nabnormal signal or enhancement of the cord.\n\nC2-C3 and C3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: A small central protrusion does not narrow the spinal canal. \nUncovertebral and facet arthropathy results in mild left neural foraminal\nnarrowing.\n\nC5-C6: A small central protrusion does not narrow the spinal canal. Mild\nuncovertebral and facet arthropathy without significant neural foraminal\nnarrowing.\n\nC6-C7: No significant spinal canal or neural foraminal narrowing. There is a\nleft 6 mm perineural cyst.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing. Bilateral\nperineural cysts are identified measuring up to 6-7 mm.\n\nA T2 hyperintense nodule arising from the superior right lobe of the thyroid\nis identified measuring approximately 1.5 cm in SI dimension. The remainder\nof the visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Minimal cervical spondylosis without evidence of significant spinal canal\nor neural foraminal narrowing.\n2. There is no evidence of abnormal signal or enhancement of the cord.\n3. A 1.5 cm right lobe thyroid nodule.\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 long segment anterior epidural enhancement (left greater than right)\nextending from the skull base to the level of C4. Vertebral body alignment is\npreserved. Vertebral body heights are preserved. A 1.1 cm T1 hypointense/STIR\nhyperintense lesion within the T3 vertebral body may demonstrate subtle\npostcontrast enhancement.\n\nIntervertebral disc heightsare preserved. Diffusely reduced T2 signal within\nthe intervertebral discs is likely on a degenerative basis.\n\nThere is no prevertebral soft tissue swelling..\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is a large central disc protrusion (0.7 cm AP x 0.8 cm TV x 1.0\ncm SI) resulting in posterior displacement and ventral indentation/flattening\nof the cord without evidence of abnormal cord signal.\n\nAt C4-5 there are uncovertebral osteophytes resulting in moderate right and\nmoderate to severe left neural foraminal narrowing.\n\nAt C5-6 there is mild disc bulging and uncovertebral osteophytes resulting in\nmild flattening/remodeling of the right anterolateral aspect of the cord\nwithout evidence of abnormal cord signal. There is severe right and mild left\nneural foraminal narrowing.\n\nAt C6-7 there are uncovertebral osteophytes resulting in mild bilateral neural\nforaminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nOther: A 0.4 x 1.3 cm nonenhancing T1 hypointense, T2 intermediate and STIR\nhyperintense subcutaneous lesion of the lower posterior neck (4:7) is favored\nto represent a sebaceous cyst. The limited portions of the included brain\nplease refer to the dedicated report of the MRI brain study performed 1 day\nprior. Redemonstrated is a small 0.7 cm Tornwaldt cyst. A 0.9 cm mucous\nretention cyst is present within the sphenoid sinus. Partially visualized\nwithin the scout views is a large right upper lobe mass (better characterized\non the recent CT chest study).", "output": "1. Redemonstrated long segment epidural thickening/enhancement extending from\nthe skull base to the level of C4 is suspicious for metastatic disease.\n2. For the limited portions of the included brain please refer to the\ndedicated report of the MRI brain study performed 1 day prior.\n3. A 1.1 cm T1 hypointense/stir hyperintense lesion within the T3 vertebral\nbody may demonstrate subtle postcontrast enhancement with the differential\nincluding osseous metastatic disease versus an atypical hemangioma. Consider\nfurther evaluation with a CT thoracic spine.\n4. Degenerative changes of the cervical spine most significant at C3-C4 where\na large central disc protrusion results in posterior displacement and ventral\nindentation/flattening of the cord without evidence of abnormal cord signal." }, { "input": "Alignment is similar to prior with mild, 3 mm, anterolisthesis of L4 on L5.\n\nThere has been interval progression of the patient's multiple myeloma when\ncompared to the ___ MRI of the lumbar spine. Overall, the bone marrow\nsignal is ddiffusely decreased on T1 weighted images. More focal abnormal\nincreased T2 and decreased T1 signal representing myelomatous involvement is\nmost severe in the sacral ala bilaterally and within the iliac bones. This\ninvolvement is partially visualized on this lumbar spine MRI.\n\nMore focal myelomatous involvement of the lumbar vertebral bodies has also\nincreased compared to ___. Abnormal signal with T11 is partially\nvisualized. T12 also has abnormal signal but maintains normal vertebral body\nheight. The involvement of T12 extends into the left pedicle. This has\nprogressed slightly compared to ___. Abnormal signal compatible with\nmyeloma is also evident within the inferior aspect of the L1 vertebral body,\ndiffusely within the vertebral body of L3, and less diffusely within L5.\n\nDeformity of the superior endplate of L3 is similar to ___ and likely\nrepresents an underlying Schmorl's node. In addition, a round focus of\nincreased T2 and decreased T1 signal within the L4 vertebral body is similar\nto ___ and may represent an atypical hemangioma.\n\nUnderlying degenerative changes are similar to the prior examination. The\nconus medullaris is at the level of the T12/L1 intervertebral disc space and\nhas normal contour and signal. There is no apparent intradural extension of\ntumor, though evaluation is limitedwithout contrast.\n\nAt L3/L4, ligamentous buckling and a left-sided disc protrusion crowd the\ncauda equina and mildly narrow the left neuroforamen.\n\nAt L4/L5, there is minimal, 3 mm, anterolisthesis and ligamentous buckling\nwhich causes moderate spinal canal and mild bilateral foraminal narrowing.\n\nAt L5/S1, moderate bilateral facet arthropathy mildly narrows the bilateral\nneural foramina.", "output": "Interval progression of multiple myeloma, particularly within the\nsacrum and ilium, when compared to ___." }, { "input": "Vertebral body heights are preserved. There is straightening of cervical\nlordosis. There is mild retrolisthesis of C4 on C5 and of C5 on C6. Mild\nloss of vertebral body height at C5 and C6 is likely age related. No\nsuspicious marrow signal abnormality is seen allowing for discogenic bone\nmarrow changes in the endplates.\n\nVolume loss is noted in the partially visualized cerebellum. There is\npartially visualized asymmetric fluid signal intensity structure medial to the\nleft cerebellar hemisphere, which may represent asymmetric cisternal\nenlargement versus an arachnoid cyst. Multiple linear areas of high signal\nover the right greater than left cerebellar hemispheres on axial postcontrast\nT1 weighted images are likely artifactual, as they are not seen on the\nsagittal postcontrast T1 weighted images.\n\nThe craniocervical junction and C1-C2 levels appear unremarkable.\n\nC2-C3: Small left paracentral disc protrusion without spinal canal narrowing. \nMild right neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC3-C4: Broad-based central disc protrusion with endplate osteophytes approach\nbut do not definitively remodel the spinal cord. Mild spinal canal narrowing.\nSevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC4-C5: There are broad-based posterior endplate osteophytes and a left\nparacentral disc protrusion, the latter minimally remodeling the left ventral\nspinal cord. There is mild to moderate spinal canal narrowing. There is\nmoderate right and severe left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Broad-based posterior endplate osteophytes and thickening of the\nligamentum flavum cause severe spinal canal narrowing. There is also severe\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Broad-based posterior endplate osteophytes minimally indent the ventral\nthecal sac without significant spinal canal narrowing. There is severe right\nand moderate to severe left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nSagittal images through the T2-T3 level demonstrate a shallow left paracentral\ndisc herniation extending slightly above the disc space, without evidence for\nsignificant spinal canal narrowing. There are no axial images through this\nlevel.\n\nThere is T2 hyperintensity in the cord from C5-C6 through C6-C7 levels with\nassociated volume loss. On axial images, this is distributed posteriorly in\nthe midline and just to the right of midline. There is no pathologic contrast\nenhancement in the spinal cord.\n\nVolume loss is noted in the partially visualized cerebellum. There is\npartially visualized asymmetric fluid signal intensity structure medial to the\nleft cerebellar hemisphere, which may represent asymmetric cisternal\nenlargement versus an arachnoid cyst. Multiple linear areas of high signal\nover the right greater than left cerebellar hemispheres on axial postcontrast\nT1 weighted images are likely artifactual, as they are not seen on the\nsagittal postcontrast T1 weighted images.\n\nMultiple nodules are seen in the right thyroid lobe, measuring up to 9 mm on\nimages 3:32 and 5:11. The thyroid gland was last assessed by ultrasound on ___.", "output": "1. Multilevel cervical degenerative disease. Spinal canal stenosis is severe\nat C5-C6, with associated nonenhancing T2 hyperintensity and volume loss in\nthe spinal cord from C5-C6 through C6-C7 consistent with myelomalacia.\n2. Partially visualized asymmetric fluid signal intensity structure medial to\nthe left cerebellar hemisphere, which may represent asymmetric cisternal\nenlargement in the setting of partially visualized cerebellar volume loss,\nversus an arachnoid cyst. Multiple linear areas of high signal over the right\ngreater than left cerebellar hemispheres on axial postcontrast T1 weighted\nimages are likely artifactual, as they are not seen on the sagittal\npostcontrast T1 weighted images. These findings may be better assessed with a\ndedicated brain MRI.\n3. Thyroid nodules measuring up to 9 mm.\n\nRECOMMENDATION(S):\n1. Consider brain MRI with and without contrast, if not previously performed\nelsewhere.\n2. Please refer to the ___ thyroid ultrasound report regarding\nmanagement recommendations.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 17:27 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Metal artifact and patient motion mildly to moderately degraded images at few\nlevels.\n\nInterval posterior C5-T1 fusion if, C5-C7 laminectomy. Surgical hardware in\nplace. Central canal is decompressed compared to prior. Vertical band of\nposterior cord T2 signal abnormality extends from C3-C6, stable since prior,\nlikely represent spondylotic myelomalacia, primary disorders involving\nposterior column could have similar appearance. No new cord T2 signal\nabnormality. No abnormal cord enhancement. Laminectomy, posterior surgical\nbed fluid collection measuring 7 cm x 2 cm x 2 cm, likely postoperative.\n\nMultilevel degenerative changes cervical spine, disc osteophyte complex C2-C3\nthrough C7-T1 levels, multilevel disc space narrowing, posterior element\nhypertrophic changes. Minimal anterolisthesis C3-C4, similar to prior. Mild\nretrolisthesis C5-C6, minimal retrolisthesis C6-C7, stable. Minimal\nanterolisthesis C7-T1, stable.\n\nAt C2-C3 level central canal is patent. Mild right foraminal narrowing. \nPatent left foramen.\n\nAt C3-C4 level there is moderate central canal narrowing, similar, preserved\nCSF about cord. Moderate left, severe right foraminal narrowing, stable.\n\nAt C4-C5 level there is moderate central canal narrowing, completely effaced\nCSF about cord, worsened since prior. Minimal effacement of the ventral cord.\nModerate to severe bilateral foraminal narrowing, worsened since prior.\n\nAt C5-C6 level central canal has been decompressed, mild central canal\nnarrowing, preserved CSF about cord. Severe bilateral foraminal narrowing,\nprobably similar.\n\nAt C6-C7 level central canal is patent. Moderate left, moderate to severe\nright foraminal narrowing, probably worsened.\n\nAt C7-T1 level central canal is patent. Probably moderate right and mild left\nforaminal narrowing, probably similar.", "output": "1. Interval postsurgical changes.\n2. Moderate central canal narrowing C3-C4 level, similar.\n3. Moderate central canal narrowing C4-C5 level, worsened.\n4. Decompressed C5-C6, C6-C7 levels.\n5. Stable posterior cord T2 signal abnormality C3-C6, likely spondylotic\nmyelomalacia, primary posterior column abnormalities could have similar\nappearance.\n6. Multilevel significant foraminal narrowing." }, { "input": "CERVICAL:\nThere is straightening of the normal cervical lordosis.There is mild\nmultilevel loss of vertebral and disc heights, more prominent at C5-C6.\n\n C2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: There is bilateral facet and uncovertebral hypertrophy. There is no\nspinal canal narrowing with severe right and mild left foraminal narrowing.\n\nC4-C5: There is bilateral facet and uncovertebral hypertrophy. There is no\nspinal canal narrowing with severe right and moderate left foraminal\nnarrowing.\n\nC5-C6: A disc bulge is seen with bilateral facet and uncovertebral hypertrophy\nand thickening of the ligamentum flavum. There is moderate spinal canal\nnarrowing with moderate-to-severe bilateral foraminal narrowing. There is\nmild flattening the spinal cord without cord compression. This appears\nrelatively unchanged when compared to the CT of the C-spine dated ___.\n\nC6-C7: No spinal canal or foraminal narrowing.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\nthere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nEvaluation is suboptimal due to extensive streak artifact from the bilateral\nhip arthroplasties.\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Small disc bulges are seen at L2-3, L3-4, L4-5 and L5-S1 without\nspinal canal or neural foraminal narrowing. Additionally, a small left\nparacentral disc protrusion is seen at L5-S1.there is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.\n\nAs seen on the previous outside MRI study there is increased signal within the\nL4-5 disc but no abnormal enhancement is identified. No paraspinal soft\ntissue abnormalities are seen. This increased signal could be related to\ndegenerative change rather than post infective changes given absence of other\nsecondary findings.\n\nOTHER: A moderate-sized complex pleural effusion is seen on the right with\natelectatic changes. There is heterogenous marrow signal identified which\ncould be related to osteopenia or anemia.", "output": "1. Degenerative changes of the cervical and lumbar spine, worst at C5-6,\ndemonstrating moderate narrowing of the spinal canal and deformity of the\nspinal cord without cord signal abnormalities and moderate-to-severe bilateral\nforaminal narrowing this appears relatively unchanged when compared to the CT\nof the C-spine dated ___.\n2. Increased signal within the L4-5 disc without abnormal enhancement or\nparaspinal soft tissue abnormalities likely related to degenerative change but\ncorrelation with patient's clinical findings recommended. This is unchanged\nfrom the outside MRI study.\n3. Moderate sized complex appearing right pleural effusion. This was seen on\nthe most recent CT of the chest.\n4. Heterogenous marrow signal could be due to osteopenia or anemia. Clinical\ncorrelation recommended." }, { "input": "Examination is moderately degraded by motion.\n\nCERVICAL:\nAlignment is normal. There is minimal height loss of the C4 and C5 vertebral\nbodies. Otherwise the cervical vertebral body heights are maintained. There\nis moderate intervertebral disc height loss at C5-C6. A rounded area of T1\nand T2 hyperintense signal in the inferior C7 vertebral body likely represents\na hemangioma. There are unchanged endplate signal abnormalities at C5-C6 with\nslight heterogeneous enhancement, which also involve the posterior disc at\nC5-C6.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: There are mild bilateral facet and uncovertebral joint osteophytes. \nThere is no spinal canal narrowing. There is moderate right and mild left\nneural foraminal narrowing. Findings are similar to prior exam.\n\nC4-C5: There is disc bulge and bilateral facet and uncovertebral joint\nosteophytes. There is mild spinal canal narrowing. There is severe right\nmoderate left neural foraminal narrowing. Findings are similar to prior exam.\n\nC5-C6: There is disc bulge, ligamentum flavum thickening, and uncovertebral\nand facet joint osteophytes. There is moderate spinal canal narrowing with\nremodeling of the ventral aspect of the spinal cord. There is also moderate\nto severe bilateral neural foraminal narrowing. Findings are similar to prior\nexam.\n\nC6-C7: There is minimal disc bulge without significant spinal canal narrowing.\nThere is mild bilateral neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThe thoracic vertebral body heights and alignment are maintained. There is a\nsmall central disc protrusion at T5-T6 with indentation of the ventral thecal\nsac. The intervertebral disc heights and intensities appear preserved. There\nis no significant spinal canal narrowing. Otherwise, there is no evidence of\nspinal canal or neural foraminal narrowing. The spinal cord appears normal in\ncaliber and configuration without evidence of edema. There is no evidence of\ninfection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nLUMBAR:\nThere are heterogeneous, ill-defined STIR hyperintense signal abnormalities\npredominately in the L4 inferior endplate and superior L5 endplate, which\ndemonstrate heterogeneous enhancement following administration of contrast.\nAgain identified is STIR and T2 hyperintense signal abnormality involving the\nL4-L5 disc, which demonstrates heterogeneous enhancement along the posterior\naspect of the disc, more pronounced and conspicuous compared to prior exam. \nThere is enhancing soft tissue emerging from the disc and extending anteriorly\nin the epidural space posterior to the margin of the L5 vertebral body and\nslightly superior posterior to L4. The findings are concerning for discitis\nand osteomyelitis with an epidural abscess.\n\nThe remaining lumbar vertebral body heights and alignment are otherwise\npreserved. The spinal cord appears normal in caliber and configuration.\n\nFrom L2-L3 through L3-L4, small posterior disc bulges are identified without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L4-L5, there is moderate intervertebral disc height loss with signal\nabnormalities. The epidural abscess indents the thecal sac and results in\nmild spinal canal narrowing. There is moderate left and mild right neural\nforaminal narrowing.\n\nAt L5-S1, there is a midline posterior disc protrusion without significant\nspinal canal narrowing. There is moderate bilateral neural foraminal\nnarrowing.\n\nOTHER: There is heterogeneous bone marrow signal throughout the spine which\ncould be related to osteopenia or anemia. Signal alterations in the right\ngreater than left dependent portions of the visualized lungs likely represent\natelectasis.", "output": "1. Examination is moderately degraded by motion.\n2. Discitis, osteomyelitis and epidural abscess evolving since the prior\nstudies.\n3. Redemonstration of degenerative changes in the cervical spine, most\npronounced at C5-C6 with moderate spinal canal narrowing and remodeling of the\nventral spinal cord with moderate to severe bilateral neural foraminal\nnarrowing.\n4. Cholelithiasis." }, { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMinimal grade 1 L5 on S1 anterolisthesis is noted. Vertebral body heights are\npreserved. L5 superior endplate Schmorl's node is present. Question left L5\nnondisplaced pars defect with minimal edema in left S1 superior articular\nfacet (7:7) versus artifact. There is transitional anatomy with partial\nsacralization L5. Type ___ ___ changes are noted at the L3-4, L4-5, and L5-S1\nendplates.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc signal and height at L3-4 through L5-S1.\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 no vertebral canal or neural foraminal narrowing.\n\nAt L3-4 there is right paracentral disc protrusion which contacts transiting\nright L4 nerve root, prominent epidural fat, facet joint hypertrophy,\nmoderatevertebral canaland mild rightneural foraminal narrowing.\n\nAt L4-5 there is disc bulge, central disc protrusion, prominent epidural fat,\nmild-to-moderatevertebral canal,and noneural foraminal narrowing. Nonspecific\nleft sided facet fluid is noted.\n\nAt L5-S1 there is disc bulge, left greater than right facet joint hypertrophy,\nligamentum flavum hypertrophy, mildvertebral canaland moderate leftneural\nforaminal narrowing. Left facet joint probable synovial cyst is noted. \nNonspecific bilateral facet joint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel lumbar spondylosis and prominent epidural fat as described, most\npronounced at L3-4, with right paracentral disc protrusion contacts transiting\nright L4 nerve root, moderate vertebral canal and mild right neural foraminal\nnarrowing.\n3. L4-5 mild-to-moderate vertebral canal narrowing.\n4. L5-S1 question nondisplaced left pars defect versus artifact, as described.\nIf clinically indicated, consider lumbar spine CT for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:18 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "From T11-12 through L L2-3 levels no significant abnormalities are seen.\n\nAt L3-4 level, there is a small right-sided disc protrusion which indents the\nthecal sac and narrows the right subarticular recess, unchanged from the prior\nstudy. There is mild right foraminal narrowing.\n\nAt L4-5 level, disc bulging and a small right-sided disc protrusion seen which\nslightly displaces the right L5 nerve root posteriorly (___) and is\nunchanged compared to the prior study. There is no foraminal narrowing.\n\nAt L5-S1 level, diffuse disc bulging is identified with moderate-to-severe\nleft foraminal narrowing and mild narrowing of the right foramen unchanged\nfrom the prior study.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Overall no significant change since the previous MRI examination of ___.\n2. Small right-sided protrusions at L3-4 and L4-5 levels. Displacement of\nright L5 nerve root within the canal at L4-5 level is unchanged.\n3. Moderate-to-severe left foraminal narrowing at L5-S1 level is unchanged." }, { "input": "Vertebral body heights and alignment are preserved. There is no suspicious\nfocal bone marrow lesion. There is no prevertebral soft tissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are relatively\nwell preserved.\n\nThe spinal cord is preserved in signal and caliber.\n\nTiny disc protrusions are noted at the T2-T3, T6-T7, and T8-T9 levels, with\nsome areas of ligamentum flavum thickening, indenting the thecal sac without\nsignificant spinal canal narrowing. Mild multilevel facet degenerative\nchanges are seen. The neural foramina are patent without significant\nnarrowing.\n\nThe visualized lungs are grossly clear. Scattered T2 hyperintense left-sided\nrenal lesions most likely represent cysts. The visualized upper abdomen is\notherwise grossly unremarkable.", "output": "1. Mild thoracic degenerative disc disease without significant spinal canal or\nneural foraminal narrowing.\n2. No cord signal abnormality." }, { "input": "Evaluation of the mid cervical spine and spinal canal is severely limited\nsecondary to blooming artifact in the setting of the patient's posterior\ncervical spinal fusion, with orthopedic hardware spanning from the occiput to\nthe level of C4. Within this limitation:\n\nThere is no definite, focal increased T2/stir signal to suggest acute\nfracture. However, the examination is limited, as detailed above. Subtle,\npreviously reported fractures involving the right fourth/fifth and left\nseventh facets are better visualized on recent CT cervical spine examination.\n\nLoss of height involving the C4, C5, and C6 vertebral bodies appear similar to\n___, likely a chronic finding. Mild anterolisthesis of C4 on C5 and C5 on C6\nis again seen. There is no definite prevertebral soft tissue edema to suggest\nacute spondylolisthesis. Similarly, the visualized posterior longitudinal\nligament appears intact.\n\n\nThe cervical spinal cord is deformed at the levels of C4-C5 and C5-C6,\npredominantly due to the patient's anterolisthesis at these levels. There is\nno definite cord signal abnormality, within the limitations of this\nexamination.\n\nSuperimposed multilevel spondylosis is noted with mild posterior disc bulges\nat C6-7, C7-T1, at T2-T3, and T3-T4. There is no severe spinal canal\nnarrowing identified at these levels. Mild to moderate spinal canal narrowing\nis present at C4-5 predominantly due to anterolisthesis at this level. \nEvaluation of neural foraminal narrowing is limited secondary to the adjacent\northopedic hardware, particularly at the levels of C3-C4, C4-C5, and C5-C6.\n\nThe visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.", "output": "1. Severely limited examination secondary to cervical orthopedic hardware and\nsubsequent blooming artifact.\n2. No definite abnormal T2/stir signal within or adjacent to the osseous\nstructures of the cervical spine to suggest acute fracture. Subtle previously\ndetailed bilateral facet fractures are better assessed by CT.\n3. Anterolisthesis of C4 on C5 and C5 on C6 without associated ligamentous\ninjury, likely progressive in degenerative in nature.\n4. Superimposed multilevel spondylosis of the cervical spine, as detailed\nabove, without severe canal stenosis. Evaluation of the neural foramina is\nagain limited by the adjacent orthopedic hardware." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Vertebral body\nand intervertebral disk signal intensity appear normal. The visualized portion\nof the spinal cord appears normal. Visualized prevertebral paraspinal soft\ntissues are unremarkable.\n\nAt the C2-C3 level, there is no spinal canal or neural foraminal stenosis.\n\nAt the C3-C4 level, there is a small central protrusion causing minimal\neffacement of the anterior thecal sac. There is no spinal canal or neural\nforaminal narrowing.\n\nAt the C4-C5 level, there is minimal disc bulge with no spinal canal or neural\nforaminal stenosis.\n\nAt the C5-C6 level, there is mild disc bulge more prominent on the right,\ncausing mild canal stenosis and mild neural foraminal stenosis on the right.\n\nAt the C6-C7 level, there are minimal intervertebral osteophytes with no\nspinal canal or neural foraminal stenosis.\n\nAt the C7-T1 level, there is no spinal canal stenosis or neural foraminal\nnarrowing.", "output": "1. No evidence of demyelinating disease within the cervical spine.\n2. Multilevel mild degenerative changes as described above." }, { "input": "The craniocervical junction appears normal. The cervical cord is normal in\nmorphology and signal intensity. No cord lesions.\n\nThe vertebral bodies are normal in number and interrelationship. No acute\nvertebral body fractures.\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: No cord or nerve root compromise.\n\nC4-5: No cord or nerve root compromise.\n\nC5-6: Broad-based disc protrusion partially effaces the CSF space anterior to\nthe cord, but there is no cord deformation or abnormal cord signal intensity. \nThere is preservation of CSF posterior to the cord. The neural foramina are\npatent.\n\nC6-7: There is a left paracentral and foraminal disc extrusion which effaces\nthe CSF space anterior to the left lateral aspect of the cord and slightly\ndeforms the cord, but there is no abnormal cord signal intensity. It results\nin severe left C6-7 neural foraminal narrowing and C7 nerve root compromise in\nthis position should be excluded.\n\nC7-T1: No cord or nerve root compromise.", "output": "Left paracentral and foraminal disc extrusion with suspected compromise of the\nleft C7 nerve root in the left C6-7 neural foramina as described above.\n\nNOTIFICATION: *** ED URGENT ATTENTION ***" }, { "input": "Alignment is normal. Vertebral body signal intensity appears normal. There\nis loss of signal of the intervertebral discs on the T2 weighted images from\nL3 through S1, a manifestation of degenerative disease. From T11-L4 there is\nno spinal canal or neural foraminal compromise.\nAt L4-5, mild bulging of the disc and facet osteophytes minimally narrow the\nspinal canal. The neural foramina appear normal.\nAt L5-S1, there is asymmetric bulge of the intervertebral disc. This and\nintervertebral osteophytes mildly narrow the spinal canal and encroach on the\nneural foramina. There does not appear to be compression of the L5 nerve\nroots.\n\nAlthough no fractures are identified, CT is more reliable than MR for\ndetecting and characterizing fractures. The spinal cord appears normal in\ncaliber and configuration. There is no abnormal enhancement after contrast\nadministration.", "output": "1. Mild degenerative disc disease without nerve root compression." }, { "input": "There is severe scoliosis of lumbar spine convex to the right side.\n\nFrom T11-12 through L1-2 levels disc degenerative change and bulging\nidentified. At L1-2 there is mild-to-moderate right foraminal narrowing seen.\nPerineural cyst is seen within the right foramen as incidental finding.\n\nAt L2-3 level, disc bulging and facet degenerative seen. There is moderate\nleft subarticular recess narrowing and moderate left foraminal narrowing. \nThere is mild spinal stenosis.\n\nAt L3-4 level, disc bulging facet degenerative changes resulting in\nmild-to-moderate spinal stenosis and moderate-to-severe left foraminal\nnarrowing unchanged from prior study.\n\nAt L4-5 moderate spinal stenosis and severe left foraminal narrowing\nidentified with compression of exiting left L4 nerve. There is only\nmild-to-moderate narrowing of the right foramen.\n\nAt L5-S1 level disc bulging and facet degenerative changes seen with severe\nright foraminal narrowing.\n\nThe visualized upper sacrum demonstrates linear areas of low signal on T2\nweighted images adjacent to both sacroiliac joint involving both ala of sacrum\nwith mild increased signal on the inversion recovery images indicative of\nsubacute insufficiency fractures. This finding is new since the previous MRI.", "output": "1. New insufficiency fracture involving the sacrum which appears subacute in\nnature.\n2. Scoliosis of lumbar spine multilevel degenerative changes. Overall no\nsignificant change in the degenerative changes compared to the prior study.\n3. Severe left foraminal narrowing at L4-5 and severe right foraminal\nnarrowing seen at L5-S1 level with compression of exiting left L4 and right L5\nnerve roots within the foramina. Moderate spinal stenosis at L4-5 level. \nOther degenerative changes as detailed above." }, { "input": "Thoracic spine:\n\nMultilevel degenerative disc disease seen. Mild bulging seen with thoracic\nregion. There is no spinal stenosis or foraminal narrowing. There is no\nacute chronic compression fracture. Incidental hemangioma is seen in a mid\nthoracic vertebral body. There is no cord compression. There is no signal\nwithin the spinal cord. Abnormal intraspinal enhancement. Paraspinal soft\ntissues are unremarkable.\n\nLumbar spine:\n\nScoliosis is seen of the lumbar spine convex to the right in the lower lumbar\nand to the left in the upper lumbar region. From T12-L1 through the L3-4\nlevels, disc degenerative change seen with minimal bulging.\n\nAt L4-5 and L5-S1 levels the patient has undergone spinal fusion. There is\nthickening of the ligament and synovial cyst on the left side with severe\nnarrowing of the left subarticular recess and mild narrowing of the left\nforamen. There is mild spinal stenosis. There is moderate-to-severe right\nforaminal narrowing due to a disc protrusion.\n\nL5-S1 level spinal fusion is seen. The spinal canal is patent. There is no\nforaminal narrowing seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. An\nincidental Tarlov cyst is partially visualized in the sacral spinal canal.", "output": "1. Spinal fusion changes in the lower lumbar region with mild scoliosis.\n2. Thickening of the ligament and synovial cyst resulting in severe left\nsubarticular recess narrowing at L4-5 level.\n3. Moderate-to-severe right foraminal narrowing with deformity of the exiting\nright L4 nerve root at L4-5 level.\n4. No acute compression fractures seen within the thoracic region. Mild\nmultilevel degenerative changes." }, { "input": "Thoracic spine: Patient is status post ___ rod placement, which\nobscures evaluation of the thoracic spine. Within the upper thoracic,\nposterior soft tissues, a T2 hyperintense, rim enhancing collection is seen\nmeasuring approximately 3.5 cm x 2.6 cm. Posterior soft tissue increased STIR\nsignal abnormality is also likely secondary to postoperative edema. \nOtherwise, the alignment appears to be normal. No definite cord signal\nabnormalities are seen. No definite spinal canal or neural foraminal\nnarrowing is seen.\n\nLumbar spine: Patient is status post lumbar decompression from L2 through S1\nstatus post laminectomy. Patient is also status post L3 pedicle subtraction\nosteotomy, with evidence of loss of height of the anterior and middle columns\nof the L3 vertebral body, and a fluid cleft seen along the superior margin. \nEvaluation of the lumbar spine is extremely limited secondary to\ninstrumentation of the lumbar spine. A fluid collection in the laminectomy\nbed is seen measuring 4.9 cm x 2 cm x 8.8 cm.\n\nCysts are seen within the kidneys bilaterally, on the left measuring up to 1.7\ncm x 2.1 cm and on the right measuring up to 0.5 cm.", "output": "1. Extensive hardware in the thoracic and lumbar spine severely limits\nevaluation of the spinal cord and canal.\n2. 3.5 cm rim enhancing collection is seen within the posterior soft tissues\nat the level of T4, likely secondary to a postsurgical seroma.\n3. Patient is status post lumbar decompression from L2 through S1 and L3\npedicle subtraction osteotomy, with evidence of loss of height of the anterior\nand middle columns of the L3 vertebral body in a fluid cleft seen along the\nsuperior margin. Surrounding increased STIR signal abnormality is consistent\nwith appropriate postsurgical changes.\n4. A 0.8 cm fluid collection is seen in the laminectomy bed. A superimposed\ninfectious process can't be excluded." }, { "input": "The vertebral body height, alignment, and marrow signal within the lumbar\nspine are normal.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe L1 level, as seen on sagittal imaging.\n\nThe paraspinal and prevertebral soft tissues appear unremarkable.\n\nAt the L2-L3 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, without significant spinal canal or neural foraminal narrowing.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, a minimal diffuse disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nThe L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge with superimposed posterior disc protrusion\ncontacting the traversing bilateral L5 nerve roots, as well as causing mild\nbilateral neural foraminal narrowing.\n\nAt the L5-S1 level, there is bilateral facet arthropathy and a diffuse disc\nbulge without significant spinal canal or neural foraminal narrowing.\n\nAxial imaging through the sacroiliac joints demonstrates mild sclerosis and\nedema, right greater than left, likely on a degenerative basis.", "output": "1. Lumbar spondylosis including disc protrusion at the L4-L5 level which\ncontacts the traversing L5 nerve roots within the subarticular zones.\n2. Sclerosis and mild edema within the sacroiliac joints, right greater than\nleft, likely on a degenerative basis." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThe lumbar spine alignment is normal. Vertebral body heights are preserved. \nUnchanged focal area of T2 high signal intensity is noted on the right side at\nL3 vertebral body consistent with hemangioma (08:19), otherwise, there is no\nmarrow signal abnormality. Mild degenerative changes are seen along the\nvisualized spine with mild intervertebral disc space narrowing and\ndesiccation. The visualized portion of the spinal cord is preserved in signal\nand caliber. The conus terminates at the L2 level.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is a minimal posterior disc bulge, mild facet joint arthropathy\nand trace joint effusions, without significant vertebral canal or neural\nforaminal stenosis.\n\nAt L2-3 there is a minimal posterior disc bulge, mild facet joint arthropathy\nwith trace, left greater than right, effusions, and ligamentum flavum\nhypertrophy without significant vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is a minimal posterior disc bulge, mild facet joint arthropathy\nwith trace, right greater than left, effusions and ligamentum flavum\nhypertrophy without significant vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is a minimal posterior disc bulge, facet joint arthropathy with\nsmall effusions, and ligamentum flavum hypertrophy without significant\nvertebral canal or neural foraminal stenosis. There is persistent mild to\nmoderate bilateral articular joint effusions (08:28).\n\nAt L5-S1 there is unchanged mild posterior disc bulge, facet joint\narthropathy, and ligamentum flavum hypertrophy resulting in minimal vertebral\ncanal narrowing. There is unchanged mild bilateral neural foraminal stenosis,\napparently contacting the left L5 exiting nerve root (08:34 and 05:46).\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Multiple T2 hyperintense lesions are seen\nscattered through both renal cortices, the largest measuring up to 3.6 cm in\nthe left kidney (08:12), likely simple cysts. Note is made of a T2\nhypointense left adrenal lesion measuring up to 2.8 cm (8:1), incompletely\nvisualized. The visualized portion of the sacroiliac joints are preserved.", "output": "1. Relatively stable mild multilevel degenerative changes along the lumbar\nspine, results in minimal spinal canal narrowing, with mild L5-S1 bilateral\nneural foraminal stenosis, apparently contacting the left L5 exiting nerve\nroot as detailed above.\n2. Incidental note made of a partially seen 2.8 cm left adrenal lesion.\n3. Multiple T2 hyperintense renal lesions, measure up to 3.6 cm, likely simple\ncysts.\n\nRECOMMENDATION(S): A dedicated CT or MR can be obtained for further\nevaluation of a partially visualized left adrenal lesion." }, { "input": "There is mild anterolisthesis of L4 on L5, new from prior. There is loss of\nnormal T2 disc signal throughout the lumbar spine, with mild loss of disc\nheight at multiple levels. There are type ___ ___ endplate changes along the\nsuperior endplate of L3 with a Schmorl's node, new from prior. Vertebral body\nmarrow signal is otherwise maintained. The spinal cord appears normal in\ncaliber and configuration. The conus terminates at the L1 level.\n\nAt T11-T12 and T12-L1, there is minimal posterior disc bulge without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is minimal posterior disc bulge without significant spinal\ncanal narrowing. There is mild right neural foraminal narrowing. No left\nneural foraminal narrowing.\n\nAt L2-L3, a small posterior disc bulge and facet arthropathy result in mild\nspinal canal narrowing. There is mild right neural foraminal narrowing. No\nleft neural foraminal narrowing.\n\nAt L3-L4, a small posterior disc bulge and facet hypertrophy result in mild\nspinal canal narrowing. There is no significant neural foraminal narrowing.\n\nL4-L5, there is new mild anterolisthesis of L4 on L5 due to facet arthropathy.\nAlong with a predominantly left-sided disc bulge and thickening of the\nligamentum flavum, this results in moderate spinal canal narrowing, slightly\nincreased from prior. There is mild bilateral neural foraminal narrowing,\nwith the left-sided disc bulge possibly contacting the descending left L5\nnerve root. There is a small posterior left facet synovial cyst projecting\ninto the paravertebral soft tissues.\n\nAt L5-S1, there is facet arthropathy without significant spinal canal\nnarrowing. There is no significant left neural foraminal narrowing. A small\nposterior disc bulge extends into the right neural foramen, causing mild to\nmoderate right neural foraminal narrowing, and may contact the exiting right\nL5 nerve root (102:65).\n\nPerineural cysts (Tarlov cysts), in the sacrum at the level of S2 remain\nunchanged.\n\nThe visualized paravertebral soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes have slightly progressed compared with\n___, worst at L4-L5 level, where there is new mild anterolisthesis due to\nfacet arthropathy, resulting in moderate spinal canal narrowing, increased\nfrom prior.\n2. A small posterior disc bulge at L5-S1 level, extends into the right neural\nforamen resulting in mild to moderate neural foraminal narrowing with possible\ncontact with the exiting right L5 nerve root." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno focal suspicious marrow lesion. Loss of disc height and signal is mild at\nL3-L4 and L4-L5. The conus medullaris terminates at the T12-L1 level, within\nexpected limits. There is no signal abnormality of the visualized cord.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: A left eccentric disc protrusion with extension into the left neural\nforamina crowds the left-greater-than-right subarticular zones, similar in\nappearance to prior exam. The disc contacts the bilateral traversing nerve\nroots likely impinging the left traversing L5. There is no significant right\nand mild to moderate left neural foraminal narrowing.\n\nL5-S1: No significant spinal canal or neural foraminal narrowing.\n\nA 1.1 x 1.0 left para-aortic cystic lesion likely represents a lymphocele. T2\nhyperintense cystic lesion of the left renal midpole is statistically most\nlikely a simple renal cyst. There is cholelithiasis without evidence of\ncholecystitis. The remainder of the visualize prevertebral paraspinal soft\ntissues are unremarkable.", "output": "1. A left eccentric L4-L5 disc protrusion with extension into the left neural\nforamina crowds the left-greater-than-right subarticular zones, similar\nappearance to prior exam. The disc contacts the bilateral traversing nerve\nroots, likely impinging the left.\n2. Unchanged appearance of a left periaortic cystic lesion, likely\nrepresenting a lymphocele.\n3. T2 hyperintense cystic lesion of the left kidney statistically likely\nrepresents a simple cyst.\n4. Cholelithiasis without cholecystitis." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. Intervertebral disc heights and\nsignal are preserved. There is no significant spinal canal or neural foraminal\nstenosis. Within the limits of this noncontrast study there is no evidence of\ninfection or neoplasm. There is no prevertebral soft tissue swelling.. The\nvisualized portion of the posterior fossa and cervicomedullary junction are\npreserved.\n\nEndotracheal as well as nasogastric tubes are noted.\nFluid is present within the nasopharynx as well as in the pharynx.\nEvaluation for prevertebral soft tissue swelling is limited secondary to the.", "output": "1. Normal cervical spine MRI exam." }, { "input": "There is unchanged minimal anterolisthesis of L2-L3 and L3-L4. Vertebral body\nheight and alignment is otherwise maintained. There is mild degenerative disc\ndisease, predominantly at L2-L3 and L3-L4. Intervertebral disc space heights\nare otherwise grossly preserved. Bone marrow signal intensity is within\nnormal limits.\n\nThe spinal cord appears normal in caliber and signal intensity. The conus\nterminates normally at the L2 level.\n\nAt T11-T12, there is a mild disc bulge with minimal indentation of the thecal\nsac, no spinal canal stenosis or neural foraminal narrowing. Findings are\nsimilar to ___.\n\nAt T12-L1, there is a mild disc bulge with minimal indentation of the thecal\nsac, no spinal canal stenosis or neural foraminal narrowing. Findings are\nsimilar to ___.\n\nAt L1-L2, there is no disc herniation, spinal canal stenosis or neural\nforaminal narrowing.\n\nAt L2-L3, there is a disc bulge which likely contacts the bilateral L2 nerve\nroots in the neuroforamen, facet joint arthropathy and ligamentum flavum\nthickening, severe spinal canal narrowing, mild left and moderate right neural\nforaminal narrowing. Findings have slightly progressed from ___.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, moderate spinal canal stenosis, mild left and moderate right\nneural foraminal narrowing. There is impingement of the bilateral L3 nerve\nroots within the neuroforamen. Findings appear similar to ___.\n\nAt L4-L5, there is facet joint arthropathy and ligamentum flavum thickening,\nno disc herniation, no spinal canal stenosis, mild bilateral neural foraminal\nnarrowing. Findings are similar to ___.\n\nAt L5-S1, there is facet joint arthropathy and ligamentum flavum thickening,\nno disc herniation, no spinal canal stenosis or neural foraminal narrowing. \nFindings are similar to ___", "output": "1. Slight progression of degenerative changes along the lumbar spine resulting\nin severe spinal canal stenosis at L2-L3 with moderate right and mild left\nneural foraminal narrowing with the disc bulge at least contacting the\nbilateral L2 nerve roots in the neuroforamen.\n2. No significant change of moderate spinal canal stenosis at L3-L4 with\nmoderate right and mild left neural foraminal narrowing and impingement of the\nbilateral L3 nerve roots within the neural foramen secondary to a disc bulge\nand hypertrophic degenerative changes." }, { "input": "Alignment is anatomic. Vertebral body and intervertebral disc signal\nintensity appear normal. There is no signal abnormality of the cervical cord.\n\nThe occipital condyle to C1, atlantoaxial joint articulation are unremarkable.\n\nThere is baseline mild spinal canal narrowing secondary to congenital\nshortening of the pedicles.\n\nC2-C3:\nDiffuse posterior disc bulge with mild interval progression of the\nsuperimposed median disc protrusion (series 8, image 11), which has lead to\nflattening of the anterior thecal sac resulting in moderate spinal canal\nnarrowing. There is bilateral uncovertebral and facet arthropathy resulting\nin moderate bilateral neural foraminal narrowing.\n\nC3-C4:\nUnchanged posterior disc bulge with bilateral (right greater than left)\nuncovertebral hypertrophy (series 8, image 16). Unchanged flattening of the\nanterior thecal sac resulting in moderate spinal canal narrowing, with severe\nleft and moderate to severe right neural foraminal narrowing.\n\nC4-C5:\nUnchanged posterior disc bulge leading to flattening of the anterior thecal\nsac, resulting in moderate spinal canal. Uncovertebral and facet arthropathy\nresults in severe bilateral neural foraminal narrowing.\n\nC5-C6:\nBroad-based disc bulge with a superimposed median disc protrusion which\nactually appears smaller in comparison to prior (series 8, image 25 and 27). \nFlattening of the anterior thecal sac with moderate spinal canal narrowing. \nUnchanged moderate narrowing of bilateral neural foramina.\n\nC6-C7:\nDiffuse disc bulge with thickening of the ligamentum flavum causing flattening\nof thecal sac (series 8, image 30) and severe spinal canal narrowing,\nminimally progressed from prior exam. Unchanged bilateral uncovertebral and\nfacet arthropathy. These have led to severe bilateral neural foraminal\nnarrowing.\n\nC7-T1:\nUnchanged diffuse disc bulge with new superimposed left paracentral protrusion\n(series 8, image 40). Flattening of the anterior left thecal sac without cord\ncontact. Unchanged bilateral uncovertebral hypertrophy. Uncovertebral and\nfacet arthropathy results in severe right greater than left neural foraminal\nnarrowing.\n\nThe previously identified multinodular goiter is not well-visualized. \nRemainder the visualized prevertebral and paraspinal soft tissues are grossly\nunremarkable.", "output": "1. Mildly progressive multilevel degenerative changes of the cervical spine as\nspecified above. In particular, there is severe spinal canal narrowing at\nC6-C7 with severe bilateral neural foraminal narrowing. There is also severe\nbilateral neural foraminal narrowing at C4-C5 and C7-T1. Severe left C3-C4\nneural foraminal narrowing.\n2. There is baseline spinal canal narrowing secondary to congenital shortening\nof the pedicles.\n3. No cord signal abnormality.\n4. Additional findings described above." }, { "input": "Levoconvex curvature of the lumbar spine with apex at L3 is identified. \nMultiple abnormally in enhancing metastatic lesions diffusely from the T11\nthrough sacral vertebral bodies as well as lesions involving the L2, L3\nspinous processes and right L3-L4 facets are visualized. Multiple lesions\ninvolving the visualized ileum and sacrum are also noted. As noted on the\nprior outside hospital examination, there is a compression fracture of L3,\nwith interval increase loss of vertebral body height (approximately 30%). \nThere is diffuse infiltration of metastatic disease in the L3 vertebral body\nwith cortical breakthrough and expansion of the posterior cortex, resulting in\nmild spinal canal narrowing (series 10, image 2). Incidental note is made of\na hemangioma of the T12 left pedicle.\n\nT11-T12: A central protrusion seen on sagittal images does not result in\nsignificant spinal canal narrowing. There is no neural foraminal narrowing.\n\nT12-L1: There is no significant spinal canal or neural foraminal narrowing.\n\nL1-L2: A central protrusion does not significantly narrow the spinal canal. \nThere is no significant neural foraminal narrowing.\n\nL2-L3: A disc protrusion does not significantly narrow the spinal canal. \nThere is no significant neural foraminal narrowing.\n\nL3-L4: As described above, there is mild spinal canal narrowing posterior to\nthe L3 vertebral body secondary to encroachment from a soft tissue lesion. At\nL3-L4: A disc bulge does not significantly narrow the spinal canal. There is\nno significant neural foraminal narrowing.\n\nL4-L5 and L5-S1: Small disc bulges and facet arthropathy does not result in\nsignificant spinal canal or neural foraminal narrowing.\n\nS1-S2: Expansile lesions of the sacrum minimally encroach on the bilateral\nS1-S2 neural foramina without significant neural foraminal narrowing.\n\nOther: Right retroperitoneal abnormal lobulated enhancing tissue arising from\nand atrophic and lobulated right kidney measuring approximately 16 x 9.0 x 8.3\ncm (SI, TRV, AP), which appears to infiltrate the right iliopsoas muscle,\ncompatible with known history of renal cell carcinoma. STIR hyperintense\nsignal of the lower lumbar paraspinal muscles is noted, which may represent\nstrain.", "output": "1. Metastatic lesions throughout its in the entire visualized thoracolumbar\nspine extending from the T11 level to the sacrum and iliac bones.\n2. There is diffuse infiltration of the L3 vertebral body with associated\npathologic compression fracture, with increased loss of vertebral body height\n(approximately 30%) when compared to CT examination of ___. Soft\ntissue expansion through the posterior cortex of L3 into the epidural space\nresults in mild spinal canal narrowing.\n3. Superimposed degenerative changes as described above without significant\nspinal canal or neural foraminal narrowing.\n4. Lobulated right retroperitoneal enhancing mass extending from and abnormal\nright kidney to the visualized pelvis with apparent involvement of the right\niliopsoas muscle." }, { "input": "Thoracic spine labeling has been provided on (series 6; image 8).\n\nTHORACIC:\n\nMultiple abnormally enhancing metastatic lesions are seen diffusely through\nthe thoracic spine. For example, in the thoracic spine, enhancing lesions are\nseen within the vertebral body of T3, T7, the superior endplate of T8, T9,\nT10, anterior superior endplate of T11, and T12. Additional lesions of the\nspinous process ease in facets are also noted. Multiple enhancing metastatic\nlesions involving the visualized cervical spine involving the C3 through C7\nvertebral bodies are noted. Lobulated metastatic lesion of the posterior\nright sixth rib (series 2, image 22) is identified.\n\nT1/T2: There is no evidence of a significant disc protrusion. There is no\nspinal canal or neural foraminal narrowing.\n\nT2/T3: There is no evidence of significant disc protrusion. There is no\nevidence of significant spinal canal or neural foraminal narrowing. A\nmetastatic focus is seen involving the spinous process T3.\n\nT3/T4 through T7/T8: There is no evidence of significant disc protrusion. \nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nT8/T9: There is mild broad-based disc protrusion however no evidence of\nsignificant spinal canal or neural foraminal narrowing. A metastatic focus is\nseen involving the right transverse process of T8.\n\nT9/T10: There is minimal broad-based disc protrusion, however no evidence of\nsignificant spinal canal or neural foraminal narrowing.\n\nT10/T11: There is minimal left paracentral disc protrusion, however no\nevidence of significant spinal canal or neural foraminal narrowing.\n\nT11/T12: There is mild left paracentral disc protrusion, however no evidence\nof significant spinal canal narrowing. There is mild left neural foraminal\nnarrowing.\n\nNo abnormal signal or enhancement of the cord is noted. .\n\nLUMBAR:\nMultiple abnormally enhancing lesions are seen throughout the lumbar spine,\nand sacral vertebral bodies, overall demonstrating interval progression\ncompared to the prior MRI from ___. Re demonstrated is levoconvex\ncurvature of the lumbar spine. Progressive, enhancing metastatic lesions are\nseen involving the vertebral bodies of L1 through L5, as well as spinous\nprocesses of L2 and L3. Multiple lesions are also seen involving the ilium\nand sacrum.\n\nThere has been interval progression of loss of vertebral body height involving\nthe L3 vertebral body, compared to the prior MRI concerning for worsening\npathologic compression fracture, with worsening spinal canal narrowing\n(18;37). No cord signal abnormalities are identified.\n\nL1/L2: There is mild broad-based disc protrusion, however no significant\nthecal sac narrowing, however minimal left neural foraminal narrowing.\n\nL2/L3: Minimal broad-based disc protrusion, however no significant spinal\ncanal or neural foraminal narrowing.\n\nL3/L4: Interval worsening of moderate spinal canal narrowing, with soft\ntissue encroachment from patient's worsening metastatic disease, as described\nabove. There is minimal left neural foraminal narrowing.\n\nL4/L5: No significant disc protrusion, spinal canal, or thecal sac narrowing.\n\nOTHER: Re demonstrated is a large lobulated enhancing tissue arising from and\natrophic right kidney measuring approximately 11.9 cm x 8.9 cm, increased in\nsize compared to the prior exam at which time this measured no more than 9 cm.\nDiffuse metastatic disease is also seen throughout the liver and partially\nvisualized lungs, incompletely evaluated on this exam.", "output": "1. Interval progression of diffuse metastatic disease throughout the lumbar\nspine, compared to the prior MRI from ___. Diffuse metastatic\ndisease is seen throughout the cervical and thoracic spine, as described\nabove.\n2. Interval progression of the pathologic compression fracture involving the\nL3 vertebral body, with worsening moderate spinal canal stenosis, secondary to\nworsening soft tissue expansion.\n3. No evidence of cord compression.\n4. Interval increase in size of the lobulated right retroperitoneal enhancing\nmass, now measuring up to 11.9 cm, previously measuring up to 9 cm.\n5. Diffuse widespread metastatic disease throughout the visualized lung fields\nand liver, is incompletely evaluated on this exam.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___ at 11:15 on\nthe day of the exam by phone." }, { "input": "CERVICAL SPINE: The vertebral body height and alignment is maintained. There\nis a normal curvature. The bone marrow has a normal signal intensity and there\nis no abnormal enhancement to suggest metastatic disease. Mild degenerative\nchanges of the cervical spine are present:\n\nAtlanto-occipital and atlantoaxial joints: No significant degenerative\nchanges. The lateral masses are symmetric.\n\nC2-C3 and C3-C4: No significant degenerative changes. The neural foramina and\nspinal canal are unremarkable.\n\nC4-C5: Minimal disc bulging without spinal canal stenosis. No neural\nforamina narrowing.\n\nC5-C6: Minimal disc bulging without spinal canal stenosis. Uncovertebral and\nfacet joint arthropathy results in bilateral moderate neural foramina\nnarrowing.\n\nC6-C7: Concentric disc bulging results in mild flattening of the spinal cord. \nUncovertebral and facet joint arthropathy result in severe left neural foramen\nnarrowing and moderate right neural foramen narrowing.\n\nC7-T1: Concentric disc bulging results in mild flattening of the spinal cord. \nNo neural foramen narrowing is identified.\n\nThe cervical spinal cord and posterior fossa demonstrate normal signal\nintensity and morphology. The posterior elements and paraspinal soft tissues\nare normal.\n\nTHORACIC SPINE: There is compression fracture of the vertebral bodies of T9\nand T12 with loss of 50-75% of height in both vertebrae, unchanged from CT\nchest performed on ___. There is no retropulsion related to\nthese fractures and no spinal canal narrowing throughout the T spine. \nHowever, a 1.5 cm T1 low/STIR high enhancing lesion in the mid vertebral body\nof T9 (series 12 image 10) raises concern for active metastatic focus. No\nsignificant degenerative changes are identified. The intervertebral disc have\nnormal height and signal intensities. There is no disc herniation, or spinal\ncanal or neural foraminal stenosis.\n\nThe thoracic spinal cord shows normal morphology and signal intensities. The\nposterior elements and paraspinal soft tissues are normal.\n\nLUMBAR SPINE: The vertebral body height and alignment is maintained. The bone\nmarrow has a normal signal intensity. T1/T2 hyperintense lesions in L1 and L2\nsuppress on the STIR sequence and are compatible with bone marrow fat lobules.\nMinimal degenerative changes are identified:\n\nT12-L1: Right paracentral disc protrusion extending into the neural foramen.\nBilateral facet joint arthropathy also present, resulting in mild bilateral\nneural foramina narrowing. No spinal canal stenosis identified.\n\nL1-L2, L2-L3: No significant degenerative changes. No spinal canal stenosis\nor neural foramina narrowing.\n\nL3-L4: Mild disc desiccation and loss of disc height is present. No spinal\ncanal stenosis. Bilateral facet joint osteophytes result in mild bilateral\nneural foramina narrowing.\n\nL4-L5: Mild disc desiccation and loss of disc height is present. No spinal\ncanal stenosis. Bilateral facet joint osteophytes result in mild bilateral\nneural foramina narrowing.\n\nL5-S1: There is no disc abnormality. No spinal canal stenosis. Left sided\nfacet joint osteophytes result in mild left neural foramen narrowing.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1-L2 level. The posterior\nelements and paraspinal soft tissues are normal.\n\nNo enhancing mass is identified throughout the spinal cord.", "output": "1. Cervical spine degenerative changes are more pronounced at C6-C7 with\nresulting severe left neural foramen narrowing and moderate right neural\nforamen narrowing at this level. No spinal canal stenosis is identified.\n\n2. T9 and T12 greater than 50% compression fractures are unchanged in\nmorphology compared to prior chest CT without significant retropulsion of bony\nfragment nor spinal canal stenosis.\n\n3. 1.5 cm T1 low/STIR high enhancing lesion in the mid vertebral body of T9\nraises concern for active metastatic focus.\n\n4. Mild degenerative changes of the lumbosacral spine as described in detail\nin the body of the report." }, { "input": "There is no abnormal signal or enhancement within the cervical\nspinal cord. Disc protrusions at C5-6 and C6-7 mildly narrow the spinal canal\nwith minimal mass effect on the anterior thecal sac. There is mild flattening\nof the ventral cord at C5-C6 due to this degenerative change.\n\nThe T2 bright mass within the right middle cerebellar peduncle and adjacent\nbrainstem is partially visualized. There is mild cervical lymphadenopathy. T2\nbright lesions within the thyroid are partially visualized.", "output": "1. No evidence of mass or demyelination within the cervical spine.\n2. Flair/T2 bright expansile lesion in the right middle cerebellar peduncle,\nnonenhancing, partially visualized. Correlating with the recent MRI from ___\n___, the findings are most suspicious for a low-grade\nglioma. Demyelination or lymphoma remain less likely possibilities.\n3. Mild cervical lymphadenopathy.\n4. T2 hyperintensities within the thyroid, partially evaluated. This could\nbe further evaluated with thyroid ultrasound if clinically warranted." }, { "input": "Mild scoliosis of lumbar spine convex to the left is noted. From T10-T11\nthrough L2-3 levels mild degenerative disc disease seen without spinal\nstenosis.\n\nAt L3-4 level disc bulging and facet degenerative changes seen resulting in\nmoderate spinal stenosis. There is no foraminal narrowing.\n\nAt L4-5 level, disc and facet degenerative changes and thickening of the\nligaments result in severe spinal stenosis and compression of the thecal sac. \nThere is moderate left foraminal narrowing.\n\nAt L5-S1 level mild disc bulging seen with facet degenerative changes without\nspinal stenosis or foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild scoliosis of lumbar spine convex to the left.\n2. Disc and facet degenerative changes resulting in severe spinal stenosis at\nL4-5 and moderate spinal stenosis at L3-4 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": "Bone marrow signal is relatively lobe without evidence for focal suspicious\nlesions on fat-suppressed IDEAL images. Vertebral body heights are preserved.\nMinimal retrolisthesis of C4 on C5 and of C5 on C6 is unchanged. No evidence\nfor edema in the bone marrow, ligaments, or other soft tissues of the cervical\nspine.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa appears unremarkable.\n\nNo evidence for spinal cord signal abnormalities allowing for motion artifact\non axial T2 weighted images.\n\nAgain seen is thickening of the posterior longitudinal ligament from C3-C4\nthrough C5-C6 levels, without ossification on the preceding CT, which\ncontributes to spinal canal narrowing at these levels. Superimposed\ndegenerative changes are seen, as detailed below: C2-C3: No spinal canal\nnarrowing. Mild right neural foraminal narrowing by uncovertebral and facet\nosteophytes. Mild left facet arthropathy without neural foraminal narrowing.\n\nC3-C4: Broad-based central disc protrusion and the thickened posterior\nlongitudinal ligament causes mild-to-moderate narrowing of the spinal canal\nwith minimal ventral cord remodeling. There is severe bilateral neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Broad-based central disc protrusion, larger on the left than right, and\nthe thickened posterior longitudinal ligament cause mild-to-moderate, left\ngreater than right spinal canal narrowing with mild ventral cord remodeling.\nSevere, left greater than right neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n\nC5-C6: There is a broad-based central disc protrusion with a larger extruded\ncomponent on the right, and overlying endplate osteophytes. There is moderate\nright and mild left spinal canal narrowing with right ventral cord remodeling.\nSevere, right greater than left neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n\nC6-C7: Broad-based left paracentral disc protrusion causes mild-to-moderate\nnarrowing of the left spinal canal with mild ventral cord remodeling. Severe\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC7-T1: No spinal canal narrowing. Moderate bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nT1-T2: No spinal canal narrowing. Mild bilateral neural foraminal narrowing\nby facet osteophytes.\n\nSagittal images through the T2-T3 and T3-T4 levels demonstrate mild disc\nbulges or protrusions indenting the ventral thecal sac without spinal cord\ncontact. Mild right T2-T3 and bilateral T3-T4 neural foraminal narrowing by\nfacet osteophytes appears present. No axial images through this level.", "output": "1. No evidence for bone marrow edema, ligamentous edema, or other soft tissue\nedema in the cervical spine. No evidence for spinal cord signal abnormalities\nallowing for motion artifact on axial T2 weighted images.\n2. Diffuse thickening of the posterior longitudinal ligament from C3-C4\nthrough C5-C6, noncalcified on the prior CT and multilevel disc protrusions,\ncausing moderate spinal canal stenosis at C5-C6, and mild-to-moderate spinal\ncanal stenosis at C3-C4, C4-C5, and C6-C7.\n3. Neural foraminal narrowing by uncovertebral and facet osteophytes appears\nsevere bilaterally from C3-C4 through C6-C7, and moderate bilaterally at\nC7-T1.\n4. Mild spinal canal narrowing in the included upper thoracic spine at T2-T3\nand T3-T4 without spinal cord contact.\n5. Diffusely low bone marrow signal without evidence for suspicious focal\nlesions, which most commonly represents red marrow reconversion in the setting\nof anemia, smoking, or chronic systemic illness. An infiltrative process is\nstatistically much less likely. Recommend correlation with clinical history\nand laboratory data.\n\nRECOMMENDATION(S): Diffusely low bone marrow signal without evidence for\nsuspicious focal lesions, which most commonly represents red marrow\nreconversion in the setting of anemia, smoking, or chronic systemic illness.\nAn infiltrative process is statistically much less likely. Recommend\ncorrelation with clinical history and laboratory data.\n\nNOTIFICATION: The recommendation above was entered by Dr. ___ on\n___ at 11:46 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Axial images are limited by motion artifact despite 2 acquisitions of each\naxial sequence.\n\nVertebral body heights are preserved. Minimal retrolisthesis of C5 on C6 is\nunchanged.\n\nThere are hemangiomas in multiple cervical and visualized upper thoracic\nvertebral bodies. Within the T1 vertebral body, there is a 1 cm focus of low\nsignal on T1 and T2 weighted images, without hyperintensity on fat-suppressed\nT2 weighted images, which corresponds to a faintly sclerotic lesion on the\n___ CT. This may represent a sclerosed hemangioma or another\nnonaggressive lesion.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa appears unremarkable.\nSpinal cord signal is within normal limits.\n\nAt C2-3 foraminal narrowing by a uncovertebral osteophytes. There is also left\ngreater than right facet arthropathy. There is no spinal canal narrowing.\n\nAt C3-4, there is no spinal canal narrowing. There is moderate right and mild\nleft neural foraminal narrowing by bilateral uncovertebral arthropathy and\nright greater than left facet arthropathy.\n\nAt C4-5, there is a shallow central/ right paracentral disc protrusion which\ndoes not contact the spinal cord. There is severe right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C5-6, there is a mild retrolisthesis with a shallow broad-based central\ndisc osteophyte complex, indenting the ventral thecal sac but not contacting\nthe spinal cord. There is moderate right and severe left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nAt C6-7, there is no spinal canal narrowing. Evaluation of the neural foramina\nis limited by motion artifact. Some degree of left neural foraminal narrowing\nis present, probably moderate based on axial T2 weighted sequence 8.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing. Left facet\narthropathy is present.\n\nAt T1-T2, there is no spinal canal or neural foraminal narrowing. Left facet\narthropathy is present.\n\nThe partially visualized palatine tonsils are unusually prominent for age.\nThere is a 5 mm T2 hyperintense focus in the right tonsil, image 10:3,\nincompletely evaluated. Nasopharyngeal soft tissues appear unremarkable on\nsagittal images.", "output": "1. Multilevel cervical degenerative disease with significant neural foraminal\nnarrowing at multiple levels bilaterally, as detailed above. Mild spinal\ncanal narrowing.\n2. Partially visualized palatine tonsils are unusually prominent for age, with\na 5 mm nonspecific T2 hyperintense focus in the right tonsil.\n\nRECOMMENDATION(S):\nDirect visualization of the palatine tonsils should be considered." }, { "input": "The study is mildly limited by motion artifact. Within these confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nMinimal, multilevel loss of intervertebral disc height within the cervical\nspine. The intervertebral disc signal is preserved.\n\nMultilevel degenerative changes are as follows:\n\nC2-C3: Mild central canal narrowing and right neural foraminal narrowing due\nto a right paracentral disc protrusion and uncovertebral and facet\narthropathy. No left neural foraminal narrowing.\n\nC3-C4: Mild central canal narrowing and right neural foraminal narrowing due\nto a right paracentral disc protrusion with uncovertebral facet arthropathy. \nNo left neural foraminal narrowing.\n\nC4-C5: Mild central canal narrowing due to a posterior disc bulge. Mild right\nneural foraminal narrowing secondary to mild uncovertebral and facet\narthropathy. No left neural foraminal narrowing.\n\nC5-C6: Mild to moderate central canal narrowing with indentation of the\nventral thecal sac due to a posterior disc bulge, which also causes moderate\nright and mild left neural foraminal narrowing, in conjunction with\nuncovertebral and facet arthropathy.\n\nC6-C7: Mild central canal narrowing due to a posterior disc bulge. At least\nmoderate to severe left neural foraminal narrowing due to the aforementioned\ndisc bulge and facet hypertrophy. No significant right neural foraminal\nnarrowing.\n\nC7-T1: No significant vertebral canal or neural foraminal narrowing.\n\nOTHER:\nThe imaged lung apices are clear. Visualized prevertebral paraspinal soft\ntissues are grossly unremarkable.", "output": "Within the confines of a mildly motion limited exam:\n\n1. Multilevel degenerative changes of the cervical spine, most prominent at\nC5-C6, where there is moderate central canal narrowing and moderate right\nneural foraminal narrowing and at C6-C7 where there is moderate to severe left\nneural foraminal narrowing.\n2. No high-grade spinal canal narrowing. No cord signal abnormality.\n3. Please refer to the separate report of the head MRI performed on the same\nday for intracranial characterization." }, { "input": "There are postsurgical changes related to C3-C7 laminectomy and fusion for\nsubdural hematoma evacuation and spinal cord compression with associated\nsusceptibility artifact due to fixation hardware and hemorrhage within the\nposterior paraspinal soft tissues extending to the posterior margin of the\nthecal sac within the laminectomy defects. There is T1 hyperintense\ncollection anterior to the cervical spinal cord extending 3.6 cm in length\nfrom the level of C4-C6 and measuring up to 4 mm in AP dimension. An\nadditional T1 hyperintense collection is seen along the anterior cervical\nspinal cord measuring 5 cm in length extending C7-T2 and measuring up to 4 mm\nin AP dimension. There is a T1 hyperintense collection posterior to the\nspinal cord measuring 3.6 cm in length extending from C5-C7 and measuring\nabout 6 mm in AP dimension. These fluid collections result in mild remodeling\nof the spinal cord primarily at the level of C6 where there is an anterior and\nposterior fluid collection. There is no cord signal abnormality. There is 2\nmm retrolisthesis of C6 on C7, similar to slightly increased since the prior\nexam. There is diffuse disc desiccation with loss of intervertebral disc\nheight predominately at C5-C6 and C6-C7 mixed ___ type marrow changes along\nthe endplates of C6-C7. Vertebral body heights are normal. There is mild\nprevertebral soft tissue edema extending from C2-C5.\n\nC2-C3: Mild left neural foraminal narrowing due to uncovertebral and facet\nspondylosis. No significant spinal canal stenosis.\nC3-C4: The posterior thecal sac is decompressed. Uncovertebral and facet\nspondylosis result in mild bilateral neural foraminal narrowing.\nC4-C5: The posterior thecal sac is decompressed. Uncovertebral and facet\nspondylosis result in mild-to-moderate right and mild left neural foraminal\nnarrowing.\nC5-C6: The posterior thecal sac is decompressed. There is a T1 hyperintense\nfluid collection anterior and posterior to the spinal cord resulting in mild\nspinal cord compression. Uncovertebral and facet arthropathy results in\nmoderate to severe left and mild right neural foraminal narrowing.\nC6-C7: The posterior thecal sac is decompressed. Uncovertebral arthropathy\nresults in mild right and moderate to severe left neural foraminal narrowing.\nC7-T1: The posterior thecal sac is decompressed. No significant neural\nforaminal narrowing is seen.\n\nMRA images demonstrates a midline prominent vessel within the surgical site,\nwhich can be seen in the early arterial phase, extending to the surgical\nhardware, demonstrating a small blush of postcontrast enhancement (series 12,\nimage 29 and 26). Although this blush of contrast does not appear to\nsignificantly increased in size across additional delays, postcontrast\ncervical spine sequences does demonstrate a prominent region of enhancement\nmeasuring up to 1.9 x 1.3 cm. This does raise concern for contrast\nextravasation, potentially arterial given its early appearance.\n\nIncidental note is made of an aberrant right subclavian artery.", "output": "1. Postsurgical changes related to C3-C7 laminectomy and fusion for subdural\nhematoma evacuation and spinal cord decompression with multiple hemorrhagic\nfluid collections along the anterior cervical cord extending from C4-C6,\npossibly continuous or separate collection extending from C7-T2 and posterior\nto the cervical cord from C5-C7 resulting in mild compression of the cervical\ncord predominately posterior to the C6 vertebral body and at C5-C6. No\ndefinite cord signal abnormality. A large postoperative midline collection in\nthe surgical bed extending from the C2 C3 through C7 levels identified.\n2. Nonspecific vessel seen extending to the surgical hardware in the posterior\nparaspinal soft tissues, possibly venous or arterial in etiology. A blush of\npostcontrast enhancement in this region on the MRA and post-contrast\nenhancement measuring up to 1.9 cm on spin echo sagittal sequences of the\ncervical spine raise concern for contrast extravasation. Close attention on\npatient clinical symptoms with low threshold for repeat imaging.\n3. No abnormal vessels are seen within the spinal canal on the MRA images. \nHowever, the exam is suboptimal secondary to postsurgical change. If there\nremains clinical concern for arteriovenous anomalies, recommend repeat MRA\nfollowing improvement of surgical changes.\n4. Multilevel degenerative changes of the cervical spine with neural foraminal\nnarrowing as detailed above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:05 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "Sagittal STIR series was not obtained.\n\nThere is minimal anterolisthesis of C7 on T1. Multilevel degenerative changes\ncervical spine. Multilevel mild disc osteophyte complexes, most prominent at\nC4-C5 level. Posterior element hypertrophic changes. No intrinsic\nabnormality of the cervical cord, although absence of sagittal STIR series\ndecreases sensitivity in evaluating cord. No cord flattening. Partial\nopacification of the visualized sphenoid sinus.\n\nAt C2-C3 level central canal, right foramina are patent. Mild left foraminal\nnarrowing.\n\nAt C3-C4 level central canal is patent. Mild right, moderate left foraminal\nnarrowing.\n\nAt C4-C5 level there is mild-to-moderate central canal narrowing, with minimal\neffacement of ventral cord, preserved CSF dorsally. No cord edema. Prominent\nventral disc osteophyte complex. Moderate bilateral foraminal narrowing,\nworse on the left.\n\nAt C5-C6 level there is mild central canal narrowing. Mild-to-moderate\nbilateral foraminal narrowing, worse on the left.\n\nAt C6-C7 level central canal, right foramina patent. Mild left foraminal\nnarrowing.\n\nAt C7-T1 level central canal, right foramina are patent. Mild left foraminal\nnarrowing.", "output": "1. Degenerative changes cervical spine.\n2. Mild-to-moderate central canal narrowing C4-C5 level.\n3. Multilevel significant foraminal narrowing, as above." }, { "input": "The sagittal T1 sequence was not performed which limits the differentiation of\ndisc versus osteophyte. Within this limitation, evaluation is as follows:\nThere is normal cervical alignment. The vertebral body heights are preserved.\nThere is heterogeneous marrow signal without discrete lesion, although\nevaluation of the marrow is suboptimal without T1 sequence. There is mild\ntype ___ ___ change at T2-T3. There is diffuse low intervertebral disc signal\nwith significant loss of height at C4 through T1 and at T2-T3.\n\nAt C2-C3 there is uncovertebral osteophytes causing mild right neural\nforaminal stenosis.\n\nAt C3-C4 there are uncovertebral osteophytes causing severe right and moderate\nleft neural foraminal stenosis.\n\nAt C4-C5 there is disc osteophyte complex and uncovertebral osteophytes\ncausing moderate spinal canal stenosis and moderate bilateral neural foraminal\nstenosis.\n\nAt C5-C6 there is disc osteophyte complex and uncovertebral osteophytes\ncausing moderate spinal canal stenosis and moderate to severe bilateral neural\nforaminal stenosis.\n\nAt C6-C7 there is disc osteophyte complex and uncovertebral osteophytes\ncausing moderate spinal canal stenosis and moderate to severe bilateral neural\nforaminal stenosis.\n\nAt C7-T1 there is disc osteophyte complex and uncovertebral osteophytes\ncausing moderate to severe bilateral neural foraminal stenosis.\n\nAt T2-T3 there is disc bulge without significant neural foramina or spinal\ncanal stenosis.\n\nThe cord demonstrates normal signal without evidence of edema myelomalacia, or\ninfarct. The cervicomedullary junction is unremarkable. There is an\nendotracheal tube in place with fluid layering within the pharynx and sphenoid\nsinus. There is no prevertebral edema. The vascular flow voids are\npreserved. The paravertebral soft tissues are unremarkable.", "output": "1. Sagittal T1 sequence was not performed which limits the differentiation of\na disc versus osteophytes and limits evaluation for marrow lesions.\n2. No evidence of ligamentous injury or cord pathology.\n3. Multilevel degenerate changes of the cervical spine, as described, with\nmultilevel moderate to severe neural foraminal stenoses." }, { "input": "At C3-4, there is a tiny posterior disc protrusion contacting the ventral cord\nmargin.\n\nAt C4-5, mild right-sided facet joint degeneration is seen, both on the prior\nCT and present MR study.\n\nAt C5-6, there is a mild posterior disc protrusion, broad-based in\nconfiguration, and mild infolding of the ligamentum flavum approaching the\nventral and dorsal cord margins, respectively. The disc space is moderately\ndecreased in height. In association with uncovertebral spurring, there is\nmoderately prominent right and milder left neural foraminal stenosis.\n\nAt C6-7, mild infolding of the ligamentum flavum approaches the dorsal cord\nmargin.\n\nThough scanned only in the sagittal plane, there appears to be a mild chronic\ncompression deformity of the T1 body, wedge shaped in configuration and\nsimilar compression deformity of the T2 and T3 bodies. The T1 deformity was\ncovered on the prior cervical spine CT scan. Small disc protrusions at T2-3,\nand possibly at T3-4, which is an incompletely seen disc space approach the\nventral cord margin.\n\nThe cervical spinal cord signal pattern, foramen magnum and its contents, as\nwell as limited thoracic cervical paraspinal soft tissue imaging does not\ndisclose additional abnormalities.", "output": "Cervical and upper thoracic spondylosis. Multiple, likely chronic compression\ndeformities of upper thoracic vertebral bodies, described above." }, { "input": "As seen on cervical spine study mild compression of the upper thoracic\nvertebral bodies appear chronic. From T1-2 to T11-12 levels degenerative disc\ndisease seen. Disc bulging is noted at T3-4, T4-5, T5-6, T6-7, T7-8 levels\nmildly indenting the thecal sac.\n\nAt T12-L1 level small central disc protrusion minimally indents the spinal\ncord without cord compression. At L1-2 and L2-3 mild degenerative disc\ndisease seen.\n\nThere is no acute compression fracture.\n\nThere is no evidence of spinal cord compression or intrinsic spinal cord\nsignal abnormalities.\n\nThere are no paraspinal soft tissue abnormalities.", "output": "1. Small disc protrusion at T12-L1 level minimally indenting the anterior\naspect of the spinal cord without cord compression.\n2. No evidence of intrinsic signal abnormalities within the spinal cord or\nextrinsic spinal cord compression in the thoracic region.\n3. Degenerative changes and disc bulging in the thoracic region.\n4. No evidence of acute compression fracture but mild chronic compression\ndeformities of the upper thoracic vertebral bodies are seen as described on\nthe previous cervical spine MRI." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. ___ type 2 endplate degenerative changes are seen at T2-3. \nAn intraosseous hemangioma is seen at T9. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing. There is no evidence of infection or neoplasm.", "output": "1. No lesions or abnormal enhancement.\n2. No spinal canal or foraminal narrowing.\n3. Multilevel disc degenerative disease without high-grade spinal stenosis or\nextrinsic spinal cord compression." }, { "input": "Minimal L4-5 anterolisthesis. Alignment is otherwise normal. Diffusely\nreduced signal on T1 weighted imaging of the lumbar vertebral bodies may be\nfrom lymphomatous involvement or reactive changes. There are multilevel\nsuperimposed degenerative endplate signal changes and multilevel disc space\nnarrowing most significant at L1-L2, L2-L3 and L5-S1. The vertebral body\nheights are preserved. The spinal cord appears normal in caliber and\nconfiguration. The conus medullaris terminates at the level of L1-L2. There\nare multiple bilateral sacral Tarlov cysts measuring up to 1.7 cm.\n\n\nThere is retroperitoneal, presacral, iliac chain soft tissue infiltration and\nenhancement, improved since ___. Today it measures measures 5.6 cm\nx 2.2 cm, compared with 5.3 cm x 1.6 cm on ___, which is\nprobably similar allowing for differences in technique end is consistent with\nknown lymphoma. Tumor abuts or infiltrates right extraforaminal L4, L5, S1\nnerves, worse at L5 nerve, probably similar compared to prior scan.\n\n\nT12-L1: Patent canal neural foramina.\n\nAt L1-L2 level there is mild central canal, mild bilateral foraminal\nnarrowing.\n\nAt L2-L3 level there is mild central canal, minimal right and mild right\nforaminal narrowing.\n\nAt L3-L4 level there is mild central canal narrowing. Minimal mass-effect on\nintrathecal traversing segment of left L4 nerve from facet arthropathy. \nPatent right foramen. Moderate left foraminal narrowing.\n\nAt L4-5 level there is minimal grade 1 anterolisthesis. Mild central canal\nnarrowing. Moderate left foraminal narrowing. Minimal right foraminal\nnarrowing.\n\nAt L5-S1 level central canal is patent. Mild left, moderate right foraminal\nnarrowing.\n\nAt S1-S2 level, central canal is patent. There is minimal tumor infiltration\nalong the very far lateral right foramen. Otherwise both foramina are patent.\n\nOther: There is moderate fatty infiltration of the lower posterior paraspinal\nmusculature.", "output": "1. Upper presacral, lower retroperitoneal, right greater than left iliac chain\ninfiltrative enhancing mass consistent with residual lymphoma, probably\nsimilar compared ___. Tumor contacts or infiltrates about\nextraforaminal segments right L4, L5, S1 nerves, worse involvement of L5\nnerve, which may account for patient's symptoms.\n2. Diffusely reduced T1 marrow signal may be from lymphoma or reactive change.\n3. Multilevel degenerative changes.\n4. Mild central canal, multilevel moderate foraminal narrowing." }, { "input": "Study is limited by patient motion\n\nCERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no suspicious marrow signal abnormality. There is no prevertebral\nsoft tissue swelling.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nAt C2-3 there is nospinal canal orneural foraminal narrowing.\n\nAt C3-4 there is a diffuse disc bulge causing indentation of the anterior\nthecal sac and mild spinal canaland mild bilateral neural foraminal narrowing.\n\nAt C4-5 there is a central disc protrusion with mildspinal canaland no neural\nforaminal narrowing.\n\nAt C5-6 there is a mild disc bulge and ligamentum flavum thickening with\nmild-to-moderatespinal canaland no neural foraminal narrowing.\n\nAt C6-7 and C7-T1 there is no spinal canalorneural foraminal narrowing.\n\nTHORACIC:\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is increased T2/STIR signal within the left side of the T2 vertebral\nbody with extension across the left pedicle into the left transverse process\n(6:14 and 6:16), overall similar to prior study dated ___, compatible\nwith a hemangioma. An additional T12 vertebral body hemangioma also\nidentified. There is no evidence of associated vertebral body height loss or\nabnormal signal within the disc space. Otherwise, there is no marrow signal\nabnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral discheightsandsignalare preserved.\n\nThere is no significant spinal canalorneural foraminal narrowing in the\nthoracic spine.\n\n\nLUMBAR:\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is increased T2 and T1 signal within the T12 vertebral body, compatible\nwith a vertebral body hemangioma (9:8 and 11:9). Otherwise, there is no \nmarrow signal abnormality.\n\nThe conus medullaris terminates at the level of the T12-L1 disc space. The\nvisualized portion of the terminal spinal cord is preserved in signal and\ncaliber.\n\nThere is diffuse intervertebral disc desiccation, most prominent at L3-L4 and\nL4-L5.\n\nAt T12-L1 and L1-L2, there is no spinal canal orneural foraminal narrowing.\n\nAt L2-3 there is a diffuse disc bulge, ligamentum flavum thickening, and facet\nhypertrophy with moderatespinal canaland mild leftneural foraminal narrowing.\n\nAt L3-4 there is a diffuse disc bulge, ligamentum flavum thickening, and facet\nhypertrophy with severe spinal canal narrowing with compression of the cauda\nequina nerve roots incomplete effacement of the CSF space. Additionally,there\nis severe bilateral foraminal narrowing.\n\nAt L4-5 there is a diffuse disc bulge, ligamentum flavum thickening, and facet\nhypertrophy with mildspinal canaland mild to moderate bilateralneural\nforaminal narrowing.\n\nAt L5-S1 there is a mild disc bulge without significant spinal canalor neural\nforaminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. T2 hyperintense cystic lesions in both kidneys are\nstatistically most compatible with simple cysts.", "output": "1. Diffuse disc bulge at L3-L4 causing severe spinal canal and bilateral\nneural foraminal narrowing with compression of the cauda equina nerve roots\nand complete effacement of the CSF space.\n2. Additional extensive multilevel degenerative changes of the lumbar spine,\nas described above.\n3. Multilevel degenerative changes of the cervical spine, most prominent at\nC5-C6 where there is mild-to-moderate spinal canal narrowing. No evidence of\ncord compression or signal abnormalities.\n4. No significant degenerative changes in the thoracic spine.\n5. Increased T2/STIR signal within the T2 vertebral body with extension across\nthe left pedicle into the left transverse process, overall similar to prior\nstudy dated ___ and likely representing a vertebral body hemangioma.\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": "Study is degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is minimal dextroscoliosis of the lumbar spine. There is approximately\n3 mm grade 1 L3 on L4 anterolisthesis. Vertebral body heights are preserved.\nPostsurgical changes related to patient's known L3-4 laminectomy are noted. \nNonspecific fluid and edema with areas of enhancement are noted within the\nsurgical bed. Bilateral L5-S1 paraspinal muscle nonspecific probable edema\nseen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber, with the conus at approximately T12-L1, with no definite abnormal\nenhancement. At approximately L3-4 level there is clumping of the lumbar\nnerve roots without definite focal enhancement (see 5, 6, ___. T12\ninferior endplate type ___ ___ changes. T12 vertebral body probable\nhemangioma is again seen.\n\nThere is loss of intervertebral disc height and signal at L2-3 through L5-S1. \nOtherwise, intervertebral discheightsandsignalare preserved. Nonspecific facet\njoint fluid is noted at multiple levels of the lumbar spine.\n\nAt T12-L1 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with no vertebral canaland no neural foraminal narrowing.\n\nAt L1-2 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canaland no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild vertebral canal, moderate left and mild\nright neural foraminal narrowing.\n\nAt L3-4 there is grade 1 anterolisthesis, disc bulge and central extrusion,\nfacet joint hypertrophy, and enhancing tissue extending along the lateral and\ndorsal thecal sac with moderate to severe vertebral canal, mild right and\nmoderate left neural foraminal narrowing.\n\nAt L4-5 there is disc bulge, central disc protrusion, facet joint hypertrophy,\nligamentum flavum thickening, with mild vertebral canaland mild bilateral \nneural foraminal narrowing.\n\nAt L5-S1 there is disc bulge, central disc protrusion, with no vertebral\ncanal and no neural foraminal narrowing.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified. Limited imaging of\nthe kidneys demonstrates right at least partially T2 hyperintense structure,\nincompletely characterized, suggestive of cyst (see 9:3).", "output": "1. Study is degraded by motion.\n2. Interval postsurgical changes related to patient's known L3-4 laminectomy,\nwith nonspecific fluid and enhancement within surgical bed.\n3. L3-4 disc bulge, central disc extrusion, and enhancing probable granulation\ntissue contributing to moderate to severe vertebral canal narrowing.\n4. Focal clumping of lumbar nerve roots at L3-4 level as described. While\nfinding may be related to vertebral canal narrowing, arachnoiditis is not\nexcluded on the basis of this examination.\n5. Multilevel lumbar spondylosis and epidural fat as described, L2-3 and L3-4\nmoderate left neural foraminal narrowing.\n6. Additional 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 s" }, { "input": "The vertebral body height and alignment are normal. The bone marrow of the\nlumbar spine is diffusely, mildly T1 hypointense which is potentially on the\nbasis of hematopoietic bone marrow. There are no suspicious osseous lesion is\nseen.\n\nThe conus medullaris is normal in signal and morphology and terminates at the\nL2 level.\n\nThere is an incompletely imaged mass within the superior and posterior aspect\nof the uterus which likely represents a uterine leiomyoma, better visualized\non the patient's prior ___ pelvic ultrasound.\n\nAt the L1-L2 level, the spinal canal and neural foramina appear normal.\n\nAt the L2-L3 level, the spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, the spinal canal and neural foramina appear normal.\n\nAt the L4-L5 level, the spinal canal and neural foramina appear normal.\n\nAt the L5-S1 level, the spinal canal and neural foramina appear normal.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.", "output": "1. No significant degenerative changes within the lumbar spine.\n2. No evidence of spinal canal or neural foraminal narrowing.\n3. Partially visualized fibroid uterus, better visualized on patient's ___ prior pelvic ultrasound." }, { "input": "There is global loss of vertebral body marrow fat, suggesting a systemic\nprocess likely related to chronic illness.\n\nCERVICAL:\nAlignment is normal.There is decreased T1 and T2 signal involving the C2\nvertebral body without appreciable edema signal which is suspicious for\nmetastatic involvement (13:9).The spinal cord appears normal in caliber and\nconfiguration.Mild multilevel degenerative changes of the cervical spine are\nmost severe at C5-C6 where a posterior disc bulge mildly impresses upon the\nthecal sac resulting in mild-to-moderate spinal canal narrowing and mild to\nmoderate right neural foraminal narrowing (17:16).There is no prevertebral\nsoft tissue swelling. A 7 mm T2 hypointense STIR hyperintensity in the\nposterior subcutaneous soft tissues at the level of C5-C6 may reflect sequela\nof prior injury (11:7).\n\nTHORACIC:\nAlignment is normal. Multilevel areas of T1 and T2 hypointensity within the\nthoracic spine including the T2, T3, T8-T12 vertebral bodies are concerning\nfor metastatic disease. These correspond to blastic lesions seen on recent CT\nabdomen pelvis. Focal fat is noted within the T7 vertebral body (13:9). \nSmall right-sided posterior disc protrusion at T8-T9 results in mild right\nneural foraminal narrowing and no appreciable spinal canal stenosis. \nOtherwise, there is no evidence of severe spinal canal or neural foraminal\nnarrowing in the thoracic spine.\n\n\nLUMBAR:\nAlignment is normal. Focal areas T1 and T2 hypointensity involving the L1,\nL2, L4, and S1 vertebral bodies are concerning for metastases. There is\nminimal multilevel degenerative changes of the lower lumbar spine:\n\nL1-L2: No significant degenerative changes. Trace bilateral facet joint fluid\nis seen. No severe spinal canal or neural foraminal narrowing at this level.\n\nL2-L3: Trace bilateral facet joint fluid. No severe spinal canal or neural\nforaminal narrowing.\n\nL4-L5: Mild left posterior disc bulge results in mild left neural foraminal\nnarrowing. No evidence of severe spinal canal stenosis.\n\nL5-S1: Mild lifts posterior disc bulge. No severe spinal canal or neural\nforaminal stenosis.\n\n\nOTHER: Small right pleural effusion. T2 hyperintensities at the right lung\nbase are compatible with known lung metastases. Large T2 hyperintense foci\nwithin the liver are not evaluated on current exam but are most compatible\nwith patient's known metastatic disease. Multiple bilateral renal cortical T2\nhyperintensities may reflect simple renal cysts but are incompletely evaluated\non this exam. T1 hypointensity involving the right iliac bone is partially\nevaluated and also concerning for osseous metastatic disease (22:42).", "output": "1. Multilevel T1 and T2 hypointensities within the cervical, thoracic, and\nlumbar spine are concerning for osseous metastatic disease. Additional foci\nof disease are also seen in the sacrum and right iliac bone.\n2. Multilevel degenerative changes without evidence of severe spinal canal or\nneural foraminal stenosis, as described above.\n3. Hepatic and lung metastases are better evaluated on prior CT abdomen pelvis\nperformed ___ and MRCP performed ___.\n4. Small right pleural effusion." }, { "input": "The single sagittal T2 weighted sequence through the cervical and upper/mid\nthoracic spine is limited by motion artifact. Again seen are hypointense\nosseous lesions involving C2, T2, T3, T8,, T9, and the partially included T10\nvertebral bodies. No acute loss of vertebral body height.\n\nMultilevel cervical degenerative disease is again seen. Broad-based central\ndisc protrusion at C5-C6, larger on the right than left, with moderate spinal\ncanal narrowing and ventral cord deformity, as well as central disc protrusion\nat C6-C7 with mild spinal canal narrowing and minimal ventral cord deformity,\nwere better assessed on the recent ___ MRI. No focal cord signal\nabnormalities are identified allowing for motion artifacts and absence of\naxial images.\n\nRight paracentral disc herniations at T5-T6, T7-T8, and T8-T9, with mild\nencroachment on the right ventral thecal sac without spinal cord deformity,\nare again seen, better assessed on the ___ MRI. Smaller upper\nthoracic disc protrusions spinal canal narrowing are also again noted.\n\nThe neural foramina are not assessed on this exam in the absence of axial\nsequences.", "output": "1. Limited, incomplete exam with motion-limited sagittal T2 weighted images\nthrough the cervical and upper midthoracic spine.\n2. Multiple hypointense cervical and thoracic bone marrow lesions are again\nseen, suggestive of metastases. No acute loss of vertebral body height.\n3. Multilevel cervical and thoracic degenerative disease is again seen, better\nassessed on the ___ complete spine MRI.\n4. No evidence for compression of the visualized cervical and\nupper/midthoracic spinal cord. No evidence for focal cord signal\nabnormalities allowing for motion artifacts." }, { "input": "THORACIC:\nSimilar to prior exam dated ___, there are multiple T1 and T2\nhypointense lesions in multiple thoracic vertebral bodies, consistent with\nmetastatic disease. There is no definite abnormal enhancement within\nlimitations of motion. There is minimal wedging of the T11 vertebral body,\nlikely physiologic. Otherwise, the thoracic vertebral heights appear\nmaintained. Again focal fat is noted in the T7 vertebral body.\n\nThere are right central disc protrusions at T5-T6 and T7-T8 without\nsignificant spinal canal narrowing. There is a right-sided disc protrusion at\nT8-T9 which results in mild right neural foraminal narrowing without\nsignificant spinal canal narrowing. At T10-T11, there is a right central disc\nprotrusion with slight superior migration and indentation of the ventral\nthecal sac without significant spinal canal narrowing. Otherwise, no evidence\nof high-grade spinal canal or neural foraminal narrowing.\n\nThe thoracic spinal cord is normal in signal intensity in configuration\nwithout evidence of abnormal enhancement.\n\nLUMBAR:\nThe lumbar vertebral body heights and alignment are maintained. There is\nredemonstration of multiple T1 and T2 hypointense lesions throughout the\nlumbar spine and sacrum and visualized iliac bones without definite evidence\nof abnormal enhancement.\n\nMultilevel degenerative changes of the lumbar spine are again demonstrated\nunchanged from prior exam dated ___. There is no evidence of severe\nspinal canal or neural foraminal narrowing.\n\nOTHER: There are partially visualized focal consolidations in the right lung\nbase, better demonstrated on the prior CT abdomen and pelvis. There are also\nirregular parenchymal band like opacities in the dependent portions of the\nlungs which may represent a combination of atelectasis and respiratory motion.\n\nThere is a 4 x 3.5 cm ill-defined lesion in the posterior right hepatic lobe,\nbetter characterized on the CT abdomen and pelvis.\n\nThere are multiple incompletely characterized T2 hyperintense lesions in the\nright greater than left kidneys. There is additional T2 hypointense lesion\nemanating from the superior aspect of the right kidney measuring up to 1.7 cm.\nThese are better demonstrated on the CT abdomen and pelvis dated ___.", "output": "1. Multiple osseous metastatic lesions of the thoracic and lumbar spine,\nsimilar to prior exam dated ___. No epidural soft tissue disease.\n2. No evidence of cord compression in the thoracic and upper lumbar region.\n3. Multilevel degenerative changes without evidence of high-grade spinal canal\nor neural foraminal narrowing.\n4. Partially visualized lung and liver metastatic lesions.\n5. Multiple bilateral renal lesions are incompletely characterized, better\nevaluated on the CT abdomen and pelvis with contrast dated ___." }, { "input": "CERVICAL:\nVertebral body heights and alignment are maintained. There is no suspicious\nfocal bone marrow signal abnormality. There is no prevertebral soft tissue\nedema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease, without significant height loss.\n\nThe spinal cord is preserved in signal and caliber. The visualized posterior\nfossa and cervicomedullary junction is preserved.\n\nThere are trace disc protrusions at multiple levels indenting the ventral\nthecal sac without cord contact or significant spinal canal narrowing. There\nis no significant neural foraminal narrowing.\n\nTHORACIC:\nVertebral body heights and alignment are preserved. Focal fat is seen at a\nfew levels. There is otherwise no suspicious focal bone marrow signal\nabnormality. There is no prevertebral soft tissue edema.\n\nThere is mild loss of T2 signal of a few thoracic intervertebral discs, a\nmanifestation of degenerative disc disease. The intervertebral disc heights\nare otherwise relatively well preserved.\n\nThe spinal cord is preserved in signal and caliber.\n\nA few tiny disc protrusions are seen, including a small central disc\nprotrusion at T1-T2 and left-sided disc protrusion at T2-T3 stopping short of\nthe neural foramen, indenting the ventral thecal sac without significant\nspinal canal narrowing. There is no significant spinal canal or neural\nforaminal narrowing throughout the thoracic spine.\n\nLUMBAR:\nVertebral body heights and alignment are preserved. There is no suspicious\nfocal bone marrow signal abnormality. There is no prevertebral soft tissue\nedema.\n\nThere is loss of T2 signal of the intervertebral discs at the L4-L5 and L5-S1\nlevel, a manifestation of degenerative disc disease. The intervertebral disc\nheights are otherwise relatively well preserved.\n\nThe distal spinal cord is preserved in signal and caliber. The conus\nmedullaris terminates at the L1-L2 level.\n\nAt T12-L1, L1-L 2, and L2-L3, there is no significant spinal canal or neural\nforaminal narrowing.\n\nAt L3-L4, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L4-L5, there is mild disc bulge with tiny central annular fissure without\nsignificant spinal canal narrowing. Facet and endplate osteophytes produce\nmild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is mild disc bulge without significant spinal canal narrowing.\nFacet and endplate osteophytes produce mild to moderate left neural foraminal\nnarrowing. The right neural foramen is patent.\n\nOTHER: The lungs are grossly clear. The visualized retroperitoneum is grossly\nunremarkable.", "output": "1. Mild degenerative disc disease throughout the total spine, as described,\nwithout significant spinal canal or high-grade neural foraminal narrowing. \nOnly up to mild to moderate neural foraminal narrowing at the left L5-S1\nlevel. No spinal cord or nerve root compression.\n2. No spinal cord signal abnormality." }, { "input": "Abnormal disc signal at L4-5 level, with adjacent endplate erosion more\nprominent at inferior L4 endplate, markedly abnormal L4-L5 marrow signal with\ndecreased T1 in bright STIR signal. There is paraspinal edema which extends\ninto the medial bilateral psoas muscles, more prominent on the left. Findings\nare worrisome for discitis osteomyelitis. Small area of fluid signal\nabnormality tracks from the posterior margin of the disc space into the\nventral epidural space along the posterior margin of the L4 vertebral body,\nextending 1.6 cm above the disc space, and measuring 0.5 cm in AP diameter, it\nmay represent phlegmon or abscess. Inflammatory changes extend into both L4-5\nforamina, causing severe foraminal narrowing, causing bilateral L4 nerve\nflattening,. There is no paraspinal fluid collection.\n\nThe spinal cord appears normal in caliber and configuration. Alignment is\nmaintained. Multilevel degenerative changes. Significant narrowed L4-5 disc\nspace. Multilevel diffuse disc bulges, lower lumbar facet arthritis. 2 small\nlesions in the upper pole right kidney, likely represent benign simple cysts\n\nAt L1-L2 level central canal, foramina are patent.\nAt L2-L3 level there is mild central canal narrowing. Annular disc tear. \nPatent foramina.\nAt L3-L4 level there is moderate central canal narrowing, preserved CSF. Mild\nright, mild-to-moderate left foraminal narrowing.\nAt L4-5 level there is moderate central canal narrowing, mild mass effect on\nthe intrathecal segment of traversing right L5 nerve. Preserved CSF. Severe\nbilateral foraminal narrowing.\nAt L5-S1 level central canal is patent moderate to severe right foraminal\nnarrowing. Mild left foraminal narrowing.\n\nSuggestion of edema within bilateral anteriorly at bones with edema, seen on\naxial T2 weighted images only.", "output": "1. Findings most consistent with discitis osteomyelitis at L4-5 level. \nParavertebral edema. Small area of fluid signal in the ventral epidural space\ncommunicating with disc space, may represent phlegmon or abscess.\n2. Moderate central canal and severe foraminal narrowing L4-5 level.\n3. Consider post gadolinium images if indicated.\n4. Degenerative changes lumbar spine as above\n\nRECOMMENDATION(S): If indicated, MRI lumbar spine post gadolinium only.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:57 am, 5 minutes after\ndiscovery of the findings. ." }, { "input": "Re demonstrated is abnormal disc signal at the L4-L5 level, with adjacent\nendplate erosion or prominent at the inferior L4 endplate, overall unchanged\ncompared to the prior exam. The extent of increased STIR signal abnormality\ninvolving L4-L5 and T1 hypointensity is unchanged compared to the prior exam. \nThere is avid enhancement after the administration of gadolinium of the bone\nmarrow at these levels. Paraspinal edema and enhancement extends into the\nbilateral medial psoas muscles, again highly concerning for discitis\nosteomyelitis. Focal intradiscal fluid collection at L4-L5 is seen measuring\nat least 1.1 cm, concerning for a small intradiscal abscess.\n\nExtensive ventral epidural enhancement is seen spanning from the L3/L4\ninterspace cranially to L5-S1 caudally, spanning approximately 5.1 cm in the\ncraniocaudal dimension. The ventral epidural soft tissue enhancement, in\nconjunction with disc bulge at L4-L5 results in at least moderate spinal canal\nnarrowing at this level. Soft tissue enhancement is seen is seen extending\ninto the bilateral L4-L5 neural foramina as well as possibly the left L5-S1\nneural foramina, with severe bilateral neural foraminal narrowing and\nbilateral L4 nerve flattening.\n\nExtensive prevertebral soft tissue phlegmonous changes are seen, with contact\nof the enhancing tissue with the distal aorta and proximal bilateral common\niliac arteries. Please note that evaluation of the vascular structures is\nlimited on this exam.\n\nNo cord signal abnormalities are identified. The cord terminates at L1-L2. \nT2 hyperintense lesions are seen within the upper pole of the right kidney. \nThe alignment is unchanged compared to the prior exam.\n\nDegenerative changes at the remainder of the levels, are unchanged compared to\nthe prior exam.", "output": "1. No significant interval change in the appearance of the\ndiscitis/osteomyelitis at the L4-L5 level compared to the prior exam from ___, with a possible small intradiscal abscess at L4-L5. Phlegmonous\nsoft tissue enhancement is seen within the ventral epidural space spanning 5.5\ncm in the craniocaudal dimension from L4 through L5, and contributing to at\nleast moderate spinal canal narrowing at these levels.\n2. Phlegmonous soft tissue is seen extending anteriorly to the prevertebral\nspace, with contact of the distal aorta/IVC and proximal common iliac\narteries/veins however please note that evaluation of the vascular structures\nis limited on this exam.\n3. Severe bilateral neural foraminal narrowing at L4-L5, secondary to\nextension of the phlegmonous enhancing tissue into the neural foramina is\nunchanged compared to the prior exam. Possible extension of phlegmonous soft\ntissue within the left L5-S1 neural foramina.\n4. No cord signal abnormalities identified.\n5. Similar involvement of the paravertebral soft tissues, including the\nbilateral medial psoas muscles." }, { "input": "Again seen is abnormal disc signal at the L4-L5 level, with interval\nprogressive destruction of the disc. Adjacent endplate erosion, predominantly\ninvolving the inferior endplate of L4, is similar to prior. There is\ncontinued T1 hypointensity with increased IDEAL signal involving L4 and L5\nvertebral bodies. Bone marrow enhancement at L4-L5 is improved from prior,\nhowever still present.\n\nThere has been interval improvement in extent of adjacent ventral epidural\nsoft tissue enhancement and associated spinal canal narrowing at L4-L5. Soft\ntissue enhancement is again seen extending into the bilateral L4-L5 neural\nforamina and the left L5-S1 neural foramina and causing foraminal narrowing,\nhowever is improved from prior. There is persistent prevertebral and\nparaspinal edema and enhancement extending into the bilateral medial psoas\nmuscles.\n\nDegenerative changes of the remainder of the lumbar spine are similar to\nprior. The conus terminates at the L1-L2 level. There is no or abnormal cord\nsignal.", "output": "1. Interval improved enhancement of L4-L5 discitis and osteomyelitis, with\ncontinued destruction of the disc and no significant change in adjacent\nendplate destruction.\n2. Ventral epidural inflammatory change extending into the bilateral neural\nforamina remains present, however is improved from prior, with interval slight\nimprovement in associated canal narrowing.\n3. Persistent paraspinal inflammatory change." }, { "input": "Interval postsurgical changes after posterior instrumented fusion with screw\nand rod fixation of the T12, L1 and L2 vertebral bodies. Hardware artifact at\nthese levels limits evaluation of the spinal cord.\n\nAs previously identified on the outside MRI, there is a T12 vertebral body\ncompression deformity with less than 25% vertebral body height loss as well as\na L1 vertebral body compression deformity with up to approximately 50%\nvertebral body height loss. There is unchanged retropulsion of the posterior\nL1 vertebral body with severe spinal canal stenosis and compression of the\nconus with increased T2 signal intensity at this level (series 3, image 82).\n\nThe visualized spinal cord appears otherwise normal in caliber and\nconfiguration. The cauda equina nerve roots appear unremarkable.\n\nVertebral body height and alignment of the remainder of the lumbar spine is\nmaintained. There is mild degenerative disc disease predominantly seen at\nT11-T12 and L5-S1 with mild disc space height loss.\n\nAt T12-L1, there is facet joint arthropathy and mild ligamentum flavum\nthickening, no spinal canal stenosis, mild bilateral neural foraminal\nnarrowing, right greater than left.\n\nAt L1-L2, there is facet joint arthropathy and ligamentum flavum thickening,\nno spinal canal stenosis, moderate left and mild right neural foraminal\nnarrowing.\n\nThere is facet joint arthropathy and ligamentum flavum thickening along the\nremaining lumbar levels but no spinal canal stenosis or neural foraminal\nnarrowing.", "output": "1. Interval postsurgical changes after posterior instrumented fusion at T12,\nL1 and L2.\n2. Stable compression deformities of the T12 vertebral body with less than 25%\nvertebral body height loss as well as a L1 vertebral body compression\ndeformity with up to approximately 50% vertebral body height loss.\n3. Unchanged retropulsion of the posterior aspect of the L1 vertebral body\nwith stable severe spinal canal stenosis and compression of the conus showing\nincreased T2 signal intensity at this level. Focus of T2 hypointensity within\nthe conus is new compared to the prior exam and may reflect evolving blood\nproducts from the prior trauma.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 12:57 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "5 lumbar-type vertebrae are again identified. The numbering is documented on\nimage 4:10.\n\nSince the prior MRI, there has been progression of a Schmorl's node in the\ninferior endplate of L5 vertebral body with new mild anterior loss of height. \nLoss of disc height at L5-S1 has also progressed. Previously noted ___ type\n1 discogenic marrow changes in the endplates at L5-S1 have transformed to\n___ type 2. Previously noted left paracentral disc herniation at L5-S1 has\nbeen resected. There is minimal enhancing granulation tissue surrounding the\ntraversing left S1 nerve root in the left subarticular zone. Left paracentral\nendplate osteophytes do not appear to alter the course of the left S1 nerve\nroot. There is also a disc bulge, a small right foraminal disc protrusion,\nand left greater than right facet arthropathy at L5-S1, with mild right neural\nforaminal narrowing.\n\nT11 through L4 vertebral body heights are preserved. No concerning bone\nmarrow signal abnormalities are seen.\n\nT12-L1: Bilateral mild facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Bilateral moderate facet arthropathy with mild bilateral neural\nforaminal narrowing, but no evidence for nerve root impingement. No spinal\ncanal narrowing.\n\nL2-L3: Minimal disc bulge and moderate bilateral facet arthropathy with\nthickening of the ligamentum flavum. The spinal canal is minimally narrowed\nwithout mass effect on the intrathecal nerve roots or impingement of the\ntraversing L3 nerve roots. Mild to moderate right neural foraminal narrowing\nhas progressed since ___. Moderate left neural foraminal narrowing is\nunchanged.\n\nL3-L4: Minimal disc bulge and moderate bilateral facet arthropathy with\nthickening of the ligamentum flavum. Mild spinal canal narrowing without mass\neffect on the intrathecal nerve roots or impingement of the traversing L4\nnerve roots. Mild to moderate bilateral neural foraminal narrowing has not\nsignificantly changed.\n\nL4-L5: Grade 1 anterolisthesis with a mild disc bulge, thickening of the\nligamentum flavum, and severe, right greater than left facet arthropathy, not\nsignificantly changed. There is a small amount of fluid in the right facet\njoint, decreased since ___. Traversing L5 nerve roots are abutted in the\nsubarticular zones, unchanged. There is no mass effect on the intrathecal\nnerve roots. Mild to moderate right and minimal left neural foraminal\nnarrowing is unchanged.", "output": "1. S/p left L5-S1 microdiscectomy without evidence for residual or recurrent\ndisc herniation. Left paracentral endplate osteophytes at L5-S1 do not appear\nto alter the course of the left S1 nerve root. Minimal enhancing granulation\ntissue is noted around the left S1 nerve root.\n2. Progression of the Schmorl's node in the inferior endplate of L5 since ___\nwith new mild anterior loss of height. Discogenic marrow changes in the L5-S1\nendplates have transformed from ___ type 1 to ___ type 2 ; this often\ncorrelates with decreased inflammation.\n3. Degenerative disease from T12-L1 through L4-L5 has not changed\nsignificantly, aside from slight progression of mild to moderate right neural\nforaminal narrowing at L2-L3. Bilateral traversing L5 nerve roots remain\nabutted in the subarticular zones at L4-L5." }, { "input": "There is mild grade I anterolisthesis at L4 upon L5 level, of uncertain\nchronicity and likely degenerative in nature.. The conus medullaris\nterminates at the level of T12-L1 and is unremarkable. At T12 vertebral body,\na focal area of high-signal intensity is identified on the right side of the\nvertebral body, consistent with a non expansile fatty hemangioma, similar\nfindings are demonstrated at S2 vertebral body also suggestive of hemangioma\notherwise, the bone marrow signal throughout the lumbar spine is normal.\n\nAt T11-T12 level, there is mild bilateral articular joint facet hypertrophy\ncausing minimal posterior thecal sac deformity, there is no evidence of\ncentral spinal canal stenosis (image 11, series 100).\n\nAt T12-L1 level, there is no evidence of neural foraminal narrowing or spinal\ncanal stenosis.\n\nAt L1-L2 level, there is mild biconvex disc bulge causing minimal bilateral\nneural foraminal narrowing, there is mild articular joint facet hypertrophy,\nthere is no evidence of central spinal canal stenosis.\n\nAt L2-L3 level, there is a diffuse disc bulge causing anterior thecal sac\ndeformity, contacting the traversing nerve roots bilaterally, there is\nmoderate articular joint facet hypertrophy and mild ligamentum flavum\nthickening resulting in crowding of the nerve roots within the thecal sac\n(image 42, series 100).\n\nAt L3-L4 level, there is a posterior broad-based disc protrusion, causing\nanterior thecal sac deformity, contacting the traversing nerve roots\nbilaterally and causing moderate left and moderate to severe right-sided\nneural foraminal narrowing, there is articular joint facet hypertrophy\nligamentum flavum thickening resulting moderate to severe spinal canal\nstenosis with crowding of the nerve roots within the thecal sac (image 52,\nseries 100).\n\nAt L4-5 level, there is diffuse disc bulge causing bilateral neural foraminal\nnarrowing, contacting the traversing nerve roots bilaterally and producing\ncrowding of the nerve roots within thecal sac (image 63, series 100),\nadditionally there is articular joint facet hypertrophy and ligamentum flavum\nthickening bilaterally.\n\nAt L5-S1 level, there is diffuse disc bulge with right paracentral disc\nprotrusion, causing bilateral neural foraminal narrowing, contacting the\ntraversing nerve roots bilaterally and apparently impinging the S1 nerve root\non the right (image 72, series 100), there is mild epidural lipomatosis,\nmoderate left and moderate to severe right-sided neural foraminal narrowing, \nmoderate articular joint facet hypertrophy and ligamentum flavum thickening\ncausing crowding of the nerve roots within the thecal sac.\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable.", "output": "1. Grade I anterolisthesis is identified at L4-L5 level.\n\n2. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, more significant from L2-L3 through L5-S1 levels, causing moderate to\nsevere spinal canal narrowing.\n\n3. Focal areas of high-signal intensity on the right side at T12 vertebral\nbody, and in the sacrum at the level of S2, likely consistent with fatty\nhemangiomas." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal aside from diffuse disc desiccation.The previously noted spinal\ncord lesion at C4, is not well seen on today's exam. Subtle increased cord\nsignal abnormality spanning from C5 through C6, is likely secondary to\nmyelomalacia from patient's severe canal stenosis at C5/C6. No concerning\nenhancing lesions are identified.\n\nC2-C3: There is no evidence of spinal canal or neural foraminal narrowing.\n\nC3-C4: Mild central disc bulge is seen however there is no significant spinal\ncanal or neural foraminal narrowing.\n\nC4-C5: Central disc protrusion is seen contacting the ventral thecal cord and\nresulting in mild to moderate thecal sac narrowing. Uncovertebral and facet\njoint arthropathy results in moderate left neural foraminal narrowing. The\nright neural foramen is patent.\n\nC5-C6: Central disc bulge with a superimposed right central disc protrusion\nresults in severe canal narrowing at this level. There is no significant\nneural foraminal narrowing.\n\nC6-C7: Central disc bulge results in mild spinal canal narrowing. There is\nno significant neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC: Spinal labeling has been provided on series 13, image 8. Alignment\nis normal. Vertebral body and intervertebral disc signal intensity appear\nnormal aside from diffuse disc degenerative desiccation. A subtle T2\nhyperintense lesion at T1/T2, without associated enhancement is unchanged\ncompared to the prior exam. Mild disc bulges are seen throughout the thoracic\nspine, most prominent at T7/T8 however there is no significant spinal canal or\nneural foraminal narrowing. No concerning enhancing lesions are identified\nthroughout the spinal cord.\n\nOTHER: T2 hyperintense cysts are seen within the liver. No other paraspinal\nor paravertebral soft tissue abnormalities are identified.", "output": "1. No new lesions concerning for demyelination are seen within the cervical or\nthoracic spine. The previously noted T2 hyperintense lesion at the level of\nC4 is not well seen on today's exam. Subtle T2 hyperintense lesion at T1/T2,\nis unchanged compared with prior exam.\n2. Cervical spondylosis, most severe at C5/C6, slightly progressed compared to\nthe prior exam. Subtle increased cord signal abnormality at this level, is\nlikely secondary to chronic myelomalacia.\n3. Mild thoracic spondylosis." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nand disc spaces are preserved. There is no marrow replacing lesion or\nabnormal enhancement. There is a focal hyperintense T2 signal within the\nspinal cord at C3-C4 (12:17) not well seen on the most immediate prior study ___, but similar to ___. This likely corresponds to\nknown demyelinating lesion, without corresponding enhancement to suggest\nactive demyelinating process.\n\nC2-C3, C3-C4: No spinal canal or neural foraminal stenosis.\n\nC3-C4: There is a central disc protrusion resulting in stable mild spinal\ncanal stenosis. There is bilateral uncovertebral joint and facet arthropathy\nand ligamentum flavum thickening, without neural foraminal stenosis.\n\nC4-C5: There is a central disc protrusion resulting in stable moderate spinal\ncanal stenosis. There is uncovertebral joint and facet arthropathy resulting\nin mild left and no significant right neural foraminal stenosis.\n\nC5-C6: There is a central disc protrusion resulting in severe but stable\nspinal canal stenosis. There is no significant neural foraminal narrowing.\n\nC6-C7: There is a central disc protrusion resulting in mild spinal canal\nstenosis. There is uncovertebral joint hypertrophy and facet arthropathy\nresulting in stable mild left and no significant right neural foraminal\nnarrowing.\n\nC7-T1: No spinal canal or neural foraminal stenosis.\n\nThere is no abnormal enhancement after contrast administration.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand disc spaces are preserved. There is a hemangioma at the T3 level. There\nis no suspicious marrow replacing lesion or abnormal enhancement. There is a\nright paracentral disc protrusion at T7-T8 level with mild spinal canal\nstenosis without neural foraminal narrowing. The remaining levels of the\nthoracic spine demonstrate no significant spinal canal or neural foraminal\nstenosis. There is no abnormal enhancement. There is normal morphology of\nthe spinal cord without abnormal enhancement.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. There is mild superior\nendplate compression deformity of L1 vertebral body without corresponding\nhyperintense STIR signal or enhancement. There is disc desiccation at L5-S1\nlevel. The conus terminates at L2 level. There is no abnormal spinal cord\nmorphology or enhancement. Incidental note is made of a hemangioma at L5.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: There is mild bilateral facet arthropathy and ligamentum flavum\nthickening without spinal canal or neural foraminal stenosis.\n\nL3-L4: There is mild bilateral facet arthropathy and ligamentum flavum\nthickening with a mild disc bulge without significant spinal canal or neural\nforaminal stenosis.\n\nL4-L5: There is mild bilateral facet arthropathy and ligamentum flavum\nthickening without spinal canal stenosis or neural foraminal narrowing.\n\nL5-S1: There is a central disc protrusion with mild indentation of the\nventral thecal sac. There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nOTHER: There are hyperintense T2 lesions within the visualized portions of the\nliver, measuring 1.2 cm within segment 7 and additional lesion lesion\nincompletely visualized for inferiorly (14:25) with corresponding enhancement,\nmay represent hemangiomas, although incompletely characterized on this study.", "output": "1. Stable multilevel degenerate changes of the cervical spine, most advanced\nat C5-C6 level, and not significantly changed from ___.\n2. Hyperintense T2 lesion within the spinal cord at C3-C4 level, likely\nrepresenting multiple sclerosis plaque without corresponding enhancement to\nsuggest active demyelinating process. This is unchanged from ___, but not well visualized on most immediate prior study ___.\n3. Mild spinal canal stenosis at T7-T8. The remaining thoracic spine\ndemonstrate no significant spinal canal stenosis or neural foraminal\nnarrowing.\n4. Mild compression deformity at L1, which is likely chronic given the lack of\nhyperintense STIR signal.\n5. Mild degenerative changes of the lumbar spine, as described above." }, { "input": "Please note that the imaging is limited by susceptibility artifact.\n\nThe imaged posterior fossa demonstrates the known left occipital and\ncerebellar subdural hemorrhage with associated subarachnoid hemorrhage which\nwas better demonstrated on prior CT brain done ___.\n\nThe craniocervical junction appears normal.\n\nThere is bone marrow edema in the vertebral body endplates of C6 and C7 with\ndark T2 signal disc material seen migrating superiorly from this C6-7 disc\nspace posterior to the C6 vertebral body which results in spinal canal\nstenosis with effacement of the CSF surrounding the cord, with cord\ndeformation as well as short-segment (4 mm) high STIR signal intensity in the\nposterior aspect of the cord at the level C6 suggesting a cord contusion. No\nevidence of cord hemorrhage.\nThere is a small amount of T2 and STIR hyperintense and T1 slightly\nhyperintense fluid posterior to the C6 vertebral body deep to the posterior\nlongitudinal ligament most likely representing associated epidural hematoma. \nThere is no prevertebral hematoma. There is no edema in the posterior element\nof the spine at this level.\n\n There is multilevel cervical spondylosis in the form of disc desiccation,\ndisc bulge, disc osteophyte complexes, facet joint arthropathy as well as\nligamentum flavum hypertrophy. Multilevel facet joint effusions. Mild\nlateral paravertebral edema, likely posttraumatic. Mild edema between C1 C5\nspinous processes, consistent with mild posterior ligamentous complex injury. \nMultilevel disc osteophyte complexes, posterior element hypertrophic changes. \nNarrowed C5-C6 disc space.\n\nC2-3: Patent canal, foramina..\n\nC3-4: Patent central canal, patent foramina.\n\nC4-5: Tiny central disc protrusion. Mild central canal narrowing. Minimal\nbilateral foraminal narrowing.\n\nC5-6: Broad-based disc osteophyte complex effaces the CSF space anterior to\nthe cord with only a trace of CSF present posterior to the cord. Moderate\ncentral canal narrowing. There is mild cord deformation. No abnormal cord\nsignal intensity. Moderate left, severe right foraminal narrowing.\n\nC6-7: There is central, superior disc extrusion posterior to the C6 vertebral\nbody effacing the CSF space anterior to the cord as well as deforming the\ncord. There is a 4 mm area cord T2 signal hyperintensity only seen on\nsagittal STIR imaging which most likely represents a cord contusion or\nspondylotic myelomalacia. Moderate to severe central canal narrowing. \nModerate to severe left, mild right foraminal narrowing.\n\nC7-T1: Patent central canal, foramina.\n\nSmall hemangioma in the left lateral aspect of T1. Multilevel small facet\njoint effusions.\n\nExtra-spinal: The patient is intubated. Retained fluid present in the\npharynx. Partial opacification of the left mastoid air cells", "output": "Disc extrusion C6-C7 level, moderate to severe central canal narrowing. Small\nfocus of cord signal abnormality, mild cord deformity, findings may represent\ncord contusion or spondylotic myelomalacia. Trace epidural hematoma at this\nlevel.\n\nSuggestion of mild posterior ligamentous complex injury C1-C5.\n\nDegenerative cervical spine changes as described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 10:42 am, 10 minutes after\ndiscovery of the findings." }, { "input": "CERVICAL:\nRetrolisthesis of C5 on C6, is likely degenerative in etiology. Compression\ndeformity of C6 appears to be chronic. Degenerative changes are seen along\nthe endplates of the cervical spine. There is no prevertebral soft tissue\nswelling or acute fracture. Moderate degenerative changes are seen throughout\nthe cervical spine.\n\nC2-C3: There is no spinal canal narrowing. Facet joint and uncovertebral\nhypertrophy results in mild bilateral neural foraminal narrowing, right\ngreater than left.\n\nC3-C4: Central disc bulge results in mild thecal sac narrowing. \nUncovertebral and facet joint hypertrophy results in moderate right and mild\nleft neural foraminal narrowing.\n\nC4-C5: Central disc bulge results in moderate spinal canal narrowing. \nUncovertebral and facet joint hypertrophy results in moderate to severe right\nand moderate left neural foraminal narrowing.\n\nC5-C6: Central disc bulge results in mild spinal canal narrowing. \nUncovertebral hypertrophy and facet joint hypertrophy results in moderate to\nsevere left and moderate right neural foraminal narrowing.\n\nC6-C7: Mild central disc bulge, with a focal left foraminal disc protrusion\nis seen. Superimposed uncovertebral hypertrophy results in severe left and\nmoderate right neural foraminal narrowing.\n\nC7-T1: Mild intervertebral disc bulge is seen. There is no significant\nspinal canal stenosis. Mild bilateral left greater than right neural\nforaminal narrowing is seen, likely secondary to uncovertebral hypertrophy.\n\nNo definite cord signal abnormalities identified. No abnormal enhancement is\nseen.\n\nTHORACIC:\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\n\nMild retrolisthesis is seen involving L4 on L5, unchanged compared to the\nprior exam. The alignment is otherwise unremarkable. Multilevel disc space\nheight loss and decreased signal, worst at L3-4 and L4-5 is re- demonstrated. \nMulti-level mild ___ type 1 endplate changes are again seen. The visualized\ncord and cauda equina appear to be unremarkable in signal intensity or\nconfiguration. A 3.5 mm focus of intradural contrast enhancement within the\nspinal canal along the posterior nerve roots is unchanged compared to the\nprior exam.\n\nL2-3: Mild disc bulge, facet hypertrophy and ligamentum flavum hypertrophy is\nseen however no significant spinal canal or neural foraminal stenosis is\nidentified.\n\nL3-4: Disc bulge, facet arthropathy, and ligamentum flavum thickening results\nin moderate to severe spinal canal stenosis as well as moderate bilateral\nsubarticular zone stenosis, and mild bilateral neural foraminal stenosis,\nright greater than left. Mild ventral epidural contrast-enhanced at this\nlevel is likely secondary to a disc bulge. There appears to be contact with\nthe traversing left L4 nerve roots.\n\nL4-5: Right central disc protrusion results in contact with the exiting right\nL4 nerve root and transiting right L5 nerve root. Mild right neural foraminal\nnarrowing is seen. Mild to moderate spinal canal narrowing is unchanged\ncompared to the prior exam. Next\n\nL5-S1: Facet arthropathy is seen however there is no evidence of spinal canal\nor neural foraminal stenosis.\n\nOTHER: No other concerning paraspinal or paravertebral soft tissue\nabnormalities are seen.", "output": "1. Moderate to severe cervical spondylosis, most prominent at C4-C5 and C5-C6\nwith moderate to severe neural foraminal and mild-to-moderate spinal canal\nnarrowing. No abnormal cord signal abnormalities are identified.\n2. Unchanged lumbar spondylosis compared to the prior MRI from ___,\nmost prominent at L3-4 and L4-5 with moderate to severe spinal canal stenosis,\nand moderate bilateral subarticular zone stenosis at L3-4.\n3. Unchanged 3.5 mm focus of enhancement within the spinal canal along the\nposterior nerve roots at the level L2. Differential again includes nerve\nsheath tumor, meningioma, less likely metastatic disease." }, { "input": "The alignment of the cervical spine is normal. The bone marrow is normal in\nsignal. No fractures are identified. There are no findings to suggest\nligamentous injury. The height of the vertebral bodies and intervertebral\ndisc spaces are maintained. There is no spinal canal or neural foraminal\nstenosis. The prevertebral and paraspinal soft tissues are normal. The\nspinal cord is normal in signal. There are no epidural fluid collections.\n\nThere is a 1.7 cm nodule in the right inferior thyroid lobe and a 0.6 cm\nnodule in the left inferior thyroid lobe. ACR guidelines recommend ultrasound\nfor thyroid lesions of this size if there nature is not already known.", "output": "1. No evidence of acute traumatic injury.\n2. Minimal degenerative changes of the cervical spine at C4-C5.\n3. Thyroid nodules, which may be further evaluated with ultrasound if\nindicated.\n\nRECOMMENDATION(S): Ultrasound of the right thyroid nodule may be indicated if\nits nature is not already known." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Intervertebral\ndisc signal intensity is normal. The visualized portion of the spinal cord\nappears normal. There is no evidence of demyelinating lesion. 4 and 3 mm\nT2/T1 hyperintense foci in the right T1 pedicle and superior right aspect of\nthe T2 vertebral body respectively represent intraosseous hemangiomas (5:5,\n6). Otherwise, bone marrow signal intensity is unremarkable. No suspicious\nenhancing lesion is identified.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or malignancy.", "output": "1. No evidence of demyelinating lesion or pathologic post-contrast\nenhancement.\n2. No spinal canal or neural foraminal stenosis." }, { "input": "There is mild reversal of the cervical lordosis. Vertebral body height and\nalignment is maintained.\nMild degenerative disc disease, predominantly involving C5-C6 and C6-C7.\n\nThere is no spinal cord signal abnormality. Visualized posterior fossa\nstructures are unremarkable.\n\nSignificant findings by level:\n\nC2-C3: Moderate left neural foraminal narrowing. No spinal canal stenosis or\nright neural foraminal narrowing.\nC3-C4: Facet joint arthropathy with mild left neural foraminal narrowing. No\nspinal canal stenosis or right neural foraminal narrowing.\nC4-C5: Very small posterior disc bulge and facet joint arthropathy with mild\nto moderate left neural foraminal narrowing. No spinal canal stenosis or\nright neural foraminal narrowing.\nC5-C6: Posterior disc bulge with indentation of the thecal sac and facet joint\narthropathy resulting in severe left and moderate right neural foraminal\nnarrowing. This is minimally progressed from the ___ study.\nC6-C7: Midline left-sided posterior disc bulge with moderate bilateral neural\nforaminal narrowing.\nC7-T1: Mild left neural foraminal narrowing. No spinal canal stenosis or\nright neural foraminal narrowing.", "output": "1. Multilevel degenerative changes of the cervical spine, most pronounced at\nC5-C6 and C6-C7 with posterior disc bulges resulting in mild spinal canal\nstenosis at these levels.\n2. Facet joint arthropathy results in moderate to severe bilateral neural\nforaminal narrowing, also most pronounced from C5-C7. Findings are minimally\nprogressed when compared to prior.\n3. No evidence of spinal cord abnormality." }, { "input": "There is a T the thoracic kyphosis and cervical lordosis. There is no\nevidence of subluxation.\n\nThere is a compression fracture of the T9 vertebral body the increased signal\nintensity on the STIR images. This corresponds to the irregular, partially\nsclerotic, T9 vertebral body identified on the torso CT. This finding is\nworrisome for malignancy. However, the STIR hyperintensity does not extend\nthroughout the entire vertebral body. This latter finding is somewhat\nreassuring that the fracture may be benign.\n\nThere is a compression fracture with high signal intensity on STIR in the T5\nvertebral body and in the T to and T3 vertebral bodies. These vertebrae also\ndemonstrate incomplete hyperintensity on STIR, a finding that suggests they\nmay well be benign, rather than pathologic fractures.\n\nThe compressed vertebral bodies are hypo intense on the T1 weighted images and\ndemonstrate enhancement after contrast administration. There is no evidence\nof abnormal soft tissue contrast enhancement. Enhancement of the vertebral\nbodies would be expected with benign or malignant compression fractures.\nThere is no encroachment on the spinal cord. The spinal cord appears normal in\ncaliber and configuration.", "output": "1. Multiple thoracic compression fractures without spinal canal compromise or\nspinal cord compression. The MR findings could be produced by benign\nfractures. The mixed sclerotic and lytic appearance of the T9 vertebral body\non the ___ CT is worrisome for a pathologic fracture." }, { "input": "Alignment is anatomic. Vertebral body heights are preserved. Vertebral body\nand intervertebral disc signal intensity preserved. The spinal cord appears\nnormal in caliber and configuration. The conus medullaris terminates at\nT12-L1. Multilevel degenerative changes. There multilevel diffuse disc\nbulges, facet arthropathy. L3-L4 disc space is narrowed. There is no\nabnormal enhancement postcontrast administration.\nAt L1-L2 level central canal, foramina are patent.\nAt L2-L3 level there is mild central canal, minimal bilateral foraminal\nnarrowing.\nAt L3-L4 level there is mild central canal narrowing, similar to prior there\nis moderate left, and mild right foraminal narrowing, similar to prior.\nAt L4-5 level there is mild central canal narrowing, similar to prior annular\ndisc tear. There is moderate bilateral foraminal narrowing, similar to prior\nAt L5-S1 level there is annular disc tear. Central canal is patent. \nBilateral foramina are patent", "output": "1. There is mild central canal narrowing at L2-L3, L3-L4 levels.\n2. There is multilevel moderate foraminal narrowing." }, { "input": "The patient is status post ACDF of C5-C7. There is mild posterior subluxation\nof C3-C4. The bone marrow signal is within normal limits. Focal T2 signal\nabnormality is seen involving the cord at C6 without expansion of the cord.\n\nC2-C3: A disc bulge is seen with bilateral uncovertebral osteophytes and\nhypertrophy of the ligamentum flavum. There is cord compression without cord\nsignal abnormality. There is moderate-to-severe spinal canal narrowing\nwithout foraminal narrowing.\n\nC3-C4: A disc bulge is seen with bilateral uncovertebral and facet\nosteophytes. There is cord compression without cord signal abnormality. There\nis moderate to severe central canal narrowing with moderate bilateral\nforaminal narrowing.\n\nC4-C5: A disc bulge is seen with bilateral uncovertebral and facet\nosteophytes. There is moderate to severe spinal canal narrowing with moderate\nbilateral foraminal narrowing.\n\nC5-C6: A disc bulge is seen with bilateral uncovertebral and facet\nosteophytes. There is moderate spinal canal narrowing with moderate bilateral\nforaminal narrowing.\n\nC6-C7: A disc bulge is seen, asymmetric to the left. There is mild spinal\ncanal narrowing with moderate bilateral foraminal narrowing.\n\nC7-T1: Bilateral uncovertebral osteophytes are seen, causing mild right and\nmoderate left foraminal narrowing.. There is no spinal canal narrowing", "output": "1. Focal signal abnormality within the cord at C6 most likely secondary to\nmyelomalacia vs a demyelinating process.\n2. Severe cervical spondylosis, worst at C2-3, C3-4 and C4-5 where\nmoderate-to-severe central canal narrowing is seen causing cord compression\nwithout cord signal abnormality.\nNOTE: Contrast enhanced MRI of the C-spine may be helpful for further\nevaluation of the signal abnormality involving the cord at the level of C6." }, { "input": "There is minimal retrolisthesis at L3 upon L4, likely degenerative in nature,\nthe signal intensity in the bone marrow is normal, no suspicious bone lesions\nare identified. Irregular contour at the superior endplate of L4 is\nconsistent with Schmorl's node. The conus medullaris terminates at the level\nof T12-L1 and is unremarkable.\nFrom T10 T11 through L2 L3 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis\n\nAt L3/L4 level, there is disc bulging causing mild anterior thecal sac\ndeformity and mild left neural foraminal narrowing, there is also right\nparacentral disc protrusion causing moderate right-sided neural foraminal\nnarrowing, contacting the traversing nerve root and extending towards the\nright foramen and extraforaminal regions (images 56 through 58, series 200),\nand also extending inferiorly at the level of the right lateral recess.\n\nAt L4/L5 level, there is a diffuse disc bulge causing anterior thecal sac\ndeformity, moderate bilateral neural foraminal narrowing, contacting the\ntraversing nerve roots bilaterally, there is moderate articular joint facet\nhypertrophy and mild ligamentum flavum thickening resulting in moderate spinal\ncanal stenosis.\n\nAt L5/S1 level, there is narrowing of the intervertebral disc space and\ndiffuse disc bulge, slightly more pronounced towards the left with left\nparacentral disc protrusion, impinging the S1 nerve root on the left and\ncausing left-sided neural foraminal narrowing which apparently is contacting\nthe exiting nerve root of L5 on the left, there is also moderate right-sided\nneural foraminal narrowing, bilateral articular joint facet hypertrophy\nligamentum flavum thickening results in moderate spinal canal stenosis.\n\nThe sacroiliac joints are unremarkable.\n\nThere is a renal cystic formation identified in the right kidney, measuring\napproximately 35 x 32 mm in the coronal scout view (image 13, series 1).", "output": "1. Mild retrolisthesis identified at L3-L4 level, likely degenerative in\nnature.\n\n2. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, more pronounced from L3-L4 through L5-S1 levels.\n\n3. Right paracentral disc protrusion noted at L3-L4 level causing right-sided\nneural foraminal narrowing with disc material extending towards the right\nlateral recess.\n\n4. Left paracentral disc protrusion is noted at L5-S1 level impinging the S1\nnerve root on the left and producing bilateral neural foraminal narrowing\n\n5. Renal cystic formation identified in the right kidney, measuring\napproximately 32 x 35 mm in coronal scout view, partially evaluated in this\nexam." }, { "input": "From T11-12 through L1-2 levels no abnormalities are seen. At L2-3 mild disc\nbulging seen without spinal stenosis or foraminal narrowing.\n\nAt L3-4 level, disc bulging is seen. Left-sided extraforaminal disc\nprotrusion is identified (07:21) with moderate narrowing of the left foramen.\n\nAt L4-5 level, there is diffuse disc bulge resulting in mild-to-moderate\nspinal stenosis with moderate left foraminal narrowing.\n\nAt L5-S1 level, disc bulging is identified. There is a disc protrusion with\nsevere narrowing of the right foramen and compression of exiting right L5\nnerve root within the foramen. There is mild narrowing of the left foramen. \nThere is no spinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Severe right foraminal narrowing at L5-S1 level with deformity of the\nexiting right L5 nerve root.\n2. Moderate left foraminal narrowing at L3-4 and L4-5 levels in the left\nextraforaminal disc protrusion at L3-4 level." }, { "input": "There is severe traumatic subluxation of C6 on C7. The posterior cortical\nmargin of C6 is displaced anterior to the anterior cortical margin of C7, with\njumped and fractured facets, better appreciated on CT. There is complete\ndisruption of the anterior longitudinal ligament, posterior longitudinal\nligament, ligamentum flavum, interspinous and supraspinous ligaments at the\nC6-7 level. There is epidural hemorrhage anterior and posterior to the cord at\nthe C6 level, with inferior extension through the posterior epidural space\nbelow the T3 level, incompletely imaged. The severe traumatic subluxation and\nepidural hemorrhage results in complete effacement of CSF at the C5-7 levels. \nThere is abnormal signal within the cord at the C4-7 levels. The epidural\nhemorrhage results in mild spinal canal narrowing at the T1-T4 level. There\nis marked prevertebral edema and paraspinal edema throughout the cervical and\nimaged upper thoracic spine.\n\nThe craniocervical articulation appears preserved. Notably, the atlanto\noccipital joints are at least partially fused. There is an acute avulsion\nfracture of the anterior inferior C2 vertebral body.", "output": "1. Severe acute traumatic subluxation of C6 on C7, with disruption of the\nanterior longitudinal ligament, posterior longitudinal ligament, ligamentum\nflavum, and interspinous ligaments, fractured and jumped facet, and associated\ncord signal abnormality at C4-7. The traumatic subluxation and epidural\nhemorrhage results in complete effacement of CSF at the C5-7 levels. The\nepidural hemorrhage extends inferiorly within the posterior epidural space\nbelow the T3 level and results in mild spinal canal narrowing.\n2. Acute avulsion fracture of the anterior inferior C2 vertebral body." }, { "input": "The cervical lordosis is straightened, otherwise cervical alignment is\nanatomic. There is no acute fracture or subluxation. Vertebral body heights\nand intervertebral disc spaces are preserved.\n\nC2-3: No canal or neural foraminal narrowing.\nC3-4: No canal or neural foraminal narrowing. Mild uncovertebral hypertrophy\non the left.\nC4-5: Moderate disc protrusion and uncovertebral hypertrophy with mild to\nmoderate canal narrowing and severe left and moderate right neural foraminal\nnarrowing.\nC5-6: Moderate disc protrusion and uncovertebral hypertrophy with moderate\ncanal narrowing and severe left and moderate right neural foraminal narrowing.\nC6-7: Mild disc protrusion and moderate uncovertebral hypertrophy. Mild canal\nnarrowing, moderate bilateral neural foraminal narrowing.\nC7-T1: No canal or neural foraminal narrowing.\n\nNo T2 hyperintense cord signal is seen on axial view. Mild prominence of the\ncentral canal at C7.", "output": "1. Multilevel degenerative changes from C4-5 to C6-7 with moderate canal\nnarrowing and moderate to severe neural foraminal narrowing at C5-6.\n2. There is no cord compression. No definite cord signal abnormality other\nthan mild prominence of the central canal at C7.\n3. Additional findings described above.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by ___\non ___ at 7:27 a.m.." }, { "input": "Abnormal cord expansion from C7 through T4 similar to prior, with areas bright\nT2 signal, intermediate T2 signal and cord expansion, possibly from edema,\ninfiltration cannot be excluded.. Syrinx extends into the cervical cord in\nthe left paramedian posterior cord 2 level of C2, on prior exam imaging was\ncarried to the level of C3-C4,. Below the level of the cord expansion, there\nis residual mild left paramedian, posterior cord T2 signal abnormality which\nextends to mid T6 level,, minimally worsened since prior.\nAs previously, the cord expansion is partially due to fluid containing cavity.\nAs previously, there is no abnormal enhancement after contrast administration.\nThere is no evidence of new hemorrhage or blood products.\nLower thoracic cord is of normal signal.\nAlignment is stable in grossly anatomic. Loss of signal of the intervertebral\ndiscs on T2 weighted images are persistent, likely due to chronic degenerative\ndisease. Pre-existing degenerative disc disease with bulges mildly narrowing\nthe spinal canal, most notable in the cervical levels are better seen on the\nprior study. Disc bulge at T2-3, T4-5, T5-6, T6-7 appear grossly similar from\nprior exam, with stable encroachment on the spinal canal and contacting the\nexpanded spinal cord. There is multilevel mild-to-moderate central canal\nnarrowing secondary to degenerative changes, most prominent at T10-T11 level\nin the thoracic spine, similar to prior, with preserved CSF about cord. No\ncord flattening.\nThere is multilevel mild-to-moderate foraminal narrowing in the thoracic\nspine, most prominent at the left T1-T2 foramen.\n\nThe lungs are grossly clear, within limits of MRI. The imaged soft tissues\nare unremarkable.", "output": "Minimal interval worsening of mild abnormal T2 signal in the spinal cord, now\nextending to T6 level, previously extending to T5 level on ___. \nOtherwise stable exam. Stable cord expansion from C7-T4, and cervical cord\nsyrinx. No new abnormal contrast enhancement or blood products. Given lack of\nenhancement neoplasm is unlikely, cannot be excluded.\nModerate degenerative changes in the thoracic spine, with multilevel endplate\nhypertrophic changes, diffuse disc bulges, including degenerative changes at\nthe upper thoracic spine." }, { "input": "The spinal cord syrinx extending from C1 inferiorly has increased in size\ncompared to the MRI examination of ___ but remains unchanged compared to the\nthoracic spine MRI of ___ with its lower extent being noted\nvisualized on the current cervical spine study. No abnormal enhancement is\nseen within the spinal cord or within the spinal canal. The syrinx\ndemonstrate expansion of the spinal cord in the upper thoracic region as\nbefore.\n\nDegenerative disc bulging from C3-4 to C6-7 levels with mild-to-moderate\nspinal stenosis at C5-6 level is again identified unchanged. There is\nmoderate-to-severe left foraminal narrowing at C6-7 level unchanged. Disc\nbulging contacts the spinal cord most pronounced at C5-6 level without\nhigh-grade deformity or compression.", "output": "1. The spinal cord syrinx with its cervical component is not significantly\nchanged since the thoracic spine MRI study of ___. No abnormal\nenhancement is identified. No Chiari malformation is seen.\n2. Degenerative changes with mild-to-moderate spinal stenosis at C5-6 level\nand moderate-to-severe left foraminal narrowing at C6-7 level are unchanged." }, { "input": "Study is mildly degraded by motion.\n\nThere is dextroscoliosis of the thoracic spine. Multiple Schmorl's nodes are\nagain seen throughout the thoracic spine. T9 through T12 minimal chronic\nanterior compression deformities are again noted. Vertebral body heights are\npreserved. T4-5 and T5-6 mixed type 1 and type ___ ___ changes are noted. T12\ninferior endplate type ___ ___ changes are seen. There is no prevertebral\nsoft tissue swelling.\n\nThe visualized portion of the spinal cord again demonstrates areas of T2\nhyperintense and intermediate signal with cord expansion extending from the\nhighest level of visualized spinal cord at C7, now extending inferiorly only\nto approximately mid T5, previously having noted to distend to approximately\nT7 level on ___ prior exam, with no definite associated enhancement (see 16,\n17, 18, 21:8; 9, 19: ___.\n\nThere is loss of intervertebral disc height and signal throughout the thoracic\nspine again noted.\n\nDisc bulges are again noted at multiple levels of thoracic spine without\ndefinite evidence of moderate or severe vertebral canal narrowing.\n\nOTHER:\n There is no paravertebral or paraspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Interval decrease in superior inferior extension of previously noted lower\ncervical and upper thoracic spinal cord lesion as described, now extending\nfrom at least C7 through T4, again without definite associated abnormal\nenhancement. Findings are again suggestive of syrinx, with atypical\nnonenhancing astrocytoma not excluded on the basis of this examination. If\nconcern for astrocytoma, consider FDG PET-CT for further evaluation.\n3. Please note that cervical extent of spinal cord lesion is not assessed on\nthis examination.\n4. Grossly stable multilevel thoracic spondylosis as described without\ndefinite evidence of moderate or severe vertebral canal narrowing." }, { "input": "Study is mildly degraded by motion.\n\nThe vertebral bodies are normal in height and sagittal alignment. \nDegenerative changes including loss of intervertebral disc height and T2\nsignal and accompanying degenerative endplate marrow signal changes with\nendplate osteophyte formation are again seen.\n\nAgain demonstrated expansile T2 hyperintense lesion involving the included\nlower cervical and upper thoracic spinal cord. Superior extent is not fully\nincluded on this exam, but it is seen to at least the C7 level, and continues\ninferiorly to T4. There is some T2 prolongation in the spinal cord just below\nthe syrinx at T5. The configuration is unchanged compared to the previous\nexamination, with no definite associated abnormal enhancement.\n\nMultiple small disc bulges are again seen throughout the thoracic spine,\ncausing no high high-grade small spinal canal or neural foraminal stenosis.\n\nParaspinal and prevertebral soft tissues are unremarkable.", "output": "1. No significant change in the T2 hyperintense lesion in the imaged lower\ncervical and thoracic spinal cord with no definite associated enhancing\nlesion. The superior extent is again not fully imaged.\n2. Multilevel degenerative changes are similar to the previous exam.\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": "CERVICAL:\nPatient is status post laminectomy from C3-C7, and spinal fusion from C2\nthrough T2. Grade 1 anterolisthesis is seen involving C7 on T1. The\nalignment is otherwise unremarkable. Endplate ___ type changes are seen\nthroughout the cervical spine. Within the right central aspect of the C5\nvertebral body, a T1 hypointense, STIR hyperintense lesion is seen measuring\napproximately 1.6 cm x 1.2 cm, series 4, image 6, worrisome for metastasis.. \nSimilar abnormality involves T1 vertebral body, partially obscured by\nhardware, suggest additional metastasis. There is no associated cord signal\nabnormality. Diffuse degenerative loss of the normal T2 signal is seen within\nthe intervertebral discs of the cervical spine.\n\nC2-C3: Disc bulge is seen however, mild central canal narrowing. Facet joint\nand uncovertebral osteophytes contribute to mild left neural foraminal\nnarrowing. The right neural foramina appears to be patent.\n\nC3-C4: Endplate osteophytes contribute to mild spinal canal narrowing. Facet\njoint and uncovertebral osteophytes results in moderate to severe bilateral\nneural foraminal narrowing.\n\nC4-C5: Endplate osteophytes are seen however there is no significant spinal\ncanal narrowing. Facet joint and uncovertebral osteophytes, although\ndifficult to evaluate secondary to artifact from the patient's hardware\ncontribute to at least moderate bilateral neural foraminal narrowing, right\ngreater than left.\n\nC5-C6: There is no evidence of spinal canal narrowing. Facet joint and\nuncovertebral osteophytes contribute to at least moderate right and mild left\nneural foraminal narrowing.\n\nC6-C7: Disc bulge, with a focal central disc extrusion migrating caudally is\nseen, however there is no significant spinal canal narrowing as the patient is\nstatus post laminectomy at this level. Facet joint and uncovertebral\nosteophytes contribute to moderate to severe right and moderate left neural\nforaminal narrowing.\n\nC7-T1: Mild disc bulge is seen however there is no significant spinal canal\nnarrowing. Facet joint osteophytes contribute to moderate to severe right and\nmild left foraminal narrowing.\n\nIncidental note is made of a prevertebral T2 hyperintense curvilinear lesion\nat the level of C2 measuring approximately 1.1 x 0.9 cm, series 10, image 4.\n\nTHORACIC: The alignment is normal. The T7 vertebral body demonstrates diffuse\nT1 hypointensity as well as STIR/mild T2 hyperintensity, concerning for\ncomplete involvement of patient's malignancy of the vertebral body, with\nextension to the bilateral pedicles as well as a right paraspinal soft tissue\ncomponent, measuring 3.4 cm x 1.4 cm, series 9, image 5. Tumor infiltrates\ninto the right T6-T7, T7-T8 foramina, along the medial right seventh rib,\nprobable rib involvement. Possible involvement of the medial left seventh\nrib.\n\nWithin the right central aspect of the T12 vertebral body, a 1.8 cm x 2.4 cm\nT1 hypointense, STIR hyperintense lesion is seen. Additional smaller lesion\ninvolves anterior T11 vertebral body.\n\nAt the level of T7, within the posterior epidural space a 2.7 x 0.8 cm STIR\nhyperintense soft tissue lesion is seen, resulting in severe anterior mass\neffect on the spinal cord. Subtle increased STIR signal abnormality is seen\nwithin the cord at this level.\n\nA focus of increased STIR signal abnormality is seen within the cord at the\nlevel of T11-T12. Diffuse loss of T2 signal is seen within the intervertebral\ndiscs of the thoracic spine, likely degenerative in etiology.\n\nMultiple disc bulges are seen throughout the thoracic spine, most prominent at\nT8-T9, T10-T11, and T11-T12. Although incompletely evaluated secondary to the\nlack of axial imaging, there there is probably moderate central canal\nnarrowing at T11-T12 secondary to ligamentum flavum thickening and a central\ndisc bulge. Probable moderate central canal narrowing T8-T9 level. \nAdditional areas of mild central canal narrowing throughout thoracic spine.\n\nOTHER: No other paraspinal or paravertebral soft tissue abnormalities are\nidentified.", "output": "1. Incomplete study secondary to lack of IV contrast and inability of patient\nto complete exam.\n2. There are osseous metastases in the cervical, thoracic spine, most\nprominent at T7 level. There is epidural tumor extension at T7 level,\nresulting in severe mass effect on the cord, severe central canal narrowing,\nand cord T2 signal abnormality, which may be from cord edema or ischemia.\n3. Subtle punctate focus of increased cord signal abnormality at the level of\nT11-T12, is incompletely evaluated on this exam secondary to the lack of axial\nimaging however may be secondary to chronic myelomalacia.\n4. Appropriate postsurgical changes status post laminectomy from C2 through T1\nand spinal fusion from C2 through T2.\n\nNOTIFICATION: Updated findings were discussed with ___ MD by\n___, M.D. on the telephone on ___ at 10:45 am, 10 minutes\nafter discovery of the findings." }, { "input": "Study is moderately degraded by motion artifact. In the context of these\nlimitations, there is enhancement of the 4.2 cm right lateral and posterior\nepidural soft tissue mass at the level of T6-T7 which results in severe\nanterior mass effect and compression on the spinal cord. There also appears\nto be subtle enhancement of the T7 vertebral body with likely subtle tumoral\nenhancement of the bilateral pedicles, although this is not well discerned on\nthis exam. The right paraspinal soft tissue component of the tumor does\ndemonstrate mild enhancement, measuring approximately 3.3 cm x 1.5 cm, series\n3, image 12, and extends through the right T7-T8 neural foramina (series 6,\nimage 6). The tumor again infiltrates the medial right seventh rib,\nconcerning for probable rib involvement.\n\nThere does appear to be mild heterogeneous enhancement of the 1.7 cm x 1.4 cm\nright central T12 vertebral body lesion as well as mild enhancement of the\nanterior lesion of the T11 vertebral body, measuring up to 1.1 cm, series 3,\nimage 5. No definite cord enhancement is identified. Cervical and upper\nthoracic posterior fusion hardware is identified.", "output": "1. Study is moderately degraded by motion artifact.\n2. The known 4.2 cm right lateral and posterior epidural soft tissue mass at\nthe level of T6-T7 which results in severe anterior mass effect and\ncompression of the spinal cord, does appear to demonstrate enhancement.\n3. Subtle enhancement is additionally seen involving the T7 vertebral body, as\nwell as the lesions within the T11 and T12 vertebral bodies, again concerning\nfor osseous metastases.\n4. Right paraspinal soft tissue component of tumor extending through the right\nT7-T8 neural foramina measuring up to 3.3 cm at the level of T7, does\ndemonstrate enhancement and again appears to infiltrate the medial right\nseventh rib concerning for rib involvement.\n5. Please refer to concurrent MRI cervical and thoracic spine of ___\nfor additional details." }, { "input": "Evaluation is extremely limited by motion artifact. Alignment is normal. \nVertebral body signal intensity appears normal. The spinal cord appears\nnormal in caliber and configuration with no evidence of signal abnormality\nwithin the limits of this motion degraded study. There is mild degenerative\nchange of the cervical spine including multilevel loss of T2 signal of the\nintervertebral discs, loss of disc space at C4-C5 and C5-C6, and ___ type I\nchanges most prominent at C7. At C4-C5, posterior disc protrusion results in\neffacement of the ventral CSF. At C5-C6, posterior disc protrusion results in\nmild spinal canal stenosis. At C6-C7 posterior disc protrusion results in\neffacement of ventral CSF. Evaluation of the neural foramina are limited by\nmotion. Within this limitation, no evidence of severe neural foraminal\nstenosis.\n\nThere is increased T2 signal of the prevertebral space spanning from C4-C7,\nwhich likely represent prevertebral edema secondary to intubation.", "output": "1. Study is extremely limited by motion artifact. Within this limitation, no\ndefinite evidence of acute spinal injury or cord compression.\n2. Degenerative changes as described above with mild spinal canal narrowing at\nC5-C6. No evidence of severe neural foraminal stenosis within the limits of\nthis motion degraded exam.\n3. Mild prevertebral edema, likely sequelae of intubation." }, { "input": "Study is mildly degraded by motion. For the purposes of numbering, the\nlowest rib bearing vertebral body was designated the T12 level.\n\nVertebral body alignment is preserved. There is transitional anatomy with\npartial sacralization of L5. Otherwise, vertebral body heights are preserved.\nSchmorl's nodes are seen the L3-4, L4-5, and L5-S1 endplates. Probable type 1\n___ changes are noted at the L3-4 and L4-5 endplates.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc signal at L2-3, L3-4, L4-5, L5-S1. There\nis loss of intervertebral disc height at L3-4 and L4-5.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \nA right renal probable cyst is noted (see 05:15).\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 disc bulge and facet joint hypertrophy with mild vertebral\ncanal and mild bilateralneural foraminal narrowing.\n\nAt L3-4 there is disc bulge and central disc protrusion, facet joint\nhypertrophy and ligamentum flavum hypertrophy resulting in mild vertebral\ncanal and ___ neural foraminal narrowing.\n\nAt L4-5 there is right paracentral disc extrusion which contacts the\ntransiting right L5 and the exiting right L4 nerve roots, resulting in\nmoderate vertebral canal and severe right neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge which contacts the exiting right L5 nerve root,\nwith mild right neural foraminal and no vertebral canal narrowing.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel lumbar spondylosis as described, most pronounced at L4-5, where\na right paracentral disc extrusion contacts exiting right L4 and transiting L5\nnerve roots, and results in moderate vertebral canal and severe right neural\nforaminal narrowing.\n3. Probable right renal cyst.\n4. Transitional anatomy with partial sacralization of L5." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen. There is mild loss of normal\nintervertebral disc signal from C2-C3 through C6-C7. There is high signal\nintensity noted in the C4-C5 intervertebral disc which is most likely\ndegenerative. The craniovertebral junction is unremarkable. The cord is\nnormal in signal intensity and morphology.\n\nAt C2-C3, there is no disc herniation, spinal canal stenosis, or neural\nforaminal narrowing.\n\nAt C3-C4, there is a mild broad-based disc protrusion asymmetric to the left\nwith minimal left neural foraminal narrowing. There is no significant spinal\ncanal stenosis or neural foraminal narrowing.\n\nAt C4-C5, there is a central disc protrusion effacing the ventral thecal sac\nand mildly narrowing the spinal canal. Disc material just abuts the ventral\nsurface of the spinal cord. There is no abnormal cord signal. There is\nbilateral uncovertebral and facet joint arthropathy resulting in moderate left\nand mild right neural foraminal narrowing.\n\nAt C5-C6, there is a mild broad-based disc protrusion without significant\nspinal canal stenosis or neural foraminal narrowing.\n\nAt C6-C7, there is a mild broad-based disc protrusion without significant\nspinal canal stenosis or neural foraminal narrowing.\n\nAt C7-T1, there is no disc herniation, spinal canal stenosis, or neural\nforaminal narrowing.\n\nThere are small bilateral perineural cyst incidentally noted in the lower\ncervical spine.\n\nThe visualized soft tissues of the neck are unremarkable.", "output": "Mild multilevel degenerative changes as described above. Findings are most\npronounced at C4-C5 where a central disc protrusion results in mild spinal\ncanal narrowing, moderate left, mild right neural foraminal narrowing." }, { "input": "The craniocervical junction appears normal. Partially empty sella appear\nsimilar compared to prior. The cervical cord is normal in signal intensity. \nNo cord lesions.\n\nNo acute vertebral body fractures. The vertebral bodies are normal in number\nand interrelationship.\n\nDegenerative changes of the cervical spine in the form of disc desiccation,\ndisc bulge/protrusion, facet joint osteophytosis and ligamentum flavum\nhypertrophy as described below:\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: No cord compromise. Moderate neural foraminal narrowing bilateral.\n\nC4-5: Small central disc protrusion partially effaces the CSF space anterior\nto the cord, but there is no cord deformation or compromise. Moderate severe\nneural foraminal narrowing bilateral (left slightly more than right).\n\nC5-6: A central posterior disc protrusion with suspected small peripheral\nosteophytes (disc osteophyte complex) efface the CSF space anterior to the\ncord and deforms the cord. There is no abnormal cord signal intensity and\nthere is still minimal CSF present posterior to the cord arguing against cord\ncompromise. Mild narrowing of the neural foramina bilateral.\n\nC6-7: No cord or nerve root compromise.\n\nC7-T1: No cord or nerve root compromise.", "output": "1. There is mild moderate degenerative changes of the cervical spine most\nmarked at the C4-5 and C5-6 levels.\n2. At the C4-5 level there is moderate severe neural foraminal narrowing\nbilateral which appears fairly similar compared to prior imaging.\n3. At the C5-6 level there is a central posterior disc protrusion/disc\nosteophyte complex which effaces the CSF space anterior to the cord and\ndeforms the cord. There is no abnormal cord signal intensity and there is\nstill minimal CSF present posterior to the cord arguing again cord compromise.\nThis is a new finding compared to prior. Mild narrowing of the neural\nforamina bilateral, but no evidence of right C6 nerve root compromise.\n4. Additional findings described above." }, { "input": "Overall there has been no significant interval change since the previous\nstudy.\n\nAt the craniocervical junction and C2-3 and C3-4 levels no significant\nabnormalities are seen.\n\nAt C4-5 level, disc bulging and uncovertebral degenerative changes seen with\nmoderate-to-severe left and mild-to-moderate right foraminal narrowing\nunchanged from prior study.\n\nAt C5-6 level, central disc herniation indents and deforms the spinal cord\nwithout cord compression. Mild bilateral foraminal narrowing is seen.\n\nAt C6-7 mild degenerative changes seen without spinal stenosis or foraminal\nnarrowing.\n\nAt C7-T1 to T2-3 no abnormalities are seen.\n\nThe spinal cord shows normal intrinsic signal.", "output": "1. Overall no significant change since the previous study.\n2. Central disc herniation indenting the spinal cord without cord compression\nat C5-6 level.\n3. Moderate-to-severe left and mild-to-moderate right foraminal narrowing at\nC4-5 level due to uncovertebral degenerative change." }, { "input": "Mild right paraspinal edema L1, L2, likely reactive. Normal adjacent disc\nspace, no evidence of infection. Mild-to-moderate edema of the right margin\nL2 vertebral body, consider subacute compression fracture.. Chronic superior\nL1 Schmorl's node, mild height loss, similar. Chronic moderate L4 compression\nfracture, similar. Normal visualized cord. Multilevel degenerative changes. \nGrade 1 L4-5 anterolisthesis, similar, degenerative in etiology. Normal\nvisualized cord. Multilevel disc space narrowing, endplate hypertrophic\nchange, diffuse disc bulges, lumbar facet arthritis. Mild edema inferior\nL2-2, superior L3 vertebral body, likely reactive.\n\nAt at L1-L2, mild central canal, mild foraminal narrowing, similar.\n\nAt L2-L3, mild-to-moderate central canal narrowing, preserved CSF, similar. \nMild-to-moderate bilateral foraminal narrowing, similar.\n\nAt L3-L4 mild-to-moderate central canal narrowing, similar. Mild-to-moderate\nbilateral foraminal narrowing, similar.\n\nAt L4-5, mild central canal narrowing, similar. Moderate left,\nmild-to-moderate right foraminal narrowing, similar.\n\nAt L5-S1, patent central canal. Mild bilateral foraminal narrowing, similar.\n\n2.5 cm right adrenal nodule, similar compared with CT abdomen pelvis ___, similar with CT abdomen pelvis ___.", "output": "1. Degenerative changes lumbar spine.\n2. Mild L2 vertebral body and adjacent paraspinal edema, nonspecific, consider\nsubacute mild compression fracture, reactive/degenerative change. Infection\nis unlikely.\n3. Mild-to-moderate central canal narrowing L2-L3, L3-L4 level.\n4. Multilevel foraminal narrowing.\n5. Stable right adrenal nodule since ___, likely benign adrenal adenoma." }, { "input": "CERVICAL:\nFrom C4 through C7, there is increased STIR signal abnormality as well as\nenhancement of the vertebral bodies diffusely, concerning for metastases. \nThere is no definite soft tissue extension. Diffuse disc desiccation is seen\nthroughout the cervical spine. No underlying cord signal abnormalities are\nidentified.\n\nC4/C5: There is a central disc protrusion resulting in mild thecal sac\nnarrowing. Uncovertebral and facet joint arthropathy contribute to mild\nbilateral neural foraminal narrowing, right greater than left.\n\nC5/C6: Central disc bulge with a superimposed central disc protrusion is seen\nresulting and moderate canal narrowing. Uncovertebral and facet joint\narthropathy results in mild bilateral neural foraminal narrowing, left greater\nthan right.\n\nC6/C7: Mild central disc bulge is seen, resulting in mild thecal sac\nnarrowing. Uncovertebral hypertrophy results in mild left neural foraminal\nnarrowing. The right neural foramen is patent.\n\nC7/T1: There is no significant spinal canal or neural foraminal narrowing.\n\nNo enhancing soft tissue component is identified. No definite paraspinal or\nparavertebral soft tissue abnormalities are identified.\n\nTHORACIC:\nSpine labeling has been provided on series 6, image 8. Alignment is normal. \nDiffuse enhancement and STIR signal abnormality is seen involving the thoracic\nvertebral bodies however without definite evidence of a an enhancing soft\ntissue component concerning for metastases. No underlying cord signal\nabnormality is identified.\n\nT6/T7: There is no significant spinal canal or neural foraminal narrowing.\n\nT7/T8: Right central disc protrusion is seen, in combination with facet joint\narthropathy resulting in mild canal narrowing. Enhancing soft tissue is seen\nsurrounding the cord, contributing to the canal narrowing at this level. Mild\nbilateral neural foraminal narrowing is seen, left greater than right.\n\nT8-T9: Right central disc bulge is seen resulting an moderate canal\nnarrowing. Enhancing soft tissue is seen surrounding the cord at this level,\ncontributing to the moderate canal narrowing and mild cord deformity. Facet\njoint arthropathy results in mild left neural foraminal narrowing. The right\nneural foramen is patent.\n\nT9-T10 through T12-L1: There is no significant spinal canal or neural\nforaminal narrowing.\n\nNo other paraspinal or paravertebral soft tissue abnormalities are identified.\n\nLUMBAR:\nT1 heterogeneity, mildly enhancement and mildly STIR hyperintense signal is\nseen throughout the lumbar spine. Diffuse disc desiccation is seen.\n\nT12-L1: There is no significant spinal canal or neural foraminal narrowing.\n\nL1-L2: No significant spinal canal or neural foraminal narrowing is seen.\n\nL2-L3: No significant spinal canal or neural foraminal narrowing is seen.\n\nL3-L4: Central disc protrusion, broad-based disc bulge, ligamentum flavum\nhypertrophy contributes to moderate canal narrowing at this level. Facet\njoint osteophytes results in mild bilateral neural foraminal narrowing.\n\nL4-L5: Central disc bulge, ligamentum flavum hypertrophy contributes to mild\nspinal canal narrowing and subarticular zone narrowing. Facet joint\nosteophytes contribute to mild bilateral neural foraminal narrowing.\n\nL5-S1: Central disc bulge, ligamentum flavum and facet joint arthropathy\nresults in mild spinal canal narrowing. There is bilateral subarticular zone\nnarrowing as well as mild-to-moderate bilateral neural foraminal narrowing.\n\nOTHER: No other paraspinal or paravertebral soft tissue abnormalities are\nidentified.", "output": "1. Diffuse marrow heterogeneity, mild STIR hyperintensity and enhancement\nthroughout the cervical, thoracic, and lumbar spine is concerning for diffuse\nmetastases.\n2. At T7/T8 and T8/T9, an enhancing soft tissue component is seen surrounding\nthe cord resulting in moderate canal stenosis as well as mildly deforming the\ncord at T8/T9. No underlying cord signal abnormalities are identified.\n3. Cervical spondylosis, as described in detail above, most pronounced at C4-5\nand C5-6.\n4. Lumbar spondylosis, most pronounced at L3-4 and L4-5.\n5. Mild thoracic spondylosis, most pronounced at T7-T8 and T8-T9.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 4:19 ___, 30 minutes after\ndiscovery of the findings." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is loss of T2 signal of multiple intervertebral discs.\n\nAgain, there is diffuse heterogeneous marrow placement throughout the thoracic\nvertebral bodies, lower cervical spine and visualized L1 vertebral body with\nareas of heterogeneous STIR hyperintensity, with some more rounded components\nsuch as a 13 mm lesion in the T5 vertebral body, corresponding to diffuse\nsclerotic areas seen on the prior CT examination, compatible with osseous\nmetastatic disease. There is no evidence of pathologic fracture. Again,\nenhancing epidural soft tissue is seen encasing the cord from the levels of T7\nthrough T9, unchanged compared to prior examination, which again contribute to\nspinal canal narrowing at these levels. Small disc protrusions at T7-T8 and\nT8-T9. There is no underlying cord signal abnormality.\n\nThere is otherwise no significant spinal canal narrowing at other levels. \nAgain, there is mild bilateral neural foraminal narrowing at the T7-T8 and\nT8-T9 levels. The neural foramina are patent at other levels.\n\nThe visualized lungs are grossly clear. The visualized upper retroperitoneum\nis grossly unremarkable. Areas of similar bone marrow placement are noted in\nthe visualized ribs as well as suggested within the sternum on sagittal view.", "output": "1. Diffuse heterogeneous bone marrow replacement with areas of enhancement\nthroughout the visualized spine, as seen on prior examination, concerning for\ndiffuse osseous metastasis. No evidence of pathologic fracture.\n2. Again there is enhancing soft tissue encasing the cord from the T7 through\nT9 levels, compatible with epidural soft tissue metastasis with mild deformity\nof the spinal cord .\n3. No underlying cord signal abnormality.\n4. Thoracic spondylosis, as described, unchanged.\n5. Additional, partially visualized areas of marrow replacement in the\nvisualized ribs and sternum, compatible with additional sites of osseous\nmetastatic disease." }, { "input": "Motion artifact degrades the diagnostic quality of the imaging.\n\nThis study was not dedicated to evaluate the cervical spine, but on these\nimages there are evidence of cervical spondylosis but no clear compromise of\nthe spinal cord in the central canal. There is narrowing of the C6-7 neural\nforamina bilateral and left C7-T1 neural foramina.\n\nThoracic:\nExtensive heterogenous, but predominantly low bone marrow signal intensity is\nincreased compared to prior in keeping with diffuse osseous metastatic\ndisease. Increased bone marrow edema at the levels T6 through T10 most likely\nrepresent postradiation changes. The previously noted epidural soft tissue at\nT7-T9 levels appear improved compared to prior. A combination of bony\nexpansion and degenerative disease (broad-based disc protrusion, facet joint\narthropathy and ligamentum flavum buckling) results in mild to moderate\nnarrowing of the central canal. No obvious myelopathic signal changes of the\ncord at this level.\n\n\nLumbar:\nDiffuse hypointense bone marrow signal in keeping with diffuse metastatic bony\ndisease is increased compared to prior.\nThe conus terminates at the L1-2 level. No conus masses.\nDesiccation of the L3-4 and L4-5 discs with associated broad-based posterior\nprotrusion.\n\nAt the level L3-4 there is a soft tissue mass in the posterior epidural space\nmeasuring 14 x 9 mm in the sagittal plane which is isointense on T1 and T2\nweighted imaging and shows homogeneous mild enhancement postcontrast (image 8,\nseries 16). This posterior epidural mass with associated degenerative changes\nresult in moderate narrowing of the spinal canal measuring 7 mm in the AP\ndiameter. There is still minimal CSF seen outlining the nerve roots at this\nlevel.\n\nAt the level T12-L1 and L1-2: Mild narrowing of the neural foramina, but no\nobvious nerve root compromise.\n\nAt the level L2-3: Moderate narrowing of the neural foramina bilateral, but no\nobvious nerve root compromise.\n\nAt level L3-4: The broad-based disc protrusion, facet joint arthropathy with\nassociated posterior epidural soft tissue mass results in moderate narrowing\nof the central canal measuring 7 mm in AP diameter as described above. There\nis still minimal CSF seen outlining the nerve roots at this level. Moderate\nnarrowing of the neural foramina bilateral.\n\nAt the level L4-5: Degenerative changes result in mild narrowing of the spinal\ncanal, but no nerve root compromise. There is moderate narrowing of the\nneural foramina with minimal fat seen outlining the nerve roots.\n\nAt level L5-S1: Degenerative changes results in mild narrowing of the spinal\ncanal with contact of the left S1 nerve root in the lateral recess, but no\nobvious compromise. There is moderate to severe narrowing of the neural\nforamina will almost complete loss of the fat aligning the nerve roots.\n\nNo nerve root compromise of the S1 nerve roots in their neural canals.\n\nExtra-spinal:\nLeft hydroureteronephrosis is new compared to prior CT abdomen done ___", "output": "1. Soft tissue mass in the posterior epidural space at the L3-4 level is\nconcerning for metastatic disease. The homogeneous enhancement favors\nmetastatic disease over hematoma, but the L3-4 level is presumably the level\nwhere the spinal interventional procedure was performed. Please also note\nthat the signal intensity of this epidural mass is similar compared to the\nprior epidural metastatic disease in the thoracic spine on the study done ___.\n2. Previously noted thoracic epidural metastatic disease appears improved\ncompared to prior.\n3. Diffuse bony metastatic disease demonstrates interval progression of\nhypointense bone marrow changes.\n4. Multilevel L3-4, L4-5 and L5-S1 spondylotic changes with moderate neural\nforaminal narrowing as described above.\n5. Left-sided hydroureteronephrosis is new. Urology consult advised.\n\nRECOMMENDATION(S): Urology consult advised.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:28 pm, 20 minutes after\ndiscovery of the findings." }, { "input": "The vertebral body height and alignment are within normal limits. Multiple\nhemangiomas are noted within the lumbar spine. Degenerative endplate marrow\nsignal is present at the L5-S1 level. The bone marrow signal is otherwise\nunremarkable.\n\nThe conus is normal in position and morphology and terminates at the L1-L2\nlevel.\n\nThere are probable bilateral renal cysts.\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 mild bilateral facet arthropathy ligamentum\nflavum thickening. The spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, there is mild bilateral facet arthropathy and ligamentum\nflavum thickening. The spinal canal and neural foramina appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy and ligamentum flavum\nthickening with a diffuse disc bulge which cause mild spinal canal narrowing.\nThe neural foramina appear normal.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge which cause moderate spinal canal\nnarrowing and moderate bilateral neural foraminal narrowing with contact of\nthe exiting bilateral L5 nerve roots and contact of the traversing bilateral\nS1 nerve roots. When compared to prior exam, this has increased.", "output": "1. Increased multilevel spondylosis, greatest at the L5-S1 level, where there\nis moderate to severe spinal canal narrowing and moderate bilateral neural\nforaminal narrowing, as described." }, { "input": "Alignment is normal. There is mild loss of signal of the intervertebral discs\non the T2 weighted images from L3 through S1. This is a manifestation of\ndegenerative disc disease. There are foci of endplate hyperintensity in the\nsuperior L2, inferior L3, inferior at L4, and both sides of the L5-S1\ninterspace on the STIR images. These suggest ___ type 1 signal intensity\nchange due to degenerative disc disease.\n\nAgain seen and incompletely imaged is an approximately 35 mm right renal cyst.\nThis appears similar to the study of ___.\nGraph\nImages at L3-4 demonstrate minimal bulging of the intervertebral disc with no\nencroachment on the thecal sac or neural foramina.\n\nAt L4-5, bulging of the disc, thickening of the ligamentum flavum, and mild\nfacet osteophyte formation produces mild spinal canal narrowing. The neural\nforamina appear normal.\n\nAt L5-S1, again seen is moderate spinal canal stenosis due to a combination of\ndisc bulge, ligamentum flavum thickening, and facet osteophytes. This appears\nto compromise the traversing S1 nerve roots bilaterally. There is mild\nnarrowing of the neural foramina with no evidence of nerve root compression.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Degenerative disc disease most marked at L5-S1 where it produces moderate\nspinal canal stenosis." }, { "input": "The patient is status post bilateral L5-S1 laminectomies with expected\npostoperative changes. Evaluation for granulation tissue is suboptimal\nwithout IV contrast.\n\nThere is no vertebral body height loss to suggest compression fracture. There\nis grade 1 anterolisthesis of L5 on S1. Otherwise, the spinal alignment is\nmaintained.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L1-L2. There is no spinal cord signal\nabnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2, L2-L3: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL3-L4: There is a posterior disc bulge with thickening of the ligamentum\nflavum and bilateral facet arthropathy resulting in mild canal stenosis. No\nappreciable neural foraminal narrowing is identified.\n\nL4-L5: There is a posterior disc bulge with thickening of ligamentum flavum\nand facet arthropathy resulting in mild canal stenosis. Moderate bilateral\nneural foraminal narrowing is most significant at the levels of the\nsubarticular recesses and proximal neural foramina.\n\nL5-S1: In addition to grade 1 anterolisthesis of L5 on S1, there is a\nposterior disc bulge and bilateral facet arthropathy. The disc does appear\nslightly smaller when compared to examination of ___. However, the patient\nis status post bilateral laminectomy, and there is no appreciable spinal canal\nstenosis. There is moderate severe bilateral neural foraminal narrowing,\nprogressed from prior examination.\n\nMultiple T2 hyperintense renal cysts are noted bilaterally, statistically\nlikely simple cysts measuring up to 4.1 cm in greatest dimension. Otherwise,\nthe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Status post L5-S1 bilateral laminectomy without evidence of canal stenosis\nat this level. Assessment for granulation tissue in tissue is suboptimal\nwithout IV contrast.\nThere is bilateral L5-S1 moderate to severe neural foraminal narrowing,\nslightly progressed from examination of ___. The disc bulge appears slightly\nsmaller compared to examination of ___.\n2. Multiple additional levels of lumbar spondylosis, as detailed above.\n3. Additional findings as described above." }, { "input": "There are areas of signal loss on the T1 weighted and fat images in the C 2,\nC3, C4, T2, T3, T6, T9, and T10, T11 and T12 the appearance is similar to the\nCT studies of ___. Vertebral bodies. This pattern is most typical of\nblastic metastatic disease.\nPost-contrast imaging demonstrates diffuse uniform enhancement of the surface\nof the spinal cord at every level. Similar enhancement is seen in all\nleptomeningeal distribution is in the included portions of the posterior\nfossa. These findings are typical of leptomeningeal metastatic disease.\n\nCERVICAL:\nAlignment is normal. intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof spinal canal or neural foraminal narrowing.\n\nTHORACIC:\n___ there is mild anterior subluxation of T2 upon T3, unchanged since the\nstudy of ___ nment is normal. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing.\n\nOTHER: There are multiple hepatic lesions, incompletely evaluated but that\nappear new since the torso CT of ___. In this clinical setting, they\nare worrisome for metastatic disease.", "output": "1. Multiple blastic osseous metastases, unchanged.\n2. Diffuse leptomeningeal enhancement throughout the spine and involving the\nposterior fossa.\n3. No evidence of vertebral body collapse or spinal cord compression." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved.\n\nSclerotic osseous metastatic lesions of the occiput, C2, C3, C4 T2 and T3\nvertebra are overall similar to prior examination. No definitive new osseous\nlesions are identified.\n\nDisc heights are maintained.\n\nInterval progression of leptomeningeal disease of the visualized posterior\nfossa, cervical spine and visualized upper thoracic spine, characterized by\nincreased enhancement and thickening along the cerebellar folia, fourth\nventricle and cord surface. There is no evidence for myelomalacia.\n\nNo significant spinal canal or neural foraminal narrowing.\n\nThere is no cervical lymphadenopathy by size criteria. Right lung apical\nscarring is unchanged.", "output": "1. Interval progression of leptomeningeal disease of the visualized posterior\nfossa, cervical and upper thoracic spine.\n2. Please refer to concurrent MRI head with without contrast for additional\ndetails.\n3. Additional findings described above." }, { "input": "Thoracic spine:\n\nDiffuse enhancement of the surface of the spinal cord is seen in the thoracic\nregion extending to the conus level indicative of leptomeningeal metastatic\ndisease. No increased signal seen within the spinal cord. The enhancement\nalong the surface of the spinal cord is unchanged from the prior study. Small\nfoci of low signal indicating sclerotic metastatic disease within the thoracic\nvertebral bodies in T2-T3-T6-T9, T10 and T12 vertebrae are unchanged from the\nprior study. No new pathologic fracture seen. No cord compression.\n\nLumbar spine:\n\nDiffuse enhancement of the nerve roots and the conus indicating leptomeningeal\nmetastasis is unchanged compared to the prior study. Foci of low signal in L1\nand L3 vertebral bodies are unchanged.\n\nMild multilevel degenerative changes are seen.\n\nThere is heterogeneity of the marrow signal which is increased from the prior\nstudy and could be related to marrow reconversion. No pathologic fracture is\nidentified. Right upper lung wedge opacity is unchanged from the prior study\nand is incompletely evaluated.", "output": "1. Diffuse enhancement along the surface of the spinal cord and thoracic and\nupper lumbar region as well as enhancement of the lumbar nerve roots\nindicative of leptomeningeal metastasis not significantly changed from\nprevious MRI examination of ___.\n2. Foci of sclerotic bony metastasis unchanged. No new pathologic compression\nfracture.\n3. New heterogeneity of the bone marrow likely related to marrow reconversion." }, { "input": "CERVICAL:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\n\nThere is an approximately 12 x 10 mm T1 and T2 hypointense lesion with\nequivocal enhancement along the left aspect of the inferior endplate of C3. A\nsmall sclerotic lesion in this location was seen on the neck CT examination\nfrom ___.\n\nThere is diffuse involvement of a similar-appearing lesion hypointense, mildly\ncontrast-enhancing of the C4 vertebral body with extension into the left\npedicle and pars interarticularis/facets, with mild narrowing left neural. No\ndefinite corresponding sclerotic lesion is seen on the ___ neck CT. The\n___ cervical spine MRI demonstrated a low-signal lesion involving the\nleft pars/facets of C5, which is not conspicuous at this time.\n\nThere is no evidence for epidural or other soft tissue mass. There is no\nevidence for leptomeningeal contrast enhancement. Spinal cord signal is\nwithin normal limits.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is no significant spinal canal narrowing. There is mild\nnarrowing of the left neural foramen at the level of the above-described\nhypointense lesion.\n\nAt C4-C5, there is trace disc protrusion without significant spinal canal\nnarrowing. Facet and uncovertebral osteophytes produce mild to moderate right\nand mild left neural foraminal narrowing.\n\nAt C5-C6, there is no significant spinal canal narrowing. Facet and\nuncovertebral osteophytes produce mild moderate bilateral neural foraminal\nnarrowing.\n\nAt C6-C7, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is an approximately 15 x 12 mm T1 and T2 hypointense lesion with subtle\npost-contrast enhancement along the posterior inferior margin of the T2\nvertebral body and a similar appearing 13 x 5 mm lesion along the anterior\nmargin of the T3 vertebral body. Additional 8 mm rounded lesion is seen\nwithin the right aspect of the T6 vertebral body, also seen on prior CT. \nAdditional 22 x 18 mm lesion is seen along the right aspect of the T10\nvertebral body as well as another 30 x 21 mm lesion along the left aspect of\nthe T11 vertebral body. Additional subtle 11 x 3 mm lesion is seen along the\nsuperior endplate of the T12 vertebral body. These correspond to sclerotic\nlesions on ___ torso CT and appear grossly unchanged in size\nallowing for differences in modalities. There is no epidural or other soft\ntissue extension. There is no abnormal leptomeningeal contrast enhancement. \nSpinal cord signal is within normal limits. There is no significant spinal\ncanal or high-grade neural foraminal narrowing.\n\nLUMBAR:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nMultiple T1 and T2 hypointense lesions with mild postcontrast enhancement are\nseen. There is a 15 mm rounded lesion within the left aspect of the L1\nvertebral body. There is a 15 x 6 mm lesion along the right superior endplate\nof L2. There is an 8 mm rounded lesion along the right lower aspect of the L3\nvertebral body. There is a 21 x 7 mm lesion along the anterior-superior\nendplate of L5 as well as another 4 mm lesion within the inferior aspect of\nthe L5 vertebral body. These appear grossly unchanged compared to the ___ CT torso, allowing for differences in modalities.\n\nThe conus medullaris terminates at L1-L2 and appears unremarkable. There is\nno leptomeningeal enhancement.\n\nAt L1-L2, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-L3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nL4-L5, there is mild disc bulge without significant spinal canal narrowing. \nTiny central annular fissure is noted (9:9). Disc bulge focally contacts the\ntraversing bilateral L5 nerve roots without displacement. Facet and endplate\nosteophytes produce mild bilateral neural foraminal narrowing, with facet\nosteophytes contacting the exiting L4 nerve roots.\n\nL5-S1, there is minimal disc bulge and mild bilateral facet arthropathy\nwithout significant spinal canal or neural foraminal narrowing.\n\nOTHER:\n\nLinear opacity is again seen at the right lung apex, unchanged compared to the\nprior CT examination, compatible with radiation fibrosis. Ill-defined area of\nsoft tissue along the right internal mammary lymph node station is better\ncharacterized on the recent prior CT examination. Multiple lung nodules as\nseen on the prior chest CT examination are not well seen on the current MR\nexamination.\n\nAdditional sclerotic lesion in the left iliac bone measuring at least 15 x 7\nmm is partially imaged, abutting the SI joint (14:32), appearing similar to\nthe prior CT examination.\n\nThere is an ill-defined mildly T2 hyperintense, enhancing 14 mm lesion in\nhepatic segment VI/VII (12:20, 17:20), corresponding to a subtle hypodense\nlesion on prior CT examination. The remainder of the visualized\nretroperitoneum is grossly unremarkable.", "output": "1. Multiple sclerotic osseous metastatic lesions involving the C3, C4, T2, T3,\nT6, T10, T11, T12, L1, L2, L3, and L4 vertebral bodies as well as the left\niliac bone, as described. The C4 vertebral body lesion appears new since the\nneck CT examination from ___. The remainder of the lesions appear\ngrossly similar to the ___ CT torso. No evidence for a\npathologic fracture.\n2. No epidural or other soft tissue extension of osseous metastases is seen. \nNo evidence for leptomeningeal metastatic disease.\n3. Ill-defined 14 mm lesion in hepatic segment VI/VII, corresponding to subtle\nhypodense lesion on CT, suspicious for metastatic disease.\n4. Ill-defined area of soft tissue along the right internal mammary lymph node\nstation is better characterized on the recent prior CT examination, and likely\nrepresents nodal involvement.\n5. Overall mild cervical, thoracic and lumbar spondylosis, as described above." }, { "input": "There is mild retrolisthesis at C5-C6 by 2 mm, and anterolisthesis C7-T1 by 2\nmm. There are multilevel endplate osteophytes particularly at left of C3-C4,\nright of C5-C6 and C6 inferior endplate contemplating to the multilevel spinal\ncanal narrowing, as described below. There is degenerative osseous fusion of\nthe left C4-C5 facets. Probable hemangioma is seen within C7 vertebral body. \nThere is no suspicious marrow replacing lesion. There is an anterior\nosteophyte at C5-C6, and corresponding to findings on prior swallow study\nwithout a suspicious marrow replacing lesion.\n\nC2-C3: There is no spinal canal or neural foraminal stenosis.\n\nC3-C4: There is a left paracentral endplate osteophytes with flattening of\nthe ventral spinal cord and mild spinal canal stenosis. Combined with\nuncovertebral joint and facet degenerative changes, left greater than right,\nthere is moderate left and no significant right neural foraminal stenosis. \nThere is hyperintense STIR signal within the left facets (03:11), likely\ndegenerative.\n\nC4-C5: There is no high-grade spinal canal stenosis. There are bilateral\nuncovertebral joint and facet degenerative changes, left greater than right,\nresulting in mild bilateral neural foraminal stenosis. There is hyperintense\nSTIR signal within the left facets, likely degenerative.\n\nC5-C6: There is mild retrolisthesis with a disc bulge contributing to\nmoderate spinal canal stenosis with cord remodeling. There is questionable\nmild hyperintense T2 spinal cord signal intensity (3:7, 6:27). Combined with\nbilateral uncovertebral joint and facet degenerative changes, there is\nmoderate to severe bilateral neural foraminal narrowing.\n\nC6-C7: There is a disc bulge with moderate spinal canal stenosis with cord\nremodeling. Combined with bilateral facet and uncovertebral joint arthrosis,\nthere is severe right and mild left neural foraminal stenosis.\n\nC7-T1: There is no high-grade spinal canal or neural foraminal stenosis.\n\nThere is STIR hyperintense signal of the paraspinal muscles\nleft-greater-than-right, which may represent atrophy. Mild retropharyngeal\nedema/fluid extends from the C2-C3 through C5-C6 levels, potentially sequela\nof intubation. The remainder the prevertebral and paraspinal soft tissues are\ngrossly unremarkable.", "output": "1. Multilevel degenerative changes of the cervical spine with moderate spinal\ncanal stenosis and cord remodeling and C5-C6 and C6-C7 with multilevel neural\nforaminal stenosis, as detailed above.\n2. Questionable hyperintense T2 spinal cord signal intensity at C5-C6, which\nmay be related to cord edema. This finding is seen only on sagittal sequences\nand not definitively confirmed on axial sequences and may be artifactual. \nClinical correlation is recommended.\n3. Presumed multilevel paraspinal muscle atrophy, left greater than right.\n4. Anterior osteophytes at C5-C6 corresponding to findings on prior swallow\nstudy. No suspicious marrow replacing lesion." }, { "input": "The cervical vertebral body heights, alignment, and intervertebral disc spaces\nare preserved.\n\nDiffuse T2 hyperintense lesions extending along the peripheral nerves of the\ncervical spine beginning at C1-C2 to the T1-T2 levels, with multilevel\nexpansion of the neural foramina.\n\nAt the level of C1/foramen magnum, bilateral neurofibromas result in moderate\ndeformation and remodeling of the cervical spinal cord. Additionally, large\nbilateral neurofibromas at the level of C5 also result in severe deformation\nand compression of the cervical cord with underlying high cord signal (series\n5, image 17), compatible with edema/myelomalacia.\n\nThese lesions also results in mild-to-moderate spinal canal narrowing at\nC7-T1.\n\nThere is minimal disc bulge at C6-C7 without significant spinal canal\nnarrowing.\n\nMultiple small T2 hyperintense subcutaneous lesions are identified along the\nposterior subcutaneous tissues.", "output": "1. Multiple fibromas and plexiform neurofibromas involving the cervical spine\nas described above.\n2. Bilateral neurofibromas result in moderate deformation and remodeling of\nthe cervical spinal cord at the level of C1/foramen magnum.\n3. Bilateral neurofibromas result in severe deformation and compression of\ncervical spinal cord at the level of C5. There is high signal of the cord at\nthis level, compatible with edema/myelomalacia." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. The conus terminates at L1 vertebral\nlevel. There is no evidence of disc herniations, significant facet\narthropathy, or vertebral canal narrowing.\n\nAgain seen are T2 hyperintense lobulated lesions along the course of bilateral\nvisualized lumbar and sacral nerve roots which remodel and expand multiple\nneural foramina, grossly unchanged since prior study in ___, and\ncompatible with plexiform neurofibromas. In addition, there are multiple\ncircumscribed neurofibromas within the paraspinal, gluteal muscles,\nsubcutaneous tissues, also unchanged.\n\nThe visualized portion of the sacroiliac joints demonstrate degenerative\nchanges. There are a couple of scattered subcentimeter T2 hyperintense\nwell-circumscribed lesions in the renal cortices, likely representing simple\nrenal cysts.", "output": "1. Redemonstrated diffuse plexiform neurofibromas involving the visualized\nspine and sacrum, similar in extent and appearance to prior exam in ___.\nNo evidence of significant spinal canal narrowing.\n2. Additional neurofibromas are seen involving the paraspinal musculature,\ngluteal musculature, and subcutaneous soft tissues, as before" }, { "input": "Cervical spine:\n\nComparison with the prior study, obtained only 6 days ago reveals negligible\nchange in the extent of elevated T2 signal within the spinal cord at the site\nof the largest neurofibroma, which is situated anterior to the compressed\nspinal cord at the C5 and C6 levels. This high signal could indicate edema,\ngliosis, or s combination of the two abnormalities. No cord edema is seen\nelsewhere within the cervical region.\n\nThe multiple neurofibromas appear to exhibit only minimal contrast\nenhancement. No other new cervical spine lesions are seen, compared to the\nprior study.\n\nThoracic spine:\n\nThere is re-demonstration of what are likely bilateral neurofibromas expanding\nthe C7-T1 neural foramina.\n\nAt T7-8, there appear to be bilateral neurofibromas contiguous to the anterior\naspect of the heads of the T7 ribs. The lesion on the right side has a small\ncystic component along its medial aspect. These tumors undergo mild\nenhancement.\n\nAt T8-9, there is a small neurofibroma extending from the lateral aspect of\nthe right neural foramen, as far distally as the head of the right ninth rib.\n\nAt T11-12, there are likely small neurofibromas within the neural foramina,\nextending laterally.\n\nThere does not appear to be evidence for neurofibromas within either the\nintra- or extradural compartments of the thoracic region.\n\nAt T10-11, there is moderate bilateral thickening of the medial facet joint\ncapsular ligaments. On the right-side, this thickened ligament contacts the\nright dorsal lateral cord margin.\n\nThere are no other visible thoracic spinal abnormalities. The spinal cord\nsignal pattern is normal.", "output": "Confirmation of the diagnosis of neurofibromatosis 1, with multiple lesions,\nas described in detail, above." }, { "input": "Compared to prior studies, the patient is now status post laminectomies from\nC4 through C7, partial resection of C3 spinous process, and instrumented\nposterior fusion of C3 through C7, with bilateral posterior element screws at\nC3, C4, and C7. Hardware related artifacts slightly limit evaluation.\n\nThe epidural components of the previously seen bilateral C5-C6 nerve sheath\ntumors have been resected, with remaining neural foraminal and extraforaminal\ncomponents. The thecal sac is well decompressed, and spinal cord compression\nhas resolved. Previously seen irregularly-shaped T2 hyperintensity in the\ncord from mid C5 through mid C6 levels has become more well-defined, and mild\ncord thinning is now evident, consistent with myelomalacia. No contrast\nenhancement in the cord. There is apparent dorsal displacement of the cord at\nC5 and C6, which may be secondary to gravity, given the laminectomies in\nsupine positioning.\n\nThere is a rim enhancing fluid collection extending from the laminectomy beds\ninto the overlying soft tissues, which has a large area of surface contact\nwith the dorsal thecal sac at C5 and C6, and which measures 7.5 cm\ncraniocaudad by 4.0 cm AP on image 2:7, and 2 cm transverse at the level of\nthe subcutaneous fat on image 8:18. T2 weighted and STIR images demonstrate\nseveral linear hypointensities within the collection, without contrast\nenhancement, which may reflect nonenhancing septations or debris.\n\nUnchanged bilateral nerve sheath tumors are again seen from C1-C2 through\nC4-C5, as well as C6-C7 and C7-T1, again demonstrating T2 hyperintensity,\nintermediate T1 signal, and no significant contrast enhancement. At the level\nof C1-C2, the right nerve sheath tumor deforms the anterior cord, and the left\nnerve sheath tumor deforms the posterior cord, with mild-to-moderate spinal\ncanal narrowing, without evidence for cord signal abnormality, unchanged. At\nthe level of C7-T1, bilateral nerve sheath tumors deform the lateral aspect of\nthe cord with moderate spinal canal narrowing without evidence for cord signal\nabnormality, unchanged.\n\nMild loss of height involving C7 through T3 vertebral bodies is unchanged. \nAlignment is preserved. No concerning bone marrow signal abnormalities in the\nvertebral bodies. Evaluation of marrow signal in the posterior elements is\nlimited by hardware related artifacts.\n\nThe cerebellar tonsils are normally positioned. Visualized brain parenchyma\nin the posterior fossa is grossly unremarkable.\n\nCurvilinear hyperintensity on T2 weighted and postcontrast T1 weighted images\nalong the left lateral pterygoid muscle, images 6:1 8:1, corresponds to a\nprominent vein on the CTA from ___.", "output": "1. Epidural components of the previously seen bilateral C5-C6 nerve sheath\ntumors have been resected, with neural foraminal and extraforaminal components\nremaining. The thecal sac is well decompressed, with resolution of spinal\ncord compression. Myelomalacia from mid C5 through mid C6 levels with mild\ncord thinning is now better defined, either progressed or better seen compared\nto ___. Apparent dorsal displacement of the cord may be secondary\nto gravity, given the laminectomies in supine positioning.\n2. 7.5 x 4 x 2 cm mildly heterogenous, possibly septated, rim enhancing fluid\ncollection extending from the laminectomy beds into the overlying soft\ntissues, with a large area of surface contact with the dorsal thecal sac at C5\nand C6. While this may represent a postsurgical seroma, a pseudomeningocele\ncannot be excluded. A superimposed infection also cannot be excluded on the\nbasis of imaging.\n3. Unchanged bilateral nerve sheath tumors from C1-C2 through C4-C5, as well\nas at C6-C7 and C7-T1. Unchanged mass effect on the spinal cord at C1-C2 and\nat C7-T1, without evidence for cord signal abnormalities." }, { "input": "There is severe dextroscoliosis centered at L2-L3. Allowing for this, there\nis grade 1 retrolisthesis of L3 on L4, with the remainder of the sagittal\nspinal alignment maintained.\n\nVertebral body heights are grossly maintained. However, there is abnormally\nelevated T2/STIR signal seen within the right L4 and L5 pedicles (2:8,9) with\nassociated T1 hypointensity. Additionally, there is increased STIR\nhyperintensity involving the bilateral lower paraspinal musculature. \nCongenital narrowing spinal canal.\n\nThe conus medullaris terminates at the level of L1-L2.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1: A posterior disc bulge flattens the ventral thecal sac with mild canal\nnarrowing. Patent foramina.\n\nL1-L2: Mild posterior disc bulging combines with facet arthropathy and\nthickening of ligamentum flavum to result in mild canal stenosis. There is a\nsmall right facet joint effusion. Mild bilateral subarticular recess\nnarrowing without significant neural foraminal narrowing is seen.\n\nL2-L3: A an asymmetric left posterior disc bulge is noted combining with facet\narthropathy, bilateral facet joint effusions, thickening of ligamentum flavum,\nand prominent dorsal epidural fat result in moderate canal narrowing with\nbilateral subarticular recess narrowing, mild-to-moderate bilateral foraminal\nnarrowing. Annular disc tear.\n\nL3-L4: There is a large posterior disc bulge which combines with thickening of\nligamentum flavum, facet joint effusions bilaterally, prominent dorsal\nepidural fat, and facet arthropathy to result in moderate to severe canal\nstenosis with compression of the cauda equina nerve roots at this level. \nIncomplete effacement of CSF within thecal sac. Moderate to severe left,\nmoderate right foraminal narrowing.\n\nL4-L5: A posterior disc bulge combines with prominent dorsal epidural fat and\nfacet arthropathy with thickening of ligamentum flavum to result in moderate\nto severe canal stenosis compression of the cauda equina nerve roots and\nproximal kinking. Incomplete effacement of CSF within thecal sac. Severe\nright, moderate left foraminal narrowing.\n\nL5-S1: A posterior disc bulge is noted without significant spinal canal\nnarrowing, but with bilateral subarticular recess narrowing, mild mass effect\non traversing right S1 nerve. Moderate left, moderate to severe right\nforaminal narrowing.\n\nIncidentally noted is aneurysmal dilation of the infrarenal abdominal aorta\nwhich measures up to 3.3 x 3.2 cm (6:1). The bilateral common iliac arteries\nappear normal in diameter. Otherwise, the remainder of the paraspinal soft\ntissues are grossly unremarkable in appearance.", "output": "1. Changes about posterior elements, paraspinal musculature at right L4 and L5\nlevel is likely reactive, degenerative. If there is concern for acute injury\nor fracture, further evaluation by lumbar spine CT could be considered.\n2. Multilevel advanced degenerative changes, congenital narrowing spinal\ncanal.\n3. Moderate to severe central canal narrowing L3-L4, L4-5 levels.\n4. Multilevel cyst significant foraminal narrowing, as above.\n5. Incidentally noted 3.3 cm infrarenal aortic aneurysm." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nA fat containing lesion in the L2 vertebral body with suggestion of internal\ntrabeculation is most consistent with a hemangioma. There is otherwise no\nbone marrow signal abnormality. The visualized portion of the spinal cord is\npreserved in signal and caliber. The conus medullaris terminates at the L1-L2\nlevel.\n\nThere is loss of T2 signal of multiple intervertebral discs, a manifestation\nof degenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T11-T12, there is no significant spinal canal or neural foraminal narrowing\n\nAt T12-L1 there is minimal right paracentral disc bulge without significant\nspinal canal or neural foraminal narrowing.\n\nAt L1-2 there is minimal disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L2-3 there is mild disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L3-4 there is minimal disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge with a right paracentral protrusion mildly\neffacing the right subarticular zone, without significant spinal canal\nnarrowing. The neural foramina are patent.\n\nAt L5-S1 there is no significant spinal canal or neural foraminal narrowing.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Mild degenerative disc disease and multiple areas of minimal disc bulging\nwithout significant spinal canal or neural foraminal narrowing.\n2. No terminal cord signal abnormality.\n3. L2 vertebral body hemangioma." }, { "input": "Levoconvex curvature of the lower cervical and upper thoracic spine\nmay be positional. Marrow signal is heterogeneously low on the T1-weighted\nimages and the T2-weighted images. There are no definite focal suspicious\nlesions.\n\nAt C3-C4, small posterior disc osteophyte complex does not significantly\nnarrow the spinal canal.\n\nAt C4-C5, posterior disc osteophyte complex and small uncovertebral joint\nosteophytes mildly narrow the foramina bilaterally.\n\nAt C5-C6, moderate posterior disc osteophyte complex and ligamentous\nthickening mildly narrows the spinal canal with remodeling of the right\ngreater than left ventral and dorsal spinal cord. There is severe right\ngreater than left foraminal narrowing as well.\n\nAt C6-C7, there is no significant narrowing.\n\nLimited views of the neck show the thyroid to be absent.", "output": "1. Disc osteophyte complex at C5-6 causes severe, right greater than left,\nforaminal narrowing.\n\n2. Heterogeneous bone marrow. While this is nonspecific, given the history\nof cancer, repeat imaging with STIR and post-gadolinium T1 sequences, or bone\nscan, is suggested." }, { "input": "For purposes of numbering, the lowest rib-bearing vertebral body is designated\nas T12.\n\nThere is moderate levoscoliosis of the lumbar spine, centered at L3. Sagittal\nalignment is maintained. Vertebral body heights are preserved. ___ type 2\nendplate degenerative changes are most prominent at T12-L1 and L4-L5 levels. \nThere is no suspicious osseous lesion.\n\nThere is diffuse loss of height and normal T2 signal of the lumbar\nintervertebral discs that is most severe at T12-L1 and L4-L5.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is no spinal canal or neural foraminal narrowing.\n\nAt L2-L3, there is a diffuse disc bulge, ligamentum flavum thickening, and\nbilateral facet arthropathy resulting in mild narrowing of the spinal canal. \nThere is no neural foraminal narrowing.\n\nAt L3-L4, there is a small disc bulge, ligamentum flavum hypertrophy, and\nbilateral facet arthropathy resulting in mild narrowing of the spinal canal. \nThere is no neural foraminal narrowing.\n\nAt L4-L5, there is a disc bulge that is eccentric to the left and combined\nwith marginal osteophytes results in mild narrowing of the left neural\nforamen. Ligamentum flavum thickening and bilateral facet arthropathy\ncontribute to mild narrowing of the spinal canal. The right neural foramen is\nnormal.\n\nAt L5-S1, there is a diffuse disc bulge the along with ligamentum flavum\nthickening and bilateral facet arthropathy results in mild narrowing of the\nspinal canal and mild bilateral neural foraminal narrowing.\n\nThe conus medullaris terminates at T12-L1. Nerve roots of the cauda equina\nare within normal limits.\n\nThere is no epidural or paraspinal fluid collection. There is no abnormal\nenhancement.\n\nNonenhancing T2 hyperintense foci in the left kidney consistent with cysts.", "output": "1. No evidence of epidural or paraspinal abscess or fluid collection.\n2. Multilevel lumbar spondylosis without high-grade spinal canal or neural\nforaminal narrowing as described above.\n3. Moderate levoscoliosis centered at L3." }, { "input": "CERVICAL:\nMinimal anterolisthesis C2-C3, likely degenerative. Multilevel degenerative\nchanges cervical spine, disc space narrowing, disc osteophyte complex C3-C4\nthrough C7-T1 levels. Posterior element degenerative changes. No cord T2\nsignal abnormality\n\nAt C2-C3 level central canal, foramina are patent.\n\nAt C3-C4 level there is mild central canal narrowing. Moderate left, mild\nright foraminal narrowing.\n\nAt C4-C5 level there is mild-to-moderate central canal narrowing. Moderate\nleft, mild right foraminal narrowing.\n\nAt C5-C6 level there is moderate central canal narrowing, preserved CSF. Mild\nright, moderate left foraminal narrowing.\n\nAt C6-C7 level there is moderate central canal narrowing, minimal flattening\nof the cord, effaced CSF about cord. No cord T2 signal abnormality. Moderate\nto severe left, moderate right foraminal narrowing.\n\nAt C7-T1 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nTHORACIC:\nThere is 0.9 cm sclerotic, enhancing lesion involving T5 vertebral body, new\nsince ___, stable since ___.\nSmall area of endplate sclerosis inferior T7, likely degenerative, metastasis\nis less likely.\nSclerosis at left T3 costovertebral joint, sclerosis of the transverse\nprocess, is indeterminate, may be degenerative, there was no sclerosis or\ndestructive changes on recent CT.\n\nThoracolumbar curve convex to the right. Degenerative changes. Multilevel\nsmall central disc protrusions, mild central canal narrowing. No cord\nflattening. No cord T2 signal abnormality. Multilevel mild foraminal\nnarrowing.\n\nLUMBAR:\nMinimal retrolisthesis L3-L4, L4-5, minimal anterolisthesis L5-S1, likely\ndegenerative. Multilevel degenerative changes lumbar spine, endplate edema L\n2, L3, L4, L5 levels, likely degenerative. Multilevel disc space narrowing,\nendplate hypertrophic changes, diffuse disc bulges, lumbar facet arthritis. \nNormal visualized cord.\n\nAt L1-L2 level there is tiny central disc protrusion. Mild central canal\nnarrowing. Patent foramina.\n\nAt L2-L3 level there is mild central canal narrowing. Patent foramina.\n\nAt L3-L4 level there is left paramedian, inferior disc extrusion, measuring 7\nmm in AP diameter, extending 9 mm below disc space. Moderate central canal\nnarrowing. Preserved CSF within thecal sac. Mass effect on traversing left\nL4 nerve secondary to disc fragment. Mild bilateral foraminal narrowing.\n\nAt L4-5 level there is moderate to severe central canal narrowing, preserved\nCSF. Moderate to severe left, moderate right foraminal narrowing.\n\nL5-S1 level there is mild central canal narrowing. Minimal mass effect on\ntraversing both S1 nerves. Moderate bilateral foraminal narrowing.\n\nOTHER: Indeterminate 1.1 cm short axis retroperitoneal lymph node. 2.6 cm\ninfrarenal aortic ectasia.", "output": "1. T5 lesion, most consistent with metastasis.\n2. Degenerative changes cervical spine, with moderate central canal narrowing\nC5-C6, C6-C7 levels, and multilevel foraminal narrowing.\n3. Mild degenerative changes thoracic spine.\n4. Advanced degenerative changes lumbar spine. Disc extrusion L3-L4 level,\nmoderate central canal narrowing. Moderate to severe central canal narrowing\nL4-5 level. Multilevel foraminal narrowing.\n5. Indeterminate retroperitoneal lymph node." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.No cord signal abnormality.Multilevel degenerative changes, disc\nosteophyte complexes C3-C4 through C7-T1 levels, disc space narrowing,\nposterior element hypertrophic changes.\n\nMultilevel central canal narrowing, stable since prior. Small central disc\nprotrusion C6-C7 level, mildly flattening ventral cord, moderate central canal\nnarrowing. Mild-to-moderate central canal narrowing C3-C4, C4-C5, C5-C6\nlevels. Multilevel foraminal narrowing, stable.\n\n\nTHORACIC:\nOsseous metastases in the thoracic spine have worsened since prior. There are\nlesions at T1, T5, T7, T8 vertebral bodies. On ___ MRI there was\nlesion at T5 vertebral body.. Left T3 transverse process metastasis.\n\nNormal visualized cord. No epidural tumor. Multilevel degenerative changes,\nmild central canal narrowing thoracic spine, stable multilevel mild foraminal\nnarrowing thoracic spine.\n\nSmall left pleural effusion. Metastasis versus subacute compression fracture\nwithout vertebral body height loss inferior T7, stable since ___..\n\n\nLUMBAR:\nNew since ___ there are metastases at L1, L4 vertebral bodies. L4\nvertebral body metastasis measures 2.9 cm. Right sacral ala metastasis. \nProbable right innominate bone metastasis, suboptimally seen.\n\nMultilevel degenerative changes lumbar spine, disc space narrowing, diffuse\ndisc bulges, facet arthritis. Normal visualized cord. No epidural tumor. \nMinimal retrolisthesis L3-L4, stable. Multilevel central canal narrowing. \nLeft paramedian disc protrusion L3-L4 level, stable, moderate central canal\nnarrowing. Stable moderate to severe central canal narrowing L4-5 level. \nMultilevel foraminal narrowing, stable, most prominent at L4-5.\n\nOTHER: A small left pleural effusion is seen. Abnormal liver, better seen on\nprior CT ___.", "output": "1. Spine metastases thoracic, lumbar spine, worsened since ___. \nFindings are difficult to compare to recent CT ___ secondary to\ndifferences in technique.\n2. Stable degenerative changes, as above.\n3. No epidural tumor. No cord signal abnormality.\n4. Metastasis versus subacute compression fracture inferior T7 vertebral body;\nmetastasis is more likely." }, { "input": "The patient has had C3 through T1 laminectomies. The C5 through 7 vertebral\nbodies are fused.\n\nThere is grade 1 anterolisthesis of C7 on T1. The alignment is otherwise\nnormal.\n\nThe background bone marrow signal is heterogeneous, with chronic degenerate\nendplate changes. There is no evidence of acute fracture. There are no\nsuspicious marrow replacing lesions.\n\nThe posterior fossa, foramen magnum and its contents, and cervical spinal cord\nare unremarkable.\n\nC2-3: Small central protrusion. Otherwise unremarkable.\nC3-4: Laminectomy with decompressed spinal canal. Broad disc osteophyte\ncomplex. Uncovertebral spurring produces moderate bilateral neural foraminal\nnarrowing.\nC4-5: Laminectomy with decompressed spinal canal. Broad disc osteophyte\ncomplex. Uncovertebral spurring produces severe left and moderate/severe\nright neural foraminal narrowing.\nC5-6: Laminectomy with decompressed spinal canal. Discectomy and vertebral\nbody fusion. Neural foramina are patent.\nC6-7: Laminectomy with decompressed spinal canal. Discectomy and vertebral\nbody fusion. Uncovertebral spurring produces mild bilateral neural foraminal\nnarrowing.\nC7-T1: Laminectomy with decompressed spinal canal. Grade 1 anterolisthesis. \nBroad disc osteophyte complex eccentric to the right. Severe bilateral neural\nforaminal narrowing, likely compresses the exiting C8 nerve roots.", "output": "1. Postsurgical changes including C3 through T1 laminectomies, C5 through 7\ndiscectomy and vertebral body fusion. Spinal canal is decompressed.\n2. Grade 1 anterolisthesis of C7 on T1.\n3. Significant bilateral neural foraminal narrowing at C4-5 and C7-T1." }, { "input": "CERVICAL SPINE: There is maintenance of the normal cervical spine curvature\nwithout malalignment. Vertebral body heights are maintained. Intervertebral\ndisc space narrowing and desiccation are noted at every level within the\ncervical spine, most prominently between C4 and C7. The cervical spinal cord\nis unremarkable, with no evidence of intrinsic cord signal abnormality. The\nvisualized portion of the posterior fossa is within normal limits. Discogenic\nmarrow endplate changes are noted, particularly at C6. There is no abnormal\nedema within the posterior paraspinal soft tissues. Prevertebral soft tissues\nare unremarkable.\n\nC3-C4: There is a mild broad-based posterior disc bulge and uncovertebral\njoint squaring. Mild bilateral foraminal narrowing is seen. There is no\ncentral canal stenosis.\n\nC4-C5: There is a broad-based disc bulge with superimposed right foraminal\ndisc protrusion which appears slightly progressed from the previous exam.\nThere is effacement of the ventral CSF and flattening of the spinal cord.\nThere is moderate central canal stenosis. Severe right-sided foraminal\nnarrowing and mild left-sided foraminal narrowing at this level.\n\nC5-C6: There is a right foraminal disc protrusion superimposed on a\nconcentric disc bulge as well as mild bilateral facet joint hypertrophy which\nappears slightly progressed from the previous exam.. There is moderate-severe\ncentral canal stenosis at this level with effacement of the CSF and flattening\nof the spinal cord. There is also severe right-sided and mild left-sided\nforaminal narrowing noted.\n\nC6-C7: There is a moderate concentric disc bulge. There is moderate central\ncanal stenosis at this level with effacement of the CSF and flattening of the\nspinal cord.\n\nC7-T1: There is a broad-based posterior disc bulge resulting in mild central\ncanal stenosis, severe left-sided foraminal narrowing, and mild right-sided\nforaminal narrowing.\n\nTHORACIC SPINE: The thoracic spine has normal curvature vertebral body\nheight, bone marrow signal and alignment. Intervertebral disc space narrowing\nand desiccation are noted, more prominently at T2 through T7. The thoracic\nspinal cord and conus medullaris have normal morphology and signal\nintensities. The posterior elements and paraspinal soft tissues are normal.\n\nT1-T2: There is no disc herniation, spinal canal narrowing or neural foramina\nstenosis.\n\nT2-T3: There is disk bulge, with a focal central left protrusion which\ncontacts the spinal cord without impinging upon it. No neural foraminal\nnarrowing is seen.\n\nT3-T4: There is loss of disk height and disk bulge, with a focal protrusion\nabout the left neural foramen resulting in moderate left neural foramen\nnarrowing. Mild spinal canal stenosis is present but no contact is seen\nbetween the cord and the disc.\n\nT4-T5: There is a broad-based central protrusion which impinges upon the\nthecal sac but does not contact the cord. No neural foramina narrowing is\nseen.\n\nT5-T6: There is a broad-based central protrusion which impinges upon the\nthecal sac but does not contact the cord. No neural foramina narrowing is\nseen.\n\nT6-T7: There is disk bulge without spinal canal stenosis or neural foramina\nnarrowing.\n\nT7-T8: There is disk bulge without spinal canal stenosis or neural foramina\nnarrowing.\n\nT8-T9: There is disk bulge without spinal canal stenosis or neural foramina\nnarrowing.\n\nT9-T10: There is no disc herniation, spinal canal stenosis or neural foramina\nnarrowing.\n\nT10-T11: There is disk bulge without spinal canal stenosis or neural foramina\nnarrowing.\n\nT11-T12: There is no disc herniation, spinal canal stenosis or neural foramina\nnarrowing.\n\nT12-L1: There is a central disc protrusion without spinal canal stenosis or\nneural foraminal narrowing.\n\nA focus of high T2 signal intensity is seen in the posterior subcutaneous\ntissues of the midline lower thoracic spine (10:9) of unclear clinical\nsignificance.", "output": "1. Degenerative changes of the cervical and thoracic spine identified, worse\nin the cervical spine. There has been slight progression of the degenerative\ndisc disease of the C spine compared to prior study from ___. Moderate\nspinal canal stenosis is seen in the cervical spine. No spinal canal stenosis\nis seen in the thoracic spine. There is no cord signal abnormality throughout\nthe spinal cord. For detailed description of neural foramina narrowing please\nrefer to the body of the report.\n\n2. A focus of high T2 signal intensity in the posterior subcutaneous tissues\nof the midline lower thoracic spine is of unclear clinical significance but\nmay represent a soft tissue injury. Correlate with clinical history and\nphysical exam." }, { "input": "There are 7 cervical, 12 rib-bearing thoracic, and 5 lumbar-type vertebrae. \nThe numbering is documented on images 3:11, 3:9, 6:9, and 6:8.\n\nLocalizer sequences demonstrate a levoconvex curvature centered in the lower\nthoracic spine or at the thoracolumbar junction.\n\nCERVICAL:\n\nThere is a T2 hyperintense lesion within the dorsal cord spanning C1-C2\nthrough C3-C4 levels, with minimal associated expansion of the cord. A\nportion of this lesion at the level of the C2 vertebral body demonstrates\ncontrast enhancement. Evaluation of the spinal cord for additional T2\nhyperintense lesions is slightly limited by the large field of view on both\nsagittal and axial T2 weighted images. There may be a T2 hyperintense lesion\nin the left lateral aspect of the cord at the level of C5-C6, images 4:10 and\n9:12, versus volume averaging artifact. Postcontrast sagittal and axial T1\nweighted images demonstrate no other enhancing lesions in the spinal cord.\n\nThe cerebellar tonsils are normally positioned, and the craniocervical\njunction appears unremarkable.\n\nVertebral body heights are preserved. There is minimal retrolisthesis of C3\non C4 and a mild smooth kyphotic curvature centered at C6-C7. No concerning\nbone marrow signal abnormalities are seen.\n\nAt C2-C3, there are left uncovertebral and facet osteophytes without\nsignificant neural foraminal narrowing. No spinal canal narrowing.\n\nAt C3-C4, there are small bilateral uncovertebral osteophytes with minimal\nbilateral neural foraminal narrowing. No spinal canal narrowing.\n\nAt C4-C5, there is mild right and moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes. No spinal canal narrowing.\n\nAt C5-C6, a broad-based disc protrusion with endplate osteophytes mildly\nnarrow the spinal canal and may minimally remodel the ventral spinal cord. \nThere is mild right and mild to moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nAt C6-C7, there is a broad-based right paracentral disc protrusion with\noverlying endplate osteophytes, which moderately narrow the spinal canal and\nmildly remodel the ventral spinal cord. There is moderate right and mild left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nTHORACIC:\n\nEvaluation of the spinal cord for T2 hyperintense lesions is limited by the\nlarge field of view on the sagittal and axial T2 weighted images. No definite\nT2 hyperintense lesions are seen. Sagittal and axial postcontrast T1 weighted\nimages demonstrate no enhancing lesions in the spinal cord. The conus\nmedullaris terminates at T12-L1 and appears normal.\n\nThere is mild anterior wedging of T8 vertebral body without marrow edema. \nOther thoracic vertebral body heights are within normal limits. The localizer\nsequence demonstrates a levoconvex curvature centered in the lower thoracic\nspine or thoracolumbar junction. No concerning bone marrow signal\nabnormalities are seen.\n\nAt T2-T3, there is a tiny left paracentral disc protrusion without spinal\ncanal narrowing.\n\nAt T4-T5, there is a tiny left paracentral disc protrusion without spinal\ncanal narrowing.\n\nAt T5-T6, there is a small central/ left paracentral disc protrusion without\nspinal canal narrowing.\n\nAt T6-T7, there is a small central disc protrusion without spinal canal\nnarrowing.\n\nAt T7-T8, there is a small central/ left paracentral disc protrusion without\nspinal canal narrowing.\n\nAt T8-T9, there is a central/right paracentral disc extrusion which mildly\nremodels the ventral spinal cord. No definite cord signal abnormality seen.\n\nAt T10-T11, there is facet arthropathy plus/minus thickening of the ligamentum\nflavum without significant spinal canal or neural foraminal narrowing.\n\nAt other thoracic levels, there is no spinal canal or neural foraminal\nnarrowing.\n\nLUMBAR:\n\nVertebral body heights preserved. There is mild retrolisthesis of L5 on S1\nwith loss of disc height, Schmorl's nodes, and discogenic marrow changes in\nthe endplates.\n\nThe intrathecal nerve roots appear unremarkable without evidence for clumping,\nthickening, or contrast enhancement.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild facet arthropathy and a minimal disc bulge. No spinal canal\nnarrowing and no significant neural foraminal narrowing.\n\nL4-L5: Mild disc bulge and moderate to severe bilateral facet arthropathy\nwith fluid in the facet joints, as well as thickening of the ligamentum\nflavum. Bilateral traversing L5 nerve roots are abutted in the subarticular\nzones without evidence for frank compression. The thecal sac is minimally\nnarrowed without crowding of the intrathecal nerve roots. There is mild\nbilateral neural foraminal narrowing. Bilateral exiting L4 nerve roots may be\ncontacted by facet osteophytes but do not appear compressed.\n\nL5-S1: Mild retrolisthesis, disc bulge with endplate osteophytes which are\nlarger on the left than right, thickening of the ligamentum flavum, and\nmoderate to severe facet arthropathy with fluid in the right facet joint. The\ntraversing left S1 nerve root appears compressed in the subarticular zone, and\nthe traversing right S1 nerve root is contacted and may be impinged in the\nsubarticular zone. The thecal sac is mildly narrowed but the intrathecal\nnerve roots do not appear crowded. There is moderate bilateral neural\nforaminal narrowing with abutment of bilateral exiting L5 nerve roots. The\nexiting left L5 nerve root may be impinged by a facet osteophyte.\n\nOTHER:\n\nIn the upper pole of the left thyroid lobe, there is a 0.8 x 0.5 x 0.6 cm T2\nhyperintense, T1 isointense, and contrast enhancing nodule, images 3:6, 9:15,\n13:5.", "output": "1. T2 hyperintense and partially contrast enhancing lesion in the dorsal cord\nspanning from C1-C2 through C3-C4 levels, with minimal cord expansion. This\nappearance is compatible with demyelinating disease, given the patient's\nhistory. Diagnostic considerations for this imaging appearance also include\ninflammatory/infectious causes; neoplasm less likely.\n2. Questionable additional small T2 hyperintense nonenhancing lesion in the\nleft lateral aspect of the cord at C5-C6 level, versus volume averaging\nartifact. If a true lesion is present, this would suggest demyelination or\ninflammation/infection.\n3. Allowing for the large field of view on sagittal and axial T2 weighted\nimages, no lesions are seen in the thoracic spinal cord.\n4. The nerve roots within the lumbar thecal sac appear unremarkable without\nthickening a contrast enhancement.\n5. Multilevel cervical degenerative disease, with up to moderate spinal canal\nstenosis at C6-7 with mild ventral cord remodeling, but no associated cord\nsignal abnormality, and up to moderate neural foraminal narrowing at several\nlevels.\n6. At T8-T9, a central/right paracentral disc extrusion mildly remodels the\nventral spinal cord, without evidence for associated cord signal abnormality\nallowing for the large field of view.\n7. Lower lumbar degenerative disease with mass effect on traversing and\nexiting nerve roots at L4-L5 and L5-S1, as detailed above.\n\nRECOMMENDATION(S): Recommend follow up cervical spine MRI with and without\ncontrast to ascertain the expected resolution of contrast enhancement. \nSmaller field of view on a dedicated cervical spine MRI would also be helpful\nfor better detection of any additional spinal cord lesions." }, { "input": "There is reversal of cervical lordosis with 3 mm anterolisthesis of C3 on C4,\n3 mm anterolisthesis of C4 on C5, 2 mm anterolisthesis of C7 on T1.\n\nThe vertebral body height is maintained. The cervical spinal cord appears\nunremarkable. No focal abnormal marrow signal is seen. The visualized\nposterior fossa structures and craniocervical junction appears unremarkable. \nThere are ___ type 1 changes at T1-T2. The remaining visualized bone marrow\nsignal appears unremarkable. The prevertebral soft tissues are unremarkable. \nNo focal mass is seen within the limits of this unenhanced study.\n\nAt C2-C3, there is posterior disc osteophyte complex with moderate left facet\narthropathy causing moderate left neural foraminal narrowing. The spinal\ncanal and right neural foramina are patent.\n\nAt C3-C4, there is pseudodisc bulge secondary to the anterolisthesis with\nmoderate to severe bilateral facet arthropathy causing mild bilateral neural\nforaminal narrowing. The spinal canal is patent.\n\nAt C4-C5 there is pseudo-disc bulge secondary to the anterolisthesis with\nmoderate bilateral facet arthropathy. The neural foramina and spinal canal\nare patent.\n\nAt C5-C6, there is diffuse posterior disc osteophyte complex with\nmoderate-to-severe bilateral facet arthropathy and moderate uncovertebral\narthropathy causing moderate bilateral neural foraminal narrowing and\nindentation of the ventral thecal sac contacting the ventral aspect of the\nspinal cord.\n\nAt C6-C7, there is posterior disc osteophyte complex with moderate to severe\nleft and mild right uncovertebral arthropathy causing mild right and moderate\nto severe left neural foramen narrowing. The spinal canal is patent with\nindentation of ventral thecal sac.\n\nAt C7-T1 there is loss of disc height and signal with posterior disc\nosteophyte complex, moderate bilateral uncovertebral arthropathy and bilateral\nfacet arthropathy causing mild bilateral neural foramen narrowing. There is\nindentation of ventral thecal sac without contacting the spinal cord.", "output": "1. Multilevel degenerative disease of the cervical spine, most severe at C5-C6\nand C6-C7, with moderate to severe neural foramen narrowing as described\nabove." }, { "input": "There are diffuse, multifocal, essentially innumerable T1 hypointense, T2/STIR\nhyperintense, heterogeneously enhancing vertebral lesions involving all\nthoracic vertebral bodies and posterior elements, compatible with either\ndiffuse metastatic disease or multifocal myelomatous lesions.\n\nThere is 1-2 mm of T2-3 anterolisthesis, likely degenerative. Mild height\nloss of the T12 vertebral body due to a compression fracture through the\nsuperior endplate, involving the anterior, middle, and posterior thirds of the\nvertebral body. There is no bony retropulsion into the spinal canal. There is\nmild associated STIR hyperintense, T1 hypointense signal surrounding the\nfracture, consistent with edema and acute/subacute compression fracture. \nThere is mild enhancement at the margins of the fracture. There is loss of the\nnormal fat-related marrow signal on sagittal FAT: IDEAL images (500:7).\n\nRemaining vertebral body heights are maintained.\n\nThe thoracic spinal cord is normal in caliber and signal intensity. The\nproximal cauda equina nerve roots appear unremarkable.\n\nSignal and height loss of thoracic spine intervertebral discs is consistent\nwith degenerative change. There are few multilevel disc bulges, mild, for\nexample at T1-2 and T2-3, not causing spinal canal narrowing. There is mild\ndiffuse T11-12 disc bulge, also not causing spinal canal narrowing. There is\nno neural foraminal narrowing in the thoracic spine.\n\nThere is no epidural collection. Prominent mid and distal thoracic ventral\nperimedullary vein is noted. No convincing evidence of leptomeningeal\nenhancement. No epidural tumor.\n\nSimilar T1 hypointense lesions are seen within the sternum on scout images,\npossibly additional metastatic or myelomatous lesions (for example 3:7, 4),\nnot fully evaluated.\n\nBulky multi station mediastinal lymphadenopathy is partially visualized,\nbetter evaluated on recent dedicated chest imaging. Multiple lung nodules and\npleuroparenchymal abnormalities are additionally seen, also better evaluated\non recent CT chest studies. T2 hyperintensities in the right renal cortex are\nnoted, without suspicious features, possibly simple cysts; there is 1\nindeterminate 10 mm medial lesion which is hyperintense on post-contrast\nimages (11:28).\n\n Prevertebral and paraspinal soft tissues are otherwise unremarkable.", "output": "1. Innumerable bone metastases.\n2. Acute/subacute compression fracture superior T12 endplate. No\nretropulsion.\n3. Degenerative changes thoracic spine.\n4. Indeterminate 10 mm lesion right kidney, refer to CT.\n5. Mediastinal adenopathy, lung opacities, refer to chest CT from yesterday." }, { "input": "12 rib-bearing vertebrae are again identified. Innumerable metastatic lesions\nare again seen throughout the visualized bone marrow.\n\nThe recent T12 superior endplate fracture is again noted with unchanged mild\nloss of height and no retropulsion. Marrow edema is again seen parallel to\nthe T12 superior endplate.\n\nThere is new linear marrow edema through the right anterior aspect of T11\nvertebral body, both inferiorly and superiorly, without loss of height or\nretropulsion (series 5, images ___.\n\nNo evidence for an epidural mass. Mildly hyperintense punctate focus in the\nright posterior thecal sac on axial postcontrast T1 weighted image 11:10,\nwithout a clear correlate on sagittal postcontrast T1 weighted or axial T2\nweighted images, most likely represents an artifact, less likely a\nleptomeningeal metastasis. No evidence for spinal cord signal abnormalities\nallowing for motion artifacts and the large field of view. The conus\nmedullaris terminates at L1.\n\nMild anterolisthesis of T2 on T3 and mild retrolisthesis of T11 on T12 are\nagain noted. Disc bulges and disc protrusions mildly indent the ventral\nthecal sac at multiple levels, most prominent at T11-T12, but without\nsignificant spinal canal narrowing. Left facet osteophytes mildly indent the\nleft dorsal thecal sac at T10-T11 without significant spinal canal narrowing. \nThere is mild bilateral T11-T12 neural foraminal narrowing.\n\nMediastinal and hilar lymphadenopathy, multifocal pulmonary abnormalities,\ninnumerable liver lesions, retrocrural lymph nodes, and lesions in the\nvisualized upper pole of the right kidney are again noted, better assessed on\nprior chest and abdominal CTs.", "output": "1. Innumerable osseous metastases are again demonstrated.\n2. Unchanged appearance of the recent T12 superior endplate fracture with mild\nloss of height and no retropulsion.\n3. Apparent new fracture lines with marrow edema through the anterior right\nT11 vertebral body without loss of height or retropulsion.\n4. No evidence for epidural mass.\n5. Mildly hyperintense punctate focus in the right posterior thecal sac on\naxial postcontrast T1 weighted images, without a clear correlate on sagittal\npostcontrast T1 weighted or axial T2 weighted images, most likely represents\nan artifact, less likely a leptomeningeal metastasis.\n6. Mediastinal and hilar lymphadenopathy, multifocal pulmonary abnormalities,\ninnumerable liver lesions, retrocrural lymph nodes, and lesions in the\nvisualized upper pole of the right kidney are better assessed on prior chest\nand abdominal CTs.\n\nNOTIFICATION: The apparent new T11 fracture was discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 10:29\nam, 5 minutes after discovery of the findings." }, { "input": "Innumerable metastases in the lumbar spine, sacrum, iliac bones. Small area\nof ventral epidural metastatic extension at L4, L5 vertebral bodies,\ncontributing to mild central canal narrowing at mid vertebral body levels.. \nNo pathologic compression fractures.\n\nMild acute/subacute compression fracture superior endplate of T12, and more\nsubtle at inferior endplate of T11, pathologic. Minimal paravertebral edema. \nNo epidural hematoma. No retropulsion.\n\nMultilevel degenerative changes. Minimal retrolisthesis L3-L4, minimal grade\n1 anterolisthesis L4-5, minimal retrolisthesis L5-S1, degenerative in\netiology. Normal visualized cord. Multilevel endplate hypertrophic change,\ndiffuse disc bulge, facet arthritis. Advanced paraspinal muscle atrophy\nposteriorly.\n\nAt L1-L 2, patent central canal, patent foramina.\n\nAt L2-L3, mild central canal narrowing. Mild bilateral foraminal narrowing.\n\nAt L3-L4, moderate central canal narrowing, preserved CSF. Mild-to-moderate\nbilateral foraminal narrowing.\n\nAt L4-5, moderate central canal narrowing, preserved CSF. Mild mass effect on\ntraversing both L4 nerves. Mild right foraminal narrowing. Patent left\nforamen.\n\nAt L5-S1, mild central canal narrowing. Mild-to-moderate right, moderate left\nforaminal narrowing.\n\nOther:\nFew benign simple renal cysts bilaterally, no further follow-up is indicated. \nHowever, at the interpolar region of the right kidney is an 8 mm hemorrhagic\ncyst, ultrasound follow-up if indicated recommended.. Artifact versus mild\nedema left ileo psoas at the level of the mid pelvis, seen on the corner of\nthe film.", "output": "1. Mild acute/subacute pathologic compression fractures T11, T12..\n2. Extensive skeletal metastases lumbar spine, sacrum, pelvis.\n3. Small volume ventral epidural tumor at L4, L5, mild central canal\nnarrowing.\n4. Advanced degenerative changes.\n5. Moderate central canal narrowing L3-L4, L4-5, from degenerative changes.\n6. Multilevel mild-to-moderate foraminal narrowing.\n7. Indeterminate 0.8 cm hemorrhagic cyst right kidney, ultrasound recommended\nif indicated.\n8. Artifact versus edema left iliopsoas midpelvis, seen at the corner of film.\n\nRECOMMENDATION(S):\n1. Real ultrasound there is recommended, if indicated." }, { "input": "There are numerable metastatic lesions throughout the visualized bone marrow,\nsimilar to the findings on the ___ thoracic spine MRI and ___ lumbar spine MRI. There is mild diffuse loss of vertebral body height at\nC5 and C6, a common age-related finding. Allowing for motion artifact on STIR\nimages and innumerable metastatic signal abnormalities, there is no clear\nevidence for a recent fracture. No evidence for an epidural mass allowing for\nabsence of intravenous contrast. No evidence for spinal cord signal\nabnormalities allowing for motion artifact.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\nbetter assessed on the concurrent dedicated brain MRI.\n\nC2-C3: Small central disc protrusion approaches but does not deform the\nventral spinal cord. There is no significant spinal canal narrowing, with\nplentiful CSF lateral and dorsal to the cord. Small right uncovertebral and\nfacet osteophytes with minimal right neural foraminal narrowing. Mild left\nfacet arthropathy without significant neural foraminal narrowing.\n\nC3-C4: Mild anterolisthesis. Small central disc protrusion approaches but\ndoes not deform the ventral spinal cord. Plentiful CSF lateral and dorsal to\nthe cord. Minimal spinal canal narrowing. Severe right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Minimal anterolisthesis. Broad-based shallow endplate osteophytes\nalong the right ventral spinal cord. There is plentiful CSF lateral and\ndorsal to the cord without significant spinal canal stenosis. Mild left\nneural foraminal narrowing by uncovertebral and facet osteophytes. No\nsignificant right neural foraminal narrowing.\n\nC5-C6: Broad-based right paracentral disc protrusion covered by endplate\nosteophytes and infolding of the ligamentum flavum. The right ventral spinal\ncord does not appear contacted, but is mildly remodeled. Plentiful CSF\nlateral and dorsal to the cord with only minimal spinal canal narrowing. \nModerate right and mild left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Mild retrolisthesis. Broad-based central/right paracentral disc\nprotrusion with endplate osteophytes. Minimal narrowing of the spinal canal\nwithout spinal cord contact. Severe right and moderate left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC7-T1: No spinal canal narrowing. Mild left neural foraminal narrowing by\nfacet osteophytes.\n\nT1-T2: Small central disc protrusion without spinal canal narrowing. Mild\nbilateral neural foraminal narrowing by facet osteophytes.\n\nT2-T3: Sagittal images demonstrate no spinal canal narrowing and mild\nbilateral neural foraminal narrowing by facet osteophytes. No axial images\nthrough this level.\n\nLeft vertebral artery flow void is absent, congruent with the recent CTA\nfindings. There is a possible 10 mm left lower pole thyroid nodule on image\n4:25. ACR guidelines do not recommend sonographic evaluation of incidentally\ndiscovered thyroid nodules smaller than 15 mm in this age group.", "output": "1. Diffuse osseous metastatic disease, similar to the previously seen diffuse\nosseous metastatic disease in the thoracic and lumbar spine.\n2. Allowing for the diffuse metastatic signal abnormalities and motion\nartifact, there is no evidence for recent cervical spine fracture. Mild\ndiffuse C5 and C6 vertebral body loss of height is a common age-related\nfinding, likely chronic.\n3. Multilevel cervical degenerative disease. Mild spinal canal stenosis. The\nventral spinal cord is mildly remodeled on the right at C4-C5 and C5-C6. No\nevidence for spinal cord signal abnormalities.\n4. Advanced multilevel neural foraminal narrowing, as detailed above.\n5. Absence of the left vertebral artery flow void, congruent with the\nocclusion seen on the recent ___ CTA." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \nLeft L5 pars defect is better characterized on the recent CT examination. \nThere is a large Schmorl's node at the inferior endplate of L1. There is\nminimal type ___ ___ endplate degenerative change at L3-L4 and L5-S1. There is\nno other focal bone marrow signal abnormality.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is up to moderate intervertebral disc height\nloss at L1-L2 and L5-S1.\n\nThe terminal spinal cord is preserved in signal and caliber. The conus\nmedullaris terminates at the T12-L1 level.\n\nSagittal view of T12-L1 demonstrates no significant spinal canal or neural\nforaminal narrowing.\n\nAt L1-L2, disc bulge and ligamentum flavum thickening is present without\nsignificant spinal canal narrowing. Disc bulge contacts the traversing nerve\nroots without displacement. The neural foramina are patent.\n\nAt L2-L3, there is mild disc bulge contacting but not displacing the\ntraversing nerve roots without significant spinal canal or neural foraminal\nnarrowing.\n\nAt L3-L4, disc bulge contacts the traversing nerve roots without displacement\nor significant spinal canal narrowing. Endplate osteophytes produce mild\nbilateral neural foraminal narrowing.\n\nAt L4-L5, disc bulge contacts the traversing bilateral L5 nerve roots, with\npossible compression against the facet (05:26). There is no significant\nspinal canal narrowing. Endplate osteophytes and foraminal component of disc\nbulge produces mild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is disc bulge with superimposed central protrusion without\nsignificant spinal canal narrowing. Foraminal component of disc bulge on the\nright along with endplate osteophytes produces mild right greater than left\nneural foraminal narrowing.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Multilevel lumbar degenerative disc disease, as described, most notable for\npossible compression of the traversing bilateral L5 nerve roots against the\nfacets. No significant spinal canal narrowing and only up to mild neural\nforaminal narrowing.\n2. Left L5 pars defect is better characterized on the recent prior CT\nexamination." }, { "input": "There is grade 1 anterolisthesis of L4 on L5 as well as L5 on S1, new compared\nto the prior examination, without associated pars defects. Vertebral body\nheights are preserved. A Schmorl's node is noted at the L5 inferior endplate.\nAgain, there is diffuse bone marrow heterogeneity without focal lesion. The\nterminal spinal cord appears normal in caliber and configuration. The conus\nmedullaris ends at the L1 level. There is no evidence of infection or\nneoplasm.\n\nFrom the levels of T10 through L2, there is no significant spinal canal or\nneural foraminal narrowing. Small perineural cysts are seen at the right\nT10-T11 and right L1-L2 levels.\n\nL2-L3: There is mild narrowing of the intervertebral disc space. Posterior\ndisc bulge and ligamentum flavum hypertrophy produces mild narrowing of the\nspinal canal. In conjunction with facet hypertrophy, there is minimal\nbilateral neural foraminal narrowing.\n\nL3-L4: There is mild to moderate narrowing of the intervertebral disc space. \nPosterior disc bulge in conjunction with ligamentum flavum hypertrophy\nproduces mild to moderate spinal canal narrowing. There is mild effacement of\nthe sub foraminal recesses, however the neural foramina are patent.\n\nL4-L5: There is mild narrowing of the intervertebral disc space. A posterior\ndisc bulge in conjunction with ligamentum flavum hypertrophy and\nanterolisthesis produces moderate spinal canal narrowing. There is effacement\nof the bilateral sub foraminal recesses. Disc bulge focally contacts the\nexiting nerve roots bilaterally with mild left-greater-than-right neural\nforaminal narrowing.\n\nL5-S1: There is mild narrowing of the intervertebral disc space. Posterior\ndisc bulge in conjunction with ligamentum flavum hypertrophy produces moderate\nspinal canal narrowing. In conjunction with facet hypertrophy, there is mild\nnarrowing of the left neural foramen . The right neural foramen is patent.\n\nT2 hyperintense 10 mm right interpolar renal lesion likely represents a cyst.", "output": "1. Multilevel degenerative changes as described above. Overall degenerative\nchanges appear fairly similar to the prior examination with the exception of a\nreduction of posterior disc bulge at L4-L5 with decreased encroachment upon\nthe exiting left L4 nerve root.\n2. Grade 1 anterolisthesis of L4 on L5 and L5 on S1 is new." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc height and signal are preserved. The\nvisualized posterior fossa is unremarkable. There is no abnormal signal or\nenhancement of the cord.\n\nMild degenerative changes do not result in significant spinal canal or neural\nforaminal narrowing. Prevertebral and paraspinal soft tissues are\nunremarkable.\n\nTHORACIC:\nThoracic alignment is anatomicvertebral body heights are preserved. There is\nno suspicious marrow signal. Disc height and signal are preserved. There is\nno abnormal signal were enhancement of the cord. There is no significant\nspinal canal or neural foraminal narrowing.\n\nLUMBAR:\nLumbar alignment is anatomic.Vertebral body heights are preserved. There is\nno suspicious marrow signal.Disc height and signal are preserved. The conus\nmedullaris terminates at the L1 vertebral level, within expected limits. \nThere is no signal abnormality or enhancement of the visualized cord, conus\nmedullaris or cauda equina. There is no evidence of spinal canal or neural\nforaminal narrowing. Mild degenerative changes of the L5-S1 facets with small\nfacet joint effusion is noted.\n\nOTHER: Very small bilateral pleural effusions are identified. The remainder\nthe prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. No spinal canal or neural foraminal narrowing.\n2. No cord signal abnormality or enhancement." }, { "input": "There is heterogeneity of marrow signal on T1 and inversion recovery images\ninvolving the lumbar vertebral bodies and sacrum consistent with bony\nmetastatic disease. There is no evidence of pathologic fracture seen. There\nis no evidence of epidural mass or leptomeningeal enhancement in the lumbar\nregion. No evidence compression. There is no evidence of spinal stenosis or\ndisc herniation. The distal spinal cord shows normal signal intensities. \nThere is no compression of the distal spinal are identified.", "output": "Diffuse bony metastatic disease involving the lumbar vertebral bodies and\nsacrum. No evidence of pathologic fracture or epidural mass." }, { "input": "Previously seen foci of signal abnormalities at posterior right aspect of the\nspinal cord at C2-3 and C6-7 levels are again identified and have somewhat\nevolved from the previous study. No abnormal enhancement is seen within these\nfoci. There are no new focal signal abnormalities seen within cervical and\nupper thoracic spinal cord up to T2 level. There is no abnormal enhancement\nseen.\n\nAt the craniocervical junction and C2-3 and C3-4 mild degenerative change\nseen.\n\nAt C4-5, C5-6 and C6-7 levels diffuse disc bulge and posterior disc\nosteophytes are seen which indent the thecal sac and contacts the spinal cord\nwithout significant deformity. This finding appears slightly exaggerated due\nto positioning on the current study with patient slightly in flexion position.\nNo foraminal narrowing is seen. From C7-T1 to T3-4 no abnormalities are seen.", "output": "1. Foci of signal abnormality within the cervical spinal cord at C2-3 and\nC7-T1 levels on the right side have evolved. No enhancement is seen in this\nfoci. No new foci of signal abnormalities are seen.\n2. Posterior disc osteophytes and degenerative changes from C4-5 to C6-7\nunchanged from the prior study." }, { "input": "There is no evidence of bony or ligamentous injury.\n\nFrom T10-11 to L3-4 levels minimal disc degenerative change seen. There is no\nevidence of disc bulge disc herniation, spinal stenosis or foraminal\nnarrowing.\n\nAt L4-5 level, severe facet degenerative changes seen. There is minimal\nanterolisthesis of L4 over L5. There is a small synovial cyst on the right\nside posteriorly within the soft tissues. There is no intraspinal synovial\ncyst seen. There is no narrowing of the spinal canal. There is minimal\nnarrowing of the foramina without compression of exiting nerve roots.\n\nAt L5-S1 level, mild disc bulging and degenerative disc disease seen. There\nis no spinal stenosis. There is no compression of exiting nerve roots.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Multilevel mild disc degenerative changes with severe facet degenerative\nchanges at L4-5 level. No evidence of spinal stenosis or high-grade foraminal\nnarrowing." }, { "input": "Examination is limited secondary to motion artifact.\n\nThere is edema within the right C7 facet as well as malalignment of the\ninferior and superior articular process of C6 and C7, compatible with\npreviously described fracture/ subluxation on prior CT. There is slight\nanterior subluxation of C6 on C7 which is unchanged when compared to prior\nexam. The remaining vertebral body heights and alignment within the cervical\nspine appear normal.\n\nThe cervical spine is normal in signal and morphology. There is no evidence of\ncontusion, edema, or epidural hematoma.\n\nAt the C2-C3 level, there is a small posterior disc protrusion. The spinal\ncanal and neural foramina appear normal.\n\nAt the C3-C4 level, there is a posterior disc protrusion which causes mild\nspinal canal narrowing. Uncovertebral and facet arthropathy cause some degree\nof neural foraminal narrowing although evaluation is limited secondary to\nmotion artifact.\n\nAt the C4-C5 level, disc protrusion, intervertebral osteophytes, and\nuncovertebral and facet hypertrophy cause moderate right neural foraminal\nnarrowing.\n\nAt the C5-C6 level, posterior disc bulge, intervertebral osteophytes, and\nuncovertebral and facet hypertrophy cause moderate bilateral neural foraminal\nnarrowing.\n\nAt the C6-C7 level, there is severe right neural foraminal narrowing secondary\nto the displaced fracture fragment of the right superior C7 facet.\n\nAt the C7-T1 level, the spinal canal and neural foramina appear normal.", "output": "1. Edema within the right C7 facet as well as subluxation of the inferior and\nsuperior articular process of C6 and C7, compatible with previously described\nfracture/ subluxation on prior CT. No obvious disruption of ligamentum flavum\nbut mild increase signal is seen at C6-7 level.\n2. Severe right neural foraminal narrowing secondary to the displaced fracture\nfragment of the right superior C7 facet.\n3. No evidence of spinal cord compression, contusion, edema, or epidural\nhematoma." }, { "input": "Lumbar vertebral bodies are maintained in height and alignment. There is a T1\nand T2 hyperintense lesion within the T12 vertebral body which partially\nsuppresses on fat-suppressed sequences and measures 1.8 x 1.5 cm, is\ncompatible with a hemangioma. No focal suspicious marrow lesion identified. \nIntervertebral disc desiccation with associated height loss seen at L4-5 and\nL5-S1. Conus terminates at the L1 vertebral body level.\n\nAt T12-L1 through L3-4, there is no significant canal or foraminal narrowing.\n\nAt L4-5, there is a disc bulge eccentric to the left with a left central\nannular fissure. There is secondary mild canal narrowing and subarticular\nrecess narrowing with contact of the traversing L5 nerve roots. There is no\nsignificant foraminal narrowing.\n\nAt L5-S1, there is a left central/subarticular disc protrusion which contacts\nand posteriorly displaces the traversing left S1 nerve root which may be\nimpinged in the subarticular recess. Overall there is mild canal narrowing. \nThere is also mild right subarticular recess narrowing without contact of the\ntraversing nerve root. No significant foraminal narrowing.\n\nIncluded retroperitoneal and paraspinal soft tissues are unremarkable.", "output": "At L5-S1 there is a left central/subarticular disc protrusion which\nposteriorly displaces and potentially impinges the traversing left S1 nerve\nroot in the subarticular recess.\nDisc bulge at L4-5 with crowding of the subarticular recesses and contact of\nthe bilateral traversing L5 nerve roots." }, { "input": "Alignment is normal. Vertebral body heights are normal. Vertebral body and\nintervertebral disk signal intensity appear normal. The visualized portion of\nthe spinal cord appears normal.\n\nThere is no evidence of high degree spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.\n\nC2-3: Minimal central discs bulge.\n\nC3-4: Mild central disc bulge. Mild central canal stenosis.\n\nC4-5: Mild central disc bulge to the left. Mild to moderate central canal\nstenosis.\n\nC5-6: Mild central disc bulge. Effacement of the ventral thecal sac. Mild to\nmoderate central canal stenosis.\n\nC6-7: Minimal disc bulge.\n\nC7-T1: Unremarkable.\n\nThe patient is intubated with ET tube partially visualized.", "output": "Mild multilevel degenerative changes of the cervical spine." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.Please note that this method is inappropriate for\nsurgical planning and that prior to any intervention appropriate levels must\nbe established.\n\nThe patient is status post left posterior L4 L5 and L5-S1 spinal fusion with\nleft inter pedicular screws at L4-L5 and L5-S1 and right hemi laminotomy at\nL4-L5. The bone marrow is normal in signal without enhancement. The conus\nmedullaris terminates at T12-L1. The spinal cord is normal in signal. There\nis no enhancement in the spinal cord or nerve roots of the cauda equina. The\nL4-L5 vertebral bodies are fused, unchanged from the prior examination. The\nheight of the vertebral bodies are maintained. The intervertebral l disc\nspace of L5-S1 is desiccated. No epidural fluid collections or soft tissue\nmasses are identified. No epidural fluid collections are identified.\n\nAt T11-T12, there is disc bulge without spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt T12-L1, there is disc bulge without spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L1-L2, there is disc bulge without spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L2-L3, there is disc bulge without spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L3-L4, disc bulge and bilateral facet arthropathy indents and deforms the\nposterior thecal sac, causing mild spinal canal stenosis, slightly progressed\nfrom the prior examination. There is no neural foraminal stenosis.\n\nAt L4-5, there is no spinal canal or neural foraminal stenosis.\n\nAt L5-S1, disc bulge with superimposed central disc protrusion, annular tear,\nand bilateral facet arthropathy cause mild neural foraminal stenosis,\nunchanged from the prior examination. There is no spinal canal stenosis.", "output": "1. No evidence of discitis, osteomyelitis, or epidural fluid collection.\n2. Postsurgical and multilevel degenerative changes of the lumbar spine,\nslightly progressed at L3-L4, where there is mild spinal canal stenosis." }, { "input": "Mild levoconvex curvature of the lumbar spine with apex at L3-L4 is unchanged\nfrom prior examination. Otherwise, lumbar alignment is anatomic. Vertebral\nbody heights are preserved. Mixed ___ 1 and 2 endplate changes at L3-L4\nthrough L5-S1 is similar in appearance to prior examination. There is no\nfocal suspicious marrow lesion. Degenerative loss of disc height and signal\nis moderate spanning L1-L2 through L5-S1. The conus medullaris terminates at\nthe L1 level, within expected limits. There is no signal abnormality or\nenhancement of the terminal cord, conus medullaris or cauda equina.\n\nNonenhancing CSF intensity cystic lesion of the sacrum measuring approximately\n6.4 by 5.4 x 4.4 cm (SI, AP, TRV) is unchanged from examination of ___. As before, the lesion extends through the right S1-S2 neural foramina\nwith remodeling and expansion of the sacrum.\n\nT10-T11 and T11-T12: On sagittal sequences, there are small disc bulges which\nresults in mild spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nT12-L1: Unremarkable.\n\nL1-L2: A disc bulge results in mild spinal canal narrowing. In combination\nwith facet arthropathy, there is mild left and no significant right neural\nforaminal narrowing.\n\nL2-L3: A disc bulge with prominent epidural fat and thickening of the\nligamentum flavum results in mild spinal canal narrowing. In combination with\nfacet arthropathy there is mild bilateral neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In combination with facet arthropathy, there is\nmoderate right and no significant left neural foraminal narrowing.\n\nL4-L5: A disc bulge with intervertebral osteophytes and prominent bilateral\nfacet arthropathy results in moderate spinal canal narrowing and effacement of\nthe subarticular zones. There is moderate bilateral foraminal narrowing.\n\nL5-S1: A disc bulge with prominent epidural fat results in severe spinal\ncanal narrowing in combination with facet arthropathy, there is moderate left\nand no significant right neural foraminal narrowing.\n\nThe above findings are unchanged from prior examination.\n\nThe visualized prevertebral and paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. Unchanged appearance of sacral meningocele since ___. .\n2. Multilevel degenerative changes, most prominent at L5-S1 where there is\nsevere spinal canal narrowing and at L4-L5 where there is moderate spinal\ncanal narrowing with effacement of the bilateral subarticular zones and\nmoderate bilateral neural foraminal narrowing." }, { "input": "The patient has undergone interval discectomy and anterior fusion of L4-5,\nwith expected postoperative changes including a small amount of T2\nhyperintense fluid anterior to the disc space at L4-5. Artifact from metallic\nfusion hardware slightly limits assessment in this region. Unchanged\nnonenhancing CSF intensity cystic lesion in the sacrum is again seen extending\nthrough the right S1-S2 neural foramina, with associated remodeling expansion\nof the sacrum, compatible with a sacral meningocele. Again seen are mixed\n___ 1 and 2 endplate changes spanning multiple levels throughout the lumbar\nspine, including L3-4 and L5-S1. The conus medullaris terminates at the L1\nlevel. No signal abnormality or enhancement with internal cord, conus\nmedullaris, or cauda equina.\nThere is no concerning focal bone marrow signal abnormality. Vertebral body\nheights are maintained.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1: No significant degenerative change. No spinal canal or neural\nforaminal narrowing.\n\nL1- 2: Disc bulge results in mild spinal canal narrowing. Bilateral facet\narthropathy results in mild bilateral neural foraminal narrowing. Overall,\nthis appearance is unchanged from prior.\n\nL2-3: Disc bulge with thickening of the ligamentum flavum and prominent\nepidural fat results in mild spinal canal narrowing. Bilateral facet\narthropathy results in mild bilateral neural foraminal narrowing. Overall,\nthis appearance is unchanged from prior.\n\nL3-4: Disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. Bilateral facet arthropathy results in moderate right\nneural foraminal narrowing. Overall, this appearance is unchanged from prior.\n\nL4-5: The status post discectomy. Intervertebral osteophytes and facet\narthropathy are again seen, resulting and narrowing of the subarticular zones\nand moderate bilateral neural foraminal narrowing.\n\nL5-S1: Disc bulge and prominent epidural fat results in severe spinal canal\nnarrowing. This, in combination with bilateral facet arthropathy, results in\nsevere left subarticular recess and foraminal fnarrowing. Overall, this\nappearance is unchanged from prior.", "output": "1. Status post anterior fusion and discectomy at L4-5, with expected\npostoperative changes.\n2. Multilevel degenerative change throughout the lumbar spine, most severe at\nL5-S1, described above. Overall, degenerative changes in lumbar spine appear\nsimilar to prior.\n3. Unchanged appearance of sacral meningocele." }, { "input": "An intramedullary spinal cord mass at the T10 vertebral body level\ndemonstrates scattered foci of intrinsic T1-hyperintensity that is hypointense\non T2-weighted images, consistent with acute blood products (e.g., series 5,\nimage 9). There is no definite enhancement identified, but this is difficult\nto assess on the sagittal only post-contrast images. T2-hyperintense signal\nextending superiorly in the cord to the level of the T8 vertebral body is\nconsistent with associated edema. Similar signal abnormality is seen just\ninferiorly in the spinal cord to the intramedullary tumor. The tumor is in\nthe spinal cord, thus, there is no cord compression. The spinal cord ends at\nthe superior aspect of the L1 vertebral level.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. No evidence of spinal canal or neural foraminal narrowing. No\nevidence of infection.", "output": "1. Intramedullary tumor with blood products but no definite enhancement. \nEpendymoma is favored, but cavernous malformation is also possible. Recommend\nreturn for repeat MR in this region with axial pre T1 and post-Gadolinium T1\nsequences and axial GRE sequence to further distinguish these two etiologies. \nAxial sequences should cover T9-T12 area.\n\n2. No cord compression.\n\nRECOMMENDATION(S): Return for repeat MRI spanning T9 through T12 with T1\naxial and sagittal pre and post-Gadolinium and GRE axial images to further\nevaluate the lesion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:56 ___, 1 minutes after\ndiscovery of the findings." }, { "input": "Previously seen signal abnormality due to cavernous malformation in the lower\nspinal cord demonstrates evolution of blood products. There is decrease in T1\nhyperintense signal in the region. There is increased in low signal areas\nindicating of hemosiderin deposition including hemosiderin along the central\ncanal above the level of the lesion. The previously identified\nhyperintensities due to edema have resolved. No signs of new hemorrhage seen.\nThere are no abnormal vascular structures. There is no significant disc bulge\nherniation or spinal stenosis. There is no extrinsic spinal cord compression.", "output": "Evolution of blood products at the site of cavernous malformation at T10 level\nwithin the spinal cord. There is increase in hemosiderin deposition\nindicating chronicity of blood products. Previously seen spinal cord edema\nhas resolved." }, { "input": "Thoracic Spine:\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear unchanged. At the T10 level, again seen is a heterogeneous, primarily\nT1 hyperintense, T2 heterogeneous with prominent hypointense components\nlesion, measuring up to 2.1 cm in craniocaudal dimension. There is mild cord\nexpansion at this level. There is minimal to no contrast enhancement. An\narea of magnetic susceptibility is again seen, consistent with blood products.\nThese findings are most compatible with a cavernous malformation, though a\nhemorrhagic mass is not entirely excluded. In comparison with the most recent\nMRI examination, there is interval resolution of the spinal cord edema. No\nother similar lesions are identified.\n\nLumbar Spine:\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The conus medullaris appears normal in configuration, and\nunchanged since the prior study. There is no evidence of spinal canal or\nneural foraminal narrowing. The visualized paravertebral structures in the\nlumbar region are unremarkable.", "output": "Heterogeneous, hemorrhagic, nonenhancing lesion at the level of T10, not\nsignificantly changed since the prior examination. While these findings are\nmost compatible with a cavernous malformation, a hemorrhagic mass is not\nentirely excluded." }, { "input": "MRI thoracic spine:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand disc spaces are preserved. There is no suspicious marrow replacing lesion\nor abnormal enhancement.\n\nAt the T10 level, again seen is a focal lesion demonstrating primarily\nhyperintense T1, heterogeneous T2 signal abnormality with associated magnetic\nsusceptibility within the spinal cord with mild cord expansion, measuring\napproximately 2.1 cm in length, with minimal to no significant contrast\nenhancement. In comparison with the prior study, there is minimal increase in\ninternal T1 hyperintensity, suggesting possible interval hemorrhage.\n\nIn comparison to ___, there is new diffuse hyperintense T2 signal\nintensity within the spinal cord extending from T5 through T7 levels, which\nappears similar to prior study from ___.\n\nThere is no spinal canal stenosis or neural foraminal narrowing.\n\nMRA thoracic spine:\nThere is no evidence of abnormal arterial or venous supply to the lesion. \nThere is no evidence of arteriovenous malformation or fistula.", "output": "1. Stable size of a spinal cord lesion at T10 level, compatible with known\ncavernous malformation, with suggestion of slight interval hemorrhage, as\ndescribed above.\n2. Diffuse hyperintense T2 signal changes within the spinal cord from T5\nthrough T7 levels, suggestive of cord edema or syrinx. This is new from\n___, but similar to ___.\n3. No evidence of cord compression or spinal canal stenosis.\n4. Unremarkable MRA of the thoracic spine without arteriovenous malformation\nor fistula." }, { "input": "Thoracic spine: There are changes from T10-T11 laminectomy and resection of an\nintramedullary cavernoma at the T10 level. Within the resection bed, there is\na residual 13 x 4 mm area with peripheral T2 hypointensity, and internal T1\nand T2 hyperintense product, with minimal peripheral enhancement, likely\nrepresenting postoperative blood products. Adjacent cord edema seen\npreviously extending from the T5 through T12 levels has essentially resolved. \nWithin the laminectomy defect, there is a 46 x 7 mm nonenhancing posterior\nepidural fluid collection (3:8), representing either postoperative seroma or\npseudomeningocele, though no frank dural defect is seen. This indents the\nposterior thecal sac without significant thecal sac narrowing.\n\nVertebral body heights and alignment are preserved. There is no focal bone\nmarrow signal abnormality. The intervertebral discs are preserved in signal\nand height.\n\nThe remainder of the spinal cord is preserved in signal and caliber. There is\notherwise no abnormal focus of post contrast enhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing at all\nthoracic levels.\n\nLumbar spine: Levels were established by counting down from the first rib. \nThere is transitional vertebral anatomy with sacralization of L5 with a\nrudimentary disc at the L5-S1 level.\n\nVertebral body heights and alignment are preserved. There is no focal bone\nmarrow signal abnormality.\n\nThere is loss of T2 signal and mild loss of height of the L4-L5 intervertebral\ndisc, a manifestation of degenerative disc disease.\n\nThe terminal spinal cord is preserved in signal and caliber. The conus\nmedullaris terminates at the T12-L1 levels. There is no epidural collection. \nThere is no abnormal focus of post contrast enhancement.\n\nAt L4-L5, there is mild disc bulge indenting the ventral thecal sac without\nsignificant spinal canal narrowing as well as a small central annular fissure.\nThere is no significant spinal canal or neural foraminal narrowing at all\nlumbar levels.\n\nOther: The visualized lungs are grossly clear. The visualized retroperitoneum\nis grossly unremarkable.", "output": "1. Postsurgical changes from T10-T11 laminectomy and resection of an\nintramedullary cavernoma at the T10 level.\n2. Residual 13 x 4 mm area of T1 and T2 hyperintensity with peripheral T2\nhypointensity and minimal peripheral enhancement within the resection bed,\nlikely representing a combination of postoperative blood product and\npostoperative change. Continued attention on follow-up imaging is advised in\norder to exclude residual cavernoma. The previously seen adjacent cord edema\nhas essentially resolved.\n3. 46 x 7 mm nonenhancing posterior epidural fluid collection within the\nlaminectomy defect likely representing postoperative seroma. \nPseudomeningocele cannot be excluded given location, though no frank dural\ndefect is seen.\n4. Mild disc bulge with central annular fissure at L4-L5 without significant\nspinal canal narrowing.\n5. No significant spinal canal or neural foraminal narrowing at all visualized\nlevels.\n6. Transitional vertebral anatomy with sacralization of L5." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.Please note that this method is inappropriate for\nsurgical planning.\n\nAlignment is normal. Vertebral body height is maintained. The marrow signal\nis unremarkable. The spinal cord appears normal in caliber and configuration. \nThe conus is unremarkable and terminates at L1-L2. No para vertebral or\nparaspinal masses seen. There are sub cm simple cysts in bilateral kidneys. \nThe retroperitoneal soft tissues are otherwise unremarkable.\n\nAt T12-L1, there is disc desiccation. The disc height is maintained. The\nneural foramina and spinal canal are patent.\n\nAt L1-L2, there is mild disc desiccation. The disc height is maintained. \nNeural foramina and spinal canal are patent.\n\nAt L2-L3, there is l mild disc desiccation and mild loss of disc height. The\nneural foramina and spinal canal are patent.\n\nAt L3-L4, there is disc desiccation with mild loss of disc height and diffuse\ndisc bulge. Also seen is mild ligamentum flavum thickening. Neural foramina\nand spinal canal are patent.\n\nAt L4-L5, there is mild disc desiccation with mild loss of disc height and\ndiffuse disc bulge, mild bilateral facet arthropathy and mild ligamentum\nflavum thickening. Neural foramina and spinal canal are patent.\n\nAt L5-S1, there is mild disc desiccation and loss of disc height with diffuse\ndisc bulge. Neural foramina and spinal canal are patent.", "output": "1. Mild degenerative disc disease of the lower lumbar spine. No neural\nforamina or spinal canal narrowing at any level." }, { "input": "Incomplete examination is nondiagnostic. Limited obtained images demonstrate\npostsurgical changes from L2/L3 laminectomy with a small lobular collection in\nthe posterior soft tissues measuring 4.1 x 2.0 cm with intermediate T2 signal\nwhich may represent a small postoperative hematoma. There is no obvious\nextradural collection. There is mild narrowing of the thecal sac with\ncrowding of the nerve roots from a combination of packing material as well as\na trace amount of fluid. Areas of signal void within the thecal sac\ncorrespond to subdural gas on the subsequent CT exam.", "output": "Nondiagnostic study with only limited images due to inability of patient to\ntolerate the examination. Postsurgical changes from lumbar laminectomy with\npossible small collection in the surgical bed. Repeat examination when\ntolerable or possibly under anesthesia is recommended." }, { "input": "Cervical spine: There is 5mm anterolisthesis of C3 on C4,, 3 mm of\nanterolisthesis of C7 on T1, and minimal anterolisthesis T2 on T3. There is\nfusion of the C4 through C6 vertebral bodies, potentially involving C3 is\nwell. There is near-complete loss of intervertebral disc space at C3-C4 and\nC7-T1. Intervertebral disc heights within the included thoracic spine are also\ndecreased in height. The bone marrow has a normal signal intensity besides\nminimal degenerative bone marrow signal changes seen at the endplates adjacent\nto the T2-T3 intervertebral disc. Vertebral body height is maintained.\n\nC2-C3: There is a broad-based disc protrusion and posterior ligamentum flavum\nthickening which results in mild narrowing of the spinal canal. There is\nbilateral facet joint arthropathy with mild bilateral neural foraminal\nnarrowing.\n\nC3-C4: A central posterior osteophyte effaces the ventral CSF and contacts\nthe cord resulting in mild narrowing without abnormal cord signal. There is\nbilateral uncovertebral and facet joint arthropathy resulting in mild right\nand moderate left neural foraminal narrowing.\n\nC4-C5: A large posterior osteophyte contacts the ventral aspect of the cord\nand results in mild narrowing of the spinal canal. There is no cord signal\nabnormality. There is no significant neural foraminal narrowing at this level.\n\nC5-C6: A large posterior osteophyte effaces the ventral CSF, contacts the\ncord which is chronically flattened. In combination with posterior ligamentum\nflavum thickening contributes to moderate to severe spinal canal stenosis and\nremodeling of the cord. There is no abnormal cord signal. Uncovertebral and\nfacet joint arthropathy results in mild left greater than right bilateral\nneural foraminal narrowing at this level.\n\nC6-C7: Posterior osteophytes efface the ventral CSF and contact the cord.\nThere is no abnormal cord signal. There is bilateral uncovertebral joint and\nleft facet joint arthropathy resulting in moderate right and severe left\nneural foraminal narrowing.\n\nC7-T1: There is anterolisthesis and posterior ligamentum flavum thickening\nwhich results in mild spinal canal narrowing. There is bilateral uncovertebral\nand facet joint arthropathy resulting in moderate left and mild right neural\nforaminal narrowing.\n\nSeveral small disc protrusions are visualized in included thoracic spine on\nsagittal images only which indent the ventral CSF without causing high-grade\nspinal canal or neural foraminal stenosis.\n\nChronic appearing right cerebellar infarct is noted as seen on prior head CT.\nThe cervical and included upper thoracic spinal cord, and posterior fossa\ndemonstrate normal signal intensity and morphology.\n\nSome fluid seen in the right mastoids.\n\nPresumed left glenohumeral joint effusion is partially visualized (7: 32).", "output": "1. Multilevel degenerative changes as described in detailed above. Spinal\ncanal stenosis which is moderate to severe is most pronounced at C5-C6. There\nis chronic remodeling of the cord without abnormal cord signal is detected.\n\n2. Multilevel left greater than right neural foraminal narrowing.\n\n3. Partially visualized T2 hyperintense structure in the region of the left\nshoulder, presumably a large glenohumeral joint effusion." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nType ___ ___ changes are noted at the L5 posterior superior endplate. The\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nL3-4 and L4-5 intervertebral disc signal and height loss is noted.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. Again is noted\nright sacral ala bone island (C6: 25 on current study and 3:74 on prior\nexam).\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is central disc protrusion with annular fissure resulting in\nmoderate to severe vertebral canal and no neural foraminal stenosis.\n\nAt L4-5 there is disc bulge with annular fissure which contacts the right L5\nnerve root within the right subarticular zone and results in mild vertebral\ncanal and no neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge withno vertebral canal or neural foraminal\nstenosis.", "output": "1. Multilevel degenerative changes as described, most pronounced L3-4, where\ncentral disc protrusion results in moderate to severe spinal canal stenosis.\n2. L4-5 disc bulge contacts right L5 nerve root within right subarticular zone\nresulting in mild vertebral canal stenosis." }, { "input": "At T11-12 abnormalities are seen. At T12-L1 there is a small central disc\nherniation seen which indents the thecal sac. There is mild spinal stenosis.\n\nAt L1-2 no abnormalities are seen. At L2-3 disc bulging and facet degenerative\nchanges are identified with anterior osteophytes without spinal stenosis.\n\nAt L3-4 and L4-5 no significant abnormalities are identified. There is no\nspinal stenosis seen or foraminal narrowing identified.\n\nAt L5 -S1 levels no abnormalities are seen.\n\nDistal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Mild multilevel degenerative changes. No spinal stenosis seen. Small central\ndisk herniation at T12-L1 level indenting the thecal sac and resulting in mild\nspinal stenosis." }, { "input": "There are 5 non rib-bearing lumbar type vertebral bodies. Lumbar spine\nalignment is normal. Vertebral body heights are preserved. There are areas\nof focal fat in several lumbar vertebral bodies. Height and signal loss of\nlumbar intervertebral discs is consistent with degenerative change, most\npronounced at L5-S1, more mild at L4-5 and L3-4. The distal spinal cord and\nconus medullaris is unremarkable and terminates at L2. The cauda equina nerve\nroots are within normal limits. There is no evidence of an epidural\ncollection. There are mild multilevel discogenic degenerative changes. \nSpecifically:\n\nA T12-L1, L1-L2, and L2-3, there is no spinal canal neural foraminal\nnarrowing.\n\nAt L3-4, there is a minimal posterior disc bulge and minimal ligamentum flavum\nthickening (04:26) which does not cause spinal canal or significant neural\nforaminal narrowing. Trace bilateral facet joint fluid is likely degenerative\nin nature.\n\nAt L4-5, there is a mild posterior disc bulge, as well as mild ligamentum\nflavum thickening and small facet osteophytes which do not cause significant\nspinal canal narrowing. Combination of disc bulge and facet osteophytes\ncauses minimal bilateral neural foraminal narrowing (for 06:16 and 6). Trace\nbilateral facet joint fluid is likely degenerative in nature.\n\nL5-S1, there may be a small annular fissure posteriorly (05:10). There is a\nmild posterior disc bulge in small facet osteophytes which do not cause\nsignificant spinal canal narrowing. Combination of disc bulge and osteophytes\ncause moderate bilateral neural foraminal narrowing at this level (6:6 and\n06:15). The disc bulge appears to contact the exiting bilateral L5 nerve\nroots (03:19).", "output": "1. Overall mild to moderate lower lumbar spine discogenic degenerative changes\nworst at L4-5 and L5-S1, causing bilateral neural foraminal narrowing at these\nlevels, worst (moderate) bilaterally at L5-S1, where there appears to be disc\nminimally contacting the exiting bilateral L5 nerve roots.\n2. No spinal canal stenosis. No spinal cord or cauda equina compression." }, { "input": "The patient is status post ACDF of C5-6 with anterior fusion plates and\nintervertebral disc spacer. These levels appear fused. The posterior fossa is\nunremarkable. The craniocervical junction and anterior atlantodental interval\nis unremarkable. The remainder of the disc spaces are preserved. Vertebral\nbody heights are maintained. There is no suspicious marrow signal. No\ndefinitive cord signal abnormality is identified.\n\nC2-3: No significant spinal canal or neural foraminal narrowing.\n\nC3-4: There is a disc protrusion as well as bilateral uncovertebral\narthropathy resulting in mild spinal canal narrowing and left greater than\nright moderate neural foraminal narrowing.\n\nC4-5: There is a prominent central disk protrusion and associated osteophytes\nas well as prominent bilateral uncovertebral and facet arthropathy. The disc\nosteophyte contacts and remodels the ventral aspect of the cord resulting in\nmoderate to severe spinal canal narrowing. There is also severe bilateral\nneural foraminal narrowing.\n\nC5-6: If posterior osteophyte is noted. With mild bilateral uncovertebral\narthropathy. There is mild spinal canal narrowing without significant neural\nforaminal narrowing.\n\nC6-7: There is a central disk protrusion with associated osteophytes and mild\nuncovertebral arthropathy. The disc osteophyte contacts and minimal remodels\nthe ventral aspect of the cord resulting in moderate spinal canal narrowing.\nThere is moderate bilateral neural foraminal narrowing.\n\nThe remainder of the visualized cervical and upper thoracic levels are\nunremarkable.\n\nNo prevertebral or paraspinal fluid sensitive hyperintense signal to suggest\nligamentous injury.", "output": "1. The patient is status post ACDF of C5-6. No evidence of acute subluxation.\n2. Multilevel multifactorial cervical spondylosis, most prominent at C4-5\nwhere there is moderate to severe spinal canal narrowing with flattening of\nthe cord and at C6-7 where there is mild spinal canal narrowing with\nremodeling of the ventral aspect of the cord. There is no underlying\ndefinitive cord signal change.\n3. Additional degenerative changes described above including severe bilateral\nneural foraminal narrowing at C4-5.\n4. No evidence of ligamentous injury." }, { "input": "3 mm retrolisthesis of T12 on L1, 2 mm retrolisthesis of L1 on L2 and L2 on L3\nand 4 mm anterolisthesis of L4 on L5 is identified. There is anterior wedge\nshape of T11 with less than 20% loss of vertebral body height without evidence\nof STIR hyperintense signal to suggest acute fracture. The remainder the\nvertebral body heights are preserved. The marrow signal is diffusely\nheterogeneous, compatible with degenerative changes without focal suspicious\nlesion. There is loss of disc height at T11-T12 and T12-L1. The remainder of\nthe disc heights are preserved. The conus medullaris terminates at the L1\nvertebral level, within expected limits. There is no signal abnormality of\nthe visualized cord, conus medullaris or cauda equina.\n\nT12-L1: Bilobed disc bulge and thickening of the ligamentum flavum results in\nmild spinal canal narrowing. In conjunction with facet arthropathy there is\nmoderate bilateral neural foraminal narrowing.\n\nL1-L2: A disc protrusion and thickening of the ligamentum flavum does not\nresult in significant spinal canal narrowing. Bilateral facet arthropathy\nresults in mild neural foraminal narrowing.\n\nL2-L3: A disc protrusion and thickening of the ligamentum flavum results in\nmild spinal canal narrowing. Facet arthropathy results in mild left neural\nforaminal narrowing and no significant right neural foraminal narrowing. \nThere is a small left joint effusion and a posteriorly projecting synovial\ncyst.\n\nL3-L4: A disc protrusion and thickening of the ligamentum flavum results in\nmild spinal canal narrowing. There is bilateral facet arthropathy without\nsignificant neural foraminal narrowing. There is a left joint effusion with a\nsmall posterior projecting synovial cyst.\n\nL4-L5: There is mild uncovering of the disc with superimposed disc bulge\nwhich crowds the right greater than left subarticular zone which appears to\nimpinge the right traversing nerve roots against facet arthropathy (series 9,\nimage 11). The disc contacts the traversing left nerve roots without\ndefinitive impingement. There is a moderate spinal canal narrowing along its\ntransverse axis secondary to facet arthropathy. Facet arthropathy results in\nmild bilateral neural foraminal narrowing worse on the left where a facet\nosteophyte and the disc bulge may contact traversing nerve roots.\n\nL5-S1: There is no significant spinal canal narrowing. There is bilateral\nfacet arthropathy which does not result in significant neural foraminal\nnarrowing.\n\nThere are multiple T2 hyperintense cystic lesions centered in the bilateral\nrenal pelves, compatible with parapelvic cysts and/or caliceal diverticula. \nSuperimposed sub cm T2 hyperintense cystic lesions in the left kidney are\nincompletely characterized but statistically most likely representing simple\ncysts.", "output": "1. Multilevel multifactorial lumbar spondylosis, most prominent at L4-L5 where\na disc bulge results in right greater than left subarticular zone narrowing,\nwhich may impinge the right traversing nerve root against the facet\narthropathy.\n2. Multiple cystic lesions in the bilateral kidneys statistically most likely\nrepresenting a combination of peripelvic cysts and simple cysts.\n\nRECOMMENDATION(S): Point 2: This could be further evaluated with renal\nultrasound as clinically indicated." }, { "input": "CERVICAL:\nMild anterolisthesis of C5 on C6 measures approximately 2 mm, unchanged\ncompared to prior exam from ___. Alignment is otherwise normal. \nMultilevel degenerative changes, disc space narrowing, disc osteophyte\ncomplexes, posterior element hypertrophic changes. No worrisome osseous\nlesions. No cord signal abnormality.\n\nMultilevel central canal narrowing, most prominent and moderate at C6-C7\nlevel, with preserved CSF about cord. Mild central canal narrowing other\nlevels. Multilevel significant foraminal narrowing, most prominent and severe\nat right C4-C5, and moderate to severe at C5-C6, C6-C7, C7-T1 levels.\n\nNormal enhancement, no tumor, no infection.\n\n\nTHORACIC:\nMultilevel degenerative changes, disc space narrowing, diffuse disc bulges. \nSmall center disc protrusion T7-T8, mild central canal narrowing. Tiny\ncentral disc protrusion T9-T10. Broad-based disc bulge and small right\nparamedian disc protrusion T11-T12, mild-to-moderate central canal narrowing. \nModerate bilateral T1-T2 foraminal narrowing. Multilevel mild foraminal\nnarrowing elsewhere, most prominent at T11-T12. No cord signal abnormality.\n\nBilateral lower lobe consolidations, volume loss, likely atelectasis, pleural\neffusions. No evidence of infection or neoplasm.\n\nLUMBAR:\n6 lumbar type vertebral bodies, transitional lumbosacral segment will be\nlabeled S1. Multilevel degenerative changes, disc space narrowing, endplate\nhypertrophic changes, diffuse disc bulges. Advanced lumbar facet arthritis.\nLinear bright T2 signal L3-L4, L4-5 levels, no adjacent bone abnormality, no\nassociated enhancement, most likely degenerative.\n\nAt L1-L2, mild central canal narrowing, mild foraminal narrowing.\n\nAt L2-L3, small left paramedian disc protrusion. Mild central canal\nnarrowing. Mild mass effect on traversing left L3 nerve. Mild bilateral\nforaminal narrowing.\n\nAt L3-L4, moderate central canal narrowing, nearly completely efface CSF. \nMild epidural lipomatosis.. Moderate left, mild right foraminal narrowing.\n\nAt L4-5, severe central canal narrowing, completely efface CSF and epidural\nfat, ligamentous thickening. Moderate left moderate to severe right foraminal\nnarrowing.\n\nAt L5-S1, moderate central canal narrowing, preserved CSF. Moderate to severe\nleft, severe right foraminal narrowing.\n\nAt S1-S2, mild central canal narrowing. Moderate bilateral foraminal\nnarrowing.\n\nMild paraspinal edema, fluffy enhancement bilaterally L3-L5, right greater\nthan left. Mild posterior paraspinal edema between spinous processes L1-L5. \nThe findings may be posttraumatic or inflammatory. No definite evidence of\ndisc space infection or septic arthritis. If there are worsening clinical\nsymptoms, and symptoms of infection, follow-up MRI lumbar spine within 1 week\nrecommended.\n\nClumping of the or nerve roots of the cauda equina in the mid lower lumbar\nspine, consistent with arachnoiditis. No abnormal enhancement.\n\nBenign simple cyst left kidney.", "output": "1. Transitional lumbosacral segment is labeled S1.\n2. Advanced degenerative changes lumbar spine, severe central canal narrowing\nat L4-5, moderate central canal narrowing at L3-L4, L5-S1 levels.\n3. Mild paraspinal edema L3-L5, edema about spinous processes, findings may\nbe posttraumatic. If there are worsening clinical symptoms inspissation of\ninfection, follow-up lumbar spine MRI without and with contrast within 1 week\nrecommended.\n4. Degenerative changes cervical spine, moderate central canal, multilevel\nsignificant foraminal narrowing.\n5. Degenerative changes thoracic spine, mild central canal, foraminal\nnarrowing as above. 6. Arachnoiditis lumbar spine.\n7. Bilateral lower lobe consolidations, most likely from atelectasis, small\npleural effusions." }, { "input": "Axial images are limited by motion artifact. The patient is status post\nanterior spinal fusion with interbody spacers at L4-5 and L5-S1. Unchanged\ngrade 1 anterolisthesis of L4 on L5 and L5 on S1 compared to presurgical\nimaging. Vertebral body heights are preserved. Allowing for hardware related\nartifacts near the L5-S1 level, no suspicious bone marrow signal abnormalities\nare seen. Presacral edema is likely postsurgical. Left retroperitoneal edema\nis likely also postsurgical.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at L1.\n\nT11-T12: Mild disc bulge and facet arthropathy without significant spinal\ncanal narrowing. Minimal bilateral neural foraminal narrowing.\n\nT12-L1: Mild facet arthropathy without significant spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Mild facet arthropathy without significant spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Minimal disc bulge, mild to moderate right and moderate left facet\narthropathy, without significant spinal canal or neural foraminal narrowing.\n\nA 3 x 2 x 5 mm focus with complete T1 and T2 hypointensity abutting the\nposterior L3 vertebral body (series 2, image 9, series 3, image 9) is new from\n___. This may represent a focus of postsurgical air, and less likely a\nfractured osteophyte or disc fragment. The thecal sac is mildly indented\nwithout mass effect on the intrathecal nerve roots.\n\nL3-L4: Mild disc bulge and moderate facet arthropathy. Traversing L5 nerve\nroots are contacted in the subarticular zones. No significant mass effect on\nthe intrathecal nerve roots. Mild bilateral neural foraminal narrowing\nwithout contact of the exiting L3 nerve roots.\n\nL4-L5: There is an interbody disc spacer at L4-5, grade 1 anterolisthesis,\nsevere facet arthropathy with bilateral facet joint effusions which have\nincreased since ___. The thecal sac is moderately narrowed with\ncrowding of the intrathecal nerve roots, and bilateral traversing L5 nerve\nroots are contacted in the subarticular zones, similar to ___. There is\nmoderate bilateral neural foraminal narrowing which has progressed since ___.\n\nL5-S1: There is an interbody disc spacer at L5-S1, grade 1 anterolisthesis,\nand severe facet arthropathy. Bilateral facet joint effusions are similar to\n___. The thecal sac is moderately narrowed with crowding of the\nintrathecal nerve roots, increased since ___. There is right greater than\nleft subarticular zone narrowing with impingement of the traversing right S1\nnerve root and abutment of the traversing left S1 nerve root, progressed since\n___. There is severe right neural foraminal narrowing with impingement of\nthe exiting right L5 nerve root and moderate left neural foraminal narrowing\nwith abutment of the exiting left L5 nerve root, progressed since ___.\n\nTwo T2 hyperintense lesions measuring 5 and 8 mm respectively arising from the\nlower pole of left kidney likely represent cysts, image 5:24. The right\nkidney also contains a 3 mm probable cyst, image 5:17.", "output": "1. S/p instrumented anterior fusion at L4-L5 and L5-S1 with persistent grade 1\nanterolisthesis at these levels. Partially visualized presacral and left\nretroperitoneal edema is likely postsurgical.\n2. 5 mm linear hypointense focus in the anterior epidural space posterior to\nthe L3 vertebral body, new since ___, may represent a focus of\npostsurgical air, and less likely a fractured osteophyte or disc fragment. \nThis" }, { "input": "Please note, diffusion-weighted sequences are nondiagnostic secondary to a\ncombination of patient motion artifact and technical artifact.\n\nCERVICAL:\nAlignment is normal.There is multilevel disc desiccation extending from C2-C3\nthrough T1-T2. There is T2 hyperintense, T1 hypointense signal abnormality at\nC5-C6, compatible with ___ type 1 degenerative endplate changes. The spinal\ncord appears normal in caliber and configuration.There is no high-grade spinal\ncanal or neural foraminal narrowing.No evidence of diffusion slowing to\nsuggest infarction within limits of artifact. The patient is intubated with\nmild fluid seen in the ___ and oropharynx.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc height and signal are preserved. \nThere is T2/STIR hyperintense signal of the bilateral cord gray matter (series\n6, image 10; series 12, image 12 through 17) involving the T3 through T5 cord\ncompatible with cord infarct. Diffusion-weighted sequences through the\nthoracic spine is nondiagnostic secondary to artifact. There is no high-grade\nspinal canal or neural foraminal narrowing.\n\nLUMBAR:\nThere is minimal 2 mm retrolisthesis of L5 on S1. There is multilevel disc\ndesiccation, most prominently at L2-L3 through L5-S1. There are mild\ndegenerative endplate changes at L5-S1. Vertebral body signal intensity\nappears normal. The spinal cord appears normal in caliber and\nconfiguration.The conus terminates at L1. Diffusion-weighted sequences\nthrough the lumbar spine are nondiagnostic.\n\nFrom T12-L1 through L3-L4, no significant spinal canal or neural foraminal\nnarrowing.\n\nAt L4-L5, there is circumferential disc bulge causing mild ventral thecal sac\neffacement and mild spinal canal narrowing with mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is a central disc protrusion causing mild effacement of\nventral thecal sac and mild bilateral neural foraminal narrowing.\n\nOTHER: The known type B aortic dissection is better visualized on CTA torso\nfrom ___. There are small bilateral pleural effusions. Visualized\nposterior fossa, posterior spinal soft tissues and visualized portions of the\nchest abdomen and pelvis are otherwise unremarkable.", "output": "1. Cord infarct of the T3 through T5 levels. Diffusion-weighted sequences are\nnondiagnostic secondary to artifact.\n2. There are very mild multilevel degenerative changes most prominent at L5-S1\nwith a central disc protrusion causing mild effacement of ventral thecal sac\nand mild bilateral neural foraminal narrowing.\n3. Type B aortic dissection is better visualized on CTA torso from ___.\n4. There are small bilateral pleural effusions.\n\nNOTIFICATION: At the time of this dictation, cord infarct had already been\ndiscussed in multi disciplinary neurology conference on ___." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. There is no cord signal abnormality. The\ncraniocervical junction and anterior atlantodental interval are unremarkable. \nThere is no evidence of epidural collection or abnormality. No evidence for\nligamentous injury. The prevertebral soft tissues are unremarkable. T2\nhyperintense foci in the pons may represent sequela of prior lacunar infarct\nor prominent perivascular spaces.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\nC3-C4 and C4-C5: Small central protrusions do not narrow the spinal canal. \nUncovertebral and facet arthropathy results in mild bilateral neural foraminal\nnarrowing.\nC5-C6: A small central protrusion with thickening ligamentum flavum results in\nmild spinal canal narrowing. Uncovertebral and facet arthropathy results in\nmild left-greater-than-right neural foraminal narrowing.\nC6-C7: A central protrusion results in mild spinal canal narrowing. \nUncovertebral and facet arthropathy results in mild to moderate bilateral\nneural foraminal narrowing.\nC7-T1: A small central protrusion does not narrow the spinal canal. There is\nno significant neural foraminal narrowing.\n\nOn sagittal sequences the visualized upper thoracic spine spanning T1-T2\nthrough T3-T4 demonstrates no significant spinal canal narrowing. There is\nmild to moderate right T2-T3 neural foraminal narrowing.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.\n\n\nLUMBAR:\nLumbar alignment is anatomic. Vertebral body heights are preserved. 2 mm\ngrade 1 anterolisthesis of L4 on L5 is identified. There is no suspicious\nmarrow lesion. Degenerative loss of disc height is mild spanning L1-L2\nthrough L4-L5. The conus medullaris terminates at the L1-L2 level, within\nexpected limits. There is no signal abnormality of the terminal cord or cauda\nequina.\n\nThere is no evidence of epidural collection. No evidence for ligamentous\ninjury.\n\nT9-T10 through L2-L3: Mild degenerative changes do not result in significant\nspinal canal or neural foraminal narrowing.\n\nL3-4: A small disc bulge does not narrow the spinal canal. In conjunction\nwith facet arthropathy, there is mild bilateral neural foraminal narrowing\nwith small osteophytes which remodel the bilateral exiting L3 nerve root.\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. A disc bulge\nresults in mild spinal canal narrowing and crowding of the subarticular zones\ncontacting but not posteriorly displacing the traversing nerve roots (series\n12, image 26). Loss of disc height with facet arthropathy results in mild to\nmoderate right and moderate left neural foraminal narrowing which remodels the\nunder surfaces of the exiting nerve roots. There is prominent bilateral facet\narthropathy with small facet joint effusions and posteriorly projecting\nsynovial cysts. No suspicious marrow edema.\n\nL5-S1: A disc bulge does not narrow the spinal canal. There is prominent\nbilateral facet arthropathy without suspicious marrow edema. Loss of disc\nheight with facet arthropathy results in mild bilateral neural foraminal\nnarrowing. The disc bulge minimally remodels the under surfaces of the\nexiting nerve roots.\n\n\nThe bladder is mildly distended. There are multiple cystic lesions\n(statistically most compatible with simple cysts) in the left kidney measuring\nup to 4.1 cm 1 of which demonstrates a simple septation, compatible with a\nBosniak 2 cyst within confines of nondedicated examination. The remainder the\nvisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. There is no evidence of cervical and visualized upper thoracic cord or\ncauda equina. There is no cord signal abnormality.\n2. No evidence of epidural collection or ligamentous injury.\n3. Mild degenerative changes of the cervical spine is most prominent at C6-C7\nwhere there is mild spinal canal narrowing and mild-to-moderate bilateral\nneural foraminal narrowing.\n4. Mild degenerative changes of the lumbar spine is most prominent at L4-L5\nand L5-S1 where there is mild-to-moderate neural foraminal narrowing which\nremodels the exiting nerve roots.\n5. Additional 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):___\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": "Patient has limited as only sagittal T2 images obtained. Within there is\nlimitations, there is no abnormal signal within the spinal cord or high-grade\nspinal cord compression seen. Disc protrusion at T9-10 level indents the\nanterior aspect of the spinal cord but without compression. Multilevel\ndegenerative changes and disc bulging seen in the cervical thoracic and lumbar\nspine.\n\nAt L4-5 level mild bilateral foraminal narrowing seen. At L5-S1 level\nmoderate-to-severe left-sided subarticular recess and moderate left foraminal\nnarrowing due to disc and facet degenerative changes. This could result in\ncompression of the descending left S1 nerve root.", "output": "Limited study with only sagittal T2 images obtained. No obvious cord\ncompression or abnormal signal within the spinal cord. Multilevel\ndegenerative changes most pronounced at T8-9 and L5-S1 levels." }, { "input": "There is no evidence of discitis osteomyelitis or epidural abscess in the\ncervical, thoracic or lumbar region.\n\nThere is no evidence of spinal cord compression or intrinsic spinal cord\nsignal abnormalities. No abnormal intraspinal enhancement seen. No abnormal\nnerve root enhancement is identified in the cervical, thoracic or lumbar\nregion.\n\nThere is no evidence of significant disc bulge or disc herniation seen or\nspinal stenosis identified in the cervical, thoracic or lumbar region.\n\nA 3 cm T2 hyperintense focal lesion within the posterior portion of the right\nlobe of the liver demonstrates enhancement suggestive of a hemangioma. No\nother paraspinal abnormalities are seen.", "output": "No evidence of discitis osteomyelitis or epidural abscess. No evidence of\ncord compression or abnormal intraspinal enhancement. No focal signal\nabnormalities within the spinal cord." }, { "input": "THORACIC:\nThe thoracic vertebral body heights and alignment are maintained. There is a\nan area of focal fat accumulation in the T12 vertebral body. There is mild\nintervertebral disc height loss and irregularity at T10-T11. There is also\nmild diffuse disc bulge with effacement of the ventral CSF space and slight\nremodeling of the ventral spinal cord. No abnormal cord signal abnormalities\nare identified. There is mild spinal canal narrowing.\n\nOtherwise, there is no evidence of spinal canal or neural foraminal narrowing.\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema. There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nThe lumbar vertebral body heights and alignment are maintained. There is\nfocal fat accumulation in the L5 vertebral body. There is mild intervertebral\ndisc space narrowing at L4-L5 and moderate intervertebral disc space narrowing\nat L5-S1.\n\nFrom T12-L1 through L2-L3, there is no spinal canal or neural foraminal\nnarrowing.\n\nAt L3-L4, there is mild disc bulge and ligamentum flavum thickening resulting\nin minimal spinal canal or neural foraminal narrowing.\n\nAt L4-L5, there is mild diffuse disc bulge and ligamentum flavum thickening\nwith compromise of the traversing L5 nerves roots bilaterally. There is mild\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is focal disc extrusion with deformation of the right ventral\nthecal sac resulting subarticular zone and right lateral recess narrowing. \nThe extrusion measures 1 cm AP x 0.8 cm TV by 0.7 cm SI. There is impingement\nand displacement of the right descending S1 nerve root. There is moderate\nspinal canal and moderate right neural foraminal narrowing.\n\nAdditionally, there are perineural sleeve cysts in the right extraforaminal\nzone at L5-S1.\n\nThere is no abnormal enhancement after contrast administration.\n\nOTHER: The bladder is distended.", "output": "1. Focal disc extrusion measuring up to 1 cm at L5-S1 with deformation of the\nright ventral thecal sac and impingement and displacement of the right\ndescending S1 nerve roots.\n2. Moderate spinal canal and moderate neural foraminal narrowing at L5-S1.\n3. No evidence of abnormal enhancement or epidural fluid collection.\n4. No evidence of cord signal abnormalities." }, { "input": "Ectomy are again seen in the midthoracic region. The spinal cord extends and\nis closer to the region of laminectomy site. Small area of hyperintensity is\nseen within the spinal cord at this level which is unchanged from the prior\nstudy. Mild surrounding enhancement is also unchanged and likely\npostoperative. Nodular new area of enhancement identified. No evidence of a\nsyringohydromyelia seen. Multilevel mild degenerative changes are seen in the\nthoracic spine.", "output": "Stable postoperative changes and focus of hyperintense signal likely\nindicating myelomalacia within the thoracic spinal cord. No signs of\nrecurrent mass lesion." }, { "input": "CERVICAL:\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin 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.\n\n At C2-3 there is minimal posterior disc bulge without spinal canal or neural\nforaminal narrowing.\n\nAt C3-4 there is mild posterior disc bulge causing mild spinal canal narrowing\nwith anterior indentation of the thecal sac without contact with the spinal\ncord. There is minimal bilateral neural foraminal narrowing..\n\nAt C4-5 there is mild posterior disc bulge, causing mild spinal canal\nnarrowing with indentation of the anterior thecal sac without contact with the\nspinal cord. This results in mild right neural foraminal stenosis. Left\nneural foramen is normal..\n\nAt C5-6 there is mild-to-moderate posterior disc bulge, causing\nmild-to-moderate spinal canal narrowing as well as mild bilateral neural\nforaminal narrowing, left greater than right..\n\nAt C6-7 there is minimal posterior disc bulge withoutvertebral canal or neural\nforaminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nAt T1 through T3, there is no vertebral canal or neural foraminal narrowing.\n\nAt T3-T4, there is mild posterior disc bulge causing minimal spinal canal\nnarrowing without neural foraminal narrowing.\n\nAt T4-5, there is mild-to-moderate posterior disc bulge causing mild spinal\ncanal narrowing, without neural foraminal narrowing.\n\nAt T5-6, there is mild posterior disc bulge causing mild spinal canal\nnarrowing. Disc bulge appears to efface CSF anterior to the cord without\ndefinite contact with the cord. There is no neural foraminal narrowing at\nthis level.\n\nAt T6 through T12, there are minimal disc bulges, causing minimal to no spinal\ncanal and no neural foraminal narrowing.\n\nLUMBAR:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. Conus medullaris terminates at the\ninferior endplate of L1.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints 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 no vertebral canal or neural foraminal narrowing.\n\nAt L3-4 there is mild posterior disc bulge, most prominent in the paracentral\nregions, causing minimal spinal canal narrowing and mild bilateral neural\nforaminal narrowing..\n\nAt L4-5 there is mild posterior disc bulge, most prominent in paracentral\nregions, causing minimal spinal canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is mild posterior disc bulge, most prominent in paracentral\nregions, causing minimal spinal canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nOTHER: Visualized abdominal aorta is normal in caliber. There is no\nhydronephrosis. Renal parenchyma appears normal on these limited views. No\nconcerning pulmonary nodularity or consolidation identified. There is no\nabnormal postcontrast enhancement. No epidural collections are identified.", "output": "Minimal degenerative change throughout the cervical, thoracic, and lumbar\nspine. No severe spinal canal or neural foraminal stenosis. No epidural\ncollection. No abnormal enhancement. No etiology identified for patient's\nsymptomatology." }, { "input": "CERVICAL:\nThe cervical spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal.There are subtle areas of T2/STIR high-signal\nintensity suggesting spinal cord edema at C2 and C4 level (series 3, image 8,\nand series 4, image 8), without cord expansion. Otherwise no other cord\nsignal abnormalities.There is no evidence of spinal canal or neural foraminal\nnarrowing.No epidural collection is seen.\n\nTHORACIC:\nThe thoracic spine alignment is normal. Vertebral body heights and\nintervertebral disc signal intensity appear normal.No thoracic cord signal\nabnormality.There is no evidence of spinal canal or neural foraminal\nnarrowing.No epidural collection.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.The conus terminates at L1 level.No terminal cord signal\nabnormalities.\n\nFrom T12-L1 through L4-5 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L5-S1, there are mild bilateral facet osteophytes and mild disc bulge with\na annular fissure without substantial spinal canal stenosis or neural\nforaminal narrowing.\n\nNo epidural collection.\n\nOTHER: The partially visualized intra-abdominal in intrathoracic organs are\nunremarkable.", "output": "1. There are two subtle ill-defined areas of T2/STIR high-signal intensity\nwithin the cervical spinal cord C2 and C4 levels, without cord expansion\nsuggesting edema. Otherwise no cord signal abnormality throughout the\nremainder of the spine. Differential diagnosis is broad but includes\ndemyelinating disease. If there is no clinical contraindication for the use\nof intravenous gadolinium contrast agent dedicated brain MRI with and without\ncontrast, and additional images of the cervical spine with MRI with contrast\nare recommended for further evaluation.\n2. No evidence cord compression or epidural collection throughout the entire\nspine.\n3. Mild degenerative changes in the lower lumbar spine without spinal canal\nstenosis or neural foraminal narrowing.\n\nRECOMMENDATION(S): There are two subtle ill-defined areas of T2/STIR\nhigh-signal intensity within the cervical spinal cord C2 and C4 levels,\nwithout cord expansion, suggesting edema. Otherwise no cord signal\nabnormality throughout the remainder of the spine. Differential diagnosis is\nbroad but includes demyelinating disease. If there is no clinical\ncontraindication for the use of intravenous gadolinium contrast, dedicated\nbrain MRI with and without contrast and additional MRI images of the cervical\nspine with contrast is recommended for further evaluation." }, { "input": "Thoracic spine:\n\nMild degenerative disc disease is seen. At T7-8 and T10-11 levels disc\nbulging is identified with a tiny disc protrusions minimally indenting the\nthecal sac without deformity of the spinal cord. There is no compression of\nthe spinal cord seen or abnormal signal within the spinal cord. There is no\nacute or chronic compression fractures seen.\n\nLumbar spine:\n\nThere is no evidence of significant disc bulge disc herniation spinal stenosis\nor compression fracture seen. There is no foraminal narrowing. Paraspinal\nsoft tissues are unremarkable.", "output": "1. Mild degenerative changes in the thoracic region. No spinal stenosis,\nspinal cord compression or intrinsic spinal cord signal abnormalities.\n2. No significant abnormalities on MRI of the lumbar spine." }, { "input": "There is reversal of the cervical lordosis. The alignment is anatomic. \nVertebral body heights are normal. Vertebral body signal intensity appear\nnormal. There is disc desiccation at all cervical levels with mild loss of\ndisc height at C5-C6 and C6-C7. The signal intensity throughout the cervical\nspinal cord is normal with no evidence of focal or diffuse lesions, there is\nno evidence of abnormal enhancement after contrast administration.\n\nFrom C2-C3 to C4-C5 there is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nC5-C6: There is disc bulge resulting in moderate canal stenosis. There is\nbilateral facet arthropathy causing mild bilateral neural foraminal narrowing.\n\nC6-C7: There is mild disc bulge with no evidence of central spinal canal\nstenosis. There is no neural foraminal narrowing.\n\nC7-T1: There is no spinal canal stenosis or neural foraminal narrowing.\n\nThe imaged prevertebral and posterior paraspinal soft tissues are\nunremarkable.", "output": "1. Mild degenerative changes of the cervical spine, most prominent at C5-C6\nwhere there is moderate canal stenosis and mild bilateral neural foraminal\nnarrowing.\n2. No abnormal cervical cord signal. No abnormal enhancement." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is mild\nbone marrow heterogeneity, and areas of focal fat deposition. There is mild\ncompression deformity of the superior endplate of L2, with mild associated\nedema. There is otherwise no focal bone marrow lesion. There is loss of T2\nsignal of all visualized intervertebral discs. The spinal cord appears normal\nin caliber and configuration. There is no obvious epidural collection. There\nare tiny osteophytes and protrusions at multiple levels, without production of\nsignificant spinal canal narrowing. Facet arthropathy produces mild bilateral\nneural foraminal narrowing the levels of C7-T1 through T2-T3, with additional\narea of mild neural foraminal narrowing at the right T3-T4 and T4-T5 levels. \nThe remainder of the neural foramen appear patent. There is no high-grade\nneural foraminal stenosis. There is no evidence of infection or neoplasm.\n\nSub cm T2 hyperintense foci in the right hepatic lobe are incompletely\ncharacterize (20:17), however may represent cysts. These appear to have been\npresent on the chest CT from ___.", "output": "1. Please note that this is an incomplete examination and neither lumbar spine\nimages nor post gadolinium images were obtained as patient could not tolerate\nthe examination.\n2. Mild superior endplate compression deformity of the L2 vertebral body.\n3. No cord signal abnormality. No definite epidural collection.\n4. Mild thoracic spondylosis, as described. No significant spinal canal or\nhigh-grade neural foraminal narrowing.\n\nRECOMMENDATION(S): Consider repeating the examination when patient is better\nable to tolerate." }, { "input": "There is diffuse increased signal identified in the L5 vertebra and the\nvisualized sacrum are clear S3 level which could be secondary to prior\nradiation therapy to the pelvis.\n\nFrom T11-12 through L3-4 mild disk degenerative change seen.\n\nAt L4-5 level, there is mild anterolisthesis of L4 over L5 seen secondary to\nfacet degenerative changes. There is no spinal stenosis seen. Mild narrowing\nof the right foramen seen.\n\nAt L5-S1 level mild disc degenerative changes are identified. The distal\nspinal cord and paraspinal soft tissues are unremarkable. A simple appearing\nrenal cyst is partially visualized on the left.", "output": "Multilevel mild degenerative changes with facet degenerative changes resulting\nin minimal anterolisthesis of L4 on L5. Mild narrowing of the right foramen\nseen at L4-5 level. No evidence of high-grade spinal stenosis. Other findings\nas described above." }, { "input": "Limited exam as patient could not tolerate the full exam. Only sagittal\nsequences could be obtained.\n\nAlignment is normal. Vertebral body marrow signal is mildly heterogeneous\nlikely reflecting degenerative change. There is mild loss of normal\nintervertebral disc signal. There is loss of normal intervertebral disc\nheight at C6-C7. The spinal cord appears normal in caliber and configuration.\nThere is a broad-based disc protrusion at C3-C4 with resulting mild spinal\ncanal narrowing and broad-based disc protrusions at C5-C6 and C6-C7 with\nresulting moderate spinal canal narrowing. There is no abnormal cord signal\ndetected but evaluation on inversion recovery images is limited due to\nartifacts. Increased signal in the interspinous region in the C7-T1 level\nappears artifactual. Mild increased signal between the spinous processes of\nC1 and C2 on inversion recovery images are nonspecific and may indicate mild\nligamentous injury without disruption. .", "output": "Limited examination. Multilevel degenerative changes most pronounced at C5-C6\nand C6-C7. No abnormal cord signal detected. Increased signal between the\nspinous processes of C1 and C2 on inversion recovery images is nonspecific and\nmay indicate mild ligamentous injury without disruption. Given the limited\nnature of examination, this could not be fully evaluated." }, { "input": "CERVICAL SPINE: The vertebral body height and alignment in the sagittal plane\nare relatively well maintained. The bone marrow is diffusely heterogeneous\nwithout focal suspicious signal abnormality. The intervertebral discs have\nnormal heights with diffuse disc desiccation.\n\nC2-C3: No disk herniation, or spinal canal or neural foraminal narrowing.\n\nC3-C4: Moderate central disk protrusion with endplate spurring partially\nremodeling the ventral aspect of the cord without cord signal abnormality, or\nsignificant spinal canal or neural foraminal narrowing.\n\nC4-C5: No disk herniation, or spinal canal or neural foraminal narrowing.\n\nC5-C6: Broad-based disk protrusion with eccentric right foraminal component\nflattening the ventral cord, ligamentum flavum thickening, and bilateral\nuncovertebral and facet joint hypertrophy causing mild spinal canal, and\nmoderate right and mild left neural foraminal, narrowing.\n\nC6-C7: Broad-based disk protrusion and endplate spurring flattening the\nventral aspect of the cord causing mild spinal canal narrowing. No significant\nneural foraminal narrowing.\n\nC7-T1: No disc herniation, or spinal canal or neural foraminal narrowing.\n\nNo abnormal cord signal intensity is appreciated.\n\nThe paraspinal soft tissues are normal.\n\nTHORACIC SPINE: The thoracic spine has normal vertebral body height and\nalignment in the sagittal plane. Type 2 degenerative endplate changes are\nnoted at T6-T7 anteriorly. Bone marrow is diffusely heterogeneous without\nfocal suspicious signal abnormality. The intervertebral disc have normal\nheight with diffuse disc desiccation. There is no disc herniation, or spinal\ncanal or neural foraminal stenosis. The thoracic spinal cord and conus\nmedullaris have normal morphology and signal intensities. THORAThe posterior\nelements and paraspinal soft tissues are normal.\n\nLUMBAR SPINE: The vertebral body height and alignment in the sagittal plane\nare relatively well maintained. Bone marrow is diffusely heterogeneous without\nfocal suspicious signal abnormality. The intervertebral discs have normal\nheights with diffuse disc desiccation.\n\nT12-L1: No disk herniation, or spinal canal or neural foraminal narrowing.\n\nL1-L2: No disk herniation, spinal canal or neural foraminal narrowing. Mild\nbilateral facet arthrosis.\n\nL2-L3: No disc herniation, spinal canal or neural foraminal narrowing. Mild\nright greater than left facet arthrosis with small left facet joint effusion.\n\nL3-L4: Mild disc bulge encroaching upon the traversing L4 nerve roots and\nbilateral facet arthrosis causing mild bilateral neural foraminal narrowing.\nNo significant spinal canal narrowing.\n\nL4-L5: Mild disc bulge encroaching upon the left greater than right traversing\nL5 nerve roots,, and bilateral facet arthrosis without significant spinal\ncanal narrowing, but mild left-greater-than-right neural foraminal narrowing.\n\nL5-S1: Mild disk bulge and bilateral facet arthrosis without significant\nspinal canal or neural foraminal narrowing.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1 level.\n\nThe paraspinal soft tissues are normal.\n\nIncidentally noted is dilatation of the common bile duct measuring up to 1.1\ncm to the level of the pancreatic head. There is also a T2 hyperintense\ncurvilinear region within the pancreatic head adjacent to this region which\nmay represent a dilated pancreatic duct versus cystic pancreatic neoplasm\n(IPMT). Dedicated cross-sectional imaging may provide further\ncharacterization.", "output": "1. No evidence of significant spinal canal narrowing, spinal cord compression,\nor abnormal cord signal intensity.\n2. Diffusely heterogeneous bone marrow signal without focal suspicious signal\nabnormality, which may relate to underlying osteopenia, anemia, or an\ninfiltrative process.\n3. Multilevel degenerative disease, as detailed above.\n4. Incidentally noted dilatation of the common bile duct measuring up to 1.1\ncm to the level of the pancreatic head. There is also a T2 hyperintense\ncurvilinear region within the pancreatic head adjacent to this region which\nmay related to a dilated pancreatic duct versus cystic pancreatic neoplasm\n(IPMT). Targeted cross-sectional imaging, if not already performed elsewhere,\nmay provide further characterization.\n5. Findings were posted to the Radiology Department's \"Critical Results\nCommunication\" dashboard by Dr. ___.." }, { "input": "There are postsurgical changes of L3-S1 lumbar interbody arthrodesis with\ninterbody devices at L3-L4, L4-L5, and L5-S1.\n\nThere is persistent right lateral subluxation of the L3 vertebral body\nrelative to the L4 vertebral body measuring 7-8 mm. Unchanged mild scoliosis.\n\nThere is mild endplate hyperintensity on STIR at L4-L5 and progressive\nendplate hyperintensity on STIR at L2-L3. Patchy areas of vertebral focal fat\ndeposition throughout the lumbar spine are re-demonstrated.\n\nThe terminal spinal cord is normal in signal intensity. The conus medullaris\nterminates at the level L1-L2.\n\nThere is apparent clumping of the cauda equina nerve roots from L3-L4 thru\nS1-S2 level, suggestive of arachnoiditis. This is new compared to prior exam\ndated ___.\n\nL1-L2: Persistent central disc protrusion with indentation of the ventral\nthecal sac and ligamentum flavum thickening results in mild spinal canal\nnarrowing. No significant neural foraminal narrowing.\n\nL2-L3: Diffuse disc bulge, facet osteophytes and ligamentum flavum thickening\nresult in severe spinal canal narrowing with crowding of the nerve roots and\nnarrowing of the subarticular zones bilaterally. Findings appear minimally\nprogressed compared to prior exam. No significant neural foraminal narrowing.\n\nL3-L4: Postsurgical changes of laminectomies. Persistent disc bulge with\ncentral annular fissure result in mild-to-moderate spinal canal narrowing and\nno significant neural foraminal narrowing.\n\nL4-L5: Postsurgical changes of laminectomies. Mild disc bulge, ligamentum\nflavum thickening and facet osteophytes resulting in mild spinal canal\nnarrowing. There is moderate right and mild left neural foraminal narrowing.\n\nL5-S1: There is persistent asymmetric right central and right foraminal disc\nprotrusion with narrowing of the right subarticular zone. Mild spinal canal\nnarrowing with slight posterior displacement of the descending right S1 nerve\nroot. There is moderate right and mild left neural foraminal narrowing with\nthe exiting L5 nerve roots contacting the disc.\n\nThere are incompletely characterized T2 hyperintense lesions emanating from\nthe left kidney. Nonspecific bilateral perinephric fluid. The paraspinal\nmuscles are unremarkable.", "output": "1. Postsurgical changes of L3-S1 lumbar interbody arthrodesis with interbody\ndevices.\n2. Persistent right lateral subluxation of L3 on L4. Unchanged mild\nscoliosis.\n3. Severe spinal canal narrowing at L2-L3 with crowding of the descending\nnerve roots.\n4. Multilevel lumbar spondylosis with moderate right neural foraminal\nnarrowing at L4-L5 and L5-S1.\n5. Suspected arachnoiditis from L3-L4 through S1-S2.\n6. Endplate edema at L2-L3 and L4-L5 is likely degenerative." }, { "input": "Thoracic spine:\nThere is normal thoracic alignment. The vertebral body heights are preserved.\nThere is diffuse mild T1 hypo intensity in the marrow, without focal lesion. \nThe intervertebral disc signal and height are preserved. The thoracic cord\ndemonstrates normal signal and morphology.\n\nThere small disc bulges at T7-T8, T10-T11, and T11-T12 without significant\nneural foramina or spinal canal stenosis. The remaining levels are\nunremarkable.\n\nLumbar spine:\nThere is lumbarization of the S1 vertebral body which will be referred to as\nS1 but can also be called L6. There is normal lumbar alignment. There are\nanterior superior compression fractures of the L2 and L3 vertebral bodies with\napproximately 25% loss of height, which is mildly progressed in comparison to\n___. There is no associated bony retropulsion.\n\nThere is diffuse low T1 marrow signal. There is low disc signal at S1-S2\nwithout significant loss of height. The conus demonstrates normal signal and\nmorphology terminating appropriately at the L2 level.\n\nAt L1-L2 there is disc bulge without significant neural foraminal or spinal\ncanal stenosis.\nAt L2-L3 there is disc bulge without significant neural foramina or spinal\ncanal stenosis.\nAt L3-L4 there are short pedicles causing mild spinal canal narrowing without\nsignificant neural foraminal stenosis.\nAt L4-L5 there are short pedicles causing mild spinal canal narrowing without\nsignificant neural foraminal.\nAt L5-S1 there is disc bulge, facet arthropathy, and short pedicles causing\nmild-to-moderate spinal canal stenosis without significant neural foraminal\nstenosis.\nAt S1-S2 there is facet arthropathy and disc bulge with a superimposed left\nsubarticular zone disc protrusion which compresses the traversing left S1\nnerve root (13:23). There is mild left neural foraminal stenosis which\ncontacts the undersurface of the exiting left S1 nerve root (10:5).\n\nThere are small T2 hyperintense lesions in the visualized liver parenchyma\nmeasuring 4 mm (09:16) and 8 mm (09:24). There is a subcentimeter right renal\ncortical cyst.", "output": "1. Mild anterior superior subacute L1-L2 compression fractures which have\nmildly progressed in comparison to ___. No associated bony\nretropulsion.\n2. Mild multilevel degenerative changes of the thoracic lumbar spine, as\ndescribed, greatest at S1-S2 with there is a left subarticular zone disc\nprotrusion which compresses the traversing left S2 nerve root.\n3. Transitional lumbosacral anatomy with lumbarization of the S1 vertebral\nbody which accounts for the aforementioned numbering.\n4. Congenitally shortened lumbar pedicles causing up to mild to moderate\nlumbar stenosis.\n5. No evidence of infection\n6. Diffuse low T1 marrow signal which is nonspecific may be seen in the\nsetting of anemia or an infiltrative process. Recommend clinical correlation.\n7. Small T2 hyperintense lesions within the visualized right liver parenchyma\nlikely representing hemangiomas or small cysts given patient age." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is mildly heterogeneous with foci of slightly decreased T1\nsignal. There is no focal marrow lesion. Disc heights are preserved. The\nvisualized posterior fossa is unremarkable. There is no cord signal\nabnormality.\n\nThere is no spinal canal or neural foraminal narrowing. At the T1 vertebral\nlevel, inferior to the right anterior scalene is a 9 mm T2 hyperintense cystic\nfocus (series 5, image 30), adjacent to the first costovertebral junction\n(series 3, image 1; series 5, image 29).\n\nThe remainder the prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. There is no spinal canal or neural foraminal narrowing.\n2. 9 mm T2 hyperintense cystic focus, closely apposed to the right first\ncostovertebral junction and the course of the right brachia plexus,\npotentially representing a synovial cyst. Recommend further evaluation with\nright brachial plexus MRI.\n\nRECOMMENDATION(S): Recommend further evaluation with brachial plexus MRI." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of lumbar spine. There is transitional anatomy with\npartial sacralization of L5. Vertebral body heights are preserved. Numerous\nSchmorl's nodes are seen throughout the visualized thoracolumbar spine.\n\n Well-circumscribed 1.5 cm T1 and T2 hyperintense lesion within the T12\nvertebral body likely represents a hemangioma.\n\nL3-4 and L4-5 mixed probable type 1 and type ___ ___ changes are seen.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal throughout the lumbar\nspine, with near complete loss of intervertebral disc height at L4-5. \nNonspecific facet joint fluid is noted in multiple levels of the lumbar spine.\n\nAt T11-12 there is epidural fat, no vertebral canal and no neural foraminal\nnarrowing.\n\nAt T12-L1, there is epidural fat, no spinal canal or neural foraminal\nnarrowing.\n\nAt L1-2, there is epidural fat, a left paracentral/foraminal disc protrusion\nwhich contacts and anteriorly displaces the traversing right L2 nerve root in\nthe lateral recess (series 5, image 16), with mild vertebral canal and mild\nleft neural foraminal narrowing.\n\nAt L2-3, there is epidural fat, disc bulge, facet joint hypertrophy, disc\nbulge, moderate vertebral canal, and mild bilateral neural foraminal\nnarrowing.\n\nAt L3-4, there is epidural fat, disc bulge which contacts bilateral exiting L3\nnerve roots, probable central disc extrusion with inferior migration extending\napproximately 1.8 cm, facet joint hypertrophy, ligamentum flavum thickening,\nsevere vertebral canal narrowing (series 200, image 60) and moderate bilateral\nneural foraminal narrowing.\n\nAt L4-5, there is disc bulge, central disc protrusion, thickening of the\nligamentum flavum, facet joint hypertrophy contacts bilateral exiting L4 nerve\nroot, epidural fat, moderate vertebral canal and moderate bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is epidural fat, disc bulge, facet joint hypertrophy, moderate\nto severe vertebral canal and severe bilateral neural foraminal narrowing.\n\n OTHER:\n\nProbable dependent edema is noted in the dorsal lumbar soft tissues.\n9 mm T2 hyperintense lesion within the right kidney, incompletely\ncharacterized (series 2, image 166).", "output": "1. Study is moderately degraded by motion.\n2. Multilevel lumbar spondylosis as described, most pronounced at L3-4, where\nthere is disc bulge and probable central disc extrusion with inferior\nmigration, with differential consideration of schwannoma, severe vertebral\ncanal moderate bilateral neural foraminal narrowing with disc bulge which\ncontacts bilateral exiting L3 nerve roots. If concern for schwannoma,\nconsider contrast lumbar spine MRI for further evaluation.\n3. L5-S1 prominent epidural fat with moderate to severe vertebral canal\nnarrowing severe bilateral neural foraminal.\n4. L4-5 facet joint hypertrophy contacts bilateral exiting L4 nerve roots,\nvertebral canal and moderate bilateral neural foraminal narrowing.\n5. L1-2 left paracentral disc protrusion contacts left descending L2 nerve\nroot.\n6. Incompletely characterized right renal lesion likely cystic as described.\nPlease note that imaging can make the anatomic diagnosis of cauda equina\nCOMPRESSION, but that cauda equina SYNDROME is a clinical diagnosis based on\nthe patient examination and clinical history. Imaging alone cannot make a\ndiagnosis of cauda equina SYNDROME.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:43 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lumbar spine numbering is based on that established on prior examination and\nthe lowest rib-bearing vertebra.\n\nThere is mild 2 mm anterolisthesis of T10 on T11, slightly more prominent when\ncompared to prior exam of ___. There is new 3 mm anterolisthesis of L4 on L5,\nnot seen on examination of ___. Disc desiccation loss of disc height at L3-4\nand L4-5 is noted. The degree disc height loss at L4-5 has slightly progressed\nfrom prior exam of ___. Vertebral body heights are maintained. There is no\nsuspicious marrow signal. The conus terminates at the inferior endplate of L1,\nwithin expected limits. There is no signal abnormality of the visualized cord.\n\nT10-11: There is a small disc bulge and bilateral facet arthropathy without\nsignificant spinal canal or neural foraminal narrowing.\n\nT11-12 through L2-3: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nL3-4: There is a disc bulge as well as bilateral facet arthropathy and mild\nthickening of the ligamentum flavum. Small bilateral facet joint effusions are\nalso noted. There is no significant spinal canal or neural foraminal\nnarrowing.\n\nL4-5: There is uncovering of the disc secondary to the anterolisthesis of L4\non 5. There is a disc bulge as well as severe bilateral facet arthropathy and\nthickening of the ligamentum flavum. Bilateral facet joint effusions are\nnoted, although the right-sided effusion is less T2 hyperintense. These\ndegenerative changes results in moderate spinal canal narrowing as well as\nsevere crowding of the bilateral subarticular recesses which impinges the\ntraversing L5 nerve roots (series 5, image 16). There is no significant neural\nforaminal narrowing. Previously described right synovial cyst narrowing of\nthe right neural foramen is not seen on current exam.\n\nL5-S1: There is severe bilateral facet arthropathy as well as thickening of\nthe ligamentum flavum. New since prior examination of ___ is a presumed\nprominent left facet osteophyte which results in moderate to severe left\nsubarticular recess which impinges on left S1 nerve root (series 5, image 21\nand series 4, image 5). There is no significant spinal canal or right neural\nforaminal narrowing. Previously described left facet synovial cyst measuring\napproximately 7 mm in greatest tiny mention is stable.\n\nOther: Prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Interval development of a presumed prominent L5-S1 left facet osteophyte,\nresulting in moderate to severe left subarticular recess narrowing which\nimpinges on the left S1 nerve root.\n2. At L4-5, there is worsening of degenerative changes, including interval\ndevelopment of a 3 mm anterolisthesis of L4 on L5 as well as a moderate spinal\ncanal narrowing with severe crowding of the bilateral subarticular recesses\nwhich likely impinges on the bilateral L5 traversing nerve roots.\n3. Additional degenerative changes as described above." }, { "input": "There is mild dextroscoliosis of the lumbar spine. The alignment is otherwise\nunremarkable. Vertebral body height is maintained. There are ___ type 2\nchanges at L4-L5 and L5-S1. The marrow signal is otherwise unremarkable. The\nvisualized spinal cord is unremarkable. The conus terminates at L1.\n\nThere is an 8 mm simple cyst in the upper pole of right kidney. The\nvisualized retroperitoneal, paraspinal and paravertebral soft tissues are\notherwise unremarkable.\n\n At T12-L1 there is mild loss of disc signal. The disc height is\nmaintained.No spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is loss of disc signal and height with diffuse broad-based disc\nbulge, mild bilateral facet arthropathy and ligamentum flavum thickening\ncausing mild bilateral neural foraminal narrowing.No spinal canal stenosis.\n\nAt L2-3 there is diffuse broad-based disc bulge with superimposed central disc\nprotrusion, moderate bilateral facet arthropathy and ligamentum flavum\nthickening causing mild bilateral neural foramen narrowing and narrowing of\nbilateral subarticular recess.Mild to moderate spinal canal stenosis caused by\ncentral disc protrusion, ligamentum flavum thickening and facet arthropathy. \nThese findings have progressed compared to the prior study.\n\nAt L3-4 there is diffuse broad-based disc bulge, moderate bilateral facet\narthropathy and mild ligamentum flavum thickening causing mild-to-moderate\nbilateral neural foramen narrowing.No spinal canal stenosis.\n\nAt L4-5 there is diffuse broad-based disc bulge, moderate bilateral facet\narthropathy and mild ligamentum flavum thickening causing moderate to severe\nbilateral neural foraminal narrowing. No spinal canal stenosis.\n\nAt L5-S1 there is diffuse broad-based disc bulge with mild bilateral facet\narthropathy and ligamentum flavum thickening causing mild left and moderate\nright neural foraminal narrowing. No spinal canal stenosis.", "output": "1. Interval progression of multilevel multifactorial spondylosis of the lumbar\nspine, worst at L2-L3 with moderate spinal canal stenosis and L4-L5 with\nneural foramen narrowing as described above." }, { "input": "The craniocervical junction and C2-3 mild degenerative change seen.\n\nApparent C3-4 disk bulging and uncovertebral degenerative changes are seen\nwith mild to moderate spinal stenosis with disk bulging in contact with the\nspinal cord without fracture deformity. Mild bilateral foraminal narrowing is\nseen.\n\nAt C4-5 and C5-6 mild disk degenerative change and facet degenerative changes\nare seen. There is no evidence of spinal stenosis or foraminal narrowing.\n\nAt C6-7 disc bulging results in mild spinal stenosis with thickening of the\nligament slightly contacting the spinal cord on the posterior aspect.\n\nRight C7-T1 mild anterolisthesis seen.\n\nT1-2 extending to T4-5 mild degenerative changes seen.\n\nThe spinal cord is of normal intrinsic signal.", "output": "Changes of cervical spondylosis with mild to moderate spinal stenosis at C3-4\nand mild spinal stenosis at C6-7 level. The disk bulging and ligamentous\nthickening contacts the spinal cord cord without deformity. No abnormal signal\nseen within the spinal cord. Mild foraminal narrowing at C3-4 level." }, { "input": "The conus terminates at the L1 level. No conus masses. Normal conus signal\nintensity.\n\nNo fractures are identified. There is edema in the interspinous ligaments at\nthe L3-4, L4-5 and L5-S1 levels as well as small facet joint effusions, but no\nabnormal enhancement.\n\nAt the level L4-5: ___ type 2 changes involving the L4 and L5 vertebral body\nendplates. There is a disc extrusion with the right paracentral component\nmigrating inferiorly towards the right L4-5 lateral recess. The disc\ndisplaces and compresses the right L5 nerve root in this right lateral recess.\nThe left paracentral disc component is at the level of the intervertebral disc\nspace which abuts and mildly displaces the left L5 nerve root in the\nsubarticular zone.\nThere is no compromise of the rest of the cauda equina nerve roots in the\nspinal canal. Disc protrusion with associated facet joint osteophytosis\nresults in moderate left and mild right neural foraminal narrowing.\n\nAt the L5-S1 level there is mild disc bulge with associated facet joint\nosteophytosis which results in moderate left and mild right neural foraminal\nnarrowing.\n\nThe rest of the spinal canal and neural foramina patent.", "output": "At the L4-5 level there is a disc extrusion with its right paracentral aspect\nmigrating inferiorly towards the right lateral recess.\nThis results in severe narrowing and suspected right L5 nerve root compromise\nin the right L4-5 lateral recess.\nThere is also moderate narrowing of the left L4-5 subarticular zone and left\nL5 nerve root compromise in this position should be excluded.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:26 pm, 2 minutes after discovery\nof the findings." }, { "input": "At the craniocervical junction, and C2-3 levels, mild degenerative changes\nseen. Mild disc bulging seen without spinal stenosis or foraminal narrowing.\n\nAt C3-4 level, there is disc bulging and thickening of the ligaments resulting\nin mild spinal stenosis. The disc bulging contacts the spinal cord without\ndeformity. There is mild right foraminal narrowing seen.\n\nAt C4-5 level, mild anterolisthesis of C4 over C5 seen. There is moderate\nleft foraminal narrowing. There is no spinal stenosis.\n\nAt C5-6 disc and uncovertebral degenerative change seen. Moderate bilateral\nforaminal narrowing is identified without spinal stenosis.\n\nAt C6-7 and C7-T1 levels mild disc bulging identified with mild narrowing of\nthe foramina.\n\nT1-2 and T2-3 and T3-4 disc degenerative change seen. At T4-5 central disc\nprotrusion identified on sagittal images which indents the anterior aspect of\nthe spinal cord.\n\nThere is no abnormal signal within the spinal cord.", "output": "1. Multilevel degenerative changes are identified.\n2. Mild spinal stenosis at C3-4 level.\n3. Central disc herniation indenting the spinal cord at T4-5 level. Given\nhistory of myelopathy, further evaluation can be obtained with thoracic spine\nMRI.\n\nRECOMMENDATION Thoracic spine MRI for further evaluation of T4-5 disc\nherniation." }, { "input": "There are 12 rib-bearing vertebrae. The numbering is documented on image 3:8.\nThere is mild anterior wedging of T5 vertebral body. No marrow edema or other\nconcerning bone marrow signal abnormalities are seen. The localizer sequence\ndemonstrates an incompletely evaluated mild levoconvex curvature centered in\nthe upper thoracic spine.\n\nT1-T2: Perineural cyst in the right neural foramen. Bilateral facet\narthropathy. No spinal canal or significant neural foraminal narrowing.\n\nT2-T3: Bilateral facet arthropathy. No spinal canal or significant neural\nforaminal narrowing.\n\nT3-T4: No spinal canal or neural foraminal narrowing.\n\nT4-T5: Large central disc herniation extending superiorly results in severe\nspinal canal narrowing with spinal cord compression. Allowing for the large\nfield of view, no definite cord signal abnormality seen. No significant\nneural foraminal narrowing.\n\nT5-T6, T6-T7: No spinal canal or neural foraminal narrowing.\n\nT7-T8: Mildly prominent Schmorl's nodes. Mild facet arthropathy. No spinal\ncanal or neural foraminal narrowing.\n\nT8-T9: No spinal canal or neural foraminal narrowing.\n\nT9-T10: Mild facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nT10-T11: Moderate facet arthropathy. Mild bilateral neural foraminal\nnarrowing.\n\nT11-T12: Prominent Schmorl's node in the T11 inferior endplate. Mild facet\narthropathy. No spinal canal or neural foraminal narrowing.\n\nT12-L1: Mild disc bulge and facet arthropathy. No spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Mild disc bulge and facet arthropathy. No significant spinal canal\nnarrowing. Mild left neural foraminal narrowing.\n\nThe conus medullaris terminates at L1 and appears unremarkable.\n\nPartially visualized left kidney demonstrates cortical thinning, and its\nlength also appears small on the localizer sequence. Partially visualized\nright kidney demonstrates normal cortical thickness. There is an\napproximately 0.8 cm round T2 hypo intense lesion in the lateral interpolar\nleft kidney on image 7:33, which may represent a complicated cyst or a solid\nmass.", "output": "1. Large central disc herniation at T4-T5, extending superiorly, results in\nsevere spinal canal narrowing with spinal cord compression, but no evidence\nfor spinal cord signal abnormality allowing for the large field of view.\n2. Mild degenerative changes at other thoracic and upper lumbar levels.\n3. 0.8 cm indeterminate T2 hypointense lesion in the lateral interpolar left\nkidney, which may represent a complicated cyst or a solid mass. The left\nkidney appears partially atrophic.\n\nRECOMMENDATION(S):\nFor further characterization of the left renal lesion, ultrasound may be\nattempted in the first instance, but renal MRI may be required of ultrasound\nis indeterminate.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at approximately 11:05 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. Disc desiccation and mild loss of disc height at\nL5-S1 is similar to prior exam of ___. The conus medullaris terminates at\nthe L1 vertebral level, within expected limits. The signal and morphology of\nthe visualized cord, conus medullaris and cauda equina are unremarkable.\n\nT10-T11 through L4-L5: No significant spinal canal or neural foraminal\nnarrowing.\n\nL5-S1: Central disc protrusion is similar in size from ___ which minimally\nindents the ventral aspect of thecal sac without significant spinal canal\nnarrowing. Mild bilateral facet arthropathy with small facet joint effusions\nare noted. There is no significant neural foraminal\n\nThe left ovary identified demonstrating multiple follicles. Otherwise,\nprevertebral paraspinal soft tissues are unremarkable.", "output": "1. L5-S1 disc protrusion is unchanged from examination ___, without\nsignificant spinal canal or neural foraminal narrowing.\n2. Additional mild degenerative changes at L5-S1 is noted." }, { "input": "Minimal retrolisthesis C5-C6. Minimal anterolisthesis C6-C7.\nVertebral body heights are maintained. There are degenerative endplate signal\nchanges at C5, C6 endplates and mild disc T2 signal abnormality. No\nparavertebral edema. No endplate destruction. The spinal cord appears normal\nin caliber and configuration. Multilevel endplate hypertrophic changes, disc\nosteophyte complexes, disc space narrowing. Posterior element hypertrophic\nchanges.\n\nC2-C3: Patent canal and neural foramina.\n\nC3-C4: Mild central canal narrowing. Patent right foramen. Moderate to\nsevere left foraminal narrowing.\n\nC4-C5: Mild-to-moderate central canal narrowing. Severe left and\nmild-to-moderate right foraminal narrowing.\n\nC5-C6: Moderate central canal narrowing, preserved CSF about cord. Severe\nbilateral foraminal narrowing.\n\nC6-C7: Mild central canal. Moderate to severe right foraminal narrowing. \nMild left foraminal narrowing..\n\nC7-T1: Patent canal and neural foramina.", "output": "1. Appearance of C5-C6 is most likely degenerative. Absence of paravertebral\nedema argues against infection, clinically correlate.\n2. Degenerative changes cervical spine.\n3. Moderate central canal narrowing C5-C6.\n4. Multilevel significant foraminal narrowing, as above." }, { "input": "The study is limited by motion.\n\nThere is anterolisthesis of C7 on T1 and retrolisthesis C3 on C4. There has\nbeen anterior fusion with hardware hardware spanning C4 through C7. \nRedemonstrated C7 fracture at the anterior vertebral body is seen on STIR (2;\n9). There is no evidence of ligamentous tear or injury.\n\nMultilevel degenerative changes are seen along the cervical spine, including\nloss of intervertebral disc space height, osteophyte formation, and loss of\nintervertebral T2 signal. The visualized portion of the spinal cord is \npreserved in signal and caliber. There is thickening of the posterior\nlongitudinal ligament extending from C6-7 through C7-T1. There is no\nprevertebral soft tissue swelling.\n\nAt C2-3 there is no vertebral canaland no neural foraminal narrowing.\n\nAt C3-4 there is diffuse disc bulge with mild vertebral canaland no neural\nforaminal narrowing.\n\nAt C4-5 there is no vertebral canaland no neural foraminal narrowing.\n\nAt C5-6 there is no vertebral canaland no neural foraminal narrowing.\n\nAt C6-7 there is facet arthropathy with mild vertebral canaland no neural\nforaminal narrowing.\n\nAt C7-T1 there is subluxation, thickening of the posterior longitudinal\nligament and a central disc protrusion. These contact the anterior surface of\nthe spinal cord.\n\nAt T1-T2 there is central disc protrusion with mild vertebral canaland no \nneural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. There is paraspinal muscle edema likely caused by\nmuscle strain.", "output": "1. Previously identified anterior C7 fracture with no evidence of ligamentous\ntear.\n2. Multilevel degenerative changes as described above." }, { "input": "Alignment is normal. There is a focus of high intensity in the T5 vertebral\nbody on the T2 weighted images. This is not hyperintense on the T1 weighted\nimages. It is incompletely evaluated, but may represent an atypical\nhemangioma. Vertebral body signal intensity is otherwise normal.\nOf signal of the intervertebral discs at every imaged level on the T2 weighted\nimages. This is a manifestation of degenerative disc disease.\n\nAxial images at C2-3 reveal no significant abnormalities.\n\nAt C3-4, bulging of the intervertebral disc mildly encroaches on the spinal\ncanal but does not contact the spinal cord. The neural foramina appear\nnormal.\n\nAxial images at C4-5 demonstrate no significant abnormalities.\n\nAt C5-6, there is a mild bulge of the disc and a tiny midline protrusion that\nslightly flattens the anterior surface of the spinal cord. The neural\nforamina appear normal.\n\nAt C6-7, intervertebral osteophytes and bulging of the disc encroaches on the\nspinal canal but do not contact the spinal cord. Uncovertebral and facet\nosteophytes produce moderate narrowing of the left neural foramen.\nThe visualized portion of the spinal cord appears normal.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.", "output": "1. Mild changes of degenerative disc disease with no evidence of spinal cord\ncompression.\n2. Mild neural foraminal narrowing." }, { "input": "From skullbase to T3 level, there is no evidence of intrinsic focal signal\nabnormalities within the spinal cord or extrinsic compression. No abnormal\nenhancement is seen. There is mild focal kyphosis of the cervical spine in\nthe midcervical region. There is no evidence of disc bulge disc herniation or\nspinal stenosis. There is no foraminal narrowing.", "output": "1. No focal abnormalities within the spinal cord to suggest demyelinating\ndisease. No abnormal enhancement.\n2. No evidence of significant disc bulge disc herniation or spinal stenosis." }, { "input": "There are 7 cervical, 12 thoracic, and 5 lumbar-type vertebrae. The numbering\nis documented on images 100:6, 6:9, 9:8.\n\nCERVICAL:\nSagittal images are limited by motion artifact, and axial images are limited\nby pulsation artifacts. There is no evidence for bone marrow edema,\nligamentous edema, or paravertebral edema. Vertebral body heights are\npreserved. Alignment is normal. There is no evidence for an epidural\ncollection. Spinal cord signal is within normal limits allowing for the above\ndescribed artifacts.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\nunremarkable.\n\nThe craniocervical junction and C1-C2 level are unremarkable.\n\nC2-C3: No spinal canal or neural foraminal narrowing. Mild left greater than\nright facet arthropathy.\n\nC3-C4: Small central disc protrusion indents the ventral thecal sac but does\nnot contact the spinal cord. No significant neural foraminal narrowing.\n\nC4-C5: Small central disc protrusion indents the ventral thecal sac and\nslightly remodels the ventral spinal cord. However, the cord is surrounded by\nplentiful CSF laterally and posteriorly. The spinal canal is only mildly\nnarrowed. No significant neural foraminal narrowing.\n\nC5-C6: Shallow broad-based disc protrusion versus endplate osteophytes\nminimally indent the ventral thecal sac without mass effect on the spinal\ncord. Mild to moderate right and mild left neural foraminal narrowing by\nuncovertebral osteophytes.\n\nC6-C7: No significant spinal canal or neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nImages are mildly limited by motion artifact. There is no evidence for bone\nmarrow edema, ligamentous edema, or paravertebral edema. Vertebral body\nheights are preserved. Alignment is normal. There is no evidence for an\nepidural collection. The spinal cord signal is within normal limits allowing\nfor motion artifact. The conus medullaris terminates at T12-L1. There is no\nsignificant spinal canal narrowing.\n\nLUMBAR:\nNondisplaced fracture through the right inferior corner of the L3 vertebral\nbody is better seen on the preceding CT torso. Only minimal associated edema\nis seen on STIR images, image 10:5. There is mild edema in the adjacent right\nanterior paravertebral soft tissues, images 12:20, 10:3. No bone marrow edema\nis seen elsewhere. There is no evidence for ligamentous edema. Vertebral\nbody heights are preserved. Alignment is normal. There is no evidence for an\nepidural collection.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: Small left paracentral disc protrusion indents the ventral thecal sac\nbut does not appear to impinge the traversing left L2 nerve root. No signet\nmass effect on the intrathecal nerve roots. No significant neural foraminal\nnarrowing.\n\nL2-L3: Mild disc bulge without spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild disc bulge without significant spinal canal narrowing. Mild\nbilateral neural foraminal narrowing.\n\nL4-L5: Mild disc bulge without significant spinal canal narrowing. Mild\nbilateral neural foraminal narrowing, left greater than right.\n\nL5-S1: No significant spinal canal or neural foraminal narrowing.\n\nOTHER:\n1.6 cm sharply marginated lobulated T2 hyperintense lesion in the posterior\nright hepatic lobe on image 13:16 is compatible with a cyst.", "output": "1. No evidence for acute traumatic injuries in the cervical or thoracic spine\nallowing for motion artifact.\n2. Nondisplaced fracture of the right inferior corner of the L3 vertebral body\ndemonstrates only minimal associated marrow edema. There is mild edema in the\nadjacent right anterior paravertebral soft tissues. No evidence for\nadditional acute traumatic injuries in the lumbar spine.\n3. Mild degenerative changes in the cervical and lumbar spine, as detailed\nabove." }, { "input": "There is mild scoliosis of the lumbar spine. From T10-T11 to L3-4 mild\ndegenerative changes identified. Previously seen left-sided protrusion at L3-4\nlevel is no longer visible.\n\nAt L4-5 level, there is progression of degenerative changes with increase\nfacet arthropathy and spondylolisthesis. There is uncovering of the disc.\nThere is moderate spinal stenosis seen with severe right foraminal narrowing\nand compression of exiting right L4 nerve root. There is mild narrowing of the\nleft foramen.\n\nAt L5-S1 level new left-sided disc herniation identified indenting the thecal\nsac and displacing left S1 nerve root. There is mild narrowing of both\nforamina.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. New left-sided disc herniation at L5-S1 level which could affect the left\nS1 nerve root.\n2. Increase facet arthropathy and spondylolisthesis of L4 over L5 resulting in\nmoderate spinal stenosis and severe right foraminal narrowing." }, { "input": "There is unchanged grade 1 anterolisthesis of L4-L5 (series 4:image 11). The\nlumbar vertebral body heights are maintained. The conus medullaris terminates\nat the level of L1 and is unremarkable.\n\nAt T12/L1 level, there is no significant canal or neural foraminal stenosis.\n\nAt L1/L2 level, there is no significant canal or neural foraminal stenosis.\n\nAt L2/L3 level, there is no significant canal or neural foraminal stenosis.\n\nAt L3/L4 level, there is a no significant canal or neural foraminal stenosis.\n\nAt L4/L5 level, there is stable grade 1 anterolisthesis of L4-L5. Degenerative\nchanges are noted in the adjacent endplates of L4-L5. There is facet\narthropathy. There is stable moderate canal narrowing and severe right and\nmild left neural foraminal stenosis.\n\nAt L5/S1 level, there is facet arthropathy with a posterior left synovial cyst\n(series 3:Image 19). Edematous changes are noted in the left adjacent\nendplates. There is a disc bulge with mild canal narrowing and bilateral mild\nneural foraminal stenosis.\n\nThe sacroiliac joints are normal .\nThe visualized paravertebral structures are unremarkable. There are stable\nbilateral T2 hyperintense lesions in the kidneys.", "output": "1. Unchanged moderate lumbar spine degenerative changes, most prominent L4-L5\nand L5-S1, as described above.\n2. Stable T2 hyperintense lesions in the kidneys.\n\nRECOMMENDATIONS: RE 2: Recommend while this finding may represent a renal\ncysts, other etiologies cannot be excluded on the basis of this examination.\nRecommend clinical correlation. If clinically indicated, further evaluation\nmay be obtained via renal ultrasound." }, { "input": "Vertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nThere is no concerning focal bone marrow signal abnormality. Fat containing\nlesions within the L2, L2, and S1 vertebral bodies most likely represent\nhemangiomas. The conus medullaris terminates at the level of L1-L2.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1 through L3-L4: There is no spinal canal or neural foraminal stenosis.\n\nL4-L5: Posterior disc bulging with slight superimposed left paracentral disc\nprotrusion indents the ventral thecal sac, mild subarticular recess and\nminimal foraminal narrowing. There is no compression or displacement of nerve\nroots.\n\nL5-S1: A posterior disc bulge is seen with superimposed left paracentral \nannular fissure. There is no displacement of nerve roots seen. There is\nminimal narrowing of the foramina.\n\nThe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Mild degenerative changes without high-grade spinal stenosis or foraminal\nnarrowing. No evidence of nerve root displacement or compression.." }, { "input": "A posterior retromedullary collection of heterogeneous intensity on STIR and\nmostly isodense to the cord on T1 is present extending from C1 to the level of\nC3, measuring 35 x 17 x 6 mm and consistent with a hematoma. The collection\npartially surrounds the cord posteriorly effacing its margin, findings that\nare more characteristics of a subdural collection. The collection is much more\nheterogeneous at the level of C1, where there is a low intensity focus along\nthe inner aspect of the posterior arch in the right which may be associated\nwith osteophytosis, however, a fracture cannot be excluded. The cord appears\nslightly displaced anteriorly. A patchy cord signal abnormality is\ndemonstrated at this level, however, whether this is related to an acute\ninjury or associated with the reported history of multiple sclerosis cannot be\nelucidated on this exam, as abnormal patchy cord signals are also seen at the\nC5-C6, C7-T1, and T2-T3 levels.\nAt least 2 additional likely subdural collections concerning for hematoma are\nalso present at the T7 through T1-T2 levels, the largest measuring\napproximately 33 x 9 x 5 mm.\nThere is a 4 mm retrolisthesis of C3 over C4 and 2 mm retrolisthesis of C6\nover C7, without evidence of ligament disruption, however, there is posterior\nsoft tissue edema from C2 through C7 levels. The vertebral bodies height is\noverall preserved.\nA focus of high STIR/low T1 signal is noted at the posterior C2-odontoid\njunction, may represent edema associated with a small fracture, although no\ndefinite cortical disruption is demonstrated within limitation of the study\nwhich is slightly limited by motion.\n\nMultilevel degenerative changes are noted.\n\nAt C2-3 there is the likely subdural hematoma slightly displacing the cord\nanteriorly. There is no significant spinal canal or neural foraminal\nstenosis.\n\nAt C3-4 there is retrolisthesis and disc bulge abutting the thecal sac\nanteriorly resulting in mild spinal canal and neural foraminal stenosis.\n\nAt C4-5 there is facet joint osteophytes resulting in mild neural foraminal\nstenosis. No significant spinal canal stenosis noted.\n\nAt C5-6 there is disc bulge effacing the thecal sac anteriorly and facet joint\nosteophytes resulting in moderate spinal canal. No neural foraminal stenosis.\n\nAt C6-7 there is retrolisthesis, disc bulge, and facet joint osteophytes\nresulting in moderate spinal canal and mild right, moderate left neural\nforaminal stenosis.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis. A posterior\nsubdural collection is demonstrated.\n\nAt T1-T2 there is no spinal canal or neural foraminal stenosis. A posterior\nsubdural collection at the level T1 abuts the cord posteriorly.", "output": "1. Subdural collections consistent with hematomas extending from C1 to C3\nmeasuring 35 x 17 x 6 mm, and at T1-T2 measuring 27 x 9 x 5 mm. Cord\nabnormalities at these and other levels as described above may be associated\nwith the reported history of multiple sclerosis or acute injury, indeterminate\nbased on this noncontrast exam.\n2. High signal abnormality in the posterior C2-odontoid junction and low\nintensity focus associated with the subdural hematoma along the inner\nposterior arch of C1 on the right, may reflect osteophytosis, however, a\nfracture cannot be excluded.\n3. Extensive soft tissue edema involving the superficial soft tissues\nposteriorly, extending from C2 to C7. No interspinous edema is demonstrated.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:20 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Alignment of the cervical spine is anatomic. Vertebral body heights are\npreserved. There is loss of intervertebral disc space height involving the\nC5-C6, C6-C7, and C7-T1 levels. Throughout the cervical spine, discs are low\nin signal intensity on the T2 weighted sequences to suggest multilevel disc\ndesiccation. No worrisome lesion is identified, bone marrow signal appears\nwithin normal limits. The spinal cord is normal in caliber and signal\nintensity.\n\nC2-C3: There is no significant spinal canal narrowing or neural foraminal\nnarrowing.\n\nC3-C4: Central disc protrusion effaces the anterior CSF space but does not\ncontact the cord. At this level is mild spinal canal narrowing. Mild\nbilateral neural foraminal narrowing is present.\n\nC4-C5: A central disc bulge effaces the anterior CSF space but does not\ncontact the cord. Mild to moderate bilateral neural foraminal stenosis, left\ngreater than right, is present.\n\nC5-C6: A large left paracentral disc bulge encroaches upon the cord but does\nnot contacted. At this level is moderate bilateral neural foraminal stenosis,\nright greater than left. Thickening of the ligamentum flavum contributes to\nmoderate spinal canal narrowing at this level.\n\nC6-C7: Central disc bulge effaces the anterior CSF space but does not\nencroach upon the spinal cord. Mild bilateral neural foraminal stenosis is\npresent. Ligamentum flavum thickening does not result in stenosis of the\nspinal canal. A 4 mm nerve root sheath dilation is noted on the left.\n\nPosterior paraspinal soft tissues are unremarkable. There is no prevertebral\nsoft tissue swelling or edema.", "output": "1. Multilevel disc desiccation and degenerative changes. Multilevel disc\nbulges which is most severe at the C5-C6 level. Thickening of the ligamentum\nflavum at this level results in moderate spinal canal narrowing.\n\n2. Moderately narrowed neural foramen at the C5-C6 and mild narrowing at the\nC6-C7 level is noted.\n\n3. Small 4mm left nerve root sheath dilation at the C6-C7 level." }, { "input": "There is mild superior endplate compression deformity of the T2 vertebral body\nwith mild associated marrow T2 hyperintensity. There is no associated bony\nretropulsion. The deformity was present on prior study from ___.\n\nThere is severe anterior compression deformity of the T6 vertebral body with\nassociated\nT5-T7 focal kyphosis and 5 mm of bony which contacts and mildly deforms the\nthoracic cord. There is no associated cord signal abnormality. This is\nunchanged comparison to ___.\n\nThere is chronic severe compression deformity of L2 vertebral body with 8 mm\nof bony retropulsion causing severe spinal canal stenosis. This is relatively\nunchanged comparison to ___.\n\nThere is a chronic superior endplate Schmorl's node at L1.\n\nOtherwise the vertebral body heights are preserved. There is 1 mm\nanterolisthesis C7 on T1.\n\nAt C5-C6 there intervertebral osteophytes causing moderate spinal canal\nstenosis which contacts the cord without associated cord signal abnormality. \nAt T1-T2 there is disc bulge and ligamentum flavum infolding causing mild\nspinal canal narrowing without significant neural foraminal stenosis. There\nis no significant spinal canal or neural foraminal stenosis at the remaining\nvisualized levels.\n\nThere is a partially visualized old left pelvic renal cysts better\ncharacterized on prior CT from ___. Otherwise the paravertebral\nsoft tissues are unremarkable.", "output": "1. Mild superior endplate compression deformity of the T2 vertebral body which\nwas present on sagittal localizer sequence from ___. The mild\nassociated marrow edema may represent a degree of superimposed acute to\nsubacute fracture versus degenerative signal. No associated bony retropulsion\nor cord compression.\n2. Severe chronic anterior wedge compression deformity of the T6 vertebral\nbody with 5 mm bony retropulsion which contacts the cord. There is no\nassociated cord signal abnormality. This is unchanged comparison to ___.\n3. Severe chronic compression deformity of the L2 vertebral body with 8 mm\nbony retropulsion causing severe spinal canal stenosis, which is unchanged\ncomparison to ___.\n4. No evidence of ligamentous injury." }, { "input": "The examination is mildly motion degraded. Within this confine:\n\nCervical alignment is anatomic. Anterior wedge shape of T2 with less than 20%\nloss of vertebral body height is unchanged from prior examination. Otherwise,\nvisualized vertebral body heights are preserved. There is no focal suspicious\nmarrow lesion. ___ type 3 C5-C6 endplate changes are identified,\ncorresponding to region of sclerosis seen on prior CT cervical spine. Loss of\ndisc height at C4-C5 and C5-C6 is severe and moderate at C6-C7 and C7-T1. \nCerebellar involutional changes are noted. There is no cord signal\nabnormality.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3-C4: There is no significant spinal canal narrowing. Uncovertebral facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nC4-C5: There is no significant spinal canal narrowing. Uncovertebral facet\narthropathy results in moderate right and mild left neural foraminal\nnarrowing.\n\nC5-C6: Intervertebral osteophytes and central protrusion with thickening of\nthe ligamentum flavum results in moderate spinal canal narrowing, minimally\nremodeling the cord. Uncovertebral and facet arthropathy results in severe\nbilateral neural foraminal narrowing.\n\nC6-C7: There is no significant spinal canal or neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nOther: On scout images, there is enlargement of the ventricles, similar\nappearance to prior examination. Given the symptoms of dating stability in\nurinary incontinence, Clinical correlation with normal pressure hydrocephalus\nis recommended. Visualize prevertebral and paraspinal soft tissues are\ngrossly unremarkable.", "output": "1. Multilevel multifactorial cervical spondylosis, most prominent at C5-C6\nwhere there is moderate spinal canal narrowing minimally remodeling the cord\nwithout underlying cord signal change.\n2. There is severe bilateral C5-C6 neural foraminal narrowing.\n3. On scout images, there is prominence of the ventricles, similar appearance\nto prior examinations of the head. Given the patient's symptoms, correlation\nwith normal-pressure hydrocephalus is recommended." }, { "input": "Chronic severe compression deformity of L2 with approximately 8 mm\nretropulsion is essentially unchanged in configuration from prior MRI. This\nresults in kyphotic angulation of the thoracolumbar junction. . The\nremainder of the lumbar alignment is anatomic. The remainder the vertebral\nbody heights are preserved. Degenerative loss of disc height and signal is\nsevere at L4-L5 and L5-S1 with associated ___ type 2 endplate changes. \nOtherwise, there is no focal suspicious marrow lesion. The conus medullaris\nterminates at the L1 level, within expected limits. There is no signal\nabnormality of the terminal cord or conus.\n\nT12-L1: There is no significant spinal canal or neural foraminal narrowing at\nthe T12-L1 level.\n\nL1-L2: There is no significant spinal canal narrowing. Compression deformity\nof L1 and facet arthropathy results in mild bilateral neural foraminal\nnarrowing.\n\nL2-L3: There is moderate spinal canal narrowing secondary to L2 fracture\ndeformity 8 mm retropulsion (series 5, image 12), similar in appearance from\nprior MRI thoracic spine allowing for technical differences. There is no\nsignificant neural foraminal narrowing.\n\nL3-L4: There is no significant spinal canal narrowing. Facet arthropathy and\nsmall disc bulge contributes to mild bilateral neural foraminal narrowing.\n\nL4-L5: There is no significant spinal canal narrowing. Facet arthropathy\ncontributes to mild bilateral neural foraminal narrowing.\n\nL5-S1: There is no significant spinal canal narrowing. Facet arthropathy\nresults in mild right greater than left neural foraminal narrowing.\n\nA 4.4 cm T2 hyperintense simple cyst in the left renal midpole is unchanged\nfrom CT examination of ___. Otherwise, the visualize prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. Re-identified is severe L2 compression deformity with 8 mm retropulsion. \nThis results in moderate spinal canal narrowing at L2-L3, similar in\nappearance to prior examination.\n2. No new fractures are identified. There is no second spinal canal narrowing\nat the remainder of the lumbar levels. No high-grade neural foraminal\nnarrowing.\n3. Additional findings as described above." }, { "input": "CERVICAL:\nUpper cervical spine is not well covered on this scan. Multilevel\ndegenerative changes cervical spine, disc osteophyte complex, posterior\nelement hypertrophic changes. Probably moderate central canal narrowing\nC4-C5. Multilevel mild-to-moderate foraminal narrowing. Minimal\nretrolisthesis C4-C5, C5-C6, degenerative. No worrisome osseous lesions, no\nprevertebral edema normal visualized cord.\n\nTHORACIC:\nAcute/subacute compression fracture T11 vertebral body, with vertebral body\nedema, mild paraspinal edema. 2 mm retropulsion. No epidural hematoma. \nFindings are similar compared to CT scan.\n\nMultilevel chronic compression fractures T2, T3, T5, T7, T9, T10, T12\nvertebral bodies. Moderate height loss at T5, T7, T9, T10, and severe height\nloss at T12. Multilevel mild retropulsion at the level of the fractures, most\nprominent at T12 measuring 4 mm, contributing to mild-to-moderate central\ncanal narrowing, preserved CSF about cord.\n\nThoracic kyphosis. Multilevel degenerative changes. Multilevel mild central\ncanal narrowing thoracic spine. Multilevel mild foraminal narrowing thoracic\nspine..\nSmall benign left renal cyst, most likely benign, no further follow-up\nindicated.\n\nLUMBAR:\nChronic L2 compression fracture, moderate height loss, 3 mm retropulsion, mild\ncentral canal narrowing. No acute fracture.\nDegenerative changes lumbar spine. Minimal L4-5 anterolisthesis,\ndegenerative. Multilevel diffuse disc bulges, lumbar facet arthritis.\nMild central canal narrowing L1-L 2, L4-5 levels. Central canal otherwise\npatent..\nModerate bilateral L4-5 foraminal narrowing. Multilevel mild foraminal\nnarrowing elsewhere.\nParaspinal muscle atrophy. Gallbladder sludge and/or stones", "output": "1. Acute/subacute T11 compression fracture, mild height loss.\n2. Multilevel chronic compression fractures thoracic, lumbar spine.\n3. Degenerative changes spine.\n4. Moderate central canal narrowing cervical spine, partially imaged.\n5. Mild central canal narrowing thoracic, lumbar spine.\n6. Multilevel foraminal narrowing, as above." }, { "input": "There is a severe compression deformity of the L1 vertebral body including\nprogressive loss of vertebral body height when compared to prior exam dated ___ although appears similar when compared to most recent lumbar spine\nradiographs dated ___. There is mild loss of height of the L2\nvertebral body with bone marrow edema which has increased when compared to\nprior MR of although is similar to most recent spinal radiographs. There is\nnew edema within the L1 and L2 vertebral bodies, as well as within the L2\nbody, pedicles, and spinous process which suggests the possibility of interval\ntraumatic injury. There is no spinal cord compression. There is no abnormal T1\nhypointense signal or soft tissue mass to suggest metastatic disease.\n\nThe remaining vertebral body heights are normal. There is minimal\nretrolisthesis of L2 on L3. There is levoconvex curvature of the lumbar spine\ncentered at the L2-L3 level.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe L1 level.\n\nIncidental note is made of cholelithiasis. The remaining paraspinal and\nprevertebral soft tissues are unremarkable.\n\nAt the T12-L1 level, the spinal canal is narrowed secondary to intervertebral\nosteophytes and compression deformity. There is no evidence of compression of\nthe traversing nerve roots. The neural foramina appear normal.\n\nAt the L1-L2 level, there is mild bilateral facet arthropathy a without\nsignificant neural foraminal narrowing.\n\nAt the L2-L3 level, there is bilateral facet arthropathy and a diffuse disc\nbulge which causes mild bilateral neural foraminal narrowing at in mild spinal\ncanal narrowing.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge which causes minimal spinal canal\nnarrowing and moderate left neural foraminal narrowing, and mild right neural\nforaminal narrowing.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge which causes mild left neural foraminal\nnarrowing.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, diffuse disc bulge,\nand superimposed posterior disc protrusion which causes mild right and\nmoderate left neural foraminal narrowing.", "output": "1. Severe compression deformity of the L1 vertebral body which is progressive\nwhen compared to ___ with additional mild compression deformity L2 vertebral\nbody with new edema of L1 on L2, as described, suggesting the possibility of\ninterval traumatic injury\n2. No significant spinal canal narrowing or evidence of neural impingement." }, { "input": "Mild convex right curvature of the thoracic spine, is re- demonstrated. \nSevere compression deformity of L1 appears unchanged compared to the prior\nexam. No definite acute fracture is identified. The conus medullaris\nterminates at T12/L1, however no cord signal abnormalities are identified.\n\nL1-L2: Re demonstrated is a compression deformity of L1, with mild\nretropulsion of the middle column of approximately 4 mm. There is no\nsignificant neural foraminal narrowing at this level. Mild spinal canal\nnarrowing is seen.\n\nL2-L3: Mild central disc bulge, with a focal left foraminal disc protrusion\nis seen. Facet joint osteophytes and ligamentum flavum arthropathy contribute\nto moderate left neural foraminal narrowing. The right neural foramen is\npatent.\n\nL3-L4: Mild central disc bulge is seen resulting an bilateral subarticular\nzone narrowing. Facet joint osteophytes are seen bilaterally, however there\nis no significant neural foraminal narrowing.\n\nL4-L5: There is no significant neural foraminal or spinal canal narrowing at\nthis level.\n\nL5-S1: Mild central disc bulge is seen however there is no significant spinal\ncanal or neural foraminal narrowing at this level.\n\nThere is an unchanged perineural cyst (Tarlov cyst), in the sacrum at the\nlevel of S1-S2 on the left.\n\nNo other paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Chronic compression fracture of L1 appears unchanged compared to the prior\nexam. No new compression fractures identified.\n2. Lumbar spondylosis, most pronounced at L2-L3, with a central disc bulge and\nleft foraminal disc protrusion. There is moderate left neural foraminal\nnarrowing and subarticular zone narrowing." }, { "input": "There is minimal retrolisthesis of C5 on C6. Vertebral body heights are\npreserved. There is increased STIR signal and corresponding decreased T1\nsignal at the anterior inferior endplate of C5 and the anterior superior\nendplate of C6, consistent with ___ type 1 change. There is no definite\nepidural collection. There is a Schmorl's node in the superior endplate of\nthe C7 vertebral body.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of disc space height at C5-6 as well as diffuse loss of signal\nthroughout the discs.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is no vertebral canal narrowing or neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, ligamentum flavum hypertrophy, facet hypertrophy\nand uncovertebral osteophytes causing mildvertebral canal narrowing, mild left\nand moderate right neural foraminal narrowing.\n\nAt C5-6 there is disc bulge resulting in deformation of the ventral thecal sac\nand spinal cord with no definite abnormal cord signal. There is mild\nvertebral canal narrowing. There is mild narrowing of the neural foramina\nbilaterally.\n\nAt C6-7 there is disc bulge causing deformation of the ventral thecal sac with\nno definite abnormal cord signal. This results in mild narrowing of the\nvertebral canal. There is no neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nLimited imaging of the thoracic spine reveals disc bulge and likely mild\nnarrowing of the spinal cord at T1-2.", "output": "1. Multilevel cervical spondylosis as described, most pronounced at C5-6,\nwhere there is mild vertebral canal narrowing deformation of the ventral\nthecal sac and spinal cord, no definite associated cord signal abnormality,\nand mild bilateral neural foraminal narrowing.\n2. C4-5 moderate right and mild left neural foraminal narrowing.\n3. Limited imaging of the thoracic spine demonstrates disc bulge with mild\nvertebral canal narrowing at T1-2. If clinically indicated, consider dedicated\nthoracic spine MRI for further evaluation." }, { "input": "Minimal 2 mm retrolisthesis of L2 on L3 and L3 on L4 as well as 9 mm right\nlateral listhesis of L2 on L3 is identified. The remainder of the lumbar\nalignment is anatomic. Vertebral body heights are preserved. ___ type 1\nendplate changes at L2-L3 and L3-L4 as well as prominent superior endplate\nSchmorl's nodes spanning T12 through L2 are identified. No focal suspicious\nmarrow lesion. The conus medullaris terminates at the L1 level, within\nexpected limits. There is no signal abnormality of the terminal cord.\n\nT12-L1: A disc bulge with thickening of the ligamentum flavum and facet\nhypertrophy results in mild spinal canal narrow. There is no significant\nneural foraminal narrowing.\n\nL1-L2: A disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. There is no significant neural foraminal narrowing.\n\nL2-L3: A disc bulge with epidural fat and thickening of the ligamentum flavum\nresults in moderate spinal canal narrowing. In combination with facet\narthropathy, there is mild to moderate left and moderate right neural\nforaminal narrowing. A facet osteophyte appears to contact the exiting right\nL2 nerve root.\n\nL3-L4: A disc bulge does not significantly narrow the spinal canal. In\ncombination with facet arthropathy, there is moderate right and mild left\nneural foraminal narrowing.\n\nL4-L5: A disc bulge mildly eccentric to the right does not significantly\nnarrow the spinal canal. There is bilateral facet arthropathy with cysts\nsmall facet joint effusions. The combination degenerative changes results in\nmild right and no significant left neural foraminal narrowing.\n\nL5-S1: A disc bulge does not significantly narrow the spinal canal. In\ncombination with facet arthropathy, there is severe left and no significant\nright neural foraminal narrowing.\n\nMultiple T2 hyperintense cystic lesions of both kidneys measuring up to 1.3 cm\nare statistically most likely simple cysts. Colonic diverticulosis without\nevidence of diverticulitis. Otherwise, the visualized prevertebral and\nparaspinal soft tissues are unremarkable.", "output": "1. Multilevel lumbar spondylosis as described above, most prominent at L5-S1\nwhere there is severe left neural foraminal narrowing and at L2-L3 where there\nis moderate spinal canal narrowing and moderate right neural foraminal\nnarrowing.\n2. Additional findings as described above." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThere is anterior wedge deformity of the T12 vertebral body with no associated\nedema or epidural collection. Schmorl's nodes are noted in the T12 and L3\nvertebral bodies. There is grade 1 L5 on S1 anterolisthesis. Degenerative\nendplate changes are noted at L1-2, L3-4, L4-5, and L5-S1 levels.\n\n The visualized portion of the spinal cord is preserved in signal and caliber,\nwith the conus noted at L1.\n\nThere is loss of intervertebral disc height and signal at the T11-12, L3-4,\nL4-5, and L5-S1 levels.\n\nAt T11-12, T12-L1, L2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is a left paracentral disc protrusion with no spinal canal or\nneural foraminal stenosis.\n\nAt L3-4 there is a disc bulge with ligamentum flavum hypertrophy and facet\njoint hypertrophy resulting in bilateral lateral recess stenosis, moderate\nspinal canal stenosis, moderate bilateral neural foraminal stenosis.\n\nAt L4-5 there is a disc bulge with ligamentum flavum hypertrophy and facet\njoint hypertrophy resulting in bilateral lateral recess stenosis, moderate\nspinal canal stenosis, moderate bilateral neural foraminal stenosis.\n\nAt L5-S1 there is grade 1 L5 on S1 anterolisthesis with partial unroofing of\nthe intervertebral disc, a disc bulge with moderate bilateral neural foraminal\nstenosis and no spinal canal stenosis.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. An\napproximately 7 mm left renal (see series 6, image 2) and at least 5 mm right\nrenal (see series 6, image 23) T2 hyperintense structures are noted within the\nvisualized portion of the kidneys.", "output": "1. Multilevel degenerative changes, most pronounced at L3-4 and L4-5 levels\nwhere there is moderate spinal canal stenosis, bilateral lateral recess\nstenosis, and moderate bilateral neural foraminal stenosis.\n2. L5-S1 Moderate bilateral neural foraminal stenosis.\n3. Anterior wedge deformity of T12 vertebral body with no associated edema or\nepidural collection, which may represent a chronic fracture. Recommend\nclinial correlation.\n4. L5 on S1 grade 1 anterolisthesis.\n5. Partial imaging of kidneys suggestive of possible renal cysts, though other\netiologies cannot be excluded on the basis of this noncontrast examination.\nRecommend clinical correlation. If clinically indicated, consider dedicated\nrenal imaging." }, { "input": "At the craniocervical junction and C2-3 and C3-4 no abnormalities are seen.\n\nAt C4-5 mild disc bulging identified without spinal stenosis or foraminal\nnarrowing.\n\nAt C5-6, C6-7 and inferiorly to T2-3 level, no abnormalities are seen.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression. \nThere is no evidence of bony or ligamentous injury seen. Facet joint\nalignment is normal. The prevertebral soft tissue thickness is maintained.", "output": "Minimal disc bulging at C4-5 level, otherwise unremarkable MRI of the cervical\nspine. No evidence of disc herniation, spinal stenosis or foraminal\nnarrowing. No signs of acute bony or ligamentous injury." }, { "input": "Mildly displaced fracture at C5 right lateral mass was better demonstrated on\nprior C-spine. STIR hyperintensity at C5 right lateral mass is consistent\nwith bone marrow contusion. STIR hyperintensity in the soft tissues\nsurrounding the spinous processes at C2-6 levels are suspicious for posterior\nligamentous complex injury. Mild prevertebral soft tissue edema is noted at\nC3-5 levels.\n\nFocal mild depression deformity of T3 superior endplate with associated\nsurrounding STIR hyperintensity of the T3 vertebral body bone marrow is\nsuspicious for compression fracture. There is no retropulsion.\n\nMild retrolisthesis of C5 over C6 is noted. Vertebral body and intervertebral\ndisc signal intensity appear normal. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of neural foraminal\nnarrowing.\n\nAt C3-4, C4-5, and C5-6, disc protrusion cause mild spinal canal narrowing. 4\nmm bone lesion in T2 spinous process (3:7) is nonspecific.", "output": "1. T3 vertebral body superior endplate mild compression fracture is\nidentified.\n2. C5 right lateral mass fracture is again demonstrated.\n3. Soft tissue edema surrounding C2-6 spinous processes is suspicious for\nposterior ligamentous complex injury.\n4. No spinal cord injury is identified." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is sigmoid scoliosis of the lumbar spine. Approximately 4 mm grade 1 L3\non L4 anterolisthesis is present. There is transitional anatomy with partial\nsacralization of L5. Schmorl's nodes are seen at multiple levels of the\nlumbar spine.\n\nL3 vertebral body linear T2 and STIR hyperintensity with corresponding T1\nhypointensity parallel to the inferior endplate is noted, with question\nminimal (approximately 5%) anterior compression deformity versus volume\naveraging artifact. Signal abnormality does not clearly extend into the\npedicles, though evaluation is limited secondary to artifact. There is no\ndefinite bony retropulsion. A question minimal prevertebral edema versus\nartifact.\n\nOtherwise, vertebral body heights are grossly preserved.\n\nL5 vertebral body focal T2, STIR, T1 hypointense lesion, suggested to\ncorrespond to areas of bony sclerosis on ___ prior abdomen and\npelvis CT is noted (see 01:15; 3, 04:10; 05:36 on current study and 05:40;\n02:49 on prior CT), suggestive of bone island.\n\nL5-S1 probable type ___ ___ changes are seen. L4 inferior endplate Schmorl's\nnode with peripheral STIR hyperintensity is noted, suggestive of acute to\nsubacute Schmorl's node.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Dural ectasia is noted. Multiple probable sacral Tarlov cysts are\nnoted.\n\nThere is loss of intervertebral disc height and signal throughout the lumbar\nspine. Nonspecific facet joint fluid is noted at multiple levels of the\nlumbar spine.\n\nAt T12-L1 there is disc bulge, facet hypertrophy, epidural fat, ligamentum\nflavum thickening, with mild vertebral canal and no neural foraminal\nnarrowing.\n\nAt L1-2 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild-to-moderatevertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with moderatevertebral canal and mild bilateral\nneural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy contacts exiting left L3\nnerve root, ligamentum flavum thickening, dural fat, with severe vertebral\ncanal and moderate bilateral neural foraminal narrowing. Nonspecific\nbilateral facet joint fluid is noted. Right-sided facet joint probable\nsynovial cyst is noted.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild vertebral canal and mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge contacts bilateral descending S1 and exiting left\nL5 nerve root, facet joint hypertrophy contacts exiting right L5 nerve root,\nligamentum flavum thickening, with mild vertebral canal and mild bilateral\nneural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Probable perineural cysts are noted at multiple\nlevels throughout the visualized thoracolumbar spine. Nonspecific probable\ndependent edema is noted in the dorsal lumbar soft tissues.\n\nLimited imaging of the kidneys demonstrate multiple bilateral subcentimeter at\npartially T2 hyperintense lesions, incompletely characterized.", "output": "1. Study is moderately degraded by motion.\n2. Findings suggestive of acute to subacute L3 compression fracture with\nquestion minimal L3 anterior compression deformity, and no definite bony\nretropulsion as described, with differential consideration of pathologic\nfracture less likely.\n3. Multilevel lumbar spondylosis and epidural fat as described, most\npronounced at L3-4, where there is facet joint hypertrophy contacts exiting\nleft L3 nerve root, with severe vertebral canal and moderate bilateral neural\nforaminal narrowing.\n4. L2-3 moderatevertebral canal and mild bilateral neural foraminal narrowing.\n5. L5-S1 disc bulge contacts bilateral descending S1 and exiting left L5 nerve\nroots and facet joint hypertrophy contacts exiting right L5 nerve root with\nmild vertebral canal and mild bilateral neural foraminal narrowing.\n6. Limited imaging of the kidneys demonstrate multiple bilateral at partially\ncystic subcentimeter lesions, incompletely characterized.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:14 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The study is limited by motion artifact.\n\nVertebral body heights are preserved. Evidence of graft-mediated fusion of C5\nand C6 vertebral bodies is again noted. Mild retrolisthesis of C6 on C7 is\nunchanged. No concerning bone marrow signal abnormalities is seen.\n\nEvaluation of spinal cord signal is somewhat limited by artifact on multiple\nsequences. However, both the sagittal and axial T1 weighted images demonstrate\na focus of high signal in the left aspect of the spinal cord at the level of\nC6 near the superior endplate, images ___ and 5:18. There is no associated\ncontrast enhancement. This was previously seen on the ___ cervical\nspine MRI, when cord compression by degenerative disease at C5-6 was present.\n\nThe cerebellar tonsils are normally positioned. Visualized portions of the\nposterior fossa appears unremarkable.\n\nThe level of the craniocervical junction and the level of the atlantoaxial\njoint appear unremarkable.\n\nAt C2-3, there is a left facet arthropathy with mild left neural foraminal\nnarrowing, similar to prior.\n\nAt C3-4, there is a small central disc protrusion which indents the ventral\nthecal sac but does not contact the spinal cord. There is also mild to\nmoderate bilateral neural foraminal narrowing by uncovertebral osteophytes ;\nassessment is limited by artifact.\n\nAt C4-5, there is a broad-based shallow central disk protrusion which indents\nthe ventral thecal sac but does not contact the spinal cord. On ___,\nthis disc protrusion had a larger right paracentral component. There is\nmoderate bilateral neural foraminal narrowing by uncovertebral osteophytes,\nunchanged.\n\nAlong the posterior aspect of the surgically fused C5 and C6 vertebral bodies,\nthere is a bone ridge, larger on the right, which flattens the ventral surface\nof the spinal cord on the right, unchanged. There is severe right and\nmoderate-to-severe left C5-6 neural foraminal narrowing by uncovertebral\nosteophytes, unchanged.\n\nAt C6-7, there is a mild retrolisthesis and a broad-based disc osteophyte\ncomplex, shallow on the left but to large on the right, which flattens the\nright ventral aspect of the spinal cord. . There is severe, right greater than\nleft neural foraminal narrowing by uncovertebral osteophytes. These findings\nare unchanged.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nPreviously described 1.8 cm oval T2 hyperintense lesion to the left of the T4\nvertebral body, without contrast enhancement, is again partially visualized on\nthe sagittal images, without interval change. On the ___ thoracic spine\nMRI, it was thought to represent a neurenteric cyst or, less likely, a\nsynovial cyst.", "output": "1. At C4-5, the previously noted disk protrusion has decreased in size\ncompared to ___, currently shallow broad-based, and previously with\na larger right paracentral component. Allowing for motion artifact, no other\nchange is seen with multilevel degenerative disease, as detailed above.\n2. Unchanged appearance of ACDF at C5-6 and minimal retrolisthesis of C6 on\nC7.\n3. Small focus of high signal in the left aspect of the spinal cord at the\nlevel of the C6 superior endplate. This is unchanged since ___\ncervical spine MRI, when spinal cord compression by degenerative disease at\nC5-6 was present, suggesting myelomalacia." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. Multiple cervical lymph nodes measuring\nup to 1.3 cm are noted, which may be reactive, better seen on the CT from ___.", "output": "Unremarkable cervical spine MRI." }, { "input": "From T11-12 through L4-5 levels, there is no evidence of significant disc\nbulge or disc herniation seen. There is an incidental hemangioma in L3\nvertebral body.\n\nAt L5-S1 level, disc bulging and degenerative change seen with a right-sided\ndisc herniation which extends inferiorly surrounding the right S1 nerve root. \nThere is mild surrounding enhancement due to epidural granulation.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. There is\nno intraspinal fluid collection. No abnormal intra or paraspinal enhancement\nseen.", "output": "Right-sided L5-S1 disc herniation extending inferiorly to the right lateral\nrecess of S1 which could result in irritation of right S1 nerve root." }, { "input": "Study is mildly degraded by motion. For the purposes of numbering, the lowest\nrib bearing vertebral body was designated the T12 level.\n\nMinimal retrolisthesis of L5 on S1 is unchanged. Vertebral body alignment is\notherwise preserved. Vertebral body heights are preserved. A 15 x 20 mm. T1\nand T2 hyperintense lesion in the L3 vertebral body is consistent with a\nhemangioma (2:7). ___ type 1 changes are present along the inferior\nendplate of L5 and superior endplate of S1. The visualized portion of the\nspinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved except at the L5-S1 level\nwere there is moderate loss of height.\n\nThere 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 stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is no vertebral canal or neural foraminal stenosis.\n\nAt L5-S1 there is asymmetric disc bulge contacts the exiting right L5 nerve\nroot. There is mild spinal canal stenosis and mild-to-moderate right neural\nforaminal narrowing. Previously seen disc herniation surrounding the right S1\nnerve root has been removed. In contact with the right S1 nerve root there\nremains a 7 x 8 mm enhancing focus of dark T1 and heterogeneous T2 signal (see\n6: 20).\n\nThere is no evidence of infection or neoplasm.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel degenerative changes as described.\n3. Postsurgical changes with removal of previously seen herniated disc\nsurrounding the right S1 nerve root.\n4. Residual enhancing material in this region contacting the right S1 nerve\nroot suggestive of granulation tissue.\n5. L5-S1 disc bulge results in mild right neural foraminal narrowing and\ncontacts right L5 exiting nerve root." }, { "input": "The patient is status post prior L5-S1 laminotomy and discectomy, with\nresidual postsurgical changes including enhancing granulation tissue that\nappears similar to the previous examination.\n\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nA vertebral body hemangioma is again noted in the L3 vertebral body. The\nconus medullaris terminates at the level of L1.\n\nT12-L1: Minimal disc bulging is seen without definite canal or neural\nforaminal narrowing.\n\nL1-L2: Posterior disc bulging flattens the ventral thecal sac with no\nappreciable canal or neural foraminal narrowing.\n\nL2-L3: There is minimal disc bulging without canal or neural foraminal\nnarrowing.\n\nL3-L4: Disc bulging slightly flattens the ventral thecal sac without canal or\nneural foraminal narrowing.\n\nL4-L5: A posterior disc bulge flattens the ventral thecal sac. There is mild\nfacet arthropathy, but no spinal canal or neural foraminal narrowing.\n\nL5-S1: Prior discectomy changes are noted. A residual posterior disc bulge is\nseen with enhancing granulation tissue, displacing the descending right S1\nnerve root laterally and narrowing the right subarticular recess. No canal\nnarrowing is seen. Neural foraminal narrowing is minimal bilaterally.\n\nThe visualized portions of the retroperitoneal soft tissues are unremarkable.", "output": "1. Status post prior L5-S1 laminotomy and discectomy with postsurgical change.\n2. Residual degenerative changes throughout the lumbar spine are noted,\noverall mild.\n3. Residual posterior disc bulging at L5-S1 combining with postsurgical\ngranulation tissue resulting in narrowing of the right subarticular recess and\nlateral displacement of the right S1 nerve root." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen. The craniovertebral junction is\nunremarkable.\n\nThe cord is normal in signal intensity.\n\nAt C2-C3 and C3-C4, there is no significant disc herniation, spinal canal\nstenosis, or neural foraminal narrowing.\n\nAt C4-C5, there is a right paracentral disc protrusion resulting in moderate\nspinal canal narrowing and flattening of the spinal cord. There is severe\nbilateral neural foraminal narrowing at this level secondary to bilateral\nuncovertebral and facet joint osteophytes.\n\nAt C5-C6, there is a posterior intervertebral osteophytes which is resulting\nin mild spinal canal narrowing and mild flattening of the cervical spinal\ncord. There is also severe bilateral neural foraminal narrowing at this level\nsecondary to bilateral uncovertebral and facet joint osteophytes.\n\nAt C6-C7, there is mild disc bulge resulting in mild spinal canal narrowing.\nThere is severe bilateral neural foraminal narrowing secondary to bilateral\nuncovertebral and facet joint osteophytes.\n\nAt C7-T1, there is a midline osteophyte which is mildly narrowing the canal\nand encroaching upon the cord. There is also severe bilateral neural foraminal\nnarrowing secondary to bilateral uncovertebral joint osteophytes.\n\nAt T2-T3, seen only on sagittal images, is a central disc protrusion which is\npartially effacing the CSF space without definitely remodeling the cervical\nspinal cord.\n\nThe visualized soft tissues of the neck are unremarkable.", "output": "Multilevel degenerative changes as detailed above. Spinal canal stenosis is\nmost pronounced at C4-C5 where a right paracentral disc protrusion narrows the\nspinal canal and remodels the ventral aspect of the cervical spinal cord.\nAdditionally, there is severe bilateral neural foraminal narrowing from C4-C5\nthrough C7-T1." }, { "input": "There is minimal retrolisthesis of C5 on C6, likely degenerative. \nAlignment is otherwise anatomic. ___ type 2 (high T1, high T2) degenerative\nsignal abnormalities are demonstrated at the C5-C6 endplates. There is marked\nloss of disc space height at this level and less severe loss of disc space\nheight at C6-C7.\n\nVertebral body height is maintained.\n\nOverall, there is multilevel diffuse disc desiccation with less prominent loss\nof disc space height at T1-T2 and T2-T3.\n\nOsseous marrow signal is otherwise unremarkable.\n\nThe patient has a congenitally narrow spinal canal. There is high signal\nwithin the spinal cord at the level of C5-C6 and extending inferiorly to the\nlevel of the mid C7 vertebral body. This is associated with high-grade spinal\ncanal narrowing at C5-C6, described below:\n\nAt C2-C3, there is mild ligamentous buckling, which causes mild spinal canal\nbut no foraminal narrowing.\n\nAt C3-C4, there is a tiny central disc protrusion which combines with mild\nligamentous buckling to mildly narrow the spinal canal. There is mild\nremodeling of the ventral and dorsal aspects of the spinal cord.\n\nAt C4-C5, there is a small central disc protrusion and mild ligamentous\nbuckling. The central disc protrusion mildly effaces the ventral spinal cord\nand causes mild spinal canal narrowing.\n\nAt C5-C6, there is a large broad-based disc bulge which combines with mild,\ngrade 1, retrolisthesis of C5 on C6 and mild ligamentous buckling to severely\nnarrow the spinal canal. The spinal cord is compressed with ventral and\ndorsal remodeling. There is high signal within the cord at this level. In\naddition, there is severe bilateral foraminal narrowing.\n\nAt C6-C7, a smaller broad-based disc bulge combines with mild ligamentous\nbuckling to cause moderate spinal canal narrowing with mild remodeling of the\nventral and dorsal spinal cord. In addition, there is mild right and moderate\nleft foraminal narrowing. \n\nAt C7-T1, there is no narrowing. \n\nAt T1-T2 and T2-T3, there are small disc protrusions which are only visualized\non the sagittal images.\n\nParaspinal soft tissues are unremarkable. The anterior and posterior\nlongitudinal ligaments are intact.", "output": "Large broad-based disc bulge with a congenitally narrowed spinal\ncanal causing high-grade spinal canal narrowing at C5-C6 with cord compression\nand high T2 signal within the spinal cord. \n\nThese findings were discussed with Dr. ___ at 5:35 pm and the pt was sent to\nthe ED for neurological evaluation." }, { "input": "The patient is status post anterior fixation of the cervical spine from C4\nthrough C7. Susceptibility artifact from the spinal hardware limits assessment\nof the vertebral bodies and discs. Allowing for this limitation there is\napparent progression of the fusion at C5 C6. The C4-C5 on C6-C7 intervertebral\ndiscs are still seen. There is no prevertebral soft tissue swelling, fluid\ncollection, or any other abnormalities suggestive of postsurgical\ncomplication. No fracture or or compression deformity is identified. Alignment\nis maintained.\n\nAtlanto-occipital joint: The foramen magnum is within normal limits. The\ncerebral tonsils are above the level of the foramen magnum. There is no pannus\nof the atlanto-occipital ligament or spinal canal narrowing.\n\nC1-C2: The lateral masses are symmetric with respect to the dens. No spinal\ncanal narrowing. No abnormality of the alar ligaments. No evidence of\nbasilar invagination.\n\nC2-C3: A focal central disc protrusion is slightly worsened compared with the\nprevious exam. There is also significant ligamentum flavum hypertrophy which\nalong with a central disc protrusion resulting spinal canal stenosis with\ndeformity of both the ventral and posterior aspect of the spinal cord. No\nneural foraminal narrowing is identified.\n\nC3-C4: Minimal concentric disc bulge as well as severe ligamentum flavum\nhypertrophy, worse in the right, resulting moderate to severe spinal canal\nstenosis with deformity of the spinal cord at this level. No cord signal\nabnormalities identified. There is no neural foraminal narrowing.\n\nC4-C5: Susceptibility artifact from anterior fusion hardware is present.\nLigamentum flavum hypertrophy more pronounced in the right resulting contact\nwith the spinal cord with minimal flattening of the right posterior aspect of\nthe spinal cord. Otherwise the anterior CSF column is preserved after fusion.\nThere is no neural foraminal narrowing.\n\nC5-C6: Susceptibility artifact from anterior fusion hardware is present. No\nsignal from the intervertebral disc is seen suggesting complete fusion at this\nlevel. There is no ligamentum flavum hypertrophy nor spinal canal stenosis.\nBilateral uncovertebral joint osteophytes result in mild neural foraminal\nnarrowing.\n\nC6-C7: Susceptibility artifact artifact from anterior fusion hardware is\npresent. There is no spinal canal stenosis. Bilateral uncovertebral joints\nhypertrophy results in bilateral mild to moderate neural foraminal narrowing.\n\nC7-T1: There is mild ligamentum flavum hypertrophy but no spinal canal\nstenosis. The right neural foramen is unremarkable. Uncovertebral osteophytes\nresult in mild to moderate left neural foraminal narrowing.", "output": "1. Status post anterior fusion of the cervical spine levels of C4 through C7,\nwithout evidence of procedure related complication. Although assessment is\nlimited there is apparent progression of the fusion at C5-C6 which now appears\ncomplete. Disc material is still seen at the levels of C4-C5 and C6-7.\n\n2. Moderate to severe spinal canal stenosis at C3-C4, mostly due to\ncontribution from significant ligamentum flavum hypertrophy at this level.\nMild spinal canal stenosis is seen at C2-C3 and C4-C5 also with a significant\ncontribution from ligamentum flavum hypertrophy.\n\n3. Mild-to-moderate neural foraminal narrowing is seen at C6 and C7 and in\nthe left neural foramen of C7-T1." }, { "input": "The patient is s/p bilateral laminectomies at L4-L5 and L5-S1. Anticipated\npostsurgical changes are seen at the surgical site. There is no fluid\ncollection. Enhancing granulation tissue is present and described in detail\nbelow.\n\nOtherwise, the prevertebral and paraspinal soft tissues are unremarkable. \nThere is an S-shaped scoliosis with a dextro component centered at L2-L3 and a\nlevo component centered at L4-L5. Alignment is otherwise relatively well\nmaintained in the sagittal plane. The visualized osseous structures exhibit\nheterogeneous T1 marrow signal without focal suspicious signal abnormality. \nDegenerative bone marrow signal changes seen at the endplates adjacent to the\nL5-S1 disk. The conus demonstrates normal signal and morphology and terminates\nat the level of L1. There is no evidence of abnormal enhancement.\n\nT12-L1 though L2-L3: No disc herniation. No evidence of canal or foraminal\nnarrowing.\n\nL3-L4: Mild disc bulge narrowing the subarticular recesses, worse in the left,\nwhich may affect the traversing left L4 nerve root, slightly worsened from the\nprevious exam. Associated ligamentum flavum thickening and bilateral facet\narthrosis contribute to mild spinal canal narrowing. Mild narrowing of the\nbilateral neural foramina is present.\n\nL4-L5: The patient is status post bilateral laminectomies. Enhancing\ngranulation tissue is seen at the resection bed. There is eccentric disk\nbulging, more pronounced towards the right, which along with facet joint\nosteophytes result in moderate right neural foramen narrowing with contact\nbetween the exiting right L4 root and the facet joint osteophyte. The left\nneural foramen is not significantly narrowed. No spinal canal stenosis\nidentified, significantly improved from prior.\n\nL5-S1: The patient is status post bilateral laminectomies. Enhancing\ngranulation tissue is seen at the resection bed. There is eccentric disk\nbulging/end-plate osteophytes eccentric to the right, which along with facet\njoint osteophytes contact and displace the exiting right L5 nerve root. Of\nnote there is partial sacralization of L5 with degenerative changes of the\nanomalous junction between the transverse process and the sacrum which also\ncomes in close proximity to the exiting right L5 nerve root laterally. The\nleft neural foramina is not narrowed. There is no significant spinal canal\nstenosis.", "output": "1. Post-laminectomy changes at L4-5 and L5-S1 with anticipated findings. No\nfluid collection or paravertebral soft tissue abnormality concerning for\ninfection.\n\n2. Degenerative changes seen at L5-S1 with disc bulge and endplate\nosteophytes eccentric to the right and in combination with degenerative\nchanges from a partially sacralized L5 may affect the exiting right L5 nerve\nroot\n\n3. Degenerative disc disease elsewhere notable for mild progression of the\nsubarticular recess narrowing on the right at L3-4. Remaining details as\nabove." }, { "input": "Interval posterior L1-S1 fusion with transpedicular screws, rods, interbody\nspacers at all levels. Metal artifact partially compromises exam.\nNormal visualized cord. Fluid collection in the laminectomy bed L1-L4,\nmeasures 9.6 cm x 4.5 cm x 2.1 cm,, additional smaller fluid collection along\nthe myofascial plane at the incision site, findings likely postoperative,\nminimal linear surrounding enhancement, without inflammatory changes in the\nsoft tissues. Postoperative changes in the posterior paraspinal soft tissues.\nDegenerative changes lumbar spine, mild diffuse disc bulges. Partially seen\nfacet joints head degenerative arthritis.\n\nAt T12-L1 level there is mild central canal narrowing from diffuse disc bulge,\nsimilar. Patent foramina.\n\nAt L1-L2 level central canal is patent. Patent foramina.\n\nAt L2-L3 level central canal is patent. Patent foramina.\n\nAt L3-L4 level central canal is patent, improved since prior. Mild bilateral\nforaminal narrowing, improved.\n\nAt L4-5 level central canal is patent, improvement since prior. Mild\nbilateral foraminal narrowing, improved.\n\nAt L5-S1 level central canal is patent. Early termination of the thecal sac. \nModerate right foraminal narrowing, improved. Mild left foraminal narrowing,\nsimilar.\n\nNo evidence of arachnoiditis. Benign simple cyst right kidney", "output": "1. Interval postoperative changes.\n2. Fluid collection at the surgical bed, likely postoperative.\n3. Patent central canal.\n4. Moderate right L5-S1 foraminal narrowing." }, { "input": "There is reversal of cervical lordosis again seen. The vertebral body heights\nare maintained. Again seen is a chronic fracture involving C7 spinous\nprocess. There is no abnormal bone marrow signal to suggest an acute fracture\nin. There is mild wedging of C5 vertebral body which appears chronic.\n\nThe spinal cord is normal in caliber and signal without cord edema, cord\ninfarction, or hemorrhage.\n\nThe prevertebral and paraspinal soft tissues appear unremarkable.\n\nC2-C3: There is no spinal canal stenosis or neural foraminal narrowing.\n\nC3-C4: There is a disc bulge with endplate osteophytes, facet and\nuncovertebral joint arthropathy causing mild spinal canal stenosis and mild\nright and no left neural foraminal narrowing.\n\nC4-C5: There is a disc bulge with ligamentum flavum thickening and facet and\nuncovertebral joint arthropathy resulting in mild spinal canal stenosis,\nsevere left and moderate right neural foraminal narrowing (07:20).\n\nC5-C6: There is posterior disc osteophyte with moderate spinal stenosis\nwithout deformity of the spinal cord. Moderate-to-severe bilateral foraminal\nnarrowing is seen.\n\nAt C6-7 disc and uncovertebral degenerative changes seen with\nmoderate-to-severe bilateral foraminal narrowing and mild spinal stenosis.\n\nAt C7-T1 to T2-3 no abnormalities are seen.\n\nThe spinal cord shows normal intrinsic signal.", "output": "1. No evidence of marrow edema or ligamentous disruption. Chronic appearing\ndeformity of the C5 vertebra identified. Chronic fracture of C7 spinous\nprocess seen.\n2. Multilevel degenerative changes from C3-4 to C6-7 with moderate spinal\nstenosis at C5-6 and mild spinal stenosis at other levels. Foraminal changes\nas described above.\n3. No intrinsic spinal cord signal abnormalities." }, { "input": "CERVICAL:\nThere is loss of signal of the intervertebral discs on the T2 weighted images\nat every level. These are manifestations of degenerative disc disease.\n\nAgain seen is interbody fusion from C4 through T1. At 5 6, this appears to be\ndegenerative. There is slight anterior subluxation of T1 upon T2, unchanged\nsince the prior studies. The canal encroachment at C3-4 due to disc material\nanteriorly and ligamentum flavum posteriorly is no longer seen. There is now\nwidening of the thecal sac into the laminectomy defect at this level.\n\nImages of the spinal cord demonstrates small areas of abnormal increased\nsignal intensity post dura laterally on the left at the C2-3 level and post\ndura laterally on the right at the C3-4 level. The cervical cord appears\nmildly atrophic.\n\nAt C2-3, the spinal canal is widely patent. Uncovertebral and facet\nosteophytes produce moderate right neural foraminal narrowing.\n\nThere is mild bulging of the C3-4 intervertebral disc with no significant\nencroachment on the spinal canal. Uncovertebral osteophytes and facet\nosteophytes mildly narrow the right neural foramen.\n\nThere is no canal encroachment at C4-5. There is mild left neural foraminal\nnarrowing due to uncovertebral and facet osteophytes.\n\nAt C5-6, there is minimal canal narrowing and the neural foramina appear\nnormal.\n\nAt C6-7, the neural foramina and spinal cord canal appear normal.\n\nAt C7-T1, there is no canal encroachment. There is mild narrowing of the left\nneural foramen due to uncovertebral osteophytes.\n\n\n\nTHORACIC:\nThere is loss of signal of the intervertebral discs on the T2 weighted images\nat every level. These are manifestations of degenerative disc disease.\n\nThe spinal cord appears mildly but diffusely atrophic.\n\nMild bulging of the intervertebral disc slightly encroaches on the spinal\ncanal at T1-2. There is slight anterior subluxation of T1 upon T2. There is\nno contact with the spinal cord. The neural foramina are mildly narrowed.\n\nSmall intervertebral osteophytes at T4-5 slightly encroach on the spinal canal\nbut do not contact the spinal cord. The neural foramina appear normal.\n\nSmall intervertebral osteophytes at T6-7 slightly encroach on the spinal canal\nto the right of midline. There is no contact with the spinal cord. The\nneural foramina appear normal.\n\nAt T12-L1, bulging of the disc, intervertebral osteophytes, ligamentum flavum\nthickening and facet osteophytes produce moderate -severe spinal canal\nnarrowing. There is narrowing of the left neural foramen due to disc bulge\nand facet osteophytes. There is hyperintensity of the endplates at this level\non the STIR images suggesting most likely ___ type 1 signal intensity\nchange.\n\nLUMBAR:\n\nThere are changes of degenerative disc disease at every level with loss of\nsignal of the intervertebral discs on the T2 weighted images. There are\nregions of high signal intensity in the L1-2, L2-3, L3-4 and L4-5\nintervertebral disc that likely represent fluid accumulation within\ndegenerative clefts. The possibility of infection, although not entirely\nexcluded, appears unlikely in the absence of abnormal enhancement after\ncontrast administration. Most of these levels with disc hyperintensity\ndemonstrate little or no changes of the endplates on T1 and STIR imaging,\nagain arguing against infection.\n\nAt L1-2, there is moderate spinal canal narrowing due to disc bulging and,\nslight retrolisthesis of L1 upon L2 and facet osteophyte formation. This is\nassociated with mild scoliosis, convex to the left. The right neural foramen\nis severely narrowed. The left neural foramen appears normal.\n\nAt L2-3, there is mild-moderate spinal canal narrowing due to disc bulging,\nslight retrolisthesis of L2 upon L3, facet osteophytes and ligamentum flavum\nthickening. There is mild narrowing of the right neural foramen.\n\nAt L3-4, bulging of the disc, facet osteophytes and ligamentum flavum\nthickening produce mild -moderate spinal canal narrowing. The disc bulge\njoints with a right-sided foraminal protrusion that displaces the exiting L3\nnerve root. The protrusion also compresses the traversing L4 nerve root. The\ncombination of bulge and superior facet osteophyte contacts the traversing\nleft L4 nerve root. The left neural foramen appears normal.\n\nAt L4-5, there is a broad disc bulge that extends into the right neural\nforamen contacting the exiting L4 nerve root. The disc bulge and prominent\nright facet osteophyte compresses the traversing L 5 nerve root. Bulging disc\nand smaller facet osteophytes also compress the traversing left L5 nerve root.\nThe disc bulge extends into the left neural foramen contacting the exiting\nleft L4 nerve root. Just below the level of the intervertebral disc,\nprominent at right-sided facet osteophytes encroach on the thecal sac and\ncompress the traversing right S1 nerve root.\n\nAt L5-S1, the L5 body is partially sacralized. The thecal sac terminates at\nthis level and there is only minimal bulging of the intervertebral disc. \nThere is no evidence of nerve root compression.\n\n\nOTHER: Again seen is a left renal cyst.", "output": "1. Changes of degenerative disc disease throughout the spine with loss of\nsignal of the intervertebral discs on the T2 weighted images and neural\nforaminal encroachment.\n2. Atrophy of the cervical and thoracic spinal cord.\n3. Foci of hyperintensity on T2 weighted images in the upper cervical cord\nperhaps related to prior compression.\n4. Lumbar disc protrusions and facet osteophytes producing neural foraminal\ncompression." }, { "input": "Some of the images have been degraded by patient motion, allowing for this;\n\nThe cervical spine alignment is normal. There is heterogenous bone marrow\nsignal intensity from C2-C7 levels, which is nonspecific but suggest bone\nedema in light of recent trauma, additional endplate degenerative changes at\nC6-C7 may represent bone marrow replacement for fat. There is reduced\nintervertebral disc height at C6-C7. Vertebral body and intervertebral disc\nsignal intensity appear otherwise normal.\n\nThere is mild patchy increased signal on the STIR sequence related to the\ninterspinous ligament between C3 and C6 (7:9), which may indicate injury. No\nother ligamentous injury is identified. There is no prevertebral or epidural\nhematoma. The imaged spinal cord appears normal in caliber and configuration.\n\nC3-C4: There is a posterior disc bulge, causing mild spinal canal narrowing. \nBilateral uncovertebral hypertrophy causes moderate bilateral neural foraminal\nnarrowing, slightly more pronounced on the right (5:13).\n\nC4-C5: There is a central and left paracentral disc protrusion causing mild\nspinal canal narrowing and no significant neural foraminal narrowing.\n\nC5-C6: There is a posterior disc bulge causing mild to moderate spinal canal\nnarrowing. There is moderate right neural foraminal narrowing.\n\nC6-C7: There is a posterior disc bulge causing mild spinal canal narrowing and\nmoderate left neural foraminal narrowing.\n\nThere is no evidence of spinal canal or neural foraminal narrowing at the\nremaining imaged vertebral levels. Normal craniocervical junction. There is\nno evidence of infection or neoplasm.", "output": "1. Hyperintensity on the STIR sequence related to the interspinous ligament\nbetween C3-C6, which may indicate injury. Otherwise no evidence ligamentous\ninjury elsewhere.\n2. Heterogeneous bone marrow signal intensity from C2 through C7 levels as\ndescribed detail above is suggestive of bone edema, probably posttraumatic, no\ncompression fractures are seen.\n3. Endplate degenerative changes noted on T1 weighted sequence at C6-C7 level\nsuggest bone marrow replacement for fat.\n4. There is no evidence of a prevertebral or epidural hematoma.\n5. Normal appearance of the imaged spinal cord.\n6. Cervical spondylosis, most marked at C3-C4, C5-C6, with mild to moderate\nspinal canal narrowing and moderate right neural foraminal narrowing secondary\nto a disc bulge and uncovertebral hypertrophy." }, { "input": "Study is mildly degraded by motion. There is straightening of the cervical\nspine. Vertebral body heights are preserved. There is no focal marrow signal\nabnormality.\n\nThe spinal cord is normal in caliber and morphology without abnormal signal\nintensity. There is loss of intervertebral disc signal at C4-5 and C5-6,\ngrossly unchanged.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: There is a disc protrusion causing mild spinal canal stenosis without\nneural foraminal narrowing.\n\nC4-C5: There is a disc protrusion causing mild spinal canal stenosis without\nneural foraminal narrowing, slightly progressed compared to prior exam.\n\nC5-C6: There is no spinal canal or neural foraminal narrowing.\n\nC6-C7: There is a disc protrusion indenting the ventral thecal sac without\nspinal canal or neural foraminal stenosis.\n\nC7-T1: There is no spinal canal or neural foraminal stenosis.\n\n Within the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling.. Limited imaging\nof sinuses suggest sphenoid sinus mucosal thickening.", "output": "1. Study is mildly degraded by motion.\n2. Mild cervical spondylosis at C3-C4 and C4-C5, as above, slightly progressed\ncompared to 12 prior exam.\n3. No evidence of cervical spinal cord compression or definite cord signal\nabnormality.\n4. Paranasal sinus disease , as described." }, { "input": "Again seen are postoperative changes after laminectomy and anterior and\nposterior fusion at L4-5. There is a large postoperative fluid collection\nthat exerts extradural mass effect upon the thecal sac with crowding of the\nroots of the cauda equina. This collection extends into the paraspinal\nmuscles. A bulging disc L5-S1 is again seen limited imaging suggests that the\nL4-5 right-sided disc protrusion has been resected.\nThere is high signal intensity in the L5 are and L5 vertebral bodies on STIR\nimaging, likely postoperative. ___ type 2 signal intensity change of the\nL5-S1 endplates appears unchanged. Alignment is normal. spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm.", "output": "1. Status post L4-5 discectomy and anterior and posterior fusion.\n2. The patient was unable to tolerate the entire examination. Therefore only\nT2 weighted and STIR sagittals were obtained.\n3. These demonstrated a large postoperative fluid collection encroaching on\nthe thecal sac and crowding the nerve roots at the surgical site." }, { "input": "CERVICAL:\nAlignment is normal.Diffuse T1 bone marrow hypointensity with no definite\nfocal lesions in the cervical spine. Degenerative endplate osteophytes noted\nat C6-C7 level. Diffuse loss of intervertebral disc T2 signal and\nintervertebral disc height which is most prominent at the C6-C7 level as well.\nNo abnormal leptomeningeal enhancement.\n\nParaspinal and prevertebral soft tissues are unremarkable.\n\nAt C4-C5, there is uncovertebral joint osteophyte formation causing mild right\nneural foraminal narrowing. There is no spinal canal or left neural foraminal\nnarrowing although a small central disc protrusion is noted.\n\nAt C5-C6, there is a disc bulge with uncovertebral joint osteophyte formation\ncausing mild narrowing of the spinal canal and mild left neural foraminal\nnarrowing.\n\nAt C6-C7, there is a disc bulge causing mild-to-moderate spinal canal\nnarrowing with some remodeling of the ventral spinal cord but no compression\nor signal abnormality clearly demonstrated. There is no definite neural\nforaminal narrowing.\n\nRemaining cervical levels, there is no spinal canal or neural foraminal\nstenosis.\n\nTHORACIC:\nAlignment is normal.Diffuse T1 bone marrow hypointensity is noted. At T4\nlevel, there is a T1 and T2 hyperintense lesion with likely striations which\nprobably reflects a hemangioma. No other focal marrow signal abnormality is\ndemonstrated in the thoracic spine.The spinal cord appears normal in caliber\nand configuration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal.There is diffuse T1 bone marrow hypointensity. There are\nscattered fatty rests, and a probable hemangioma at the L3 level. There is\ndiffuse disc desiccation and loss of intervertebral disc height.\n\nThe conus medullaris terminates normally at the L1 level.The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing. There is no evidence of infection or\nneoplasm. There is no abnormal enhancement after contrast administration.\nFacet arthropathy is noted at the L3-L4, L4-L5, and L5-S1 levels, but there is\nno spinal canal stenosis. Mild bilateral neural foraminal narrowing is noted\nat the L5-S1 level. No significant neural foraminal stenosis at the remaining\nlevels.\n\nOTHER:", "output": "1. No spinal cord compression. No evidence of metastatic disease to the\nspine.\n2. Multilevel degenerative changes as described with no high-grade spinal\ncanal or neural foraminal stenosis or evidence of nerve root compression.\n3. Diffuse T1 bone marrow hypointensity may reflect red marrow reconversion or\nother marrow infiltrating process. This can be correlated with clinical\nhistory and laboratory testing\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": "The examination is moderately degraded by patient motion, particularly\naffecting the T2 weighted sequences, allowing for this:\n\nThere is levoscoliosis centered within the upper lumbar spine. Additionally,\nthere is transitional anatomy with a rudimentary S1-S2 intervertebral disc.\n\nVertebral body heights are maintained. There is grade 1 anterolisthesis of L3\non L4 and L4 on L5, likely degenerative.\n\n___ type 1 degenerative endplate changes are most prominent at L4-L5 and\nL5-S1. Elevated STIR signal within the bilateral right greater than left\nparaspinal musculature (for example 14:18) may reflect muscular strain.\n\nBone marrow edema on the right L3 and L4 pars interarticularis and facet is\nnoted (14:13,14), nonspecific but also potentially relating to strain versus\ndegenerative change. The conus medullaris terminates at the level of L2.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1, L1-L2: There is no spinal canal or neural foraminal stenosis.\n\nL2-L3: Posterior disc bulging flattens the ventral thecal sac combining with\nthickening of the ligamentum flavum to result in mild-to-moderate canal\nnarrowing. Neural foraminal narrowing is mild bilaterally.\n\nL3-L4: Posterior disc bulging combines with facet arthropathy and thickening\nof ligamentum flavum to result in mild-to-moderate canal narrowing overall. \nNeural foraminal narrowing is mild-to-moderate on the right and mild on the\nleft.\n\nL4-L5: Posterior disc bulging with superimposed disc protrusion combines with\nfacet arthropathy and thickening of ligamentum flavum to result in moderate\nsevere canal narrowing. Neural foraminal narrowing is moderate to severe on\nthe right and mild on the left.\n\nL5-S1: Posterior disc bulging with annular fissure flattens the ventral thecal\nsac with mild canal narrowing overall. Neural foraminal narrowing is moderate\nsevere on the left and moderate to severe on the right.\n\nThere is a right-sided sacral Tarlov cyst. A large T2 hyperintense cystic\nstructure on the right in the expected location of the right kidney may\nreflect severe hydronephrosis (for example 101:79), but is incompletely\nimaged. The rest of the visualized paraspinal soft tissues are grossly\nunremarkable.", "output": "1. Moderately motion degraded examination, further complicated by\nlevoscoliosis and transitional vertebral body anatomy.\n2. Multilevel spondylosis throughout the lumbar spine is prominent, and\ndetailed above.\n3. Findings are most notable at L4-L5 with moderate to severe canal narrowing.\n4. Foraminal narrowing most pronounced on the right at L4-5 and bilaterally at\nL5-S1 level.\n5. Asymmetric increased STIR signal involving the right paraspinal musculature\nand L3/L4 right-sided facets, a nonspecific finding and likely related to\ndegenerative changes.\n6. Hydronephrosis of the right kidney is not fully evaluated and was\ndemonstrated on the previous ultrasound of ___. A follow-up\nultrasound can be obtained for any changes if clinically indicated." }, { "input": "There is mild anterolisthesis of C3 on C4, C7 on T1 and T1 on T2. Vertebral\nbody signal intensity appears normal. There decreased signal intensity within\nthe intervertebral discs, suggestive of disc desiccation.\n\nC2-3: There is no substantial neural foraminal narrowing. The spinal cord is\nnormal in configuration.\nC3-4: Uncovertebral and facet osteophytes contribute to mild left neural\nforaminal narrowing. There is mild posterior disc bulge. The spinal cord is\nnormal in configuration.\nC4-5: Uncovertebral and facet osteophytes contribute to severe bilateral\nneural foraminal narrowing. There is a posterior disc bulge contacting the\nspinal cord, with flattening of the anterior aspect.\nC5-6: Uncovertebral and facet osteophytes contribute to severe bilateral\nneural foraminal narrowing. There is a posterior disc bulge contacting the\nspinal cord, with flattening of the anterior aspect.\nC6-7: Uncovertebral and facet hypertrophy contribute to mild bilateral neural\nforaminal narrowing. There is a posterior disc bulge contacting the spinal\ncord, with minimal flattening of the anterior aspect.\nC7-T1: There is no substantial neural foraminal narrowing. The spinal cord is\nnormal in configuration.", "output": "There are multilevel degenerative changes of the cervical spine." }, { "input": "The study is severely limited due to motion artifact. Although the patient\nreceived pain medication, she was unable to remain motionless for this study. \nThe examination was halted and is incomplete.\n\n\nCERVICAL:\nLimited views of the cervical spine demonstrate degenerative disc disease with\nloss of height of the intervertebral discs and loss of signal of the discs on\nthe T2 weighted images. Disc bulges or protrusions encroach on the spinal\ncanal but there relationship to the spinal cord is uncertain due to the\nlimited quality of the study.\n\nTHORACIC:\nThere is a compression fracture of the T3 vertebral body with abnormal\nincreased signal intensity on the T 2 weighted images and loss of signal on\nthe T1 weighted images. Soft tissue encroaches on the spinal canal and\nappears to compress the spinal cord at this level. The severity of\nencroachment is not adequately assessed due to motion artifact. These\nfindings suggest a pathologic fracture with neoplastic soft tissue extending\ninto the spinal canal and likely causing cord compression.", "output": "1. Motion limited study demonstrates a T3 compression fracture that is likely\npathologic. Soft tissue encroaching on the spinal canal likely causes cord\ncompression." }, { "input": "There are 7 cervical, 12 rib-bearing, and 4 lumbar-type vertebrae, and an\nalmost completely sacralized L5. The numbering is documented on images 2:10,\n2:11, 10:10.\n\nCERVICAL:\n\nThere is no evidence for osseous, epidural, or leptomeningeal metastatic\ndisease. Vertebral body heights are preserved. Alignment is normal.\n\nThe cerebellar tonsils are normally positioned. Concurrent brain MRI is\nreported separately.\n\nNo spinal cord signal abnormality seen allowing for motion artifact.\n\nC2-C3: A central disc protrusion indents the ventral thecal sac but does not\ncontact the ventral spinal cord. Ligamentum flavum infolding mildly remodels\nthe left dorsal lateral spinal cord. The spinal canal is overall mildly\nnarrowed. The left neural foramen is mildly narrowed by facet osteophytes.\n\nC3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: Left paracentral disc protrusion mildly remodels the left ventral\nspinal cord. The left neural foramen is mildly narrowed by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Broad-based disc osteophyte complex, larger on the left than right,\nmildly remodels the left ventral spinal cord. There is at least moderate\nbilateral neural foraminal narrowing by bilateral uncovertebral and left facet\nosteophytes ; evaluation is limited by motion artifact.\n\nC6-C7: A shallow central disc protrusion indents the ventral thecal sac but\ndoes not contact the spinal cord. There may be minimal left neural foraminal\nnarrowing, not well assessed due to motion artifact.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\n\nT3 vertebral body demonstrates abnormally low signal throughout on precontrast\nT1 weighted images and heterogeneous signal throughout on fat-suppressed IDEAL\nimages, with high signal on the fat-suppressed IDEAL images extending into\nbilateral pedicles, laminae, and articular facet. There is approximately 25%\nanterior loss of T3 vertebral body height. In the posterior aspect of the T3\nvertebral body, there is an enhancing mass extending into the anterior\nepidural space, which is larger on the left than right, and which also extends\ninto the left neural foramen and the left anterior paravertebral soft tissues.\nThe epidural mass abuts but does not compress the left ventral spinal cord. \nMild cord edema cannot be excluded, though evaluation is limited by motion\nartifact. Bilateral neural foramina are narrowed by the pathologic fracture.\n\nT6 and T7 vertebral bodies demonstrate minimal anterior wedging without marrow\nedema.\n\nT5-T6: Left paracentral endplate osteophytes remodel the left ventral spinal\ncord. Evaluation of cord signal is limited by artifact in the axial plane and\nvolume averaging in the sagittal plane.\n\nT6-T7: Left paracentral endplate osteophytes remodel the left ventral spinal\ncord. Evaluation of cord signal is limited by artifact in the axial plane and\nvolume averaging in the sagittal plane.\n\nT7-T8: There are discogenic bone marrow changes in the endplates at T7-T8. \nBilateral posterior endplate osteophytes mildly narrow the spinal canal and\nremodel the ventral spinal cord bilaterally.\n\nT8-T9: A mild disc bulge and bilateral posterior endplate osteophytes mildly\nnarrow the spinal canal. The spinal cord is mildly remodeled on the left,\nwhere the osteophytes are larger. Evaluation of cord signal is limited by\nartifact in the axial plane and volume averaging in the sagittal plane.\n\nIn the right posterior aspect of the T11 vertebral body, there is a\ncircumscribed 1.2 x 1.1 x 1.2 cm lesion (images 15:11, 32:22) with low to\nintermediate signal on precontrast T1 weighted images, high signal on\nfat-suppressed IDEAL images, and enhancement on postcontrast T1 weighted\nimages. It is new compared the ___ thoracic spine MRI and ___ lumbar spine MRI. There is no associated loss of vertebral body\nheight, cortical bulging, surrounding marrow edema, or epidural mass.\n\nIn the ___ the T12 vertebral body, sagittal fat-suppressed IDEAL images\nraise the question another hyperintense lesion measuring 1.6 x 1.1 cm, 15:9,\nbut this is not well seen on other sequences. There is no loss of vertebral\nbody height. This may represent marrow heterogeneity rather than a lesion.\n\nA dilated nerve root sleeve is again seen at T11-T12 on the right, similar to\nthe ___ in ___ MRIs.\n\nLUMBAR:\n\nThere are 4 lumbar-type vertebrae and an almost completely sacralized L5, as\nstated above.\n\nThere are circumscribed lesions with low to intermediate signal on precontrast\nT1 weighted images, high signal on fat-suppressed IDEAL images, and\nenhancement on postcontrast T1 weighted images in the anterior inferior\nendplate of L2, in the right aspect of the L3 vertebral body abutting the\nanterior and superior endplates, in the posterior superior aspect of the L4\nvertebral body, and within the S1 vertebral body abutting the anterior cortex.\nThere is also patchy similar signal abnormality in the L5 vertebral body. No\nevidence for associated pathologic fractures or epidural masses.\n\nThere is bulging of the anterior sacral cortex at the S4-S5 level without\nassociated signal abnormality, probably due to prior healed fracture or\ndegenerative remodeling. It was partially visualized on the ___ lumbar spine\nMRI.\n\nThe conus medullaris terminates at L1 and appears unremarkable.\n\nL1-L2: No significant spinal canal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge. No significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: Mild disc bulge, mild to moderate facet arthropathy, prominent\nposterior epidural fat, and congenitally short pedicles result in abutment of\nbilateral traversing L4 nerve roots in the subarticular zones as well as\nmoderate spinal canal narrowing with crowding of the intrathecal nerve roots. \nThere is also a left foraminal disc protrusion, which in combination with\nfacet arthropathy results in moderate left neural foraminal narrowing. The\nright neural foramen is mildly narrowed by the disc bulge and facet\narthropathy.\n\nL4-L5: Mild disc bulge and moderate, left greater than right facet\narthropathy are present. There also congenitally short pedicles. There is\nmild spinal canal narrowing with mild crowding of the intrathecal nerve roots.\nTraversing L5 nerve roots are abutted in the subarticular zones. There is\nmild bilateral neural foraminal narrowing.\n\nL5-S1: Hypoplastic disc and facet joints. No spinal canal or neural\nforaminal narrowing.\n\nOTHER:\n\nDependent fluid in the visualized pharynx is likely secondary to prolonged\nsupine positioning.\n\nDependent opacities in bilateral visualized lungs are nonspecific and may\nrepresent atelectasis superimposed upon the nodules demonstrated on the chest\nCT from ___.\n\n3.3 cm lobulated T2 hyperintense mass in the right hepatic lobe, image 3:16 ,\nwas characterized as a hemangioma on the ___ MRCP. Mild left adrenal\ngland thickening is again noted.\n\nThere is a small amount of pelvic free fluid.", "output": "1. There are 7 cervical vertebrae, 12 rib-bearing vertebrae, L1 through L4\nwith conventional anatomy, and an almost completely sacralized L5.\n2. Pathologic fracture of T3 vertebral body with approximately 25% anterior\nloss of height and with an enhancing mass extending from the posterior aspect\nof the vertebral body into the anterior epidural space, larger on the left\nthan right, abutting but not compressing the ventral spinal cord. Mild cord\nedema cannot be excluded , the lesion is limited by artifact. The soft tissue\nmass also extends into the left neural foramen ; bilateral neural foramina are\nnarrowed by the pathologic fracture. The soft tissue mass also extends into\nthe left anterior paravertebral soft tissues.\n3. Lesions within T11, L2, L3, L5, and S1 vertebral bodies, and possibly also\nwithin the T12 vertebral body, are new compared to the ___ thoracic spine MRI\nand ___ lumbar spine MRI, consistent with metastases. No associated\npathologic fractures or soft tissue masses.\n4. Multilevel degenerative disease in the cervical, thoracic, and lumbar\nspine, as detailed above.\n5. Dependent opacities in bilateral visualized lungs are nonspecific and may\nrepresent atelectasis superimposed upon the nodules demonstrated on the ___ CT chest.\n6. Small amount of pelvic free fluid." }, { "input": "There is mild levoscoliosis centered at L3. Otherwise, lumbar alignment is\nanatomic. There is diffuse low signal of the intervertebral discs with mild\nloss of height at L2-L3 and L3-L4. There is heterogeneous signal of the discs\nat L5-S1. The conus terminates at L1-L2. There is no signal abnormality of\nthe terminal cord.\n\nOn sagittal imaging at T10-T11, there is a disc bulge causing mild spinal\ncanal stenosis. There is no significant neural foraminal stenosis.\n\nOn sagittal imaging at T11-T12, there is a disc bulge resulting in moderate\nspinal canal stenosis but no significant neural foraminal stenosis.\n\nAt T12-L1, there is disc bulge, facet arthropathy, and ligamentum flavum\nthickening resulting in mild spinal canal narrowing without significant neural\nforaminal stenosis.\n\nAt L1-L2, there is disc bulge, facet arthropathy, and ligamentum flavum\nthickening causing mild to moderate to severe spinal canal narrowing. There\nis mild right-sided neural foraminal narrowing and moderate left-sided neural\nforaminal narrowing.\n\nAt L2-L3, there is disc bulge, facet arthropathy, and ligamentum flavum\nthickening causing moderate spinal canal narrowing and crowding of the nerve\nroots. There is moderate right-sided and mild left-sided neural foraminal\nnarrowing.\n\nAt L3-L4, there is disc bulge, facet arthropathy, and ligamentum flavum\nthickening causing severe spinal canal stenosis with displacement of the\nbilateral transversing L4 nerve root. There is severe right-sided neural\nforaminal stenosis and moderate left-sided neural foraminal stenosis.\n\nAt L4-L5, there is a disc bulge with superimposed disc extrusion resulting in\nsevere spinal canal narrowing and compressing of the nerve roots. There is\nsevere right-sided and moderate to severe left-sided neural foraminal\nstenosis. Multiple posteriorly projecting synovial cysts are identified.\n\nAt L5-S1, there is a central annular fissure, facet arthropathy, ligamentum\nflavum thickening causing moderate spinal canal narrowing. There is moderate\nright-sided and severe left-sided neural foraminal stenosis.\n\nRe-demonstrated is a T2 hyperintense focus in the midpole of the left kidney\nmeasuring up to 1.8 cm (6:11) likely representing a simple cyst, increased in\nsize as compared to MRI lumbar spine ___.", "output": "1. Multilevel degenerative changes of the lumbar spine, most prominent at\nL4-L5, where there is severe spinal canal stenosis and L3-L4, where there is\nmoderate to severe spinal canal stenosis. There is multilevel bilateral\nneural foraminal stenosis, most severe at L4-L5, where there is severe\nright-sided and moderate to severe left-sided neural foraminal stenosis. \nOverall degenerative findings are similar to slightly progressed since\nexamination of ___.\n2. Additional findings as described above." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL AND THORACIC SPINE:\n\nThere is reversal of cervical lordosis. There is 3 mm C7 on T1\nanterolisthesis. There is sigmoid scoliosis of the thoracic spine. Vertebral\nbody heights are preserved. Schmorl's nodes are seen throughout the cervical\nand thoracic spine. C4 inferior endplate type ___ ___ changes are seen. \nThere is no prevertebral soft tissue swelling.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc signal throughout the cervical and\nthoracic spine. Nonspecific facet joint fluid is noted at multiple levels of\nthe cervical and thoracic spine.\n\nAt C2-3 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, with mild vertebral canal, mild right and moderate leftneural\nforaminal narrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, with mild vertebral canal, severe right and moderate leftneural\nforaminal narrowing.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy,\nligamentum flavum thickening, with mild-to-moderatevertebral canal and\nmoderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, uncovertebral hypertrophy, central disc\nprotrusion, facet hypertrophy, with mild vertebral canal, moderate right and\nsevere leftneural foraminal narrowing.\n\nAt C6-7 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, with mild vertebral canal, moderate right and severe leftneural\nforaminal narrowing.\n\nAt C7-T1 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, ligamentum flavum thickening, with mild vertebral canal, moderate\nright and mild leftneural foraminal narrowing.\n\nAt T1-2 through C6-7 there is no vertebral canal or neural foraminal\nnarrowing.\n\nAt T7-8, T8-9, T9-10, T10-11 there is disc bulge and facet joint hypertrophy\nwith mild vertebral canal narrowing. At T9-10 T10-11 there is mild bilateral\nneural foraminal narrowing.\n\nAt T11-12 there is disc bulge, facet hypertrophy, ligamentum flavum\nthickening, and epidural fat with moderate to severe vertebral canal, moderate\nleft and mild right neural foraminal narrowing, grossly similar to ___ prior lumbar spine MRI.\n\nAt T12-L1 there is disc bulge, facet hypertrophy, epidural fat, ligamentum\nflavum thickening, mild-to-moderate vertebral canal and no neural foraminal\nnarrowing, grossly similar to ___ prior lumbar spine MRI.\n\nOtherwise, there is no definite evidence of moderate or severe thoracic spinal\nvertebral canal neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. Interval progression of multilevel cervical spondylosis compared to ___\nprior exam as described, most pronounced at C4-5 where there is\nmild-to-moderate vertebral canal and moderate bilateral neural foraminal\nnarrowing.\n3. C5-6 and C6-7 mild vertebral canal, moderate right and severe left neural\nforaminal narrowing.\n4. Multilevel thoracic spondylosis as described, better demonstrated on ___ prior lumbar spine MRI, most pronounced at T11-12 where there is\nmoderate to severe vertebral canal, moderate left and mild right neural\nforaminal narrowing.\n5. Within limits of study, no definite evidence of cervical or thoracic spinal\ncord signal abnormality." }, { "input": "A transitional vertebral body is noted at the lumbosacral junction. Otherwise,\nthere are 5 non rib-bearing and non transitional lumbar vertebral bodies\nidentified. For the purposes of labeling, the transitional vertebral body\nwill be considered S1.\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno focal suspicious marrow lesion allowing for ___ type 2 L5-S1 endplate\nchanges. There is severe loss of L5-S1 disc space the remainder of the\nvisualized disc heights are preserved. The conus medullaris terminates at the\nL1-L2 level, within expected limits. There is no signal abnormality of the\nterminal cord.\n\nThere is borderline spinal canal narrowing at baseline secondary to congenital\nshortening of the pedicles in the lower lumbar spine.\n\nL1-L2 and L2-L3: Mild degenerative changes not significantly narrow the spinal\ncanal or neural foramina.\n\nL3-L4: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is mild right greater than left\nneural foraminal narrowing.\n\nL4-L5: A disc bulge is not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is mild to moderate bilateral neural\nforaminal narrowing.\n\nL5-S1: A disc bulge with thickening ligamentum flavum results in moderate\nspinal canal narrowing. Loss of disc height in conjunction with the disc\nbulge and facet arthropathy results in moderate to severe bilateral neural\nforaminal narrowing, which flattens the undersurface of the exiting bilateral\nnerve roots. There is crowding of the left-greater-than-right subarticular\nzones, contacting the traversing nerve roots and posterior displacing the\nleft.\n\nS1-S2: There is no significant spinal canal or neural foraminal narrowing.\n\nA 1.5 x 1.3 cm (AP, TRV) exophytic left renal T2 hypointense lesion is\nidentified. The remainder the visualized prevertebral paraspinal soft tissues\nare grossly unremarkable.", "output": "1. Transitional lumbosacral vertebral body, with 5 non-rib-bearing and non\ntransitional lumbar bodies. Of note, the transitional lumbar sacral vertebral\nbody is considered S1 for the purposes of vertebral body labeling.\n2. Degenerative changes are most prominent at L5-S1 where there is severe loss\nof disc height, moderate spinal canal narrowing and moderate to severe\nbilateral neural foraminal narrowing which appears to flatten the undersurface\nof the exiting nerve roots. Crowding of the left-greater-than-right\nsubarticular zones contacts the bilateral traversing nerve roots, posteriorly\ndisplacing the left.\n3. 1.5 cm T2 hypointense exophytic left renal lesion, potentially representing\na cyst. However further evaluation with renal ultrasound is recommended to\nexclude solid lesion.\n\nRECOMMENDATION(S): Renal ultrasound for evaluation of impression 3." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body signal intensity is normal. There is\nmild disc desiccation throughout the cervical spine. The cervical spinal cord\nis normal in caliber and configuration. No spinal cord signal abnormality.\nThere is no spinal canal or neural foraminal narrowing the cervical.\n\nTHORACIC:\nAlignment is normal. Vertebral body signal intensity is normal. There are\nmultiple levels of Schmorl's nodes with mild disc desiccation, more pronounced\nat T7-T8, T8-T9 and T9-T10 levels (series 11, image 9). The thoracic spinal\ncord is normal in caliber and configuration. No cord signal abnormality. The\nconus medullaris terminates at L1. There is no abnormal postcontrast\nenhancement.", "output": "1. No spinal cord signal abnormality. No evidence of a traumatic injury in\nthe cervical or thoracic spine.\n2. Minimal degenerative disc changes without spinal canal or neural foraminal\nnarrowing in the cervical or thoracic spine.\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": "Study is mildly degraded by motion.\n\nThere is minimal anterolisthesis of C3 on C4. Vertebral body heights are\npreserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal. \nThere is no epidural collection.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nWithin limits of study, there is no abnormal enhancement on postcontrast\nimaging. There is no evidence of infection or neoplasm. There is no\nprevertebral soft tissue swelling.. The visualized portion of the posterior\nfossa, and cervicomedullary junction are preserved.\n\nThe spinal canal is congenitally narrow, contributing to narrowing at all\nlevels.\n\n At C2-3 there is small central disc protrusion without significant\nsuperimposed spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is anterolisthesis, central disc protrusion and ligamentum\nflavum thickening producing moderate spinal canal narrowing, with deformation\nof the ventral thecal sac and spinal cord, without definite associated cord\nsignal abnormality. Facet and uncovertebral osteophytes produce mild\nleft-greater-than-right neural foraminal narrowing.\n\nAt C4-5 there is minimal central disc protrusion without significant\nsuperimposed spinal canal narrowing. Facet and uncovertebral osteophytes\nproduce mild right neural foraminal narrowing.\n\nAt C5-6 there is no significant superimposed spinal canal narrowing. Facet\nand uncovertebral osteophytes produce minimal left neural foraminal narrowing.\nThe right neural foramen is patent.\n\nAt C6-7 there is small disc protrusion right of midline with endplate\nosteophytes and ligamentum flavum thickening producing mild superimposed\nspinal canal narrowing with minimal flattening of the ventral cord without\nassociated cord signal abnormality. The neural foramina are patent.\n\nAt C7-T1 there is no significant spinal canal or neural foraminal narrowing.\n\nSagittal view of the T1-T2 demonstrates no significant spinal canal or neural\nforaminal narrowing", "output": "1. Study is mildly degraded by motion.\n2. Congenitally narrowed spinal canal with up to moderate spinal canal\nnarrowing at C3-C4.\n3. Mild neural foraminal narrowing at the bilateral C3-C4 and right C4-C5\nlevels.\n4. Deformation of cervical spinal cord at C3-4 and C6-7 without definite cord\nsignal abnormality.\n5. Within limits of study, no definite abnormal enhancement on postcontrast\nimaging." }, { "input": "The vertebral body heights and alignment are normal. There is no bone marrow\nsignal abnormality. There is mild loss of height and normal T2 signal of the\nL4-L5 intervertebral disc.\n\nAt T12-L1, there is no disc herniation. No spinal canal neural foraminal\nnarrowing.\n\nAt L1-L2, there is no disc herniation. No spinal canal or neural foraminal\nnarrowing.\n\nAt L2-L3, there is no disc herniation no spinal canal or neural foraminal\nnarrowing.\n\nAt L3-L4, there is a disc bulge that is eccentric to the left. There is also\nthickening of the ligamentum flavum and severe degenerative changes of\nbilateral facet joints with osteophyte formation. These result in severe\nnarrowing of the spinal canal and crowding of the nerve roots and\nmild-to-moderate narrowing of the left neural foramen. The right neural\nforamen is normal.\n\nAt L4-L5, there is a disc bulge, ligamentum flavum thickening, and severe\ndegenerative changes of bilateral facet joints with trace bilateral effusions\nand osteophyte formation. These result in severe narrowing of the spinal\ncanal with severe crowding of the nerve roots and no CSF signal in the thecal\nsac (series 8, image 14). There is mild narrowing of the right and\nmild-to-moderate narrowing of the left neural foramina.\n\nAt L5-S1, there is no spinal canal or neural foraminal narrowing. Bilateral\nfacet osteophytes are noted.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.\n\nThe distal spinal cord is normal in caliber and signal intensity. Conus\nmedullaris terminates at L1-L2.\n\nThere is no epidural or paraspinal fluid collection or soft tissue\nabnormality.", "output": "1. Multilevel degenerative changes as described above result in severe\nnarrowing of the spinal canal at L4-5 and L3-4. Similar changes were present\non the prior abdominal CT of ___, however an exact comparison is\ndifficult.\n2. Neural foraminal narrowing is mild to moderate on the left at L3-4 and\nL4-L5." }, { "input": "The spinal cord has normal contour and signal. The cauda equina is at the\nlevel of the T12 vertebral body with normal contour and signal. There is no\nsuspicious intra or extradural mass and no suspicious enhancement to suggest\nspinal or epidural metastatic disease. The vertebral bodies have uniform low\nsignal on STIR with no evidence for metastasis. Vertebral body enhancement is\nuniform. Paraspinal tissues are unremarkable.\n\nUnderlying degenerative changes include:\n\nCERVICAL SPINE: \n\nAt C4-C5 a left paracentral disc protrusion indents the left anterior thecal\nsac but does not significantly narrow the spinal canal. \n\nAt C5-C6 a broad-based disc bulge, larger on the right has similar effect on\nthe thecal sac without significant spinal canal narrowing. \n\nAt C6-C7 a smaller broad-based disc bulge does not cause significant spinal\ncanal narrowing. \n\nTHORACIC SPINE:\n\nAt T8-T9, a right paracentral disc bulge (series 3: image 9) is seen only on\nthe sagittal images, and does not significantly narrow the spinal canal. \n\nLUMBAR SPINE: \n\nAt L5-S1, there is a small broad-based disc protrusion, slightly larger on the\nleft, with no significant foraminal or spinal canal narrowing.", "output": "1. No evidence of metastases.\n2. Mild degenerative changes most prominent in the cervical spine." }, { "input": "There is an acute burst fracture of the L2 vertebral body with retropulsion of\nthe posterior margin causing mild to moderate spinal canal stenosis. There is\nno large epidural hematoma. Edema from the fracture extends into the bilateral\npedicles. There is edema within the ligamentum flavum at L1 and L2, indicating\nligamentous injury. The interspinous ligaments appear normal. The conus is\nnormal in appearance and position, terminating at L1.\n\nFractures of the right L1 and L2 transverse processes demonstrated on CT from\n___ are not well appreciated by MRI.\n\nThere is a left renal cyst.", "output": "Acute L2 burst fracture with retropulsion causing mild to moderate spinal\ncanal stenosis. No epidural hematoma identified. Edema from the fracture\nextends into the bilateral pedicles and there is ligamentous injury of the\nligamentum flavum." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T12 and is\nunremarkable.\n\nFrom T11/T12 through L1/L2 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L2/L3 level, there is interval progression in the disc degenerative\nchanges, with more pronounced left paracentral disc bulging, causing\nleft-sided neural foraminal narrowing, apparently contacting the left dorsal\nroot ganglion (images 13, 14, series 6), mild bilateral articular joint facet\nhypertrophy is present, there is no evidence of spinal canal stenosis at this\nlevel.\n\nAt L3/L4 level, unchanged diffuse disc bulge is again seen, causing mild\nanterior thecal sac deformity, there is mild right neural foraminal narrowing\nand moderate left-sided neural foraminal narrowing, contacting the traversing\nnerve roots (image 5, series 7), mild articular joint facet hypertrophy\nappears unchanged.\n\nAt L4/L5 level, there is disc desiccation and diffuse disc bulge, causing\nmoderate bilateral neural foraminal narrowing, contacting the traversing nerve\nroots, there is mild unchanged articular joint facet hypertrophy.\n\nAt L5/S1 level, there is disc desiccation and slightly more pronounced left\nparacentral disc bulge, causing mild to moderate left-sided neural foraminal\nnarrowing, apparently contacting the left exiting nerve root as (image 5,\nseries 2). Mild bilateral articular joint facet hypertrophy appears\nunchanged.\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable.", "output": "Multilevel, multifactorial degenerative changes throughout the lumbar spine as\ndescribed in detail above, with interval progression and more significant disc\ndegenerative changes at L2/L3, and L5/S1 levels." }, { "input": "Limited examination due to patient motion.\n\nThe cervical spine alignment is normal. Vertebral body and intervertebral\ndisc signal intensity appear normal. The spinal cord appears normal in\ncaliber and configuration. Minimal prominence of the central canal at the\nlevel of C6-7 (3:9). Otherwise, no definite cord signal abnormalities are\nidentified within the limitations of this study. Tiny central disc bulge is\nnoted at C5-C6, where there is also some mild uncovertebral hypertrophy\nresulting in minimal neural foraminal narrowing at this level.\n\nThere is prominence of the adenoids and palatine tonsils.", "output": "1. No cord signal abnormalities identified, within the limitations of this\nslightly motion limited study.\n2. Minimal disc bulging along with uncovertebral hypertrophy at C5-C6,\nresulting in minimal bilateral neural foraminal stenosis. No spinal canal\nstenosis.\n3. Prominence of the adenoids and palatine tonsils, may be physiologic in a\npatient of this age or may be reactive if there is underlying\ninfection/inflammation." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL:\nMild retrolisthesis of C4 over C5 is present.Straightening of cervical\nlordosis is again noted.\nVertebral body heights are grossly preserved. C6-7 endplate type ___ ___\nchanges are noted.\n\nCervical spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4, disc osteophyte complex and ligamentum flavum thickening cause\nmild-to-moderate spinal canal narrowing which contacts anterior and posterior\nsurface of the spinal cord without definite associated cord signal\nabnormality. Bilateral neural foraminal narrowing is severe.\n\nAt C4-5, disc osteophyte complex and ligamentum flavum thickening cause\nmoderate spinal canal narrowing which deforms anterior and posterior surfaces\nof the spinal cord without definite associated cord signal abnormality. \nBilateral neural foraminal narrowing is severe.\n\nAt C5-6, disc osteophyte complex and left uncovertebral joint osteophytes\ncause mild spinal canal narrowing and severe bilateral neural foraminal\nnarrowing.\n\nAt C6-7, bilateral uncovertebral joint osteophytes cause severe bilateral\nneural foraminal narrowing. Spinal canal narrowing is mild.\n\nTHORACIC:\n Vertebral body alignment is preserved. Mild chronic anterior vertebral height\nloss is noted at T7-9 vertebral bodies, unchanged. T2-3, T3-4 and T8-9 type 2\n___ changes noted. Multiple Schmorl's nodes are seen throughout the\nthoracic spine.\n\nAt T2-3, extensive ligamentum flavum thickening cause moderate to severe\nspinal canal narrowing which narrows the transverse diameter of the spinal\ncord resulting in elongation of the anterior posterior diameter of the cord. \nT2 hyperintense signal is identified in the left hemicord (8:8), similar to ___. Bilateral neural foraminal narrowing is severe.\n\nAt T3-4 there is ligamentum flavum thickening and facet joint hypertrophy,\nwith less deformity of the spinal cord and without cord signal abnormality,\nwith moderate vertebral canal narrowing. Severe right and moderate left\nneural foraminal narrowing is noted.\n\nAt T4-5, ligamentum flavum thickening cause mild spinal canal narrowing. \nRight neural foraminal narrowing is moderate to severe and left neural\nforaminal narrowing is mild.\n\nOtherwise, there is no vertebral canal or neural foraminal narrowing of the\nthoracic spine.\n\nLUMBAR:\nVertebral body alignment is preserved. Patient is post L3-5 laminectomy. \nHeterogeneous marrow signal of the L4 and L5 vertebral bodies are grossly\nunchanged.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Nonspecific paraspinal muscle edema is noted at L3-5 levels.\n\nGrossly stable loss of intervertebral disc height and signal is again noted\nthroughout the lumbar spine.\n\nAt T12-1, disc protrusion causes mild spinal canal narrowing and contacts the\nanterior surface of the spinal cord.\n\nAt L1-2, disc osteophyte complex and prominent epidural fat causes moderate to\nsevere spinal canal narrowing with trace amount of CSF space remaining between\nthe nerve roots. Bilateral neural foraminal narrowing is mild.\n\nAt L2-3, disc osteophyte complex and facet joint hypertrophy cause severe\nspinal canal narrowing with near complete effacement of the CSF space between\nthe nerve roots.\n\nAt L3-4, there is disc osteophyte complex and facet joint hypertrophy with no\nvertebral canal and mild bilateral neural foraminal narrowing.\n\nAt L4-5, disc osteophyte complex and facet joint hypertrophy with no vertebral\ncanal and severe bilateral neural foraminal narrowing.\n\nAt L5-S1, disc osteophyte complex and facet joint hypertrophy with no\nnarrowing, moderate right and mild left neural foraminal narrowing.\n\nOTHER:\nAtrophic bilateral kidneys with multiple renal probable cysts are noted.\nRight lower abdominal transplant kidney is present.", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable thoracic spine multilevel degenerative changes compared to\n___ prior thoracic spine MRI, again most pronounced at T2-3,\nwhere there is moderate to severe vertebral canal narrowing with deformity of\nthe spinal cord with narrowing of the transverse cord diameter and elongation\nof the anterior posterior diameter and cord signal abnormality is identified\nat this level in the left hemicord.\n3. Grossly stable nonspecific edema of L4 and L5 vertebral bodies compared to\n___ prior lumbar spine MRI, likely degenerative.\n4. Postsurgical changes related to L3-5 laminectomy.\n5. Grossly stable multilevel degenerative changes cervical spine as described,\nmost pronounced at C4-5, where there is deformation of the dorsal and ventral\nthecal sac and spinal cord without definite associated cord signal\nabnormality, moderate vertebral canal and severe bilateral neural foraminal\nnarrowing.\n6. Grossly stable multilevel degenerative changes lumbar spine as described,\nmost pronounced at L1-2, where there is moderate to severe vertebral canal and\nmild bilateral neural foraminal narrowing.\n7. Nonspecific paraspinal muscle edema is present at L3-5 levels.\n8. Additional grossly stable severe degenerative changes of the cervical,\nthoracic, and lumbar spine as described above.\n9. Bilateral atrophic kidneys with multiple renal probable cysts and pelvic\nrenal transplant as described." }, { "input": "CERVICAL:\nAlignment is unchanged.No abnormal signal is identified in the spinal cord. \nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration. Multilevel degenerative changes,\ndisc osteophyte complexes, disc space narrowing, posterior element\nhypertrophic changes, as seen on prior.\n\nAt C2-3, there is mild central canal narrowing. Mild right foraminal\nnarrowing.\n\nAt C3-4, moderate spinal canal narrowing which contacts the anterior and\nposterior surfaces of the spinal cord. Severe right, moderate left foraminal\nnarrowing.\n\nAt C4-C5 there is moderate central canal narrowing, mild flattening of the\ncord. No definite cord T2 signal abnormality. Severe left, moderate right\nforaminal narrowing.\n\nAt C5-6, suggestion of small left paramedian disc protrusion. \nMild-to-moderate central canal narrowing. Moderate right, severe left\nforaminal narrowing.\n\nAt C6-7, severe bilateral foraminal narrowing. Minimal central canal\nnarrowing.\n\nAt C7-T1 level there is mild right, moderate left foraminal narrowing. \nMinimal central canal narrowing.\n\nTHORACIC:\nMild anterior vertebral body height loss is noted at T7-9 vertebral bodies.\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration. Mild epidural lipomatosis dorsal\nepidural space from T4-T9.\n\nAt T1-T2 level there is mild central canal narrowing. Mild left, moderate\nright foraminal narrowing.\n\nAt T2-3, extensive ligamentum flavum thickening, posterior element\nhypertrophic changes, causing severe spinal canal narrowing which narrows the\ntransverse diameter of the spinal cord resulting in cord flattening. Central\ncord T2 signal abnormality is again seen. Bilateral neural foraminal\nnarrowing is severe. Findings similar compared with ___.\n\nAt T3-4, ligamentum flavum thickening and facet joint hypertrophy causes\nmoderate to severe spinal canal narrowing leading to deformity of the spinal\ncord with subtle T2 cord signal abnormality, stable. Severe right and\nmoderate left neural foraminal narrowing is noted. Findings are similar\ncompared with ___.\n\nSubtle fluid signal in the dorsal epidural space from C7-T4 level, similar to\nprior,, findings may be reactive or from vascular congestion, no evidence of\nacute or subacute epidural hematoma. Infection is unlikely.\n\nAt T4-5, ligamentum flavum thickening causes mild spinal canal narrowing. \nModerate bilateral foraminal narrowing.\n\nAt T12-L1, disc protrusion causes mild spinal canal narrowing.\nNo significant spinal canal or neural foraminal narrowing is identified in\nother levels.\n\nAt L1-L2 level there is moderate central canal narrowing, suboptimally seen\n\nOTHER: Bilateral kidneys are atrophic with multiple cystic lesions, unchanged.\nTiny probable benign cyst right hepatic lobe.", "output": "1. Degenerative changes cervical, thoracic spine.\n2. Moderate central canal narrowing cervical spine at C3-C4, C4-C5. \nMultilevel significant foraminal narrowing cervical spine.\n3. Stable severe T2-T3, moderate to severe T3-T4 level central canal\nnarrowing, with cord T2 signal abnormality. Subtle fluid signal and minimal\npossible enhancement in the dorsal epidural space, may be reactive, no\nevidence of acute or subacute hematoma. Infection is unlikely given\nstability.\n4. Multilevel foraminal narrowing in the thoracic spine." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. A 3 mm\nT1 hypointense, T2 hyperintense rounded focus of the midline L1 anterior\nspinous process (series 4, image 10; series 3, image 10) is identified. There\nis no other suspicious marrow signal. Loss of disc height and signal is mild\nat L3-L4 and L4-L5 and moderate at L5-S1. The conus medullaris terminates at\nthe L1-L2 level, within expected limits. There is no signal abnormality of\nthe visualized cord or conus.\n\nT12-L1 through L2-L3: Mild degenerative changes not result in significant\nspinal canal or neural foraminal narrowing.\n\nL3-L4: A central protrusion with small annular fissure does not significantly\nnarrow the spinal canal. There is no significant neural foraminal narrowing.\n\nL4-L5: A small disc bulge does not significantly narrow the spinal canal. \nThere is mild bilateral facet arthropathy without significant neural foraminal\nnarrowing.\n\nL5-S1: A small disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy there is moderate right and no significant\nleft neural foraminal narrowing.\n\nVisualize prevertebral paraspinal soft tissues are grossly unremarkable\nnoncontrast enhanced examination.", "output": "1. Mild degenerative changes as described above, most prominent at L5-S1 where\nthere is moderate right neural foraminal narrowing.\n2. Rounded T1 hypointense, T2/STIR hyperintense 3 mm focus of the L1 spinous\nprocess. This most likely represents an atypical hemangioma but incompletely\ncharacterized on the current examination and more worrisome lesion is not\nentirely excluded, although considered unlikely. This could be further\nevaluated with dedicated CT lumbar spine.\n\nRECOMMENDATION(S): CT lumbar spine could be performed for further evaluation\nof a T1 hypointense 3 mm lesion in the L1 spinous process." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. There is mild\nrightward curvature of the lumbar spine. There is grade 1 anterolisthesis of\nL5 on S1. There are bilateral pars interarticularis defects at L5. The\nlumbar vertebral body heights are preserved. There is moderate intervertebral\ndisc height loss at L5-S1 and mild intervertebral disc height loss at the\nremaining levels. A 1.9 cm T1 and T2 hyperintense lesion within the L5\nvertebral body is unchanged compared to prior exam and most consistent with a\nhemangioma.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of T12.\n\n There are 5 non-rib-bearing lumbar type vertebral bodies. Alignment of the\nlumbar spine is maintained. The lumbar vertebral body heights and\nintervertebral disc spaces are maintained.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of L1-L2.\n\nL2-L3: There is mild disc bulge and ligamentum flavum thickening resulting in\nmild spinal canal narrowing. There is mild bilateral neural foraminal\nnarrowing.\n\nL3-L4: There is mild disc bulge and ligamentum flavum thickening resulting in\nmild spinal canal narrowing. Mild bilateral neural foraminal narrowing due to\nfacet osteophytes. Mild nonspecific facet joint fluid is present.\n\nL4-L5: Mild disc bulge resulting without significant spinal canal narrowing. \nModerate bilateral neural foraminal narrowing with remodeling of the exiting\nleft L4 nerve root due to facet osteophytes. Minimal nonspecific left facet\njoint fluid is present.\n\nL5-S1: Anterolisthesis of L5 on S1. There is severe right and moderate to\nsevere left neural foraminal narrowing resulting in impingement and remodeling\nof the right greater than left exiting L5 nerve roots. Suspected compression\nof the exiting right L5 nerve root. Findings are unchanged dating back to ___.\n\nOther: There is a partially visualized intermediate T2 lesion in the upper\npole of the left kidney.", "output": "1. Grade 1 anterolisthesis of L5 on S1 due to bilateral pars interarticularis\ndefects at L5.\n2. Severe right and moderate to severe left neural foraminal narrowing at\nL5-S1 with possible compression of the exiting right L5 nerve root. \nRemodeling and impingement of the exiting left L5 nerve root. The findings\nare unchanged dating back to ___." }, { "input": "There is S-shaped scoliotic deformity; upper thoracic dextroscoliotic and a\nlower lumbar compensatory levoscoliotic deformities. The bone marrow\ndemonstrates normal signal intensity with no no evidence of metastatic\ndisease. Multilevel moderate disc degenerative disease manifested by disc\nosteophyte complex formation, disc desiccation, facet arthropathy and\nligamentum flavum thickening.\n\nThe spinal cord appears normal. There is no abnormal enhancement.\n\nCERVICAL:\nThere is reversal of normal lordosis of the cervical spine.\n\nC2-C3 there is a disc bulge with no significant spinal canal or neural\nforaminal narrowing.\n\nC3-C4 there is a mild central disc bulge indenting anterior thecal sac with no\nsignificant spinal canal or neural foramina stenosis.\n\nC4-5: There is no spinal canal or neural foraminal stenosis.\n\nC5-C6: Intervertebral osteophytes mildly encroach on the spinal canal. A\nsmall disc bulge contributes to canal encroachment and indents the anterior\nsurface of the spinal cord.\n\nC6-C7: There is no spine narrowing..\n\nTHORACIC:\n\nT10-T11: There is moderate facet arthropathy and ligamentum flavum thickening\nindenting posterior thecal sac and abutting posterior thoracic cord causing\nmild spinal canal narrowing. No new neural foraminal narrowing.\n\nT11-12: There is moderate facet arthropathy and ligamentum flavum thickening\nindenting posterior thecal sac and abutting posterior thoracic cord causing\nmild to moderate spinal canal narrowing. No significant neural foraminal\nnarrowing.\n\nOther thoracic vertebral levels; no significant disc bulge, spinal canal\nnarrowing or neural foraminal stenosis.\n\nLUMBAR:\nL1-L2: Bilateral facet arthropathy and ligamentum flavum thickening causing\nmild narrowing of spinal canal and indenting posterior thecal sac. Bilateral\nmild neural foraminal narrowing.\n\nL2-L3: There is a mild disc bulge. There is bilateral facet arthropathy and\nligamentum flavum thickening causing mild narrowing of spinal canal and\nindenting posterior thecal sac. Bilateral mild to moderate neural foraminal\nnarrowing; more the right-side.\n\nL3-L4: There is a mild to moderate disc bulge. There is bilateral facet\narthropathy and ligamentum flavum thickening causing mild narrowing of spinal\ncanal and indenting posterior thecal sac. Bilateral moderate neural foraminal\nnarrowing; more the right-side.\n\nL4-L5: There is a mild to moderate disc bulge. There is bilateral facet\narthropathy and ligamentum flavum thickening causing moderate narrowing of\nspinal canal and indenting posterior thecal sac. Bilateral moderate neural\nforaminal narrowing; more in the left side.\n\nL5-S1 There is a mild disc bulge. There is bilateral facet arthropathy and\nligamentum flavum thickening causing mild narrowing of spinal canal and\nindenting posterior thecal sac. Bilateral moderate neural foraminal narrowing;\nmore in the left side.", "output": "1. No evidence of metastatic disease.\n2. Redemonstration of history moderate scoliotic deformity seen with moderate\ndisc degenerative disease as described" }, { "input": "There is anterior subluxation of L3 upon L4 and L4 upon L5. The patient is\nstatus post laminectomies and posterior fusion from L1 through L5. There is a\npostoperative fluid collection posterior to the thecal sac mildly indenting\nupon the thecal sac. Vertebral body signal intensity appears normal. There\nis loss of signal of the intervertebral discs at all imaged levels on the T2\nweighted images. These are manifestations of degenerative disc disease.\n\nThe conus medullaris ends at L1-2.\n\nAxial images at T10-11 and T11-12 demonstrate mild canal narrowing due to disc\nbulge and facet osteophytes. The neural foramina are not compromise.\n\nAt T12-L1, a prominent disc bulge and thickening of the ligamentum flavum\noverlying facet osteophytes produces severe spinal canal stenosis and\ncompression of the conus medullaris.\n\nAt L1-2 and L2-3 there are postoperative changes with extensive scarring\nreplacing the anterior and lateral epidural fat. However, there is no\nevidence of spinal canal or thecal sac encroachment.\n\nAt L3-4, disc bulging and subluxation produces mild canal narrowing. The\nbulging of the disc produces bilateral moderate -severe neural foraminal\nnarrowing. Again seen is postoperative epidural scarring surrounding the\nthecal sac and extending into the neural foramina.\n\nAt L4-5, there is more extensive involvement of the neural foramina with\nepidural scarring. There is mild -moderate canal narrowing due to subluxation\nand disc bulging.\n\nThere is a mild bulge of the disc at L5-S1 with no compromise of the spinal\ncanal or neural foramina. There is no evidence of infection or neoplasm.", "output": "1. Status post laminectomy and posterior fusion L1 through L5 with\ndegenerative changes and postoperative scar encroaching on the neural foramina\nand mildly narrowing the spinal canal.\n2. Postoperative fluid collection with mild encroachment on the spinal canal.\n3. Severe spinal stenosis and conus compression at T12-L1 due to disc bulge,\nligamentum flavum thickening and facet osteophytes.\n\nRECOMMENDATION(S): Urgent evaluation of conus medullaris compression\n\nNOTIFICATION: The finding of conus medullaris compression was discussed by\ntelephone by Dr. ___ with at 16:30 ___ immediately upon noting the\nfindings. Dr. ___ Ms. ___ home phone at 4:50 pm ___,\nand spoke with her nephew, ___, who agreed to bring her to the\nEmergency Department for evaluation." }, { "input": "From T9-10-T11-12 levels disc degenerative changes and mild bulging seen. At\nT12-L1 diffuse disc bulge and thickening of the ligaments result in moderate\nspinal stenosis. There is moderate right foraminal narrowing. Indentation on\nthe right side of the spinal cord is seen by facet degenerative changes but no\nevidence of cord compression.\n\nAt L1-2, L2-3 and L3-4 levels disc degenerative change and mild bulging seen. \nThere is no spinal stenosis.\n\nAt L4-5 level, mild spondylolisthesis of L4 over L5 seen with severe facet\ndegenerative changes and thickening of the ligaments which to gather with\nbulging disc result in severe spinal stenosis. There is moderate-to-severe\nright and moderate left foraminal narrowing.\n\nAt L5-S1 level, mild spondylolisthesis of L5 over S1 seen with facet\ndegenerative changes and mild-to-moderate bilateral foraminal narrowing. \nThere is no central canal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Severe spinal stenosis at L L4-5 level due to disc and facet degenerative\nchanges with mild spondylolisthesis. Moderate-to-severe right and moderate\nleft foraminal narrowing at this level.\n2. Moderate spinal stenosis at T12-L1 level due to disc and facet degenerative\nchanges.\n3. Other degenerative changes as described above." }, { "input": "There are 5 lumbar-type vertebrae. Lumbar vertebral body heights are\npreserved. Mild loss of height involving T10 and T11 vertebral bodies appears\nunchanged. The localizer sequence again demonstrates an incompletely imaged\ndextroconvex curvature of the visualized thoracic spine. Recent ___ radiographs better demonstrated minimal levoconvex curvature centered at\nthe thoracolumbar junction. Grade 1 anterolisthesis of L4 on L5 and of L5 on\nS1 appears unchanged.\n\nThe conus medullaris terminates near the upper aspect of L2, as seen\npreviously.\n\nT9-T10: There is a disc bulge, a left paracentral disc protrusion, and right\nlarger than left facet osteophytes. The spinal canal is mildly narrowed. \nThere is moderate right and severe left neural foraminal narrowing. \nAppearances are similar to the sagittal images of the prior MRI, which did not\ninclude axial images through this level.\n\nT10-T11: There is a disc bulge and a left paracentral disc herniation\nextending inferiorly, the latter approaching the spinal cord without clear\nevidence for cord remodeling. Evaluation of spinal cord signal is somewhat\nlimited by artifacts, without clear evidence for signal abnormalities. There\nis mild-to-moderate spinal canal narrowing. There is moderate to severe\nbilateral neural foraminal narrowing by the disc bulge, endplate osteophytes,\nand facet osteophytes. Appearances are similar to the sagittal images of the\nprior MRI, which did not include axial images through this level.\n\nT11-T12: There is a disc bulge covered by broad-based endplate osteophytes,\nand facet arthropathy. The spinal canal is mildly narrowed without mass\neffect on the spinal cord. There is moderate bilateral neural foraminal\nnarrowing by endplate and facet osteophytes. Appearances are similar to the\nsagittal images of the prior MRI, which did not include axial images through\nthis level.\n\nT12-L1: There is a disc bulge, a small central disc protrusion, moderate to\nsevere right and moderate left facet arthropathy, and infolding of the\nligamentum flavum. Facet osteophytes abut the dorsal spinal cord without\nevidence for remodeling or cord signal abnormality. There is mild-to-moderate\nspinal canal stenosis. There is moderate to severe right neural foraminal\nnarrowing. Appearances are similar to the prior MRI.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge, mild facet arthropathy, and mild infolding of the\nligamentum flavum. No significant spinal canal narrowing. Mild bilateral\nneural foraminal narrowing. No change since the prior MRI.\n\nL3-L4: Mild disc bulge which is slightly larger on the left than right,\nmoderate facet arthropathy, and infolding of the ligamentum flavum. The\nthecal sac is mildly narrowed with mild crowding of the intrathecal nerve\nroots. Traversing left L4 nerve root is contacted in the subarticular zone. \nBilateral neural foramina are mildly narrowed. Appearances are similar to the\nprior MRI.\n\nL4-L5: There is grade 1 anterolisthesis with an uncovered and bulging disc,\nsevere facet arthropathy with left facet joint effusion, and infolding of the\nligamentum flavum. There is severe spinal canal stenosis with severe crowding\nof the intrathecal nerve roots and compression of traversing L5 nerve roots in\nthe subarticular zones, unchanged. Moderate bilateral neural foraminal\nnarrowing with abutment of the exiting L4 nerve roots is also unchanged.\n\nL5-S1: There is grade 1 anterolisthesis with an uncovered and bulging disc,\nand severe bilateral facet arthropathy with small bilateral facet joint\neffusions. The thecal sac is mildly narrowed without mass effect on the\nintrathecal nerve roots. Bilateral traversing S1 nerve roots are contacted in\nthe subarticular zones. The neural foramina are foreshortened with mild right\nand mild-to-moderate left narrowing. No change since the prior MRI.\n\nMild degenerative changes of the bilateral sacroiliac joints are again noted.\n\nCircumscribed T2 hyperintense cortical foci in the lateral mid right kidney on\nimage 5:16 and in the mid/lower right kidney on image 5:19 statistically\nlikely represent cysts.", "output": "1. No change compared to the ___ MRI.\n2. Grade 1 anterolisthesis at L4-L5 and L5-S1.\n3. Lumbar spinal canal stenosis is severe at L4-L5 with compression of the\nintrathecal nerve roots and traversing L5 nerve roots, and mild at L3-L4 and\nL5-S1. Multilevel neural foraminal narrowing is also again seen, as detailed\nabove.\n4. In the lower thoracic spine, there is mild spinal canal stenosis at T9-T10,\nmild-to-moderate spinal canal stenosis at T10-T11, mild spinal canal stenosis\nat T11-T12, and mild-to-moderate spinal canal stenosis at T12-L1, as well as\nmultilevel neural foraminal narrowing. No evidence for signal abnormalities\nin the distal spinal cord allowing for mild artifacts." }, { "input": "There is grade II anterolisthesis of L5 on S1 with bilateral pars defect. \nVertebral body height and alignment is otherwise preserved. There is\ndegenerative disc disease at L5-S1 with severe disc space height loss. The\ndisc spaces are otherwise maintained. Bone marrow signal intensity is normal.\n\nThe spinal cord is normal in caliber and configuration. The conus terminates\nnormally at the L1 level.\nThe cauda equina nerve roots are unremarkable.\n\nFrom T12-L1 through L4-5 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L5-S1, there is facet joint arthropathy and ligamentum flavum thickening,\nuncovering disc causing severe bilateral neural foraminal narrowing, with mild\ncompression of the L5 nerve roots in the neural foramen bilaterally.\n\nOtherwise, there is no spinal canal stenosis or significant neural foraminal\nnarrowing at the remaining lumbar levels.", "output": "Grade II anterolisthesis at L5-S1 level, with bilateral pars defects, severe\nbilateral neural foraminal narrowing, resulting in mild compression of the\nbilateral L5 nerve roots in the neuroforamen." }, { "input": "The thoracic kyphosis is exaggerated. There is no evidence of malalignment.\nNumerous enhancing metastatic lesions are seen throughout the thoracic and\nimaged portion of the lumbar spine, involving both the anterior and posterior\nelements of the vertebral bodies.\n\nThere is a compression fracture of the vertebral body of T6, which measures 7\nmm along the anterior aspect of the vertebral body, which represents a loss of\n50-75% of the vertebral body height. There is a focal left paracentral\nprotrusion associated with this fracture (series 11, image 26) which narrows\nthe spinal canal but does not appear to contact the cord.\n\nThere is also a central compression fracture or of T7, with loss of ___ of\nthe vertebral body height which now measures 10 mm in its mid posterior\nportion, with associated retropulsion of the L2 vertebral body, more\npronounced towards the right, resulting in moderate to severe spinal canal\nstenosis, with contact between the retropulsed vertebral body and the cord. No\ncord signal abnormality is seen at this level and the posterior column of CSF\nis maintained. However, there is extension of the retropulsion into the right\nneural foramen of T7-T8 (series 12 image 3) resulting in mild neural foramen\nnarrowing.\n\nThere is also a large metastatic lesion centered on the left pedicle and\ntransverse process of T5, which encases the costovertebral joint, invades the\nparaspinal tissues in the left, and appears to transgress the thecal sac\n(series 11, image 19). This lesion also results in complete encasement of the\nleft neural foramina at T4-T5, with encasement of the traversing left T5 nerve\nroot.\n\nThe remaining metastatic lesions in both anterior and posterior elements of\nthe thoracic spine do not demonstrate invasion of the thecal sac nor result in\nspinal cord compression.\n\nMinimal degenerative changes of the thoracic spine identified, oval there is\nno resultant spinal canal stenosis or neural foramina narrowing from such\nchanges. Degenerative changes of the cervical spine and imaged portion of the\nlumbar spine are incompletely evaluated and seen only on the sagittal\nsequences. The thoracic spinal cord and conus medullaris have normal\nmorphology and signal intensities.\n\nThis study is suboptimal for assessment of the lungs, mediastinum and abdomen.\nAllowing for these limitations, innumerable liver lesions are incompletely\nevaluated (series 8 images 14 through 35).", "output": "1. Extensive metastatic disease of the thoracic spine. No evidence of\nintrathecal metastases.\n2. Compression fractures of T6 and T7, with retropulsion of T7 resulting in\nsevere spinal canal stenosis with contact between the cord and the retropulsed\nvertebral body. No cord signal abnormality identified.\n3. Compression fracture of T6 results in a left paracentral protrusion which\nimpinges the thecal sac but does not contact the cord.\n4. Metastatic lesion centered on the left pedicle and transverse process of T5\ncompletely encases the left T4-T5 neural foramen and its contents, including\nthe exiting T5 root.\n5. Extension of the retropulsed vertebral body of T7 into the right neural\nforamen of T7-T8 results in mild neural foramen narrowing.\n6. Innumerable liver lesions incompletely evaluated in this exam. Recommend\nclinical correlation. If clinically indicated, consider dedicated hepatic\nimaging." }, { "input": "From T10-T11 through L2-3 levels mild disc degenerative changes and minimal\nbulging seen without spinal stenosis.\n\nAt L3-4 level, mild disc bulging is identified with minimal narrowing of the\nspinal canal and mild narrowing of the left foramen.\n\nAt L4-5 level, disc and facet degenerative changes seen with grade 1\nspondylolisthesis of L4 over L5. There is moderate-to-severe spinal stenosis\nvisualized with moderate-to-severe bilateral foraminal narrowing. The\nspondylolisthesis appears to be unchanged from the plain film examination of\n___ and CT of ___.\n\nAt L5-S1 level, disc bulging is identified with moderate left and mild right\nforaminal narrowing without spinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. No\nabnormal intraspinal or paraspinal enhancement is seen. There are no focal\nbony abnormalities suspicious for infiltrative lesions.", "output": "1. Disc and facet degenerative changes and grade 1 spondylolisthesis of L4\nover L5 with moderate-to-severe spinal stenosis and bilateral\nmoderate-to-severe foraminal narrowing.\n2. Degenerative changes at other levels as described.\n3. No abnormal enhancement." }, { "input": "CERVICAL:\nThe patient is status post C5-6 discectomy and anterior fusion. The metallic\nplates and screws results in susceptibility artifact. Interbody spacer. Mild\nprevertebral edema,, small volume fluid, likely postoperative, from C2-3 level\nthrough the T1-2 level.\n\nPostoperative level:\nIn the right hemi cord at the C5-C6 level (series 6, image 20) there is\nincreased T2 and STIR hyperintense changes which is larger compared to prior. \nLeft cord T2 signal abnormality at the same level is similar.\nSpinal canal narrowing at this level is slightly improved compared to prior,\npreviously the spinal canal measured 7 mm in the AP diameter, currently\nmeasures 8 mm in the AP diameter. Trace ventral pidural fluid at C5 and C6\nlevel. There is severe bilateral foraminal narrowing, similar\n\nMultilevel advanced degenerative changes in the cervical spine. Mild\nanterolisthesis C4-C5, C7-T1 levels, similar to prior. Multilevel disc\nosteophyte complexes C2-C3 through C7-T1 levels. Posterior element\ndegenerative changes. Facet joint fluid C5-C6 level is more prominent since\nprior. Congenital narrowing spinal canal\n\nAt C2-C3 level, central canal is patent. Mild bilateral foraminal narrowing.\n\nAt C3-C4 level there is mild-to-moderate central canal narrowing, minimal\neffacement left ventral cord from disc osteophyte complex, similar. Moderate\nleft, mild right foraminal narrowing, stable.\n\nAt C4-C5 level there is moderate to severe central canal narrowing, mild\nflattening of the cord, similar to prior. Moderate bilateral foraminal\nnarrowing, stable.\n\nAt C5-C6 level, see above under operated level.\n\nAt C6-C7 level there is moderate central canal narrowing, stable. Moderate\nright, mild left foraminal narrowing, similar.\n\nAt C7-T1 level mild-to-moderate central canal narrowing, stable. Moderate\nleft, moderate to severe right foraminal narrowing, stable.\n\n\n\nTHORACIC:\nLimited exam.\nAlignment is normal.There is multilevel degenerative changes of the thoracic\nspine, but there is no acute fracture, epidural or paraspinal collection. \nThere is no abnormal cord signal intensity. There is no compromise of the\ncord in the spinal canal. Multilevel minimal central canal and mild foraminal\nnarrowing.\n\nOTHER: Simple appearing renal cysts. Prominent left extrarenal pelvis, no\nhydronephrosis. Single cortical scar left kidney.", "output": "1. Post C5-6 discectomy and anterior fusion, with moderate to severe central\ncanal narrowing at this level, mildly improved since prior. There is mildly\nworsened right cord T2 signal abnormality at this level, on the background of\nunderlying spondylotic myelopathy, may represent edema or sequela of ischemia.\n2. Significant degenerative changes remainder cervical spine, as above.\n3. Mild degenerative changes thoracic spine." }, { "input": "Evidence of ACDF at C5-C6 is again seen. The hardware is not assessed by MRI.\nAlignment at C5-C6 remains anatomic. Mild anterolisthesis of C7 on T1 is\nunchanged. Vertebral body heights are preserved. Marrow signal within C5 and\nC6 vertebral bodies is distorted by hardware related artifacts. No suspicious\nmarrow signal abnormalities are seen elsewhere.\n\nCerebellar tonsils are normally positioned. Visualized posterior fossa is\nunremarkable.\n\nThere is high T2 signal in the right aspect of the cord from the lower C5\nthrough the mid C6 level, and high T2 signal in the left aspect of the cord at\nthe upper C6 level, unchanged in craniocaudad extent compared to ___. Associated mild expansion of the right portion of the cord in AP\ndimension has decreased. No new cord signal abnormalities are seen. No\nabnormal intrathecal contrast enhancement.\n\nC2-C3: No spinal canal or neural foraminal narrowing. Bilateral facet\narthropathy is again noted.\n\nC3-C4: Left paracentral disc protrusion with endplate osteophytes does not\ncontact the spinal cord, yet the left ventral aspect of the cord is remodeled.\nMild right and severe left neural foraminal narrowing by uncovertebral and\nfacet osteophytes. No interval change.\n\nC4-C5: Central disc protrusion moderately narrows the spinal canal and\nremodels the ventral spinal cord. Mild right and moderate left neural\nforaminal narrowing by uncovertebral and facet osteophytes. No interval\nchange.\n\nC5-C6: Broad-based, left larger than right endplate osteophytes cause moderate\nto severe spinal canal narrowing with spinal cord deformity. Mild to moderate\nleft neural foraminal narrowing by uncovertebral and facet osteophytes. \nSevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes. No interval change.\n\nC6-C7: Central disc protrusion indents the ventral thecal sac with mild spinal\ncanal narrowing, and approaches the ventral spinal cord without definite cord\ndeformity. Moderate bilateral neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC7-T1: Mild anterolisthesis with an uncovered disc are again noted. No\nsignificant spinal canal narrowing. Moderate bilateral neural foraminal\nnarrowing by endplate and facet osteophytes. No interval change.\n\nThere is a 3 mm T2 hyperintense focus in the partially visualized right\nthyroid lobe, image 7:17, which does not require further evaluation according\nto the ACR guidelines. There is a stable 4 mm nonspecific oval nodule in the\nleft posterior subcutaneous fat at the level of T1, image 7:10, possibly a\nnonenlarged lymph node.", "output": "1. Status post ACDF at C5-C6 in anatomic alignment.\n2. Multilevel degenerative disease. Spinal canal stenosis remains moderate to\nsevere at C5-C6 with spinal cord deformity, and moderate at C4-C5 with ventral\ncord deformity.\n3. T2 signal abnormality in the right aspect of the cord from lower C5 through\nmid C6 levels, and in the left aspect of the cord at the upper C6 level,\nunchanged in craniocaudad extent, compatible with myelomalacia plus/minus\nedema. Decreased AP diameter of the cord on the right at this level,\nindicating decreased/resolved edema." }, { "input": "Alignment is normal. Vertebral body signal intensity appears normal. There\nis loss of signal of the L4-5 intervertebral disc on the T2 weighted images, a\nmanifestation of degenerative disc disease. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing. There is no evidence of infection or neoplasm.\n\nAxial images from L2-L4 demonstrate no significant abnormalities.\n\nAt L4-5, there is bulging of the disc minimally encroaches on the spinal\ncanal, but disc material bulges into the neural foramina bilaterally. The an\nannular fissure also extends into the left neural foramen. The disc compresses\nthe exiting L4 nerve roots bilaterally at this level.\n\nAxial images at L5-S1 demonstrate mild bulging of the intervertebral disc and\nfacet osteophytes bilaterally. There is no encroachment on the spinal canal or\nneural foramina.", "output": "There is mild degenerative disc disease at L4-5 with contact with the exiting\nL4 nerve roots in the neural foramina bilaterally." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. Hyperintense signal within the C5 vertebral body on initial\nimaging is not seen on subsequent sequences and likely artifactual in nature.\nThere are minimal disc bulges at C4-C5 and C5-C6. The spinal cord appears\nnormal in caliber and configuration, and there is no abnormal cord signal. \nThere is no evidence of spinal canal or neural foraminal narrowing.", "output": "No signs of ligamentous injury or fracture." }, { "input": "There are degenerative changes in the partially seen cervical spine, with\nprobably moderate central canal narrowing at C6-C7 level.\n\nMild thoracic kyphosis.. Minimal anterolisthesis T2-T3. Multilevel disc space\nnarrowing, diffuse disc bulges. Posterior element hypertrophic changes. No\nworrisome osseous lesions. No cord T2 signal abnormality. No compression\nfractures. No T4 level abnormality.\n\nMultilevel diffuse disc bulges cause multilevel mild central canal narrowing\nin the thoracic spine. Small left paramedian shallow disc protrusion T7-T8\nlevel, contacts ventral cord, mild central canal narrowing.\n\nMultilevel mild foraminal narrowing in thoracic spine.\n\nDegenerative changes in the upper lumbar spine, L1-L 2, L2-L3 disc space\nnarrowing, diffuse disc bulges. Mild central canal narrowing L1-L2 level.\nProbably moderate central canal narrowing L2-L3 level.\n\nMild esophageal hiatal hernia.", "output": "Degenerative changes thoracic spine, mild central canal, mild foraminal\nnarrowing.\nCervical, lumbar spine degenerative changes, partially seen." }, { "input": "Many of the sequences are degraded by motion artifact. Within these confines:\n\nThe vertebral body heights and sagittal alignment are maintained. There is\nstraightening of the cervical spine which may be positional. The bone marrow\nsignal is unremarkable. Of\n\nThe cervical cord is normal in morphology and signal intensity. There is no\nabnormal enhancement.\n\nAt C4-C5, and C5-C6 there are minimal disc bulges with superimposed a\nextrusions resulting in mild spinal canal narrowing and ventral remodeling of\nthe cord. There is no significant spinal canal or neural foraminal narrowing\nat the other levels.", "output": "There is no evidence of demyelinating disease.\n\nMild cervical spondylosis as described above." }, { "input": "THORACIC SPINE: On the provided fat saturated T1-weighted post-gadolinium\nsequences, there is no abnormal enhancement involving the thoracic spine. \nAlignment and vertebral body height are maintained. There is no high-grade\nspinal canal narrowing. Disc protrusions at T8-T9 and T9-T10 are similar to\nprior.\n\nLUMBAR SPINE: The patient is status post L4-S1 laminectomy. There has been a\nslight interval decrease in size of the deep subcutaneous fluid collection,\nmeasuring 2.8 x 3.4 x 0.7 cm (CC x AP x transverse) compared to 4.2 x 4.0 x\n1.1 cm ___. Adjacent stranding and increased T2/STIR signal and\nenhancement within the posterior paraspinal soft tissues adjacent to the\nlaminectomy site are otherwise similar to prior. This enhancing granulation\ntissue extends from the subcutaneous region to the deeper tissues, abutting\nthe thecal sac within the surgical site, partially surrounding the thecal sac,\nsimilar to prior. The extent of enhancement is similar to ___ and\n___. As before, the enhancing tissue surrounds the right L5 nerve root\nin the lateral recess. \n\nAlignment is unchanged and near-anatomic. Disc desiccation is similar to\nprior, most severe at L1-L2, L4-L5, and L5-S1, with associated degenerative\nendplate signal irregularity and scattered Schmorl's nodes, similar to prior.\n\nThe cauda equina terminates at the level of the mid L1 vertebral body with\nnormal contour and signal.\n\nOtherwise, underlying degenerative changes are unchanged and include:\n\nPosterior subluxation of L1 on L2.\n\nAt T12-L1, right focal disc protrusion indents the ventral thecal sac,\nnarrowing the right lateral recess, and displacing traversing nerve roots.\n\nAt L1-L2, diffuse disc bulge mildly narrows the spinal canal.\n\nAt L2-L3, mild disc bulge, larger on the left, does not significantly narrow\nthe spinal canal or neural foramina.\n\nAt L3-L4, diffuse disc bulge flattens the ventral thecal sac and mildly\nnarrows the spinal canal.\n\nAt L4-L5, diffuse disc bulge combines with facet degeneration to mildly narrow\nthe foramina bilaterally.\n\nAt L5-S1, diffuse disc bulge and facet degeneration moderately narrows the\nforamina bilaterally.", "output": "1. Status post L4 through S1 laminectomy with enhancing tissue within the\nposterior paraspinal soft tissues and adjacent to the thecal sac. The fluid\ncollection within the deep subcutaneous soft tissues of the surgical bed is\ndecreased in size compared to ___. Otherwise, there has been no\nsignificant change. Again seen is low signal in the vertebral endplates at\nL4-5 with enhancement on T1 weighted images. This may be a consequence of\ndegenerative disk disease and surgery. Although these findings do not require\ninfection, it is impossible to exclude infection in the setting of extensive\nenhancement and fluid collections described above. \n\n2. Underlying degenerative changes, unchanged." }, { "input": "There are acute compression fractures of T12, L2, and L3 with corresponding\nhypointense T1 and hyperintense STIR signal with loss of vertebral body height\nby approximately 40 % anteriorly at T12, 70 % mid L2, and less than 10% at L3.\nThere is an associated L2 retropulsion component with trace anterior epidural\nhematoma posterior to L2 and L3 vertebral bodies (3:12). There is L1 through\nL3 prevertebral soft tissue edema with disruption of the anterior longitudinal\nligament at L1-L2 (03:11).\n\nThe conus terminates at L1-L2. There is no abnormal spinal cord signal\nintensity or morphology.\n\nL1-L2: There is loss of intervertebral disc height posteriorly with a disc\nbulge and ligamentum flavum thickening and facet osteophytes with mild spinal\ncanal stenosis, narrowing of bilateral subarticular recess, mild left and no\nright neural foraminal stenosis. In addition, there is an extruded disc\nfragment (06:17) measuring 0.7 x 0.5 cm with cephalad extension posterior to\nL2 vertebral body with resulting mild spinal canal stenosis and impingement of\nthe posterior longitudinal ligament (05:10).\n\nL2-L3: There is a disc bulge with bilateral facet osteophytes and ligamentum\nflavum thickening. There is mild spinal canal stenosis with remodeling of the\nspinal cord and mild bilateral neural foraminal narrowing.\n\nL3-L4: There is a disc bulge with ligamentum flavum thickening. There is no\nspinal canal or neural foraminal stenosis.\n\nL4-L5: There is a disc bulge with ligamentum flavum thickening and facet\nosteophytes. There is no spinal canal stenosis. There is narrowing of\nbilateral subarticular recess contacting the traversing nerve roots. There is\nmild right and no left neural foraminal stenosis.\n\nL5-S1: There is a central and paracentral disc protrusion extending into the\nneural foramina with bilateral facet osteophytes and ligamentum flavum\nthickening. There is no spinal canal stenosis or neural foraminal stenosis.\n\nThere are multiple T2 hyperintense lesions within the right kidney, presumably\nrenal cysts with thin septations in the upper pole right kidney renal cyst.", "output": "1. Acute compression fractures of T12, L2, and L3 vertebral bodies with\nassociated loss of vertebral body heights and L2 retropulsion component, as\nabove.\n2. L2-L3 anterior longitudinal ligament injury with mild prevertebral soft\ntissue edema.\n3. Disc extrusion at L1-L2 with cephalad extension causing mild spinal canal\nstenosis with remodeling of the spinal cord and impingement of the posterior\nlongitudinal ligament.\n4. Trace anterior epidural hemorrhage posterior to L2 and L3 vertebral bodies.\n5. Multilevel degenerative changes of the lumbar spine, as detailed above.\n\nRECOMMENDATION(S): There are multiple T2 hyperintense lesions within the\nright kidney, presumably renal cysts with thin septations in the upper pole\nright kidney renal cyst. Correlation with renal ultrasound recommended as\nclinically warranted." }, { "input": "Numbering has been provided on series 5, image 10, and series 8, image 10, and\nis based on counting from cervical spine down to lumbar spine level. Based on\nthis numbering, there is lumbarization of the S1 vertebral body.\n\nCervical spine: The alignment is normal. No bone marrow signal abnormalities\nare identified. Uncovertebral, facet degenerative changes. Multilevel disc\nosteophyte complexes. Narrowed C5-C6, C6-C7 disc spaces. Diffuse loss of the\nnormal T2 signal is seen within the intervertebral discs of the cervical\nspine, degenerative in etiology.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: Moderate spinal canal narrowing. Facet joint and uncovertebral\nosteophytes contribute to moderate right and mild left neural foraminal\nnarrowing.\n\nC4-C5: Moderate to severe central canal narrowing, complete loss of CSF about\ncord, mild cord flattening.. Suggestion of subtle cord T2 signal abnormality.\nFacet joint and uncovertebral osteophytes contribute to moderate to severe\nbilateral neural foraminal narrowing.\n\nC5-C6: Moderate spinal canal narrowing. Facet joint and uncovertebral\nosteophytes contribute to moderate to severe bilateral neural foraminal\nnarrowing, left greater than right.\n\nC6-C7: Probable small broad-based right paramedian disc protrusion. Mild\nspinal canal narrowing. Facet joint and uncovertebral arthropathy results in\nmoderate right and mild left neural foraminal narrowing.\n\nC7-T1: There is no significant central canal narrowing. Mild right foraminal\nnarrowing. Left foramen is patent.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.\n\n\n\nThoracic spine: The alignment is normal. The T9 vertebral body demonstrates a\ncompression deformity of the anterior and middle columns, with subtle\nincreased STIR signal abnormality. There is no evidence of retropulsion of\nfragments.\n\nThe T12 vertebral body demonstrates a new compression deformity, with\nincreased STIR signal abnormality along the superior endplate, with minimal\ndisplacement of posterior aspect of upper vertebral body line, causing mild\ncentral canal narrowing. Compression deformity at the L1 vertebral body,\nappears unchanged compared to the prior exam, with subtle increased STIR\nsignal abnormality along the superior endplate. No cord signal abnormalities\nare identified. Diffuse loss of the normal T2 signal is seen throughout the\nintervertebral discs of the thoracic spine, degenerative in etiology.\n\nThere is no significant spinal canal or neural foraminal narrowing.\nCholelithiasis.\n\n\n\nLumbar spine: There is 6 lumbar type vertebral bodies, with lumbarization of\nS1 segment. New compression fractures are seen involving the anterior and\nmiddle columns of the L2 and S1 vertebral bodies, with increased STIR signal\nabnormality. Compression deformity of the L3 vertebral body appears slightly\nprogressed compared to the prior exam. There is minimal upper endplate edema\nat L4, improved since prior. The cord terminates at L2. No terminal cord\nsignal abnormalities are seen. The intervertebral disc signal is\nunremarkable. Small amount of prevertebral soft tissue edema is seen at the\nlevel of L2-L3, likely sequelae of patient's known fractures. Prominent\ndorsal epidural fat. Mild congenital narrowing spinal canal.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: Disc bulge, with a focal right central extruded disc with cephalad\nextension is seen measuring up to 1 cm which in conjunction with ligamentum\nflavum thickening and facet joint osteophytes contributes to mild-to-moderate\nspinal canal narrowing, similar. Stable mild bilateral foraminal narrowing..\n\nL3-L4: Disc bulge, with facet joint osteophytes and ligamentum flavum\nthickening results in mild spinal canal narrowing. Facet joint osteophytes\ncontributes to mild bilateral neural foraminal narrowing.\n\nL4-L5: Disc bulge, ligamentum flavum thickening and posterior epidural fat\nresults in mild spinal canal narrowing, stable. Facet joint osteophytes\ncontribute to mild to moderate bilateral neural foraminal narrowing, stable.\n\nL5-S1: Disc bulge, ligamentum flavum thickening and facet joint arthropathy\ncontributes to moderate spinal canal narrowing, stable. Facet joint\nosteophytes contribute to moderate right, mild-to-moderate left foraminal\nnarrowing, similar\n\nS1-S2: Disc bulge, ligamentum flavum thickening and facet joint osteophytes\nare seen resulting in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to moderate right and mild left neural foraminal narrowing.\n\nA by 2 cm T2 hyperintense lesion is seen within the upper pole of the right\nkidney. Additional smaller 2 right renal lesions, presumably cysts,\nsuboptimally evaluated. Suggestion of AVN right femoral head seen on scout\nimages. Foley catheter in the bladder.", "output": "1. Numbering is based on counting from the level of cervical spine.\n2. New compression fractures are seen at the T12, L2 and S1 levels.\n3. Possible subacute compression fracture seen involving the T9 vertebral\nbody.\n4. Compression deformity of L1 is unchanged compared to the prior exam.\n5. Compression deformity of the L3 vertebral body is more prominent.\n6. Disc bulge with a focal right central extruded disc with cephalad extension\nis seen measuring up to 1 cm at the level of L2-L3, unchanged compared to the\nprior exam and resulting in mild-to-moderate spinal canal narrowing.\n7. Advanced degenerative changes cervical spine. Moderate to severe central\ncanal narrowing at C4-C5 level, suggestion of subtle cord T2 abnormality." }, { "input": "THORACIC:\nAlignment is normal.T9 and T12 compression deformity is unchanged in\nappearance, with increased STIR signal abnormality suggestive of subacute\nchronicity. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.There is slight\nenhancement of the vertebral bodies at the site of subacute compression\ndeformities after contrast administration. Otherwise, no abnormal enhancement\nis seen.\n\nLUMBAR:\nAlignment is normal. There is lumbarization of S1. Compression deformities\nof L2, L3, L5 and S1 are again seen, with increased STIR signal abnormality at\nL2 and L3, suggesting subacute chronicity. Lack of significant increased STIR\nsignal abnormality at S1 suggests a more chronic deformity. Intervertebral\ndisc signal intensity appear normal. The conus medullaris appears normal in\ncaliber and configuration.\nL1-2: There is a mild disc protrusion at L1-2, without significant spinal\ncanal or neural foraminal narrowing.\nL2-3: Right disc protrusion at L2-3 with cephalad extension contacting the\nnerve roots at this level. Facet joint hypertrophy causing mild bilateral\nneural foraminal narrowing.\nL3-4: Mild disc protrusion without spinal canal narrowing. Facet joint\nhypertrophy causing mild bilateral neural foraminal narrowing.\nL4-5: Disc bulge, causing moderate spinal canal narrowing. Facet joint\nhypertrophy causing mild moderate bilateral neural foraminal narrowing.\nL5-S1: Disc bulge, causing moderate spinal canal narrowing. Facet joint\nhypertrophy causing moderate right and mild left neural foraminal narrowing.\nS1-S2: Mild disc bulge, without significant spinal canal narrowing. Facet\njoint hypertrophy causing moderate right and mild left neural foraminal\nnarrowing.\nThere is no evidence of infection or neoplasm.There is slight enhancement of\nthe vertebral bodies of the site of subacute compression deformities after\ncontrast administration. Otherwise, there is no abnormal enhancement after\ncontrast administration.\n\nOTHER: Again seen is a 2 cm hyperintense lesion in the upper pole of the right\nkidney, and multiple additional T2 hyperintense lesions which are not well\ncharacterized. Note is made of a large left and moderate right pleural\neffusion.", "output": "1. Subacute compression deformities at T9, T12, L2, L3, and L5, and chronic\ncompression deformity at S1.\n2. Right disc protrusion at L2-3 with cephalad extension, contacting the nerve\nroots at this level.\n3. No evidence of epidural abscess.\n4. Large left and moderate right pleural effusions." }, { "input": "Sagittal STIR image is motion degraded. Within this confine:\n\nDiffuse T1 hypointense and STIR hyperintense lesions of the thoracic and\nvisualized lumbar spine involving the bodies and posterior elements compatible\nwith metastatic disease.\n\nThe dominant lesions include:\n\nT4 1.3 cm left posterior body minimally expansile lesion (series 13, image 16)\n\nT7 2.3 x 1.9 cm (TRV, AP) expansile lesion involving the right pedicle and\nposterior elements resulting in mild right T6-T7 neural foraminal narrowing\nand mild spinal canal narrowing (series 13, image 26). There are additional\nlesions at T7.\n\nT8 0.6 x 1.4 cm (TRV, AP) minimally expansile lesion involving the right\npedicle, with minimal encroachment on the epidural space.\n\nT10 1.7 x 2.3 cm (TRV, AP) right anterior body lesion (series 15, image 16)\n\nT11 1.1 cm left anterior body lesion (series 11, image 9).\n\nThere is no high-grade spinal canal or neural foraminal narrowing.\n\nNo definite evidence of abnormal cord enhancement although there is equivocal\nenhancement of the conus medullaris and proximal cauda equina on sagittal\nimages (series 16, image 9), which may be entirely artifactual.\n\nNo cord signal abnormality.\n\nA 1 cm cystic lesion in the body of the pancreas is unchanged from prior\nexamination, likely representing an IPMN. A 1.4 cm left periaortic abnormal\nlymph node is unchanged from prior examination. Small nodules of the right\nlung base likely represents metastatic disease, better evaluated on CTA chest.\n\nT2 hyperintense signal abnormality of the cervical spine at multiple levels on\nnondiagnostic sagittal counting sequence.", "output": "1. Diffuse T1 hypointense and STIR hyperintense lesions of the thoracic and\nvisualized upper lumbar spine compatible with metastatic disease at nearly all\nlevels.\n2. The dominant lesions include a 2.3 cm T7 expansile lesion of the right\npedicle and posterior elements resulting in mild right T6-T7 neural foraminal\nnarrowing and mild spinal canal narrowing. A smaller right pedicle lesion at\nT8 minimally encroaches on the epidural space.\n3. No definite abnormal signal or enhancement of the thoracic cord. There is\nequivocal enhancement of the conus medullaris and proximal cauda equina on\nsagittal T1 sequences, which may be entirely artifactual. Recommend further\nevaluation with dedicated lumbar spine MRI.\n4. T2 hyperintense signal abnormality on nondiagnostic sagittal counting\nsequence of the cervical spine. This is suggestive of additional metastatic\nlesions. Recommend further evaluation with MRI cervical spine.\n5. Additional findings described above including a 1 cm cystic lesion of the\npancreatic body, possibly representing an IPMN and a 1.4 cm left periaortic\nabnormal lymph node, which can be seen on outside hospital CT abdomen pelvis. \nA right lung base pulmonary nodule is identified, presumably representing\nmetastatic disease, which can be seen on prior CTA chest.\n6. There is no high-grade spinal canal or neural foraminal narrowing.\n\nRECOMMENDATION(S): Recommend further evaluation with contrast enhanced MRI\ncervical and lumbar spine." }, { "input": "CERVICAL:\nNew diffuse heterogeneously enhancing T1 hypointense and ideal hyperintense\nfoci are seen in the cervical spine, with the dominant lesions involving the\nposterior aspect of C3 and C4, compatible metastatic disease.\n\nThere is mild reversal of the normal cervical lordosis. There is near\ncomplete fusion of the C5-C6 vertebral bodies, unchanged. Subcentimeter old\ninfarcts are seen in the bilateral pons. The cervical cord is unremarkable. \nMultilevel disc desiccation and loss of disc height are seen:\n\n C2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Bilateral facet uncovertebral osteophytes, no spinal canal narrowing,\nmoderate right and mild left foraminal narrowing, unchanged.\n\nC4-C5: Disc bulge, effacement of the ventral thecal sac, bilateral facet\nuncovertebral osteophytes, moderate spinal canal narrowing, severe right and\nmoderate to severe left foraminal narrowing, unchanged.\n\nC5-C6: Left paracentral disc bulge and osteophyte, bilateral facet and\nuncovertebral osteophytes, no spinal canal narrowing, mild bilateral foraminal\nnarrowing, unchanged.\n\nC6-C7: Disc bulge, bilateral facet uncovertebral osteophytes, no spinal canal\nnarrowing, no right and moderate left foraminal narrowing, unchanged.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\n\n\nTHORACIC:\nDiffuse heterogeneously enhancing T1 hypointense and ideal hyperintense foci\nare seen in the thoracic spine, with the dominant lesions involving the right\nT7 and T8 pedicles and T10 vertebral body, compatible with metastatic disease.\n\nThe alignment is normal. The thoracic cord is unremarkable. Mild multilevel\nloss of disc height is seen:\n\nT6-T7: Expansion of the right T7 pedicle due to metastatic disease, effacement\nof the right thecal sac, with mild epidural enhancement and mild to moderate\nspinal canal narrowing, mild right and no left foraminal narrowing, unchanged.\n\nT7-T8: Mild expansion of the right T8 pedicle due to metastatic disease, no\nspinal canal narrowing, mild right and no left foraminal narrowing, unchanged.\n\n\nLUMBAR:\nDiffuse heterogeneously enhancing T1 hypointense and ideal hyperintense foci\nare seen in the thoracic spine, with the dominant lesions involving the right\nL3 and L4 transverse processes, compatible with metastatic disease.\n\nGrade 1 anterolisthesis of L4-5 is seen. The lumbar cord terminates at L1 and\nis unremarkable. Multilevel disc desiccation loss of disc height are seen:\n\n T12-L1: No spinal canal or foraminal narrowing.\n\nL1-L2: Mild disc bulge, no spinal canal or foraminal narrowing.\n\nL2-L3: Mild disc bulge, no spinal canal or foraminal narrowing.\n\nL3-L4: Mild disc bulge, bilateral facet osteophytes infusions, thickening of\nthe ligamentum flavum, no spinal canal narrowing, moderate right and mild left\nforaminal narrowing.\n\nL4-L5: Anterolisthesis, disc bulge, thickening of the ligamentum flavum,\nbilateral facet osteophytes, no spinal canal narrowing, moderate bilateral\nforaminal narrowing.\n\nL5-S1: Disc bulge, bilateral facet osteophytes, no spinal canal narrowing,\nmild right and moderate left foraminal narrowing.\n\n\nOTHER:\nA 6 mm nodule is re-demonstrated in the right lower pulmonary lobe, as seen on\nthe prior CTA chest and likely representing metastatic disease.\n\nAn enhancing expansile lesion is seen in the left posterior fourth rib, seen\non the prior CTA of the chest.\n\nA 1.6 cm mildly enhancing nodule seen seemingly contiguous with the right\nadrenal gland (11:27), unchanged from prior CT of the chest dated ___.\n\nA previously characterized angiomyolipoma in the upper pole of the left kidney\nand a cystic lesion in the interpolar region of the left kidney are unchanged.\n\nA 9 mm T2 hyperintense lesion in the body/tail of pancreas is unchanged,\npreviously characterized as an intraductal papillary mucinous neoplasm.", "output": "1. Diffuse osseous metastatic disease, with moderate effacement of the right\nthecal sac at T6-7, mild to moderate spinal canal narrowing and mild right\nforaminal narrowing. No evidence of cord compression.\n2. Otherwise, no other spinal canal or foraminal narrowing secondary to\nmetastatic disease.\n3. No intradural abnormal enhancement or lesions.\n4. Cervical spondylosis, worst at C4-5 with moderate spinal canal narrowing\nand severe right moderate left foraminal narrowing, unchanged.\n5. Degenerative changes of the lower lumbar spine, as above.\n6. 6 mm right lung base pulmonary nodule, likely representing metastatic\ndisease.\n7. Enhancing expansile lesion in the left posterior fourth rib, likely\nrepresenting metastatic disease." }, { "input": "Re-identified is a dominant metastatic lesion of the T7 posterior vertebral\nbody and elements, with cortical expansion into the epidural space, greater on\nthe right. The gross meant on the thecal sac is similar when compared to the\nprior examination. However, additional innumerable osseous metastatic lesions\nof the thoracic spine have increased in number and size when compared to\nexamination of ___. This results in mild spinal canal narrowing\nand mild right T6-T7 and T7-T1 neural foraminal narrowing. There is moderate\nleft T6-T7 neural foraminal narrowing with possible impingement of the exiting\nnerve root in the foraminal to extraforaminal zone, potentially minimally\nprogressed from prior exam. No areas of worsening expansion into the spinal\ncanal.\n\nThere is no evidence of abnormal signal or enhancement of the visualized cord.\n\nNo evidence of acute pathologic fracture.\n\nT2 hyperintense lesions of the bilateral kidneys with a T2 hypointense\ndominant left renal 2 cm cystic lesion are similar to prior examination,\npresumably representing oval cysts. A 2 cm right adrenal nodule is unchanged.\nThere is a T2 hyperintense lesion in the pancreas measuring 1 cm, also\nunchanged in size from prior exam allowing for technical differences.", "output": "1. Re-identified is a dominant metastatic lesion of the T7 posterior vertebral\nbody and elements with cortical expansion into the epidural space, worse on\nthe right. Overall the encroachment on the thecal sac is similar to prior\nexamination.\n2. However, additional innumerable osseous lesions of the thoracic spine has\nincreased in number and size when compared to prior examination of ___.\n3. There may be interval increased left T6-T7 neural foraminal narrowing with\npossible impingement of the exiting nerve root in the foraminal to\nextraforaminal zone.\n4. There is no evidence for acute pathologic fracture.\n5. There is no abnormal signal or enhancement of the cord.\n6. Additional findings as described above." }, { "input": "There is no evidence of spinal cord or cauda equina compression.\n\nThere are multiple T1 hypointense and enhancing lesions throughout the\nlumbosacral spine, in keeping with the metastases. There is grade 1\nanterolisthesis of L4 on L5 (6 mm). Alignment is otherwise normal. There is\nendplate degenerative change, most marked at L5-S1, also noted at T11-T12\nanteriorly. There is reduced intervertebral disc height and hydration\nthroughout the imaged spine, this is most marked at T11-T12, L1-L2 and L5-S1. \nThe conus ends at L1 vertebral level. The imaged spinal cord appears normal\nin caliber and configuration.\n\nL1-L2: Mild disc bulge, with mild indentation of the thecal sac. No\nsignificant spinal canal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge, with mild indentation of the thecal sac. No\nsignificant spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild disc bulge, which indents the thecal sac. There is ligamentum\nflavum thickening. No significant spinal canal narrowing. Moderate right and\nmild left neural foraminal narrowing.\n\nL4-L5: Mild disc bulge, indenting the thecal sac. There is ligamentum flavum\nthickening and bilateral facet joint arthropathy. There is moderate bilateral\nneural foraminal narrowing.\n\nL5-S1: Mild disc bulge, indenting the thecal sac. No spinal canal narrowing. \nThere is moderate left and mild right neural foraminal narrowing.\n\n\nThere is no evidence of infection. There is no pathological leptomeningeal\nenhancement and no enhancing lesions are identified within the imaged cord.\n\nOTHER: The right adrenal lesion is again noted and is unchanged in size. The\npreviously characterized angiomyolipoma in the upper pole of the left kidney\nand the left interpolar renal cyst are again noted and are unchanged.", "output": "1. Diffuse vertebral metastases are again noted. There is no evidence of\ncauda equina or spinal cord compression.\n2. There is no pathological leptomeningeal enhancement.\n3. Moderate lumbosacral spondylosis, unchanged compared with previous.\n4. The right adrenal lesion is unchanged in size and appearance." }, { "input": "There is no evidence of spinal cord or cauda equina compression.\n\nCERVICAL: Compared to ___:\nAlignment is normal.Redemonstrated multiple T1 hypointense and enhancing\nlesions throughout the cervical spine and clivus compatible with metastatic\ndisease, not substantially changed. Most notable lesion being at C2, odontoid\nprocess, C3, C4 and C5-C6. No pathologic compression fractures noted. There\nis mild canal narrowing at C4-C5 due to central disc bulging, contacting the\nanterior aspect of the cord without compression. There is no epidural\nenhancement. Moderate bilateral neural foraminal narrowing noted at this\nlevel.\n\nAt C3-C4, mild spinal canal narrowing, unchanged from prior, due to mild\nbroad-based disc bulging. No significant neural foraminal narrowing.\n\nTHORACIC: Compared to ___:\nAlignment is normal.There is no spinal canal narrowing or cord signal\nabnormality. Overall similar multiple T1 hypointense lesions throughout the\nthoracic spine. The dominant metastatic lesion is at T7 posterior vertebral\nbody extending to bilateral elements, with cortical expansion into the\nepidural space bilaterally. The degree of epidural enhancement appears\nimproved since prior MRI (series 12, image 27). There are no compression\nfractures. There is no epidural enhancement.\n\nThere is no worsening of the mild right neural foraminal narrowing at T6-T7\nand similar moderate right neural foramina at T7-T8.\n\nLUMBAR: Compared to ___:\nStable grade 1 anterolisthesis of L4 on L5. Overall no substantial change of\nthe diffuse metastatic disease involving the lumbar spine and sacrum. There\nis no compression fracture. There is no spinal canal narrowing, cord signal\nabnormality or epidural enhancement.\n\nOTHER: 1.5 cm cystic lesion in the body of the pancreas has increased in size\nfrom ___, previously measuring 0.9 cm (14:12), however is stable since\n___. Stable 1.8 cm fat containing lesion in the left kidney consistent\nwith an AML. Redemonstrated multiple cystic lesions in bilateral kidneys,\nlargest on the left measuring 1.3 cm. Stable 8 mm. Stable, allowing for\ndifferences in technique, right adrenal nodule measuring up to 1.5 cm. CBD in\nthe context of cholecystectomy.\n\nFor findings in the ribs please refer to separately reported same day CT\nchest.", "output": "1. No evidence of the spinal cord or cauda equina compression, cord signal\nabnormality, pathological compression fractures or epidural enhancement.\n2. Similar diffuse bone metastatic disease in the cervical, thoracic and\nlumbar spine.\n3. Improvement of the epidural extension of a right posterior element\nmetastatic lesion in T7, previously causing mild spinal canal narrowing.\n4. Stable 1.5 cm pancreatic body cyst since ___, increased from ___.\n5. Please refer to separately reported CT chest from the same day for findings\nin the ribs.\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": "Re-identified is diffuse osseous metastatic disease involving the entire\ncervical, thoracic and lumbar spine anterior and posterior elements as well as\nsacrum and iliac bones. No evidence of decreased vertebral body height or\nacute fracture. The metastatic lesions have increased in either size or\ninfiltrative appearance from prior exam.\n\nCERVICAL:\nThe visualized posterior fossa is unremarkable. Cervical alignment is\nanatomic. No definite soft tissue extension of tumor into the epidural space.\nThere is no abnormal signal or enhancement of the cord.\n\nC4-C5: Degenerative disc protrusions intervertebral osteophytes at C4-C5\nresults in moderate spinal canal narrowing and uncovertebral and facet\narthropathy results in moderate to severe right and moderate left neural\nforaminal narrowing, similar to prior exam.\nC5-C6: A left central protrusion results in mild spinal canal narrowing, rim\nremodeling the left ventral aspect of the cord. There is no significant\nneural foraminal narrowing.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are maintained. Disc\nheights are maintained. There is no abnormal signal or enhancement of the\ncord. There is no high-grade spinal canal or neural foraminal narrowing. \nExpansion of the T5 and T7 pedicles, effacing the epidural space is overall\nsimilar in size to prior exam. However, there is now significant subpleural\nextension of tumor along the right and left aspect of the T7 vertebral body\nmeasuring up to 1 cm in thickness, not seen on prior exam (series 30, image\n36).\n\nThere is moderate spinal canal narrowing at T7 secondary to tumoral expansion\nof the pedicles. Otherwise, there is no evidence of high-grade spinal canal\nor neural foraminal narrowing of the thoracic spine.\n\nMultiple pulmonary lesions are better described on CT chest of ___.\n\nThere is a 1.8 cm T2 heterogeneous lesion as well a few small nonenhancing\nsimple appearing cysts. The adrenal glands appear nodular bilaterally. \nAbdominal findings are better evaluated on concurrent CT urogram with without\ncontrast. A 8 mm cyst in the pancreas is unchanged from prior exam.\n\nLUMBAR:\nMinimal 1-2 mm stepwise retrolisthesis of L1 on L2 and L2 on L3 as well as 3\nmm anterolisthesis of L4 on L5 is unchanged from prior exam. Vertebral body\nheights are maintained. Degenerative loss of disc height is moderate to\nsevere throughout the lumbar spine. The conus medullaris terminates at the\nL1-L2 level, within expected limits. There is no abnormal signal or\nenhancement of the terminal cord, conus medullaris or cauda equina.\n\nThere are small disc bulges spanning L1-L2 through L4-L5 resulting in mild\nspinal canal and neural foraminal narrowing. At L5-S1, a left eccentric disc\nbulge results in no significant spinal canal narrowing but moderate left\nneural foraminal narrowing. There is no significant right neural foraminal\nnarrowing.\n\nNo evidence of soft tissue epidural extension of the tumor.", "output": "1. When compared to the prior examination of ___, there appears\nto be increased infiltrative appearance of the diffuse metastatic lesions\ninvolving the entire cervical, thoracic and lumbar spine as well as sacrum and\niliac bones. However, there remains no substantial soft tissue extension into\nthe epidural space, although expansion of the T7 pedicles encroaches on the\nepidural space.\n2. Significant increased soft tissue extension into the subpleural space right\ngreater than left at T7 when compared to the prior exam.\n3. There remains no abnormal signal or enhancement of the cord.\n4. Vertebral body heights are intact.\n5. Additional details as described above. Please refer to recent CT chest\nwith contrast as well as CTU with without contrast of ___ for\nfurther evaluation of extra-spinal findings.\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 alignment is normal. ___ type 1 endplate changes are seen at C6-C7. \nFusion and loss of the intervertebral disc space of the C5 and C6 vertebral\nbodies, appears progressed compared to the prior exam from ___, and is likely\ndegenerative in etiology. Intervertebral disc height loss noted at C4-5 and\nC6-7. No cord signal abnormalities are identified.\n\nThere is fluid within the right atlanto occipital articulation. \nCraniocervical junction is otherwise unremarkable.\n\nC2-C3: There is no spinal canal or foraminal narrowing.\n\nC3-C4: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nUncovertebral joint hypertrophy results in moderate left and mild right neural\nforaminal narrowing.\n\nC4-C5: Disc osteophyte complex results in moderate spinal canal narrowing,\nprogressed compared to the prior exam from ___. Uncovertebral joint\nhypertrophy results in moderate to severe left and severe right foraminal\nnarrowing, also progressed compared to the prior exam.\n\nC5-C6: Endplate osteophytes are seen resulting in mild spinal canal narrowing,\nnot significantly changed compared to the prior exam. Uncovertebral joint\narthropathy results in mild left neural foraminal narrowing.\n\nC6-C7: Disc osteophyte complex is seen resulting in mild spinal canal\nnarrowing. Uncovertebral joint arthropathy results in mild left worse than\nright neural foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Cervical spondylosis, most pronounced at C4-C5 with moderate spinal canal\nnarrowing secondary to disc bulge, progressed compared to the prior exam from\n___. Severe neural foraminal narrowing has also progressed compared to the\nprior exam.\n2. No cord signal abnormalities identified." }, { "input": "The alignment is normal. The bone marrow signal is within normal limits. \nThere is no fracture. The cord terminates at L1 and is unremarkable. The\nintervertebral discs have normal signal intensity. Mild disc bulges and\nbilateral facet osteophytes are seen at L3-4 and L4-5, causing mild bilateral\nforaminal narrowing. Otherwise, there is no spinal canal narrowing or\nforaminal narrowing of the lumbar spine.\n\nA subcentimeter T2 hyperintense lesion is seen in the left kidney, most likely\nrepresenting a simple cyst.", "output": "1. No fracture or infection. No signs of discitis or osteomyelitis. No\nintraspinal fluid collection.\n2. Mild bilateral foraminal narrowing L3-4 and L4-5. No spinal canal\nnarrowing.\n3. Subcentimeter left renal simple cyst.\n\nRECOMMENDATION(S): Management of Incidental Renal Cyst Completely\nCharacterized on CT or MRIBosniak I or II- No further workup" }, { "input": "The exam is moderately degraded by motion artifact. Within these confines:\n\nCERVICAL:\nThere is mild reversal of cervical lordosis. There is multilevel disc\ndesiccation with loss of intervertebral disc height there is mild anterior\nwedging of C5, otherwise the vertebral body heights are grossly preserved. No\nabnormal cord signal identified. The bone marrow signal in the cervical spine\nis grossly preserved throughout. There is no abnormal enhancement identified.\n\nAt C3-C4, there is disc bulge with associated ventral effacement of the thecal\nsac and mild bilateral neural foraminal narrowing.\n\nAt C4-C5, there is disc bulge mild bilateral facet arthropathy with mild\nspinal canal narrowing, moderate right neural foraminal narrowing, and mild\nleft neural foraminal narrowing.\n\nAt C5-C6, there is disc protrusion, paracentral disc herniation, resulting in\nsignificant deformation of the cord, moderate spinal canal narrowing, moderate\nright neural foraminal narrowing, and mild left neural foraminal narrowing. \nNo abnormal cord signal is appreciated.\n\nAt C6-C7, there is disc bulge, resulting in mild effacement of the thecal\nsac,. There is no significant neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal.\n\nThere is a 7 x 6 mm well-circumscribed lesion at the superior endplate of T6\nvertebral body that demonstrate hyperintensity on T1, T2, and STIR images. It\nis difficult to evaluate the enhancement of this lesion given the presence of\nintrinsic T1 shortening. (05:11, 15: 11, 06:11).\n\nThe lesion the posterior aspect of T3 vertebral body is felt to be an\nhemangioma into to fat suppression on STIR images. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of spinal canal or\nneural foraminal narrowing.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.At\nthe L2-L3 level, there is mild anterior disc bulge, with no significant spinal\ncanal or neural foraminal narrowing. At L5-S1, there is disc bulge,\nparacentral disc herniation, with mild central canal narrowing and bilateral\nneural foraminal narrowing.There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.\n\nOTHER: Small bilateral pleural effusions noted.", "output": "1. Nonspecific, small well-circumscribed focus of T1 and T2 hyperintense\nsignal at the superior endplate of T6 vertebral body, which does not suppress\non STIR images. Given the patient's history of malignancy, metastatic osseous\nlesion cannot be excluded. Evaluation with bone scan is suggested to further\ncharacterize this lesion and/or MRI follow-up to establish stability.\n2. The remainder of the spine show no evidence of malignancy or metastatic\ndisease.\n3. Multilevel degenerative changes as described above, more pronounced at\nC4-C6\n\nRECOMMENDATION(S): Nonspecific, small well-circumscribed focus of T1 and T2\nhyperintense signal at the superior endplate of T6 vertebral body, which does\nnot suppress on STIR images. Given the patient's history of malignancy,\nmetastatic osseous lesion cannot be excluded, correlation with bone scan is\nrecommended for further characterization." }, { "input": "Lumbar spine numbering is established by the lowest rib-bearing vertebra\ndesignated as T12. Based on this schema, there is transitional anatomy of S1\nwith a rudimentary S1-S2 disc.\n\nDextroconvex scoliosis of the lumbar spine with apex at L2-L3 is identified. \n7 mm right lateral listhesis of L4 on L5 is unchanged from prior exam. In\naddition, there is 4-5 mm anterolisthesis of L3 on L4. The conus medullaris\nterminates at the L2-L3. No evidence of fatty filum or lipoma. No signal\nabnormality of the terminal cord.\n\nVertebral body heights are preserved. No focal suspicious marrow lesion. \nMultilevel ___ type 2 L1-L2 through L3-L4 and mixed ___ 1 into L4-L5\nthrough L5-S1 endplate changes are noted. Degenerative loss of disc height is\nsevere at L1-L 2, L2-L3, L4-L5 and L5-S1 and moderate at L3-L4.\n\nT12-L1: A prominent central protrusion results in moderate to severe spinal\ncanal narrowing, remodeling the cord without underlying cord signal change. \nIn conjunction with facet arthropathy and scoliosis there is moderate right\nand mild left neural foraminal narrowing.\n\nL1-L2: A small disc bulge results in mild spinal canal narrowing. In\nconjunction with scoliosis and facet arthropathy, there is moderate to severe\nleft and moderate right neural foraminal narrowing.\n\nL2-L3: No significant spinal canal narrowing. In conjunction with scoliosis\nand facet arthropathy, there is at least moderate right and severe left neural\nforaminal narrowing.\n\nL3-L4: A disc bulge and thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing. There is crowding of the right subarticular\nzone without definitive posterior displacement of the traversing nerve roots. \nIn combination with facet arthropathy and scoliosis, there is at least\nmoderate right and severe left neural foraminal narrowing.\n\nL4-L5: There is mild spinal canal narrowing. In conjunction with facet\narthropathy and scoliosis, there is moderate to severe left and at least\nmoderate right neural foraminal narrowing.\n\nL5-S1: No significant spinal canal narrowing. Loss of disc height with facet\narthropathy results in severe right and mild left neural foraminal narrowing.\n\nVisualized prevertebral paraspinal soft tissues are grossly unremarkable.", "output": "1. Multilevel lumbar spondylosis most prominent at L2-L3 and L3-L4 where there\nis severe left neural foraminal narrowing. At L3-L4 there is moderate spinal\ncanal narrowing with crowding of the right subarticular zone.\n2. At L5 S1, there is severe right neural foraminal narrowing.\n3. At T12-L1 a prominent central protrusion results in moderate to severe\nspinal canal narrowing, remodeling the cord without definitive cord signal\nchange.\n4. Additional findings as described above." }, { "input": "There is dextroconvex scoliosis of the lumbar ___ around L2-3. \nGrade 1 anterolisthesis of L3 on L4 is similar to prior. There are multi\nlevel endplate degenerative changes throughout the lumbar spine. A Schmorl's\nnode is seen along the superior endplate of L4. There is multilevel severe\nloss of intervertebral disc height. There is no evidence of infection or\nneoplasm. There is lumbarization of S1.\n\nAt T12-L1 a central disc protrusion and ligamentum flavum hypertrophy causes\nmild to moderate spinal canal narrowing with deformation of the spinal cord. \nFacet hypertrophy causes moderate right and mild left neural foraminal\nnarrowing.\nAt L1-2 an asymmetric posterior disc bulge, greater on the left, and facet\nhypertrophy cause moderate left and mild right neural foraminal narrowing and\nmild spinal canal narrowing with deformation of the spinal cord.\nAt L2-3 posterior disc bulge and facet hypertrophy causes mild right and\nsevere left neural foraminal narrowing.\nAt L3-4 posterior disc bulge, facet hypertrophy, and ligamentum flavum\nhypertrophy cause moderate spinal canal and moderate-to-severe left foraminal\nnarrowing.\nAt L4-5 posterior disc bulge and ligamentum flavum and facet hypertrophy cause\nmild spinal canal narrowing and moderate-to-severe left and mild right\nforaminal narrowing.\nAt L5-S1 posterior disc bulge and facet hypertrophy cause mild left neural\nforaminal narrowing and severe right neural foraminal narrowing.", "output": "1. Multilevel degenerative changes of the lumbar spine most extensive at L3-4\nwith moderate spinal canal narrowing similar to prior.\n2. Multilevel foraminal changes predominantly on the left side due to\nscoliosis are unchanged compared to the prior study.\n3. Central disc protrusion at T12-L1 and left paracentral disc bulge at L1-2\ncauses remodeling of the cord without cord signal change.\n4. Stable grade 1 anterolisthesis of L3 on L4.\n5. Transitional vertebra with rudimentary disc between S1 and S2 as designated\npreviously." }, { "input": "The L1 vertebra demonstrate moderate anterior wedging and compression without\nretropulsion or abnormal signal indicative of chronic compression fracture. \nThere is compression of superior endplate of L2 with a Schmorl's node\ndemonstrating mild decreased T1 and increased inversion recovery signal\nindicative of subacute compression. There is no retropulsion.\n\nThere is moderate compression of L3 vertebra with a linear low signal on T1\nimages and diffuse increased marrow signal on inversion recovery images\nindicative of an acute compression fracture. There is no retropulsion seen. \nThere is no ligamentous disruption identified. There is no spinal stenosis.\n\nFrom T11-12 through L3-4 levels mild disc degenerative changes seen. At L4-5\nlevel, mild disc bulging and a central annular tear identified. No spinal\nstenosis seen. Mild degenerative changes are seen at L5-S1 level.\n\nThere is no evidence of compression of the distal spinal cord or cauda equina.\nNo evidence of high-grade foraminal narrowing or compression of exiting nerve\nroots within the foramina. The distal spinal cord shows normal signal\nintensities.", "output": "1. Acute moderate compression fracture of L3 vertebra without retropulsion,\nthecal sac compression or ligamentous disruption.\n2. Subacute Schmorl's node in the superior endplate of L2 and chronic\ncompression of L1 vertebra.\n3. Mild multilevel degenerative changes in the lumbar spine without high-grade\nspinal stenosis or foraminal narrowing.\n4. No evidence of distal spinal cord or cauda equina compression." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen.\n\nThe craniovertebral junction is unremarkable.\n\nThe cord is normal in signal intensity.\n\nAt C2-C3, there is a tiny central disk osteophyte complex without significant\nspinal canal stenosis or neural foraminal narrowing.\n\nAt C3-C4, there is a tiny central disc protrusion which effaces the ventral\nCSF, mildly narrows the spinal canal, and slightly remodels the ventral cord. \nThere is no abnormal cord signal. There is bilateral mild uncovertebral and\nfacet joint arthropathy with mild right greater than left neural foraminal\nnarrowing.\n\nAt C4-C5, there is a tiny central disc protrusion without significant spinal\ncanal stenosis. There is mild bilateral uncovertebral and facet joint\narthropathy with mild to moderate bilateral neural foraminal narrowing.\n\nAt C5-C6, there is no significant disc herniation or spinal canal stenosis.\nThere is bilateral facet and uncovertebral joint arthropathy resulting in mild\nleft greater than right neural foraminal narrowing. There are small bilateral\nperineural cysts.\n\nAt C6-C7, there is no significant disc herniation or spinal canal stenosis.\nThere is bilateral uncovertebral and facet joint arthropathy resulting in left\ngreater than right moderate to severe neural foraminal narrowing. There are\nbilateral perineural cysts.\n\nAt C7-T1, there is no significant disc herniation spinal canal stenosis or\nneural foraminal narrowing. There are bilateral perineural cysts.\n\nSeen only on sagittal images are bilateral perineural cysts at T3-T4 and\nT4-T5.\n\nThe visualized soft tissues of the neck are unremarkable.\n\nThere is a partially visualized small fluid level in the right sphenoid sinus.", "output": "Mild multilevel degenerative changes as detailed above. Spinal canal stenosis\nis most pronounced at C3-C4 where there is effacement of the ventral CSF and\nremodeling of the ventral cord without abnormal cord signal. Neural foraminal\nstenosis is most pronounced at C6-C7." }, { "input": "CERVICAL:\nThere are postoperative changes from apparent prior C3-C6 laminectomies and\nposterior fusion consisting of bilateral vertical rods and multiple lateral\nmass screws. Hardware artifact limits evaluation of immediately adjacent\nstructures. Additionally, exam is limited due to large field-of-view required\nfor total spine imaging. Within these confines:\n\nAlignment is within normal limits. Vertebral body heights are maintained. \nThere is osseous fusion of the C6-7 vertebral bodies. Cervical spinal cord is\natrophic. There are multiple areas of T2/STIR hyperintense cord signal\nabnormality which are short-segment, seen at the levels of the C4, C5, and C7\nvertebral bodies (series 8 and 6, images 7, 8, 9). These are not well seen on\naxial images due to large field of view and suboptimal spatial resolution,\nlikely areas of chronic myelomalacia given similar appearance on prior study\nfrom ___, although not optimally visualized/evaluated.\n\nSignal height loss of intervertebral discs is consistent with degenerative\nchange.\n\nMultilevel spinal canal narrowing is worst (moderate to severe) at C6-7 (8:9\nand 14:29), with slight cord flattening in the AP dimension. There is likely\nat least mild and moderate multilevel neural foraminal narrowing, however this\nis suboptimally assessed due to large field-of-view and artifact from\nposterior spinal fusion hardware.\n\nThere is minimal likely postoperative scarring and trace fluid within the\nposterior subcutaneous soft tissues along the surgical approach. No evidence\nof focal fluid collection.\n\nOtherwise, the prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\n Alignment is normal. Vertebral body heights are maintained. There is slight\nmixed ___ type 1 and ___ type 2 degenerative endplate changes seen most\nconspicuously the anterior aspect of T10-11. Marrow signal is otherwise\nunremarkable. The thoracic spinal cord appears normal in caliber and signal\nintensity. Intervertebral discs demonstrate mild signal and height loss\nconsistent with sequelae of degenerative change. There is no evidence of\nthoracic spinal canal or neural foraminal narrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR:\n There are postoperative changes from prior L1-2 through L5-S1 laminectomies.\n\n2-3 mm of L4-5 anterolisthesis, and 2-3 mm of L5-S1 retrolisthesis are\nunchanged. Alignment is otherwise normal. Vertebral body heights are\nmaintained. There are multilevel primarily ___ type 2 degenerative endplate\nchanges seen most conspicuously at L1-2, also at L5-S1. Scattered areas of\nfocal fatty marrow are noted. There is a Schmorl's node in the inferior\nendplate of L4 which is unchanged. Marrow signal is otherwise unremarkable.\n\nThe distal spinal cord and conus medullaris is normal terminates at L1. The\ncauda equina nerve roots are redundant above the level of most severe spinal\ncanal narrowing seen at L2-3. Cauda equina nerve roots are otherwise\nmorphologically normal.\n\nSignal height loss of intervertebral discs is consistent with degenerative\nchange. Specifically:\n\n T12-L1: Unremarkable.\nL1-2: Mild disc bulge, ligamentum flavum thickening, facet osteophytes causing\nmild spinal canal and bilateral mild neural foraminal narrowing.\nL2-3: There is an at least 8 mm inferiorly-extending extruded disc fragment\ndraped along the upper aspect of the central posterior L3 vertebral body (see\nseries 17, images ___ and 10:8). This, in combination with diffuse\nbackground disc bulge, ligamentum flavum thickening, facet osteophytes, and\nprominent posterior epidural fat causes severe spinal canal narrowing with\ncrowding and possibly compression of the cauda equina nerve roots (17:19),\nslightly progressed since ___. Moderate bilateral neural foraminal\nnarrowing.\nL3-4: Moderate to severe spinal canal narrowing, croWding of the cauda equina\nnerve roots, no compression (17:25). Neural foraminal narrowing is moderate\non the left and moderate to severe on the right (12:5).\nL4-5: Diffuse disc bulge, facet osteophytes, causing only mild spinal canal\ndue to posterior laminectomies. Severe left and moderate right neural\nforaminal narrowing, likely with impingement of the exiting left L4 nerve root\n(12:13).\nL5-S1: Mild disc bulge, ligamentum flavum thickening, facet osteophytes\ncausing mild spinal canal narrowing. Neural foraminal narrowing is moderate\non the left and severe on the right likely with impingement of the exiting\nright L5 nerve root (12:5).\n\nT2/STIR hyperintense signal within the erector spinae posteriorly overlying\nthe lower lumbar spine is likely postoperative, possibly with superimposed\nmuscle strain. There is no evidence of focal fluid collection.\n\nOTHER:\nThere is linear atelectasis in the right lung. There is dependent atelectasis\nin the basilar portion of the left lung. Trace fluid layers within the mid to\nupper esophagus. There may be a small left layering pleural effusion, not\nwell visualized. There is multifocal cystic replacement of the normal renal\nparenchyma bilaterally, partially visualized.\n\nThere is suggestion of a left adrenal nodule, partially visualized, measuring\nup to 2.0 x 1.4 cm (17:6), incompletely evaluated, similar to prior studies\nbetter evaluated on recent prior dedicated abdominal imaging.", "output": "1. Severe spinal canal narrowing with crowding and possibly compression of the\ncauda equina at L2-3, mildly progressed since ___, largely in part\ndue to an inferiorly extruded 8 mm L2-3 disc fragment. Correlate clinically\nwith any clinical signs of cauda equina syndrome.\n2. No evidence of discitis-osteomyelitis in the cervical, thoracic, or lumbar\nspine.\n3. Multifocal short-segment T2/STIR hyperintense cord signal abnormalities in\nthe cervical spine are similar appearance to prior study from ___\nhowever poorly visualized due to technical limitations of the study as above;\nwithin these confines, these appear unchanged and late to chronic\nmyelomalacia.\n4. Multilevel cervical spine degenerative changes. Spinal canal narrowing is\nworst (moderate to severe) at C6-7.\n5. Expected cervical spine postoperative changes. Expected lumbar spine\npostoperative changes. Mild residual edema, likely postoperative, and/or\nmuscle strain in the lower lumbar spine erector spinae. No focal fluid\ncollection.\n6. Multilevel high-grade degenerative lumbar spine neural foraminal narrowing.\n7. No acute findings in the thoracic spine. Mild thoracic spine degenerative\nchange.\n8. Possible small left layering pleural effusion, poorly visualized. Other\nincidental findings, as above.\n\nRECOMMENDATION(S): Correlation with any symptoms or physical examination\nsigns of cauda equina syndrome is recommended, as above.\n\nNOTIFICATION: The findings regarding the degree of L2-3 spinal canal\nnarrowing and recommendation above were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:51 am, 5 minutes\nafter discovery of the findings." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. Advanced degenerative changes cervical spine. Congenital\nnarrowing of the spinal canal. C6-C7 vertebral bodies are fused. Multilevel\ndisc osteophyte complexes. Posterior element degenerative changes.\n\nMultilevel flattening of the cervical cord secondary to multilevel significant\ncentral canal narrowing, as detailed below. There is T2 signal abnormality at\nC3-C4, C4-C5, mid C5 vertebral body, and at C6-C7 level, most consistent with\nspondylotic myelopathy.\n\nAt C2-C3 level there is moderate central canal narrowing, preserved CSF about\ncord, similar to prior. Mild-to-moderate bilateral foraminal narrowing,\nprobably similar to prior.\n\nAt C3-C4 level there is severe central canal narrowing, cord flattening,\ncomplete loss of CSF there is component of diffuse broad-based disc bulge,\nsimilar. Severe bilateral foraminal narrowing, probably worsened.\n\nAt C4-C5 level there is severe central canal narrowing, cord flattening,\ncomplete loss of CSF. Broad-based shallow disc bulge, similar. There is\nsevere bilateral foraminal narrowing, similar to prior.\n\nAt C5-C6 level there is moderate to severe central canal narrowing, near\ncomplete effacement of CSF, mild cord flattening, similar. Severe bilateral\nforaminal narrowing, similar.\n\nAt C6-C7 level there is moderate central canal narrowing, probably similar,\nincomplete effacement of CSF L5. Moderate right, severe left foraminal\nnarrowing, similar.\n\nAt if C7-T1 level there is moderate central canal narrowing, preserved CSF. \nModerate bilateral foraminal narrowing, similar.\n\nAt T1-T2 level there is moderate central canal narrowing. Mild-to-moderate\nbilateral foraminal narrowing, similar.\n\nThere is minimal opacification left mastoid air cells. 1.6 cm right thyroid\nlobe nodule, also seen on prior, ultrasound evaluation recommended..", "output": "1. Severe degenerative changes cervical spine.\n2. Congenitally narrow spinal canal.\n3. Multilevel severe central canal narrowing, probably similar to prior.\n4. Multilevel cord flattening, multilevel myelomalacia, as described above.\n5. Multilevel significant foraminal narrowing, similar.\n6. 1.6 cm thyroid nodule, ultrasound exam recommended.\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 16:52 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "C3 through C6 posterior fusion hardware artifact limits examination.\n\nCERVICAL:\nThe patient is status post C3-C6 bilateral posterior spinal fusion and C4\nthrough C6 laminectomies. There are extensive postoperative changes\nidentified, including large areas of soft tissue swelling and edema.\n\nAdditionally, there is an irregular postoperative fluid collection seen within\nthe midline and to the left of center extending from the patient's incision,\nthrough the deep soft tissues, and involving the dorsal epidural space with\nmass effect upon the thecal sac at the levels of C4 and C5. Associated\nperipheral and mild internal enhancement is seen throughout this fluid\ncollection.\n\nThese postoperative changes combine with underlying extensive degenerative\ndisc disease and a congenitally narrow cervical spinal canal to result in\nmultiple areas of severe canal stenosis, as detailed below. Numerous areas of\nintrinsic T2/STIR signal abnormality within the cord itself appear chronic,\nsimilar to the preoperative examination and compatible with areas of\nmyelomalacia.\n\n Vertebral body alignment is preserved. There is fusion of the C6 and C7\nvertebral bodies. Otherwise, vertebral body heights are preserved.\n\n The visualized portion of the spinal cord is grossly preserved in signal.\n\nC2-C3: Posterior disc bulging and uncovertebral joint hypertrophy result in\nmild-to-moderate moderate canal, mild bilateral left neural foraminal\nnarrowing.\n\nC3-C4: A posterior disc bulge flattens the ventral thecal sac and indents the\nspinal cord, remodeling it, with moderate to severe canal stenosis. This\ncombines with uncovertebral joint hypertrophy to result in moderate to severe\nbilateral neural foraminal narrowing.\n\nC4-C5 and C5-C6: A posterior disc bulge and epidural posterior fluid\ncollection results in severe canal stenosis, combining with uncovertebral\njoint hypertrophy result in severe bilateral neural foraminal narrowing.\n\nC6-C7: There is near complete fusion of the C6 and C7 vertebral bodies, with\nposterior asymmetric left spondylitic ridging indenting the left ventral\nthecal sac, minimally contacting the ventral cord, with moderate to severe\ncanal stenosis and severe bilateral neural foraminal narrowing.\n\nC7-T1: A posterior disc bulge with superimposed left paracentral disc\nprotrusion indents the ventral thecal sac with moderate canal stenosis,\ncombining with uncovertebral joint hypertrophy to result in moderate right and\nmoderate severe left neural foraminal narrowing.\n\nTHORACIC:\nMild dextroscoliosis of the thoracic spine is noted. Vertebral body heights\nare preserved. Multiple Schmorl's nodes are noted throughout the thoracic\nspine. There is no focal marrow signal abnormality.\n\nMild multilevel spondylosis with minimal posterior disc bulging is seen\nthroughout multiple levels within the thoracic spine, without associated\nmoderate or severe vertebral canal narrowing. The visualized portion of the\nspinal cord is preserved in signal and caliber.\n\nLUMBAR:\nThe patient is status post L4-L5 bilateral laminectomies with postsurgical\nchanges.\n\nMinimal vertebral body height loss at L2 appears chronic. There is a\nSchmorl's nodule involving the superior endplate of L3. There is minimal grade\n1 retrolisthesis of L1 on L2 L3 on L4 and L5 on S1.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L1-L2.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1: There is no spinal canal or neural foraminal stenosis.\n\nL1-L2: There is a posterior disc bulge with leftward asymmetry flattening the\nventral thecal sac, combining with prominent dorsal epidural fat, facet\narthropathy, and thickening of ligamentum flavum to result in moderate to\nsevere canal narrowing with crowding of the cauda equina nerve roots. \nAdditionally, there is mild to moderate right mild left neural foraminal\nnarrowing at this level.\n\nL2-L3: A posterior disc bulge combining with prominent dorsal epidural fat and\nfacet arthropathy results in moderate to severe canal narrowing with near\ncomplete loss of CSF signal in crowding of the cauda equina nerve roots. \nThere is bilateral subarticular recess narrowing with moderate right and\nmild-to-moderate left neural foraminal narrowing.\n\nL3-L4: A posterior disc bulge combines with facet arthropathy to result in\nsevere canal stenosis. There is compression of the cauda equina nerve roots\nwith associated T2 hyperintensity and probable focal enhancement at this\nlevel. Neural foraminal narrowing is moderate severe bilaterally.\n\nL4-L5: A posterior disc bulge indents the ventral thecal sac with moderate to\nsevere canal stenosis. Facet arthropathy and bilateral facet joint effusions\nare noted. There is severe left and moderate right neural foraminal\nnarrowing, with compression of the exiting left L4 nerve root.\n\nL5-S1: Mild posterior disc bulging is noted without significant canal\nstenosis. However, there is moderate to severe bilateral neural foraminal\nnarrowing seen at this level.\n\nOTHER: The urinary bladder is severely distended. Bilateral polycystic\nkidneys are noted. Small nonspecific left mastoid fluid is present.", "output": "1. Cervical spinal fusion hardware artifact limits examination.\n2. Status post recent C3-C6 posterior spinal fusion and multilevel laminectomy\nwith extensive postoperative changes, including a large peripherally enhancing\nfluid collection extending from the superficial incision site to the dorsal\nepidural space at the levels of C4-5. These findings are most compatible with\na postoperative seroma, although superimposed infection is not excluded.\n3. Postoperative changes combine with a congenitally narrowed cervical spinal\ncanal and underlying multilevel spondylosis to result in numerous areas of\nsignificant canal stenosis, severe at C4-5 and C5-6 with associated\ncompression of the spinal cord. Overall the degree of canal stenosis and\nunderlying cord myelomalacia appears grossly similar to the preoperative MRI\nexamination.\n4. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most notable at L3-4 with severe canal stenosis, moderate to severe\nbilateral neural foraminal narrowing, compression of the cauda equina nerve\nroots, and associated T2 hyperintensity and focal enhancement of the nerve\nroots.\n5. L4-L5 severe left neural foraminal narrowing with associated compression of\nthe exiting left L4 nerve root.\n6. Polycystic kidney seen bilaterally and a grossly distended urinary bladder.\n7. Small nonspecific left mastoid fluid.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 2:11 am, 10 minutes after discovery of\nthe findings." }, { "input": "Study is moderately degraded by motion. Additionally, fusion hardware\nartifact limits examination. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nS shaped scoliosis of the thoracolumbar spine is noted grade 1 L2 on L3\nretrolisthesis is present. Grade 1 L5 on S1 anterolisthesis is present\n\nL1 severe anterior compression deformity with adjacent fluid and right\nvertebral body and pedicle T2 and STIR hyperintensity and T1 hypointensity is\nnoted. Approximately 3 mm bony retropulsion with no definite evidence of\nspinal cord contact at this level. Additional T2 and STIR hyperintensity is\nnoted within the left pedicle. No definite associated soft tissue mass is\nnoted.\n\nPostsurgical changes related to L4-5 through S1 posterior and interbody fusion\nwith L4 through S1 laminectomies is noted.\n\nT12 vertebral body linear T2 and STIR hyperintense structure is noted (see 4,\n5, 6:9; 9:5).\n\nL3 chronic anterolateral compression deformity is noted.\n\nMultiple Schmorl's nodes are noted throughout the thoracolumbar spine.\n\nLimited imaging of the thoracic spine demonstrates T11 vertebral body T2\nhyperintense, stir partially suppressing, T1 partially hyperintense, lesion\nwith trabeculated pattern suggestive of hemangioma.\n\nNonspecific edema is seen dorsal soft tissues overlying L5-S1. Sacral\nprobable Tarlov cysts are noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal throughout the\nthoracolumbar spine.\n\nAt T12-L1 there is disc bulge, minimal bony retropulsion, facet joint\nhypertrophy, mildvertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is facet joint hypertrophy, novertebral canal and no neural\nforaminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, prominent epidural fat, mild-to-moderatevertebral canal, moderate\nright and mild leftneural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy creating novertebral\ncanal and no neural foraminal narrowing.\n\nAt L4-5 there is facet joint hypertrophy, novertebral canal and no neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge, facet joint hypertrophy, novertebral canaland\nsevere leftneural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is moderately degraded by motion and limited secondary to fusion\nhardware artifact.\n2. L1 vertebral body severe probable acute to subacute compression fracture\nwith approximately 3 mm bony retropulsion resulting in mild vertebral canal\nnarrowing at T12-L1 and focal edema within the left pedicle. If clinically\nindicated, consider lumbar spine CT for further evaluation. Please note that\nneoplastic and infectious etiologies are not excluded on the basis\nexamination. If clinically indicated, consider follow-up imaging to\nresolution.\n3. T12 linear marrow abnormality suggestive of compression fracture, with\ndifferential consideration of degenerative changes. If clinically indicated,\nconsider lumbar spine CT for further evaluation. Please note that neoplastic\nand infectious etiologies are not excluded on the basis examination. If\nclinically indicated, consider follow-up imaging to resolution.\n4. Postsurgical changes related to L5 through S1 fusion and laminectomies as\ndescribed.\n5. L3 vertebral body chronic anterolateral compression deformity.\n6. Multilevel lumbar spondylosis as described, most pronounced at L2-3, where\nthere is mild-to-moderate vertebral canal, moderate right and mild left neural\nforaminal narrowing.\n7. L5-S1 severe left neural foraminal narrowing.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:31 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. There is a T1/T2 hyperintense lesion in the right L2\nvertebral body, consistent with an intraosseous hemangioma. Vertebral body\nsignal intensity is otherwise normal. Vertebral body heights are preserved. \nThere is disc desiccation signal predominantly at L4-5 and L5-S1. The conus\nmedullaris terminates at T12. There is no evidence of infection or neoplasm.\n\nFrom T12-L1 through L2-3, there is no canal or neural foraminal narrowing.\n\nAt L3-4, small disc bulge in combination with facet hypertrophy and ligamentum\nflavum thickening results in mild canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nAt L4-5, small disc bulge in combination with ligamentum flavum thickening and\nfacet hypertrophy results in mild canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is a right paracentral disc extrusion with a possible\nsequestered fragment. Edema within the L5-S1 disc and extruded fragment\nsuggested this is somewhat acute. Additionally, there is a Schmorl's node in\nthe inferior endplate of L5 with associated edema. The extrusion\nsignificantly narrows the subarticular zone and displaces the traversing nerve\nroots. There is also moderate spinal canal narrowing due to this extrusion. \nThere is mild bilateral neural foraminal narrowing.", "output": "1. Right-sided disc extrusion at L5-S1 with probable sequestered fragment\nresulting in compression and displacement of the traversing nerve roots in the\nsubarticular zone. It also results in moderate canal narrowing.\n2. Additional mild multilevel degenerative changes of the lumbar spine as\ndescribed 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": "Motion and spinal fusion hardware artifact limits examination.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of the lumbar spine. Partially visualized are\npostsurgical changes related to patient's known thoracic through L3 posterior\nspinal fusion. There is transitional anatomy with partial sacralization of\nL5. Vertebral body heights are grossly preserved. There is no definite focal\nmarrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Nonspecific close proximity of lumbar nerve roots from conus (mid\nL2) through L4-5 level, with some areas intervening CSF suggested at all\nlevels.\n\nIntervertebral discheightsandsignalare grossly preserved.\n\nArtifact prevents evaluation of neural foramina at left T12-L1, left L1-2, and\nright L2-3. At L3-4 through L5-S1 disc bulges are present without definite\nevidence of moderate or severe vertebral canal narrowing.\n\nAt L5-S1 nonspecific bilateral facet joint fluid is noted.\n\nOtherwise, there is no definite evidence of moderate or severe vertebral canal\nor neural foraminal narrowing of the lumbar spine.\n\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified. Limited imaging of\nthe kidneys demonstrate bilateral at least partially T2 hyperintense\nstructures, incompletely characterized.\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.", "output": "1. Motion and spinal fusion hardware artifact limits examination as described.\n2. Partially visualized postoperative changes compatible patient's known\nremote thoracic through L3 posterior spinal fusion.\n3. Within limits of study, no definite evidence of moderate or severe\nvertebral canal or neural foraminal narrowing of lumbar spine.\n4. Nonspecific close proximity of lumbar nerve roots from conus (mid L2)\nthrough L4-5 level, with some areas intervening CSF suggested at all levels,\nno definite evidence of abnormal enhancement, within limits of study. While\nfindings may be positional, nerve root clumping is not excluded on the basis\nof this examination.\n5. Limited imaging of the kidneys demonstrate bilateral at least partially\ncystic structures, incompletely characterized.\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": "Several lesions are demonstrated in the cervical spine.\n\nA T2/FLAIR hyperintense, T1 hypointense lesion with slight postcontrast\nenhancement measuring 10 x 16 mm is seen in the odontoid process, not\nsignificantly changed from prior brain MRI (10:9). Multiple calvarial lesions\nare also re-identified.\n\nThe C4 vertebral body is completely T1 and T2 hypointense, with extension into\nthe right pedicle, lateral mass and pars interarticularis (10:8, 10:13). \nThere is minimal postcontrast enhancement. No evidence of pathologic fracture\nor extension of lesion into the spinal canal.\n\n5 mm enhancing lesions are also seen in the C6 and C7 vertebral bodies (10:7,\n9).\n\nAn 8 x 8 mm peripherally T2/FLAIR hyperintense, T1 hypo intense and slightly\nenhancing lesion right posterior T1 vertebral body is also seen (07:10).\n\nPartially seen on the localizer images is hyperintensity in the T5 and T7\nvertebral bodies (2:1)\n\nMultilevel degenerative changes of the cervical spine are moderate.\n\nAt C2-3, there is no significant canal or neural foraminal narrowing.\n\nAt C3-4, slight posterior disc protrusion causes mild canal narrowing. \nUncovertebral and facet arthropathy results in left neural foraminal\nnarrowing.\n\nAt C4-5, a posterior disc protrusion mild canal narrowing. Uncovertebral\nfacet and arthropathy bilateral neural foraminal narrowing.\n\nAt C5-6, a posterior disc protrusion causes mild canal narrowing, but no\nsignificant neural foraminal narrowing.\n\nAt C6-7, a left posterior disc protrusion causes mild canal narrowing and\nuncovertebral and facet arthropathy results in left sided neural foraminal\nnarrowing. No significant right-sided neural foraminal narrowing.\n\nIncidental note is made of a 6 mm left lobe of the thyroid T2 hyperintense\nnodule.", "output": "1. Numerous lesions suspicious for metastases are seen throughout the cervical\nspine, including the odontoid process, C4 vertebral body and posterior\nelements, and C6 and C7 vertebral bodies. No evidence of extension into the\nspinal canal or pathologic fracture.\n2. Partially imaged signal abnormality in the T5 and T7 vertebral bodies are\nincompletely assessed on this examination. The entire extent of osseous\nmetastases could be further evaluated with a bone scan.\n3. Metastatic calvarial lesions are re-identified.\n4. Mild to moderate degenerative changes of the cervical spine as described\nabove.\n5. Incidental note is made of a 7 mm left lobe of the thyroid T2 hyperintense\nnodule.\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": "The cervical spine was scanned in a slightly flexed position.\n\nAt C4-5, uncovertebral spurring produces, at most, minimal right neural\nforaminal stenosis. The posterior disc margin approaches the ventral cord\nmargin.\n\nAt C5-6, the posterior disc margin contacts the ventral cord margin. \nUncovertebral spurring causes slight right-sided neural foraminal stenosis.\n\nFollowing the intravenous infusion of a gadolinium based contrast agent, there\nis no pathological enhancement.\n\nThe cervical spinal cord signal pattern, foramen magnum and its contents, as\nwell as limited cervical paraspinal soft tissue imaging does not disclose\nadditional abnormalities.", "output": "Minimal extent of cervical spondylosis, as described above." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is no marrow\nsignal abnormality or acute fracture. The visualized portion of the spinal\ncord is preserved in signal and caliber. The spinal cord is unremarkable with\nno focal signal abnormality.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. Within the\nlimits of this noncontrast examination, there is no evidence of infection or\nneoplasm. Partially visualized is mild mucosal thickening in the left\nmaxillary sinus.\n\n At C2-3 there is normal disc height and signal.No spinal canal or neural\nforaminal stenosis.\n\nAt C3-4 there is normal disc height and signal. Mild bilateral uncovertebral\nand facet arthropathy causing mild right neural foraminal narrowing.No spinal\ncanal or left neural foraminal stenosis.\n\nAt C4-5 there is normal disc height and signal.No spinal canal or neural\nforaminal stenosis.\n\nAt C5-6 there is loss of disc height and signal with disc osteophyte\ncomplex.No spinal canal or neural foraminal stenosis.\n\nAt C6-7 there is disc osteophyte complex.No spinal canal or neural foraminal\nstenosis.\n\nAt C7-T1 there is normal disc height and signal.No spinal canal or neural\nforaminal stenosis.", "output": "1. Mild multilevel degenerative disease of the cervical spine, most pronounced\nat C3-C4 with mild right neural foramen narrowing.\n2. Paranasal sinus disease as described." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body signal is within normal limits.The spinal\ncord is intact without signal abnormality.\n\nExtramedullary hemorrhage is seen tracking inferiorly posterior to the clivus\nand along the posterior aspect of the cervical vertebral bodies down to the\nlevel of C5 (6:9).\n\nThere is severe loss of intervertebral disc height at C6-7.\n\nAt C2-3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4, there is severe right neural foraminal narrowing. No significant\nspinal canal or left neural foraminal narrowing.\n\nAt C4-5, there is mild spinal canal narrowing secondary to broad-based\nposterior disc protrusion associated with mild remodeling ventral cord. Mild\nright and moderate left neural foraminal narrowing are also noted.\n\nAt C6-7 there is mild spinal canal narrowing secondary to left paracentral\nposterior disc protrusion, associated with mild remodeling of the left ventral\ncord.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThere is an acute severe compression fracture of the T5 vertebral body. \nIncreased T2 signal intensity along the inferior endplate of the T4 vertebral\nbody likely reflects contusion injury and possible mild fracture. There is no\nretropulsion of contents into the spinal canal. Local paravertebral soft\ntissue edema is also noted.\n\nAlignment remains normal.Vertebral body heights and signal of the remainder of\nthe thoracic spine are preserved. Thoracic intervertebral disc height and\nsignal are grossly preserved. Mild-to-moderate degenerative endplate changes\nare noted at multiple levels.\n\nThe thoracic spinal cord is normal in caliber and configuration, without\nsignal abnormality.There is no significant spinal canal or neural foraminal\nnarrowing.\n\nA chronic moderate compression deformity of the L1 vertebral body is again\ndemonstrated.\n\nOTHER: Parenchymal consolidation in the dependent portions of the bilateral\nlung bases may represent atelectasis or infection. A 1.0 cm area of focal\nsignal abnormality in the medial right lower lobe (15:40) may represent a\nnodule, which was not previously seen. A few simple cysts are noted in the\nright kidney.", "output": "1. Severe acute compression fracture of the T5 vertebral body. No\nretropulsion of contents into the spinal canal. No cord signal abnormality.\n2. Contusion injury along the inferior endplate of T4.\n3. Extra medullary hemorrhage is seen tracking inferiorly posterior to the\nclivus and along the posterior aspect of the cervical vertebral bodies to the\nlevel of C5.\n4. Parenchymal consolidation in the dependent portions of the bilateral lung\nbases may represent atelectasis or infection.\n5. Possible 1 cm nodule in the medial right lower lobe. Recommend correlation\nwith dedicated chest imaging on a nonemergent basis." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. L5 vertebral body fatty rest is noted. There is\nmild ___ type 2 L5-S1 endplate changes. There is mild loss of disc signal\nand height spanning L3-L4 through L5-S1 compatible degenerative changes. The\nconus medullaris terminates at T12-L1 vertebral level, within expected limits.\nThere is no signal abnormality of the visualized cord, conus medullaris or\ncauda equina. Mild buckling of the conus medullaris at the L4-L5 vertebral\nlevel is noted.\n\nPrevertebral paraspinal soft tissues are unremarkable. Mild STIR signal in\nsubcutaneous fat is identified likely representing dependent edema. The\npatient is status post bilateral total hip arthroplasties. There is\nasymmetric atrophy of the right iliopsoas muscle. This could be secondary to\nthe hip arthroplasty. There are incompletely characterized bilateral renal\ncystic lesions measuring up to 1.5 cm, similar in size to prior CT\nexamination. These is statistically most compatible with simple cysts. \nPartially visualized is a right adrenal nodule, demonstrated to be an adenoma\non prior CT examination.\n\nT10-T11 through L2-L3: Mild degenerative changes do not result in significant\nspinal canal or neural foraminal narrowing.\n\nL3-L4: A disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing with crowding of the subarticular zones, contacting but\nnot posteriorly displacing the traversing nerve roots. In conjunction with\nfacet arthropathy, there is mild left and moderate right neural foraminal\nnarrowing.\n\nL4-L5: A disc bulge and thickening of ligamentum flavum results in severe\nspinal canal narrowing (series 6, image 5). Facet arthropathy results in\nmoderate to severe bilateral neural foraminal narrowing.\n\nL5-S1: A disc bulge with superimposed central extrusion with superior\nmigration crowds the subarticular zones contacting and posteriorly displacing\nthe traversing nerve roots. In conjunction with facet arthropathy, there is\nsevere bilateral neural foraminal narrowing.\n\nThe patient is status post L5 bilateral laminectomy. Assessment for\ngranulation tissue cannot be made secondary to lack of IV contrast.", "output": "1. The patient is status post L5 bilateral laminectomy. Assessment for\ngranulation tissue cannot be made secondary to lack of IV contrast.\n2. Severe L4-L5 and L5-S1 spondylosis resulting in severe spinal canal\nnarrowing at L4-L5 and crowding of the subarticular zones at L5-S1. There is\nmoderate severe L4-L5 neural foraminal narrowing and severe L5-S1 neural\nforaminal narrowing." }, { "input": "Degenerative changes lumbar spine. Narrowed L4-5 disc space. Multilevel\ndiffuse disc bulges, endplate hypertrophic changes. Few Schmorl's nodes. No\nworrisome osseous lesions. Posterior element hypertrophic changes. Normal\nvisualized cord. Normal spine alignment. Congenital narrowing spinal canal. \nL4-5, L5-S1 facet joint effusions.\n\nAt L1-L 2, L2-L3 patent central canal, patent foramina.\n\nAt L3-L4, mild central canal narrowing. Patent foramina.\n\nAt L4-5, moderate central canal narrowing. Broad-based central diffuse disc\nbulge narrows subarticular zones, mild mass effect on traversing both L5\nnerves. Moderate left, mild right foraminal narrowing.\n\nAt L5-S1, moderate to severe central canal narrowing, preserved CSF, diffuse\ndisc bulge, small shallow central disc protrusion. Narrowed subarticular\nzones, mass-effect on both traversing S1 nerves. Mild-to-moderate left,\nmoderate right foraminal narrowing\n\nBenign simple cyst right kidney.. Right pleural effusion. Low T2 signal in\nthe liver, spleen. Enlarged retroperitoneal lymph nodes, indeterminate,\nlargest measures 1.3 cm short axis. Mild paraspinal edema bilaterally, may be\nreactive, mild T2 signal abnormality at L4-5 disc space, mild endplate edema,\nlikely degenerative in the absence of clinical suspicion of infection.", "output": "1. Degenerative changes lumbar spine.\n2. Moderate central canal narrowing L4-5 level.\n3. Moderate to severe central canal narrowing L5-S1 level\n4. Multilevel foraminal narrowing, as above.\n5. Retroperitoneal adenopathy, indeterminate.\n6. Right pleural effusion.\n7. L4-5 disc space signal changes are likely degenerative in the absence of\nclinical suspicion of early infection." }, { "input": "CERVICAL SPINE MRI Vertebral body heights are preserved. Alignment is\nnormal. No concerning bone marrow signal abnormalities are identified. Small\nbroad-based disc protrusions are again seen at C4-5, C5-6, and C6-7, indenting\nthe ventral thecal sac but not contacting the spinal cord. The spinal cord\nmaintains normal signal intensity. The cerebellar tonsils are normally\npositioned, and the imaged portion of the posterior fossa is unremarkable.\n\nTHORACIC SPINE MRI There are 12 thoracic type vertebrae. Vertebral body\nheights are preserved. Alignment is normal. No concerning bone marrow signal\nabnormality is seen. There is no spinal canal narrowing. The spinal cord\nmaintains normal morphology and signal intensity. The conus medullaris\nterminates at T12, as seen previously.\n\nLUMBAR SPINE MRI Vertebral body heights are preserved. Alignment is normal.\nLarge foci of high signal on T1 and T2 weighted images in the L4 and L5\nvertebral bodies, which partially suppress signal on STIR images, are\nconsistent with hemangiomas. No concerning bone marrow signal abnormalities\nare seen.\n\nAt L4-5, there is disc desiccation, disc bulge, and a left paracentral disc\nprotrusion, as well as some mild bilateral facet arthropathy. The traversing\nleft L5 nerve root is compressed in the obliterated subarticular zone. The\ntraversing right L5 nerve root is contacted in the subarticular zone. The\nremainder of the spinal canal is mildly narrowed without crowding of the nerve\nroots within the thecal sac. There is mild to moderate left neural foraminal\nnarrowing.\n\nAt L5-S1, there is a mild disc bulge, a tiny central disc protrusion, and mild\nbilateral facet arthropathy. There is no spinal canal or neural foraminal\nnarrowing.", "output": "1. Unchanged mild degenerative disease in the cervical spine without mass\neffect on the spinal cord. The cervical spinal cord appears normal.\n2. The thoracic spinal cord and the remainder of the thoracic spine appear\nnormal.\n3. At L4-5, a disk bulge, left paracentral disc protrusion, and mild bilateral\nfacet arthropathy result in compression of the traversing left L5 nerve root\nin the subarticular zone, abutment of the traversing right L5 nerve root in\nthe subarticular zone, and mild narrowing of the remainder of the spinal canal\nwithout crowding of the nerve roots within the thecal sac. The left L4-5\nneural foramen is mildly to moderately narrowed." }, { "input": "The posterior fossa appears normal. The craniocervical junction appears\nnormal. The tectorial ligament and apical ligament appear intact. No\nevidence for ligamentous injury. The cervical cord is normal in volume and\nsignal intensity.\n\nNo acute C-spine fractures. Mild decrease in bone marrow signal intensity of\nthe cervical vertebral bodies are nonspecific, but most likely related to\nmarrow reconversion. Laboratory correlation advised. Multilevel degenerative\nchanges in the form of disc desiccation, broad-based disc osteophyte complexes\nand facet joint arthropathy. No prevertebral soft tissue abnormality.\n\nC2-3: No nerve root compromise.\n\nC3-4: Mild narrowing of the right neural foramina.\n\nC4-5: Central protrusion with intervertebral osteophytes partially effaces the\nanterior CSF space, but there is no deformation of the cord. Normal cord\nsignal intensity. CSF space posterior to the cord is preserved. Mild left\nand moderate right neural foraminal narrowing.\n\nC5-6: 2-3 mm retrolisthesis of C5 on C6. Central protrusion with\nintervertebral osteophytes effaces the CSF space anterior to the cord\nresulting in moderate spinal canal narrowing with mild cord deformation, but\nthere is still minor CSF present posterior to the cord and there is no\nincreased cord signal. Moderate left and severe right neural foraminal\nnarrowing.\n\nC6-7: Degenerative changes, but no nerve root compromise.\n\nC7-T1: Degenerative changes but no nerve root compromise.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. No acute fracture or evidence of ligamentous injury.\n2. Generalized degenerative changes of the cervical spine.\n3. Mild spinal canal narrowing at the C4-5 and moderate spinal canal narrowing\nat the C5-6 level. No cord signal abnormality.\n4. Moderate to severe neural foraminal narrowing at C5-6 levels as described\nabove." }, { "input": "There is minimal retrolisthesis of C3 on C4 and C4 on C5. Remaining vertebral\nbodies are preserved in alignment. No focal suspicious marrow lesion is\nidentified. Intervertebral disc height loss seen at C4-5 thru C6-7. \nVisualized spinal cord is normal in signal and caliber. Included portion of\nthe posterior fossa is unremarkable.\n\nCraniocervical junction is unremarkable.\n\nAt C2-C3, there is a central disc osteophyte complex partially effacing the\nventral CSF without overall canal or foraminal narrowing.\n\nAt C3-4, there is a disc osteophyte complex and uncovertebral joint\nosteophytes with secondary effacement of the ventral CSF and moderate\nbilateral foraminal narrowing.\n\nAt C4-5, there is a disc osteophyte complex and uncovertebral joint\nosteophytes, worse on the left which result in mild canal narrowing and\neffacement of the ventral CSF. There is moderate to severe left and moderate\nright foraminal narrowing\n\nAt C5-6, there is disc osteophyte complex and uncovertebral joint osteophytes\nwhich contribute to moderate canal narrowing, severe right foraminal and\nmoderate left foraminal narrowing. This is not significantly changed.\n\nAt C6-7, there is a disc osteophyte complex and left greater than right\nuncovertebral joint osteophytes causing moderate to severe left and\nmild-to-moderate right foraminal narrowing. There is moderate canal\nnarrowing.\n\nAt C7-T1, there are uncovertebral joint osteophytes and mild facet joint\nhypertrophy resulting in mild canal narrowing and moderate bilateral foraminal\nnarrowing.\n\nPrevertebral soft tissues are unremarkable.", "output": "Multilevel degenerative changes resulting in up to moderate canal narrowing AT\nC5-6 AND C6-7. Most significant foraminal narrowing seen at C4-5 which is\nmoderate to severe on the left. Remaining details as above." }, { "input": "Again seen is minimal retrolisthesis of C3 on C4 and C4 on C5 as seen\npreviously. Remaining vertebral bodies are preserved in alignment and they\nare preserved in height throughout. No focal suspicious marrow lesion\nidentified. Intervertebral disc height loss is seen throughout the cervical\nspine, most extensive at C4-5 and C5-6.\n\nThe spinal cord is preserved in signal and caliber. Included portion of the\nposterior fossa is unremarkable.\n\nCraniocervical junction is unremarkable.\n\nAt C2-3, there is a disc osteophyte complex which effaces the ventral CSF and\nresults in mild canal narrowing. No significant foraminal narrowing.\n\nAt C3-4, there is a disc osteophyte complex and thickening of the ligamentum\nflavum resulting in effacement of the ventral CSF and overall mild canal\nnarrowing. In combination with uncovertebral joint hypertrophy, there is\nmoderate bilateral foraminal narrowing.\n\nAt C4-5, there is a disc osteophyte complex and uncovertebral joint\nhypertrophy contributing to moderate canal narrowing. There is moderate right\nand severe left foraminal narrowing, similar to prior.\n\nAt C5-6, there is a disc osteophyte complex and right worse than left\nuncovertebral joint hypertrophy. There is overall moderate canal narrowing,\nsevere right and moderate left foraminal narrowing. These findings are\nunchanged since prior.\n\nAt C6-7, there is a disc osteophyte complex and bilateral uncovertebral joint\nhypertrophy with secondary mild canal and moderate right and moderate to\nsevere left foraminal narrowing, similar to prior.\n\nAt C7-T1, there is uncovertebral joint hypertrophy and facet joint hypertrophy\nwhich result in moderate to severe bilateral foraminal narrowing, similar to\nprior.\n\nIncluded paraspinal soft tissues are unremarkable.", "output": "Degenerative changes as above overall, not significantly changed since ___. \nMultiple levels with severe foraminal narrowing, specifically on the left at\nC4-5 and on the right at C5-6. Moderate to severe foraminal narrowing\nbilaterally at C7-T1, on the left at C6-7." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. T1 intrinsically hyperintense signal of the left\nT10 vertebral body is partially visualized, unchanged from prior exams,\ncompatible with an osseous hemangioma. There is mild loss of disc height and\nsignals spanning L1-L2 through L5-S1. The conus medullaris terminates at the\nL1-L2 level, within expected limits. There is no abnormal signal or\nenhancement of the visualized cord, conus medullaris or cauda equina. There\nis buckling of the cauda equina superior to the L2-L3 level.\n\nThe patient is status post L4-L5 laminectomy. There is mild enhancing\nepidural granulation tissue without significant encroachment of the spinal\ncanal or neural foramina.\n\nT11-T12: On sagittal sequences, there is a disc bulge and thickening of the\nligamentum flavum which does not result in significant spinal canal narrowing.\nFacet arthropathy results in mild bilateral neural foraminal narrowing.\n\nT12-L1: A small disc bulge with thickening of the ligamentum flavum does not\nresult in significant spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nL1-L2: A disc bulge and thickening of the ligamentum flavum does not result\nin significant spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nL2-L3: A disc bulge with superimposed central protrusion and thickening of\nthe ligamentum flavum results in moderate spinal canal narrowing, unchanged\nfrom prior examination. The disc contacts the bilateral traversing nerve\nroots. There is moderate left neural foraminal narrowing secondary to facet\narthropathy. No significant right neural foraminal narrowing.\n\nL3-L4: A disc bulge and thickening of the ligamentum flavum does not result\nin significant spinal canal narrowing. Facet arthropathy results in mild\nbilateral neural foraminal narrowing.\n\nL4-L5: A disc bulge does not result in significant spinal canal narrowing. \nFacet arthropathy results in moderate right and no significant left neural\nforaminal narrowing, unchanged from prior examination.\n\nL5-S1: A central protrusion does not significantly narrow the spinal canal. \nIn conjunction with facet arthropathy, there is mild bilateral neural\nforaminal narrowing, similar in appearance to prior examination.\n\nMultiple nonenhancing cystic lesions of the bilateral kidneys measuring up to\n2.5 cm are compatible with simple cysts. Mild STIR hyperintense signal of the\nlower lumbar paraspinal muscles may represent a variation injuries secondary\nto prior surgery. Prevertebral and paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, most prominent at L2-L3 where\na disc protrusion with thickening of the ligamentum flavum and facet\narthropathy results in moderate spinal canal narrowing. There is moderate\nleft neural foraminal narrowing. The findings are similar appearance to prior\nexamination.\n2. Degenerative changes at the L3-L4 levels results in mild bilateral neural\nforaminal narrowing, similar appearance to prior examination." }, { "input": "THORACIC:\nThere is mild superior T11 endplate STIR hyperintense signal without T1\nhypointense linear fracture line. Alignment is normal. Vertebral body\nheights are preserved. There is no other suspicious marrow signal. Disc\nheight and signal are preserved. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. Mild bilateral\ndependent atelectasis is noted. STIR hyperintense signal of the lower\nthoracic paraspinal muscles and subcutaneous fat is identified which may\nrepresent muscle strain and edema.\n\nLUMBAR: Anterior wedge fracture deformity of L1 with approximately 30% loss\nof vertebral body height and retropulsion of the posterior fracture fragments\ninto the spinal canal is identified. The fracture does not extend into the\nlateral or posterior elements. There is no other marrow signal abnormality of\nthe lumbar spine. Disc heights and signal are preserved.\n\nThe anterior longitudinal ligament at the T12-L1 level is attenuated and\nlikely disrupted. There is a small prevertebral 3 mm prevertebral hematoma\nspanning T11 through L2. Although the posterior longitudinal ligament is not\nclearly disrupted, there is attenuation of the L1 ligamentum flavum,\ncompatible with ligamentous injury. Interspinous STIR hyperintense signal of\nT12-L1 and L1-L2 is noted compatible with interspinous ligamentous injury\nwithout evidence of frank disruption. There is no evidence of epidural\nhematoma.\n\nThe conus medullaris terminates at the L1 vertebral level, within expected\nlimits. There is no signal abnormality of the visualized cord, conus\nmedullaris or cauda equina.\n\nL1-L2: There is right greater than left retropulsion of the L1 posterior\nvertebral body fracture fragments resulting in moderate spinal canal\nnarrowing. There is no significant neural foraminal narrowing.\n\nL2-L3 through L5-S1: There is no significant spinal canal or neural foraminal\nnarrowing.\n\n Paraspinal an subcutaneous edema pattern spanning the lower thoracic spine to\nthe L2 vertebral level is noted compatible with muscle strain and edema. \nVisualized abdominal visceral is unremarkable.", "output": "1. Anterior wedge compression fracture of L1 with retropulsion of the\nposterior fracture fragments resulting in moderate spinal canal narrowing at\nL1-L2. There is approximately 30% loss of L1 vertebral body height.\n\n2. Bone contusion pattern of the T11 superior endplate without definite\nfracture line. Attention on followup examination is recommended.\n\n3. Attenuation of the anterior longitudinal ligament and ligamentum flavum at\nT12-L1 and STIR hyperintense signal of the T12-L1 and L1-L2 interspinous\nligaments are compatible with ligamentous injury." }, { "input": "There is transitional anatomy at the lumbosacral junction. Assuming the last\nrib-bearing vertebra is T12, there is partial lumbarization of S1 with a\nrudimentary disc at S1-S2.\n\nThere is mild anterolisthesis of L4 in relation to L5. There is Mild\nretrolisthesis of L2 in relation to L3, and L1 in relation to L2.\n\nThe vertebral body heights is grossly preserved. There is discogenic endplate\nmarrow signal change at L5-S1. No suspicious abnormal marrow signal is\nidentified.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L2\n\nThere is multilevel disc desiccation with loss of intervertebral disc height\nthroughout the lumbar spine, most pronounced at L4-L5.\n\nThere is no paravertebral paraspinal abnormality identified.\n\nAt T12-L1 level, there is no significant disc disease, spinal canal or neural\nforaminal narrowing.\n\nAt L1-L2 level, there is mild disc bulge and facet joint hypertrophy without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L2-L3 level, there is broad-based disc bulge, ligamentum flavum\nhypertrophy, bilateral articular facet joint hypertrophy with joint effusions\nresulting in mild canal narrowing and significant right subarticular recess\nnarrowing, crowding the traversing right L3 nerve root. Mild right worse than\nleft neural foraminal narrowing.\n\nAt L3-L4 level, there is broad-based disc bulge, ligamentum flavum\nhypertrophy, bilateral articular facet joint hypertrophy resulting in mild\ncanal narrowing. There is no significant bilateral neural foraminal\nnarrowing.\n\nAt L4-L5 level, there is broad-based disc bulge, ligamentum flavum\nhypertrophy, bilateral articular facet arthropathy, resulting in mild canal\nnarrowing and bilateral subarticular recess narrowing, crowding the traversing\nL5 nerve roots. No significant neural foraminal narrowing bilaterally.\n\nAt L5-S1 level, there is broad-based disc bulge, central disc protrusion,\nbilateral articular facet arthropathy, ligamentum flavum hypertrophy,\nresulting in mild canal narrowing. There moderate left worse than right\nforaminal narrowing.", "output": "1. Multilevel degenerative changes of the spine, as described above. Moderate\nleft worse than right neural foraminal narrowing at L5-S1. Disc bulge in\ncombination with retrolisthesis and facet joint hypertrophy result in\nsubarticular recess narrowing crowding the traversing right L3 nerve root at\nL2-3.\n2. Additional findings as described above." }, { "input": "There is scoliosis of lumbar spine convex to the left in the lower lumbar and\nthe right in the upper lumbar region.\n\nThere extensive degenerative changes with diffuse skeletal hyperostosis\nidentified.\n\nFrom T10-T11 through L1-2 lytic levels, disc degenerative changes identified. \nIncreased signal within the disc on T2 images and T1 images indicates\ncalcification and degenerative change.\n\nAt L2-3 level, disc degenerative change and bulging identified resulting in\nmild spinal stenosis with moderate foraminal narrowing.\n\nAt L3-4 level, disc bulging and facet degenerative changes with thickening of\nthe ligaments result in moderate spinal stenosis and moderate bilateral\nforaminal narrowing.\n\nAt L4-5 level, severe facet degenerative changes seen with endplate\ndegenerative change on the left side. There is thickening of the ligaments. \nThere is severe spinal stenosis and severe bilateral foraminal narrowing\nidentified.\n\nAt L5-S1 level, there is disc bulging without spinal stenosis but with\nmoderate-to-severe bilateral foraminal narrowing.\n\nThe distal spinal cord shows normal signal intensities. No evidence of an\nacute compression fracture seen the paraspinal soft tissues are unremarkable\nexcept for a simple appearing cyst in the left kidney.", "output": "1. Multilevel degenerative changes identified with scoliosis of lumbar spine.\n2. Severe spinal stenosis and foraminal narrowing at L4-5 level.\n3. Moderate spinal stenosis and foraminal narrowing at L3-4 level.\n4. Moderate-to-severe bilateral foraminal narrowing at L5-S1 level." }, { "input": "THORACIC SPINE:\nThere is a severe compression deformity of the T5 vertebral body with extreme\nfocal kyphosis centered at the level. There are posterior pedicle screws at\nT3-T4 and T6-T7, with bilateral fusion rods spanning from T3-T7. Artifact\nfrom fusion hardware slightly limits evaluation. There is elevated T2 signal\nin the T4 vertebral body. There is no definite epidural fluid collection\nwithin the limitations of noncontrast scan. There is no definite paraspinal\nphlegmon or abscess within the limitations of noncontrast scan.\n\nLUMBAR SPINE:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nBilateral pleural effusions and bibasilar consolidations are better evaluated\non recent CT chest.", "output": "1. Severe compression deformity of the T5 vertebral body with extreme focal\nkyphosis centered at the level, with posterior fusion hardware spanning from\nT3-T7.\n2. Elevated T2 signal within the T4 vertebral body consistent with marrow\nedema likely subacute but of uncertain chronicity given the lack of prior\nexams for comparison.\n3. Evaluation for epidural abscess is limited without IV contrast, however\nthere is no large epidural or paraspinal collection identified.\n4. Bilateral pleural effusions and bibasilar consolidations are better\nevaluated on recent CT chest." }, { "input": "Grade 1 anterolisthesis is seen involving L4 on L5 with 2 mm retrolisthesis of\nL5 on S1. Mild facet joint edema is seen involving the right L3/L4 facet\njoint. The cord terminates at L1. No terminal cord signal abnormalities\nidentified. Mild loss of the normal T2 signal is seen throughout the\nintervertebral discs of the lumbar spine likely degenerative in etiology.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: Disc bulge, facet joint arthropathy and ligamentum flavum thickening\nare seen resulting in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to mild to moderate left and mild right neural foraminal narrowing.\n\nL3-L4: The disc bulge, facet joint arthropathy and ligamentum flavum\nthickening results in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to mild bilateral neural foraminal narrowing.\n\nL4-L5: Disc bulge including uncovering of the intervertebral disc secondary to\nanterolisthesis, ligamentum flavum thickening and facet joint arthropathy\nresults in mild spinal canal narrowing. Facet joint osteophytes contribute to\nmild to moderate bilateral neural foraminal narrowing. A facet osteophyte\nappears to contact the exiting left L4 nerve root (series 4, image 14).\n\nL5-S1: Disc bulge with a focal central disc protrusion is seen, which in\nconjunction with ligamentum flavum thickening and facet joint arthropathy\nresults in mild spinal canal narrowing. Facet joint osteophytes contribute to\nmild bilateral neural foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Lumbar spondylosis, most pronounced at L4-L5, with mild spinal canal\nstenosis as well as mild to moderate bilateral neural foraminal narrowing. A\nfacet osteophyte however appears to contact the exiting left L4 nerve root.\n2. No terminal cord signal abnormalities identified.\n3. Additional findings as described above." }, { "input": "The patient is status post C4 through C5 laminectomy as well as right\nposterior fusion with lateral mass screws spanning C3 through C6. The patient\nis decompressed with resolution of previously seen severe spinal canal\nnarrowing spanning C3-C4 through C5-C6. There is residual moderate C2-C3\nspinal canal narrowing. Metallic artifact from the fusion hardware results in\nsuboptimal evaluation of adjacent structures. Within this confine:\n\nTrace T2 hyperintense cord signal at the C3-C4 level with mild cord volume\nloss is unchanged from prior examination. No new cord signal abnormality. No\nsignificant enhancing granulation tissue encroaches on the spinal canal or\nneural foraminal\n\nThe visualized posterior fossa is unremarkable. Cervical alignment is\nanatomic.\n\nC2-C3: Unremarkable.\n\nC3-C4: Uncovertebral and facet arthropathy results in severe left and moderate\nto severe right neural foraminal narrowing, similar to slightly improved from\nprior exam. The patient is decompressed.\n\nC4-C5: The patient is decompressed. A small central protrusion is identified.\nUncovertebral and facet arthropathy results in moderate bilateral neural\nforaminal narrowing, improved to prior exam.\n\nC5-C6: A central protrusion and intervertebral osteophytes is identified. The\npatient is decompressed. Uncovertebral and facet arthropathy results in mild\nbilateral neural foraminal narrowing, improved from prior exam.\n\nC6-C7: Intervertebral osteophytes central protrusion results in moderate spine\nin, overall similar to prior examination. Uncovertebral and facet arthropathy\nresults in mild bilateral neural foraminal narrowing, similar to improved from\nprior exam.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nAllowing for postsurgical findings, visualize prevertebral paraspinal soft\ntissues are grossly unremarkable.", "output": "1. The patient is status post C4 through C5 laminectomy as well as right\nposterior fusion spanning C3 through C6.\n2. Unchanged mild cord signal at C3-C4 with associated volume loss. No new\ncord signal abnormality.\n3. No interval progression of degenerative ptosis compared to prior\nexamination. Degenerative changes are most prominent at C3-C4 where there is\nsevere left and moderate to severe right neural foraminal narrowing, similar\nto slightly improved from prior exam.\n4. Additional findings as described above." }, { "input": "2 mm degenerative anterolisthesis of L4 on L5 is unchanged from prior\nexamination. Mild levoconvex curvature of the lumbar spine with apex at L3 is\nidentified. Otherwise, lumbar alignment is anatomic. Vertebral body heights\nare preserved. No focal suspicious marrow lesion. Degenerative loss of disc\nheight is mild at L2-L3 and moderate at L4-L5 and L5-S1, also overall similar\nto prior exam. There is associated degenerative loss of disc signal. The\nconus medullaris terminates at the L1-L2 level, within expected limits. There\nis no signal abnormality of the terminal cord.\n\nT10-T11: A disc bulge results in mild to moderate spinal canal. In\ncombination with facet arthropathy, there appears to be at least moderate\nbilateral neural foraminal narrowing. This is not within the field of view of\nprior study.\n\nT11-T12: A small disc bulge results in mild to moderate spinal canal\nnarrowing. In conjunction with facet arthropathy, there is mild bilateral\nneural foraminal narrowing.\n\nT12-L1: A small disc bulge does not narrow the spinal canal. There is no\nsignificant neural foraminal narrowing.\n\nL1-L2: Small disc bulge does not narrow the spinal canal. There is no\nsignificant neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. No significant neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in\nmild-to-moderate spinal canal narrowing. There is mild left neural foraminal\nnarrowing where a facet osteophyte remodels the exiting left L3 nerve root. \nThis is overall unchanged from prior exam.\n\nL4-L5: A left eccentric disc bulge slightly more prominent when compared to\nprior examination. There is uncovering of the disc secondary to\nanterolisthesis. There is crowding of the left subarticular zone contacting\nbut not definitively posterior displacing the traversing left L5 nerve root. \nIn conjunction with facet arthropathy, there is mild bilateral neural\nforaminal narrowing a facet osteophyte contacts the exiting left L4 nerve root\n(series 3, image 104), similar to slightly progressed from prior exam.\n\nL5-S1: A central protrusion, with inferior migration contacts the right\ngreater than left traversing S1 and S2 nerve roots, overall similar to prior\nexam. In conjunction with facet arthropathy, there is mild bilateral neural\nforaminal narrowing, also overall similar to prior exam.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Multilevel lumbar spondylosis, slightly progressed at L3-L4 and L4-L5. At\nL3-L4, there is mild left neural foraminal narrowing where a facet osteophyte\nremodels the exiting left L3 nerve root. At L4-L5, there is mild bilateral\nneural foraminal narrowing where facet osteophyte contacts the exiting left L4\nnerve root.\n2. At L5-S1, there is a central protrusion with inferior migration contacting\nthe right greater than left traversing S1-S2 nerve roots, overall similar to\nprior exam.\n3. There is mild-to-moderate spinal canal narrowing at L3-L4, similar to prior\nexam.\n4. There is no high-grade spinal canal or neural foraminal narrowing.\n5. Additional findings as described above." }, { "input": "Vertebrae are normal in stature and alignment. There is a hemangioma of the L2\nvertebral body. There are type ___ degenerative endplate changes at L5-S1.\nThere is intervertebral disc desiccation with disc height loss at L5-S1. \nThere is mild multilevel facet degenerative joint disease with tiny,\nposteriorly-projecting facet synovial cysts at L3 through S1.\n\nT12-L1: There is no significant spinal canal or foraminal stenosis.\n\nL1-L2: There is no significant spinal canal or foraminal stenosis.\n\nL2-L3: There is no significant spinal canal or foraminal stenosis.\n\nL3-L4: There is no significant spinal canal or foraminal stenosis.\n\nL4-L5: There is no significant spinal canal or foraminal stenosis. Mild\nbulge with bil. Mild formainal narrowing by disc and facet changes\n\nL5-S1: There is intervertebral disc desiccation with disc height loss at\nL5-S1.\nThere is an annular fissure and disc extrusion. There is possible mild\nnarrowing of the bilateral foramina.\n\nThe conus medullaris is normal in appearance and position, terminating at\nL1-L2 level.\n\n\nThere is a 1.3 x 1.2 x 1.7 cm rim enhancing fluid collection within the\nsubcutaneous fat of the very low back at the level of the inferior sacrum\n(series 12 image 10). This collection is within the subcutaneous fat, far \nremote from Lower lumbar spine and with no identifiable connection to the\nthecal sac. This collection appears to correspond to the collection identified\non ultrasound from ___.\n\nThere is small amount free fluid in the pelvis.", "output": "1. Approximately 1.7 cm fluid collection with some enhancement around within\nthe subcutaneous fat of the low back overlying the inferior sacrum. This\ncollection may be an evolving abscess. Clinical correlation with direct\ninspection suggested. There is no communication of this collection to the\nthecal sac.\n2. Multilevel, multifactorial degenerative changes in the lower lumbar spine,\nwith disc and facet changes\nL4-5: Mild foraminal narrowing, mild to moderate facet degenerative changes\nL5-S1: Mild bulge, Small disc extrusion with possible minimal foraminal\nstenosis.\nHemangioma L2 body\nOther details as above" }, { "input": "The vertebral body height and marrow signal within the lumbar spine are\nnormal. There is retrolisthesis of L5 on S1 which measures approximately 5 mm.\nThere is a rudimentary disc between S1 and S2.\n\nThe conus medullaris is normal and position and morphology in terminates at\nthe L1 level.\n\nThe paraspinous and prevertebral soft tissues are unremarkable.\n\nAt the L3-L4 level, the spinal canal and neural foramina appear normal.\n\nAt the L4-L5 level, the spinal canal and neural foramina appear normal.\n\nAt the L5-S1 level, there is a posterior disc protrusion which mildly narrows\nthe spinal canal and contacts the traversing S1 nerve roots, left greater than\nright. Additionally, there is a sequestered disc fragment. Along the left\nposterior aspect of the L5 vertebral body. The neural foramina appear normal.", "output": "1. L5-S1 disk protrusion likely affecting the traversing S1 nerve roots, left\ngreater than right, with additional sequestered disc fragment posterior to the\nL5 vertebral body, as described." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level. There is transitional vertebral anatomy with\npartial lumbarization of S1.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is a Schmorl's node at the inferior endplate of T12 and superior\nendplate of L4 as well as the inferior endplate of L5 there is otherwise no\nbone marrow signal abnormality. The visualized portion of the spinal cord is\npreserved in signal and caliber.\n\nThere is loss of T2 signal and intervertebral disc height at T11-T12, T12-L1\nand L5-S1. The remainder of the intervertebral disc heights and signal are\nrelatively well preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is a tiny central disc protrusionwithout significant spinal\ncanal or neural foraminal narrowing..\n\nAt L1-2 there is no significant spinal canal and neural foraminal narrowing.\n\nAt L2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-4 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L4-5 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L5-S1 there is left paracentral disc protrusion, which has improved\ncompared the prior examination, which contacts and minimally displaces the\ntraversing left S1 nerve root, though there is no evidence for impingement. \nThere is mild narrowing of the left subarticular recess. There is a small\nforaminal component of disc protrusion on the left, producing moderate neural\nforaminal narrowing, which appears new compared the prior examination. The\nright neural foramen is patent..\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Left paracentral disc protrusion at L5-S1 has mildly improved compared the\nprior examination, however now there is a small foraminal component producing\nmoderate left neural foraminal narrowing at this level.\n2. No significant spinal canal narrowing or neural foraminal narrowing at\nother levels.\n3. No terminal cord signal abnormality." }, { "input": "Accentuated cervical lordosis. Minimal retrolisthesis C4-C5, C5-C6. \nMultilevel degenerative changes, disc space narrowing, mild disc osteophyte\ncomplexes, posterior element degenerative changes. No cord signal\nabnormality. Symmetric mild bilateral posterior paraspinal edema,\nnonspecific, could be reactive dependent edema; similar findings can be seen\nwith posttraumatic, inflammatory or infectious myositis. No fluid collection.\nFluid in the sphenoid sinus, likely from intubation. No evidence of facet or\ndisc space infection.. Brain parenchymal atrophy.\n\nMild central canal narrowing C4-C5, C5-C6 levels. Central canal patent at\nother levels.\nMild-to-moderate bilateral C3-C4, moderate bilateral C4-C5, moderate bilateral\nC5-C6, mild bilateral C6-C7, foraminal narrowing", "output": "1. Degenerative changes cervical spine.\n2. Mild central canal narrowing.\n3. Multilevel foraminal narrowing.\n4. Mild symmetric bilateral posterior paraspinal, muscular edema, may be\nreactive dependent edema; posttraumatic, inflammatory or infectious myositis\ncould have similar appearance. No fluid collection." }, { "input": "THORACIC:\nVertebral body alignment is preserved.Vertebral body heights are preserved. \nBone marrow signal is normal.\n\nThere is loss of T2 signal within multiple intervertebral discs, a\nmanifestation of degenerative disc disease. The intervertebral disc heights\nare otherwise relatively well preserved.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nepidural collection.\n\nLimited sagittal views demonstrate a disc bulge at the C7-T1 level with\nextruded portion of disc traversing superiorly along the posterior aspect of\nthe C7 vertebral body (08:10). Facet and uncovertebral arthropathy produces\nmoderate neural foraminal narrowing at the left C7-T1 level (11:1).\n\nSmall disc protrusions are seen at multiple thoracic levels, without\nsignificant spinal canal narrowing. There is otherwise no evidence of\nsignificant neural foraminal narrowing in the thoracic spine.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is mild heterogeneity of the bone marrow, without focal lesion. The\nvisualized portion of the spinal cord is preserved in signal and caliber. The\nconus medullaris terminates at the L2-L3 level.\n\nThere is loss of T2 signal within multiple intervertebral discs, a\nmanifestation of degenerative disc disease. The intervertebral disc heights\nare otherwise relatively well preserved.\n\nThere is no abnormal focus of enhancement. There is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is a right paracentral disc protrusion indenting the ventral sac\nwithout significant spinal canal narrowing. The neural foramina are patent.\n\nAt L2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-4 there is no significant spinal canal or neural foramina narrowing.\n\nAt L4-5 there is disc bulge indenting the ventral thecal sac without\nsignificant spinal canal narrowing. The neural foramina are patent.\n\nAt L5-S1 there is a right-sided disc protrusion, focally contacting the\nexiting right L5 nerve root.There is no significant spinal canal or neural\nforaminal narrowing.\n\nOTHER: A 3 mm T2 hyperintense, lesion is noted within the spleen. This region\nis not seen on the precontrast T1 weighted images but it is hyperintense on\nthe postcontrast images, suggesting enhancement, likely a hemangioma (12:16,\n22:16).\n\nArea of non masslike T2 hyperintense signal in the hepatic dome, corresponds\nto an area of diaphragmatic invagination on prior CT. Nonenhancing, T2\nhyperintense 6 mm left interpolar renal lesion is compatible with cyst. The\nremainder of the visualized retroperitoneum is grossly unremarkable.", "output": "1. Mild multilevel thoracolumbar spondylosis, as described.\n2. No evidence of osseous metastatic disease." }, { "input": "ACDF at C3-C5 and ACDF at C6-7 are again seen. The hardware is not assessed\nby MRI. Minimal retrolisthesis of C6 on C7 is unchanged. Vertebral body\nheights appear unchanged. Evaluation of bone marrow signal is limited by\nhardware related artifact.\n\nThe cerebellar tonsils are normally positioned, and the visualized posterior\nfossa appears unremarkable.\n\nAxial gradient echo images are limited by hardware related artifacts. Axial\nT2 weighted images and sagittal images are used for assessment of the spinal\ncanal or neural foramina, as detailed below.\n\nThe craniocervical junction and the C1-C2 level appear unremarkable.\n\nAt C2-3, there is a small central disc protrusion which indents the ventral\nthecal sac but does not contact the spinal cord. There is right greater than\nleft facet arthropathy with mild right neural foraminal narrowing. There is\nno change since the prior MRI.\n\nAt C3-4, posterior endplate osteophytes indent the ventral thecal sac. The\nspinal cord is not contacted, but the left ventral cord surface is mildly\nremodeled, unchanged. No neural foraminal narrowing is seen.\n\nAt C4-5, there is no spinal canal or neural foraminal narrowing.\n\nAt C5-6, posterior endplate osteophytes indent the ventral thecal sac. The\nspinal cord is not contacted, but the right ventral cord surface is mildly\nremodeled, unchanged. No significant neural foraminal narrowing is seen.\n\nAt C6-7, there is minimal retrolisthesis and small left posterior endplate\nosteophytes, indenting the ventral thecal sac but but not contacting the\nspinal cord. There is mild bilateral neural foraminal narrowing by\nuncovertebral osteophytes. There is no interval change.\n\nAt C7-T1, there is no spinal canal narrowing. The right neural foramen is\nmoderately narrowed by either endplate osteophytes or a disc herniation,\nincompletely evaluated on T2 weighted images alone due to hardware-related\nartifact on gradient echo images, but not significantly changed compared to\nthe prior MRI. Left facet arthropathy is again seen with minimal left neural\nforaminal narrowing, unchanged.\n\nAt T1-T2, there is a mild disc bulge and a left foraminal/extra foraminal disc\nprotrusion, new since ___, and mild facet arthropathy with left\ngreater than right neural foraminal narrowing.", "output": "1. S/p ACDF at C3-C5 and ACDF at C6-7. C2-3 through C6-7 levels appear\nunchanged compared to ___.\n2. At C7-T1, the right neural foramen is moderately narrowed by either\nendplate osteophytes or a disc herniation, incompletely evaluated on T2\nweighted images alone due to hardware-related artifact on gradient echo\nimages, but unchanged compared to ___. Left facet arthropathy with\nminimal left foraminal narrowing at C7-T1 is also unchanged.\n3. At T1-T2, a minimal disc bulge and a left foraminal/extra foraminal disc\nprotrusion a new since ___. In combination with mild facet\narthropathy, this results in left greater than right neural foraminal\nnarrowing." }, { "input": "Limited thoracic spine. The signal intensity throughout the vertebral bodies\nis heterogeneous, consistent with bone marrow infiltration due to metastatic\ndisease. The cord signal can not be completely assess due to motion artifact.\nThere is no evidence of spinal cord compression. At C7/C8 level, the T1\nweighted sagittal image demonstrates possible protrusion of soft tissue into\nthe ventral spinal canal, of unclear if this is related with metastatic,\ncorrelation with gadolinium contrast is recommended for further\ncharacterization (8:4).\n\nMRI of the lumbar spine. The signal intensity in the bone marrow is\nheterogeneous consistent with metastatic disease. Multilevel degenerative\nchanges are present, consistent with disc desiccation and posterior disc\nbulging at L4/L5 and L5-/S1 level. In the sacrum there is a perineural Tarlov\ncyst extending at S1 and S2 levels, measuring approximately 12 x 32 mm in\nsagittal projection (10:7).", "output": "1. Limited examination, the patient aborted the scan. In the thoracic spine,\nthere is no frank evidence of spinal cord compression. At C7 the/C8 level\nthere is possible protrusion of soft tissue into the ventral spinal canal,\nunclear if this is related with metastatic disease, correlation with MRI of\nthe thoracic spine with contrast is recommended for further characterization.\n\n2. Mild to moderate multilevel degenerative changes are visualized throughout\nthe lumbar spine. Perineural Tarlov cyst is noted at S1 and S2 levels." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level. There are 5 lumbar type vertebra with partial\nsacralization of L5.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. Previously seen 4 mm lesion in the T10\nvertebral body possibly representing a bone island is not included on the\nfield of view. Scattered focal fat deposits and/or hemangiomas within the\nbone marrow are similar to prior. ___ type 2 and 3 changes are again seen\nat L4-L5.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of T12-L1.\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 mild disc bulge, facet hypertrophy, and mild ligamentum\nflavum thickening with mildvertebral canal and mild bilateral neural foraminal\nnarrowing. There is contact on the traversing L3 nerve root in the\nsubarticular zone.\n\nAt L3-4 there is disc bulge, bilateral facet hypertrophy, and ligamentum\nflavum hypertrophy with mildvertebral canal and severe bilateral neural\nforaminal narrowing. A tiny annular fissure is noted.\n\nAt L4-5 there is mild disc bulge, facet hypertrophy, with mildvertebral canal\nand moderate bilateral neural foraminal narrowing.\n\nAt L5-S1 there is mild disc bulge with mildvertebral canalbut noneural\nforaminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \n0.8 cm T2 hyperintense area of the right interpolar kidney represent a cyst or\nartifact.", "output": "1. Moderate to severe multilevel degenerative changes most prominent at L2-3\nand L3-4, as above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere are scattered degenerative endplate signal changes most significant at\nL5-S1 where there is near complete loss of intervertebral disc height.\n\nThe visualized portion of the no cord is preserved in signal and caliber. The\nconus medullaris terminates at the level of L1-L2.\n\nReduced T2 signal within the L2-L3 through L4-L5 intervertebral discs is\nlikely on a degenerative basis.\n\nAt T12-L1 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2 there are small facet osteophytes and bilateral facet joint effusions\nwithout significant spinal canal stenosis or neural foraminal narrowing.\n\nAt L2-L3 there is mild symmetric disc bulging, ligamentum flavum thickening\nand small facet osteophytes with mild spinal canal narrowing and mild right\nneural foraminal narrowing. There are small bilateral facet joint effusions.\n\nAt L3-L4 there is mild symmetric disc bulging, ligamentum flavum thickening\nand facet osteophytes with mild spinal canal narrowing and mild bilateral\nneural foraminal narrowing. There are small bilateral facet joint effusions.\n\nAt L4-L5 there is symmetric disc bulging, a superimposed left\ncentral/foraminal disc protrusion or synovial cyst, ligamentum flavum\nthickening and facet osteophytes with mild-to-moderate spinal canal narrowing\nand effacement of the left subarticular zone with medial displacement of the\ntraversing L5 nerve root. There is mild bilateral neural foraminal narrowing\nand small bilateral facet joint effusions.\n\nAt L5-S1 there is symmetric disc bulging and facet osteophytes with mild\nbilateral neural foraminal narrowing.\n\n2 mm T2 hyperintense cystic structures in right kidney are statistically most\nlikely simple cysts. There is increased prominence of a 9 mm left S2\npresacral lymph node (series 7, image 8), increased in size from examination\n___. Otherwise, visualized prevertebral paraspinal soft tissues are\nunremarkable.", "output": "1. Degenerative changes of the lumbar spine most significant at L4-L5 where\nthere is mild-to-moderate spinal canal narrowing and a superimposed left\ncentral/foraminal disc protrusion or synovial cyst causing medial displacement\nof the traversing left L5 nerve root. A proteinaceous synovial cyst rather\nthan disc protrusion is felt more likely given STIR hyperintense signal\nsimilar to CSF.\n2. A 9 mm left S2 presacral lymph node, not pathologic by size criteria but\nincreased in size since examination ___. Clinical correlation is\nrecommended.\n3. Additional findings as described above." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is mild signal heterogeneity of the cervical vertebral bodies a reduced\nT2 signal of the intervertebral discs, likely degenerative.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. The conus medullaris terminates at the level of L1-L2.\n\nThere is no evidence of infection or neoplasm. There is no prevertebral soft\ntissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nThere is mild multilevel degenerative changes of the cervical spine most\nprominent at C5-C6 where there is mild-to-moderate spinal canal narrowing. \nThe neural foramina are suboptimally evaluated due to motion artifact.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nDegenerative endplate signal is most significant at L5-S1 where there is also\nintervertebral disc space narrowing. Reduced T2 signal within the L2-L3\nthrough L5-S1 intervertebral discs is likely on a degenerative basis.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L1-L 2.\n\nThere are multilevel facet joint effusions most significant on the right at\nL4-L5.\n\nAt L1-L2 there are small facet osteophytes without significant spinal canal or\nneural foraminal narrowing.\n\nAt L2-L3 there is mild symmetric disc bulging, ligamentum flavum thickening\nand small facet osteophytes with mild spinal canal narrowing and mild right\nneural foraminal narrowing.\n\nAt L3-L4 there is mild symmetric disc bulging, ligamentum flavum thickening\nand facet osteophytes with mild spinal canal narrowing and mild bilateral\nneural foraminal narrowing.\n\nAt L4-L5 there is symmetric disc bulging, a superimposed left\ncentral/foraminal synovial cyst, ligamentum flavum thickening and facet\nosteophytes with mild-to-moderate spinal canal narrowing and effacement of the\nleft subarticular zone with medial displacement of the traversing L5 nerve\nroot. Of note, the probable synovial cyst does not demonstrate evidence of\nabnormal postcontrast enhancement. There is mild bilateral neural foraminal\nnarrowing.\n\nL5-S1 there is symmetric disc bulge that is suggested to contact bilateral\ntransiting S1 nerve roots, and facet osteophytes with mild-to-moderate\nbilateral neural foraminal narrowing.\n\nOverall, degenerative findings are not significantly changed since ___.\n\nOTHER: The previously noted left S2 presacral enlarged lymph node is only\npartially included in the field of view of the current examination (see 8, 9,\n10, 16: 15).", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of an epidural abscess.\n3. Stable degenerative changes of the lumbar spine most significant at L4-5\nwhere there is evidence of a left central/foraminal synovial cyst resulting in\neffacement of the left subarticular zone and medial displacement of the\ntraversing L5 nerve root.\n4. Multilevel facet joint effusions are most significant on the right at\nL4-L5.\n5. Overall, degenerative findings of the lumbar spine are not significantly\nchanged since ___.\n6. Limited evaluation of the cervical spine due to motion artifact. Allowing\nfor this, there is mild multilevel disc bulging most significant at C5-C6\nwhere there is mild-to-moderate spinal canal narrowing.\n7. No definite evidence of thoracic spine moderate severe vertebral canal or\nneural foraminal narrowing.\n8. Previously noted presacral S2 enlarged lymph node is only partially\nincluded within the field of view current exam." }, { "input": "Study is degraded by motion. Within these confines:\n\nTHORACIC AND LUMBAR SPINE:\n\n Levels were established by counting down from the C2 level using series 4.\n\n There is levoscoliosis of the thoracic spine. Approximately 2 mm grade 1 L5\non S1 retrolisthesis is noted. Schmorl's nodes are seen at multiple levels\nthroughout the thoracic and lumbar spine. Fatty marrow replacement of the T12\nthrough L4 vertebral bodies versus artifact are noted. Nonspecific probable\nedema of the L5 inferior endplate without definite peripherally enhancing\nfluid collection is noted. Question presacral edema and enhancement versus\nartifact (see 8, 9, 10, 14:9; 11, 15: 34-42). Question additional edema\nenhancement within sacrum versus artifact.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal at L1-2 through L5-S1.\nOtherwise, intervertebral disc heights and signal are grossly preserved.\n\nAt T12-L1 there is facet hypertrophy, ligamentum flavum thickening, epidural\nwith no vertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canal and no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canal and mild bilateral neural foraminal\nnarrowing.\n\nAt L3-4 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild-to-moderate vertebral canal and mild bilateral neural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge with annular fissure, facet hypertrophy,\nligamentum flavum thickening, epidural fat, with mild-to-moderate vertebral\ncanal and mild bilateral neural foraminal narrowing.\n\nAt L5-S1 there is grade 1 retrolisthesis, disc bulge, facet hypertrophy,\nepidural fat, with mild vertebral canal and mild bilateral neural foraminal\nnarrowing.\n\nAdditionally, multilevel degenerative changes of the thoracic spine are noted\nwithout definite evidence of moderate or severe vertebral canal or neural\nforaminal narrowing.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified.", "output": "1. Study is degraded by motion.\n2. L5 and S1 vertebral body enhancement and prevertebral edema without\ndefinite peripherally enhancing collection. Question additional edema\nenhancement within sacrum versus artifact. While findings may represent\ndegenerative change, infectious or inflammatory etiologies are not excluded on\nthe basis of this examination.\n3. Multilevel thoracic and lumbar spondylosis and epidural fat as described,\nwithout definite evidence of severe vertebral canal or neural foraminal\nnarrowing.\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 final impression findings were emailed to ED QA nurses by\n___, M.D. on the telephone on ___ at 1:42 pm." }, { "input": "From T10-T11 through L2-3 levels, disc degenerative changes seen with mild\nbulging without spinal stenosis or foraminal narrowing.\n\nAt L3-4 level, there is diffuse disc bulge and mild anterolisthesis with\nsevere facet degenerative changes. There is moderate-to-severe left-sided and\nmoderate right-sided foraminal narrowing not changed from the previous study.\nAt L4-5 level, there is disc and facet degenerative changes. There is\nmoderate-to-severe left-sided and moderate right-sided foraminal narrowing\nwhich has not significantly changed from the prior study. Next L5-S1 level,\ndisc degenerative change and mild bulging seen without spinal stenosis. There\nis no change from the previous study.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. Which is\nnot significantly changed", "output": "Multilevel degenerative changes most pronounced at L3-4 and L4-5 levels with\nforaminal narrowing have not significantly changed since the previous MRI\nexamination." }, { "input": "At T12-L1 and L1-2 levels no abnormalities are seen.\n\nAt L2 vertebra demonstrate mild increase signal in the anterior superior\nportion due to a Schmorl's node. At L2-3 L3-4 and L4-5 levels, there is no\nevidence of significant disc bulge or disc herniation identified.\n\nAt L5-S1 level, mild disc bulging is identified. There is no spinal stenosis\nidentified. There is no evidence of high-grade foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Mild degenerative changes identified without spinal stenosis or foraminal\nnarrowing. No evidence of nerve root displacement." }, { "input": "From T10-T11 through T12-L1 no abnormalities are seen.\n\nAt L1-2 to L4-5 levels disc degenerative changes are seen. Mild disc bulging\nis seen at L4-5 level. Fluid is seen within the facet joints at L4-5 level.\n\nAt L5-S1 level, mild disc bulging is identified without spinal stenosis or\nforaminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Mild degenerative changes which are not significantly changed compared with ___. No evidence of spinal stenosis, foraminal narrowing or focal\ndisc herniation. No evidence of nerve root displacement." }, { "input": "The examination is slightly motion degraded. Within these confines:\n\nCervical: There is normal cervical alignment. The vertebral body heights are\npreserved. The marrow signal is unremarkable. The cervical cord demonstrates\nnormal signal and morphology. The the intervertebral disc spaces demonstrate\nnormal signal and height. There is no significant neural foraminal or spinal\ncanal stenosis.\n\nThere is partially visualized right occipital craniotomy anatomy and right\ncerebellar mass resection. There remains mild downward herniation of the\ncerebellar tonsils. There is a small fluid collection at the craniotomy site\nwhich extends to the skin surface with the deep component measuring\napproximately 2.7 cm TV oblique x 1.3 cm AP oblique x 4.0 cm SI (11:4; 5:6). \nThe paraspinal soft tissues are otherwise unremarkable.\n\nThoracic spine: There is normal thoracic alignment. The vertebral body\nheights are preserved. The marrow signal is unremarkable. The thoracic cord\ndemonstrates normal signal and morphology. There is no abnormal enhancement. \nThe intervertebral disc spaces demonstrate normal signal and height. There is\nno significant neural foraminal or spinal canal stenosis. The paraspinal soft\ntissues are unremarkable.\n\nLumbar spine: There is normal lumbar alignment. The vertebral body heights\nare preserved. The marrow signal is unremarkable. The intervertebral disc\nspaces demonstrate normal signal and height. The conus terminates\nappropriately at the L1-L2 level. There is no abnormal enhancement. At L5-S1\nthere is disc bulge without significant neural foramina or spinal canal\nstenosis.\n\nThe paraspinal soft tissues are unremarkable. There is no abnormal\npostcontrast enhancement.", "output": "1. Expected postsurgical changes, as described, with a small fluid collection\nat the right craniotomy bed likely representing a seroma.\n2. No evidence of metastatic disease." }, { "input": "A 2.4 x 2.7 by 4.7 cm T2 hyperintense, T1 hypointense, homogeneously enhancing\nright prevertebral mass extends from C5-C6 to C7-T1. This mass likely invades\nand lifts the right longus coli muscle anteriorly. The right prevertebral\nmasses does not demonstrate susceptibility. The right prevertebral mass\nextends into the posterior C7 vertebral body and right anterior cortex of the\nC6 vertebral body. The mass abuts, but does not appear to involve the exiting\nright C8 nerve roots. The mass does not enter the neural foramen or spinal\ncanal.\n\nAdditional mass at the T4 left costovertebral junction is re-identified\n(series 3, image 4), measuring approximately 1.8 x 1.5 cm.\n\nThe alignment of the cervical spine is normal. There is mild loss of height\nof the C7 vertebral body. The intervertebral discs are diffusely desiccated. \nThe spinal cord is normal in signal without enhancement.\n\nAt C2-C3, there is left facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt C3-C4, there is left facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt C4-C5, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt C5-C6, a posterior disc osteophyte complex and bilateral facet arthropathy\ncause moderate spinal canal stenosis.\n\nAt C6-C7, a disc protrusion intervertebral osteophyte results in a mild spinal\ncanal narrowing, minimally remodeling the ventral aspect of the cord. \nBilateral facet arthropathy results in no significant neural foraminal\nnarrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.\n\nA round right level 2 lymph node is enlarged, measuring 1.2 by and 0.9 cm on\n5:7.", "output": "1. Enhancing right prevertebral mass, consistent with metastatic lymphoma,\nextending from C5-C6 to C7-T1 with involvement of the C6 and C7 vertebral\nbodies and right longus coli muscle. No evidence of involvement of the right\nC6-C7 neural foramen or spinal canal.\n2. Enlarged right level 2 lymph node, consistent with metastases.\n3. Multilevel degenerative changes of the cervical spine, most advanced at\nC6-C7, where there is moderate spinal canal stenosis.\n4. Re-identified is a partially visualized left T4 costovertebral junction\npresumed metastatic lesion." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.There is no cord T2 signal abnormality. There is no evidence of\ninfection or neoplasm. There is no abnormal enhancement after contrast\nadministration. There is no evidence of disc space infection. There are\ndegenerative changes in the cervical spine, with disc osteophyte complexes at\nC3-C4 through C6-C7 levels.\nAt C2-C3 level, central canal and bilateral foramina are patent.\nAt C3-C4 level central canal and foramina are patent.\nAt C4-C5 level there is mild central canal narrowing. Bilateral foramina are\npatent.\nAt C5-C6 level there is small right paramedian broad-based disc protrusion\ncontributing to moderate central canal narrowing, and mild effacement of the\nventral cord. There is no cord edema. There is mild left foraminal\nnarrowing. Right foramen is patent.\nAt C6-C7 level there is mild-to-moderate central canal narrowing, with mild\neffacement of the ventral cord, without cord T2 signal abnormality. There is\nmild left foraminal narrowing. Right foramen is patent.\nAt C7-T1 level central canal, bilateral foramina are patent.\n\nTHORACIC:\nAlignment is normal. There is chronic mild T12 compression fracture. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration.There is no evidence\nof infection or neoplasm. There is no abnormal enhancement after contrast\nadministration. There is tiny right paramedian disc protrusion at T6-T7\nlevel, not causing any significant central canal narrowing. There are mild\ndegenerative changes in the lower thoracic spine,, with diffuse disc bulges,\ncausing mild central canal narrowing at T10-T11, T11-T12 levels. There is no\nsignificant foraminal narrowing in the thoracic spine.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration. There are degenerative changes in\nthe lumbar spine. L5-S1 disc space is narrowed. There is lower lumbar facet\narthritis. Small volume fluid at bilateral L4-5 facet joints. Multilevel\nmild diffuse disc bulges are seen.\nAt L1-L2, L2-L3 levels central canal, foramina are patent.\nL3-L4 level: There is mild central canal narrowing. There is minimal\nbilateral foraminal narrowing.\nL4-5 level: There is mild central canal narrowing. There is mild bilateral\nforaminal narrowing.\nL5-S1 level: There is small broad-based central shallow disc protrusion which\ncontacts the traversing right S1 nerve. There is mild central canal\nnarrowing. There is moderate bilateral foraminal narrowing, more prominent on\nthe left.\n\nOTHER: Common bile duct is mildly dilated measuring 0.8 cm, which can be seen\nwith cholecystectomy, correlate with LFTs if clinically indicated to exclude\nobstruction.", "output": "1. There is no evidence of infection. There is no cord T2 signal abnormality.\n2. There is chronic T12 mild compression fracture.\n3. There are degenerative changes. There is moderate central canal narrowing\nat C5-C6 level.\n4. There is multilevel foraminal narrowing.\n5. There is mildly dilated common bile duct, correlate for history of prior\ncholecystectomy or LFTs if clinically indicated." }, { "input": "Minimal retrolisthesis C4-C5, new since prior. Degenerative changes cervical\nspine. Disc osteophyte complex C3-C4 through C6-C7 levels. Posterior element\nhypertrophic changes. No cord T2 signal abnormality. Few benign vertebral\nbody hemangiomas.\n\nAt C2-C3 level central canal, foramina are patent.\n\nAt C3-C4 level there is mild central canal narrowing, stable. Patent\nforamina.\n\nAt C4-C5 level there is mild central canal narrowing, similar. Patent\nforamina.\n\nAt C5-C6 level there is mild central canal narrowing, similar. Patent\nforamina.\n\nAt C6-C7 level there is mild central canal narrowing, similar. \nMild-to-moderate left, mild right foraminal narrowing, more prominent.\n\nAt C7-T1 level central canal, right foramina are patent. Mild left foraminal\nnarrowing, stable.", "output": "1. Degenerative changes cervical spine, mildly worsened.\n2. Mild central canal narrowing, similar.\n3. Foraminal narrowing, as above." }, { "input": "L1, L2, L4, L5 vertebral bodies and the sacrum at S2 level demonstrates low T1\nand high inversion recovery signal indicative of infiltrative process such as\nmetastatic disease. There is mild pathologic compression and reduced height\nof L2 vertebra with minimal retropulsion without spinal stenosis. There\nappears to be subtle epidural soft tissue changes at this level indenting the\nthecal sac without spinal stenosis.\n\nFrom T11-12 to L3-4 levels disc degenerative changes identified. At L4-5\nlevel, disc and facet degenerative changes result in moderate to severe spinal\nstenosis and moderate bilateral foraminal narrowing. Posterior to the L4\nvertebral body mild show epidural soft tissue changes are identified. At\nL5-S1 level disc bulging identified without spinal stenosis.\n\nIncreased signal is identified in the right iliacus muscle as well as in the\nleft psoas muscle which could be secondary to edema. The enlargement in\nproper prominence of right iliacus muscle may be secondary to infiltrative\nprocess from a adjacent metastatic disease.\n\nThe distal spinal cord shows normal signal intensities.", "output": "Findings indicative of metastatic disease involving several lumbar vertebral\nbodies as well as sacrum with pathologic fracture involving the L2 vertebra\nwith minimal retropulsion and mild epidural soft tissue disease. Mild\nepidural disease posterior to L4 vertebra. Disc and facet degenerative\nchanges resulting in moderate-to-severe spinal stenosis at L4-5 level. If\nclinically indicated a gadolinium enhanced study can be obtained further\nassessment.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 9:10 AM, 5 minutes after discovery of the\nfindings.\n\nRECOMMENDATION Gadolinium enhanced MRI for better assessment of epidural soft\ntissue disease if clinically indicated." }, { "input": "Please note the study is moderately degraded by motion.\n\nCERVICAL:\nAlignment is normal.There is increased water signal in the C2, C4, and C6\nvertebral bodies with associated T1 hypo intense signal. No pathologic\ncompression fracture is seen. The spinal cord appears normal in caliber and\nconfiguration.There are multilevel disc protrusions at C 3- C7 with ligamentum\nflavum hypertrophy at C6-7. Limited evaluation for the degree of spinal canal\nand neural foraminal stenosis given marked motion.\n\nTHORACIC:\nAlignment is normal.There is increased water signal in the T11 vertebral body\nwith associated T1 hypo intense signal. Mild increased water signal is also\nseen in the posterior T10 vertebral body extending into the posterior elements\nwith associated T1 hypo intense signal. There is a focus of increase water\nsignal in the left transverse process of T12 with associated T1 hypo intense\nsignal. Multiple additional areas of mild increased water signal is also\nseen throughout the thoracic spine but limited in evaluation given motion\nartifact. There is limited evaluation of the spinal cord given the motion\nartifact. There is no evidence of spinal canal or neural foraminal narrowing.\n\nPartially visualized abnormal signal is also seen in the L1 vertebral body,\nbetter visualized on the dedicated MRI of the lumbar spine.\n\nThere is a T2 hyperintense lesion in the right kidney, likely representing a\nsimple cyst. The right adrenal lesion is again seen. There is a mildly T2\nhyperintense lesion in the right hepatic lobe measuring 2.1 cm. The left\nupper lobe lung mass is seen, better visualized on the prior dedicated CT\nchest from ___.", "output": "1. Metastatic disease throughout the cervical and thoracic spine, as described\nabove with no evidence of pathologic compression fracture or cord compression.\n2. Limited evaluation of the spinal cord given motion artifact.\n3. Partially visualized metastatic disease in the upper lumbar spine, better\nvisualized on the dedicated previously performed dedicated lumbar MRI.\n4. Partially visualized left upper lobe lung mass, right adrenal lesion and\nhepatic lesions, better visualized on the previously performed CT." }, { "input": "The vertebral body height, alignment, and marrow signal are normal.\n\nThere is no cerebellar tonsillar ectopia. The cervical spinal cord is normal\nin signal and morphology.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nThere is no significant spinal canal narrowing or neural foraminal narrowing\nfrom the C2-T1 levels.", "output": "1. Normal cervical spine MRI." }, { "input": "There is loss of the normal cervical lordosis with minimal anterolisthesis at\nC3 upon C4 and C4 upon C5 levels, there is no evidence of bone edema to\nindicate acute fracture. The signal intensity throughout the cervical spinal\ncord is normal with no evidence of focal or diffuse lesions.\n\nAt C2/C3 level, there is minimal central disc bulge with no evidence of neural\nforaminal narrowing or spinal canal stenosis.\n\nAt C3/C4 and C4/C5 levels, both neural foramina are patent, there is no\nevidence of spinal canal stenosis.\n\nAt C5/C6 level, there is anterior and posterior spondylosis, endplate changes\nconsistent with bone marrow replacement for fat ___ type type 2 endplate\nchanges,, there is a small Schmorl's node, previously demonstrated by CT of\nthe cervical spine, small disc protrusion and osteophytic formation,\nasymmetric towards the left, contacting the ventral aspect of the spinal cord\n(image 26, series 6), there is no evidence of significant spinal canal\nstenosis or nerve root compression.\n\nAt C6/C7 level, there is mild diffuse disc bulge, causing mild anterior thecal\nsac deformity, mild uncovertebral hypertrophy is present with no evidence of\nnerve root compression, there is no evidence of spinal canal stenosis.\n\nAt C7/T1 level, the intervertebral disc space appears maintained. The\nvisualized aspect of the thoracic spine demonstrates mild disc bulge at T3/T4\nlevel with no evidence of spinal canal stenosis. The visualized paravertebral\nstructures are unremarkable.", "output": "1. Multilevel multifactorial degenerative changes throughout the cervical\nspine, more significant at C5/C6 level. Minimal anterolisthesis is identified\nat C3/C4, and C4 upon C5 levels.\n\n2. There is no evidence of focal or diffuse lesions throughout the cervical\nspinal cord to indicate spinal cord edema or cord expansion." }, { "input": "There are stable postoperative changes related to C3 through C7 laminectomies\nand posterior fusion bilateral rods and trans pedicle screws. The vertebral\nbody height is maintained. Previously described T2 hyperintense signal within\nthe cord from C2-C3 to C5-C6 is less conspicuous on current study.\n\nThere has been interval resolution of the posterior soft tissue collections.\n\nThere is stable findings of ossification of the posterior longitudinal\nligament (OPLL).\n\nAt C2-C3, there is mild thecal sac narrowing that has improved from prior\nstudy due to the resolution of the posterior collection. There are\nuncovertebral and facet osteophytes resulting in severe bilateral neural\nforaminal narrowing.\n\nAt C3-C4, there is mild thecal sac narrowing that has improved from prior\nstudy due to the resolution of the posterior collection. There are\nuncovertebral and facet osteophytes resulting in mild bilateral neural\nforaminal narrowing.\n\nAt C4-C5, there is prominent OPLL, facet and uncovertebral osteophytes\nresulting in stable moderate thecal sac narrowing. There is also moderate\nbilateral neural foraminal narrowing.\n\nAt C5-C6, there is unchanged prominent OPLL, facet and uncovertebral\nosteophytes resulting in moderate thecal sac narrowing. There is also mild\nbilateral neural foraminal narrowing.\n\nAt C6-C7, there is unchanged prominent OPLL, disc bulge, facet arthropathy and\nuncovertebral osteophytes resulting in moderate thecal sac narrowing and mild\nbilateral neural foraminal narrowing.\n\nAt C7-T1, there is unchanged prominent OPLL, uncovertebral and facet\nosteophytes resulting in mild spinal canal narrowing, and moderate bilateral\nneural foraminal narrowing.", "output": "Interval resolution of the posterior soft tissue collection resulting in\nimproved mild thecal sac narrowing from C2-C3 to C3-C4. Also the cord signal\nabnormality from C2-C3 to C5-C6 is less conspicuous on current study. \nMyelomalacia C3-4 level with spinal cord atrophy C3-4 to C5-6.\n\nCervical spondylosis at other levels is unchanged." }, { "input": "There is unchanged levoconvex curvature of the lumbar spine with apex at L3. \nApproximately 4-5 mm retrolisthesis of L5 on S1 is also unchanged. Otherwise,\nthe remainder of the lumbar alignment is anatomic. Vertebral body heights are\npreserved. ___ type 1 L1-L2 and L2-L3 endplate changes are noted, without\nsuspicious marrow lesion. Degenerative loss of disc height and signal is\nsevere spanning L2-L3 through L4-L5, moderate at L1-L2 and mild to moderate at\nL5-S1. The conus medullaris terminates at the L1 level, within expected\nlimits. There is no signal abnormality of the terminal cord.\n\nOn sagittal images, there are small disc bulges spanning T10-T11 and T11-T12\nwhich results in mild spinal canal narrowing and mild to moderate bilateral\nneural foraminal narrowing.\n\nT12-L1: A small disc bulge with thickening of ligamentum flavum results in\nmild spinal canal narrowing. There is no significant neural foraminal\nnarrowing.\n\nL1-L2: A disc bulge with thickening ligamentum flavum results in mild to\nmoderate spinal canal narrowing in combination with facet arthropathy in\nscoliotic changes, there is moderate left-greater-than-right neural foraminal\nnarrowing.\n\nL2-L3: A disc bulge with thickening ligamentum flavum results in mild spinal\ncanal narrowing. In combination with facet arthropathy and scoliosis, there\nis moderate right and no significant left neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In conjunction with facet arthropathy and scoliosis,\nthere is mild to moderate right and mild left neural foraminal narrowing.\n\nL4-L5: A left eccentric disc bulge severely crowds the left subarticular zone,\nposteriorly displacing the traversing L5 nerve root (series 5, image 31). \nThere is moderate spinal canal narrowing. In conjunction with facet\narthropathy and scoliosis, there is severe right greater than left neural\nforaminal narrowing. The disc appears to flatten the undersurface of the\nexiting right L4 nerve root and contacts and posteriorly displaces the\nextraforaminal left L4 nerve root.\n\nL5-S1: A disc bulge with thickening of the ligamentum flavum results in\nmoderate to severe spinal canal narrowing, overall similar to prior\nexamination with severe crowding of the bilateral subarticular zones, overall\nsimilar to prior examination. In combination with facet arthropathy, there is\nmild right and severe left neural foraminal narrowing.\n\nThere are T2 hyperintense cystic lesions in the left kidney, incompletely\ncharacterized measuring up to 2.7 cm in greatest dimension, statistically\nlikely simple cysts. There is subcutaneous dependent edema. The remainder of\nthe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel since lumbar spondylosis, most prominent at L4-L5 and L5-S1.\n2. At L4-L5, a left eccentric disc bulge severely crowds the left subarticular\nzone posteriorly displacing the traversing L5 nerve root and results in\nmoderate spinal canal narrowing. There is severe right greater than left\nneural foraminal narrowing, which flattens the undersurface of the exiting\nright L4 nerve root and the disc contacts the extraforaminal left L4 exiting\nnerve root.\n3. At L5-S1, there is moderate to severe spinal canal narrowing with severe\ncrowding of the bilateral subarticular zones. There is severe left neural\nforaminal narrowing.\n4. Overall the degenerative changes appear similar to examination of ___.\n5. Additional findings as described above." }, { "input": "The visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.\n\nThe cervical spinal cord itself is normal in morphology and signal intensity,\nwithout abnormal areas of enhancement. Some heterogeneity of the cord signal\nappears artifactual.\n\nThe cervical spine alignment is maintained. Vertebral body heights and disc\nspaces are preserved. The bone marrow signal is normal.\n\nMild, multilevel degenerative changes are noted within the cervical spine,\nincluding minimal central posterior disc protrusions at C3-C4, C4-C5, and\nC5-C6 which indent the thecal sac but do not contact the spinal cord. There\nis no appreciable spinal canal stenosis. Mild right-sided neural foraminal\nnarrowing is noted at C5-C6 secondary to facet and uncovertebral joint\nhypertrophy.", "output": "1. No evidence for discrete areas of abnormal signal or contrast enhancement\nwithin the cervical spinal cord.\n2. Mild multilevel cervical spondylosis, as detailed above." }, { "input": "The localizer sequence, series 8, demonstrates 12 rib-bearing and 5 non\nrib-bearing vertebrae. L5 is partially sacralized as seen on prior CTs. The\nlocalizer sequence also again demonstrates a dextroconvex curvature in the\nthoracic spine and a levoconvex curvature in the lumbar spine.\n\nTHORACIC SPINE:\nSTIR images are technically limited with limited fat suppression.\n\nT8 vertebral body demonstrates moderate loss of height and mild, approximately\n2 minutes posterior inferior corner retropulsion, as seen on the recent CTs. \nNo evidence for bone marrow edema. T1 and T2 hypointensity is seen along the\nposterior aspect of the inferior endplate, corresponding to mild sclerosis on\nCT. Mild associated spinal canal narrowing without mass effect on the spinal\ncord. Bilateral T8-T9 neural foramina are foreshortened and substantially\nnarrowed. No evidence for an epidural or paraspinal mass.\n\nT10 vertebral body demonstrates severe loss of height and mild to moderate\ndiffuse posterior cortex bulging into the spinal canal, with the greatest, 4\nmm degree of retropulsion of the superior corner. There is mild associated\nspinal canal narrowing. Morphology is unchanged compared to the recent CTs,\nwhich demonstrated visible fracture line parallel to the superior endplate\nextending into the left pedicle. The present MRI demonstrates marrow edema in\nthe T10 vertebral body extending into the left pedicle. There is also marrow\nedema and a minimally displaced fracture of the tip of the T10 spinous process\non image 10:12, which is suboptimally visualized on the prior abdominal CTs as\nthey are not technically optimized for evaluation of the spine. No evidence\nfor an epidural or paraspinal mass.\n\nThe retropulsed T10 vertebral body approaches the ventral spinal cord, but\nplentiful CSF is preserved lateral and dorsal to the cord. At T10-T11, disc\nbulge, facet arthropathy, and infolding of the ligamentum flavum cause mild\nnarrowing of the thecal sac without mass effect on the spinal cord. \nSubstantial bilateral T9-T10 and T11-T12 neural foraminal narrowing.\n\nThere is minimal anterior wedging of T11 vertebral body and mild anterior\nwedging of T12 vertebral body, similar to the recent CTs, with T1 and T2\nhyperintense ___ type 2 discogenic bone marrow changes in the anterior\nendplates, demonstrating corresponding sclerosis on CT. No marrow edema. \nKyphotic angulation, disc bulge, and facet arthropathy minimally indent the\nthecal sac at T11-T12 without mass effect on the spinal cord. Mild left\nneural foraminal narrowing.\n\nSimilarly, there are ___ type 2 discogenic marrow changes in the anterior\nendplates at T12-L1 without marrow edema.\n\nNo significant spinal canal narrowing in the upper thoracic spine above the T8\nlevel.\n\nNo evidence for thoracic spinal cord signal abnormalities. No evidence for\npathologic intrathecal contrast enhancement.\n\nAbove-described lower thoracic compression deformities cause exaggerated\nkyphotic curvature of the lower thoracic spine.\n\nLUMBAR SPINE:\nThe lumbar spine is not fully included on the sagittal images, which extend\nfrom the midline of the lumbar spine to the right only. The lumbar spine is\nfully included on axial images.\n\nL1 vertebral body demonstrates mild-to-moderate loss of height with a large\ninferior endplate deformity presumably secondary to or Schmorl's node and a\nsmall superior endplate Schmorl's node, as seen on recent CTs. No evidence\nfor marrow edema in the right portion of L1 which is included on STIR images.\n\nL2 vertebral body demonstrates severe loss of height minimal superior\nposterior corner retropulsion, minimally indenting the ventral thecal sac\nwithout mass effect on the intrathecal nerve roots. There is T1 and T2\nhyperintense, fatty signal along the L2 inferior endplate without evidence for\nmarrow edema in the right portion of L2 vertebral body which is included on\nSTIR images.\n\nL4 vertebral body demonstrates moderate to severe loss of height with large\nsuperior endplate deformity. There is minimal, if any, edema along a small\nportion of the superior endplate. No fracture line is seen on the recent CTs.\n\nNo evidence for an epidural or intrathecal mass on the axial images which\nfully included the lumbar spine, nor on the sagittal images. The conus\nmedullaris appears unremarkable, terminating at L1.\n\nL1-L2: Disc bulge, endplate osteophytes, and minimal facet arthropathy. No\nsignificant spinal canal narrowing or significant neural foraminal narrowing.\n\nL2-L3: Mild disc bulge and mild-to-moderate facet arthropathy. No mass effect\non the intrathecal nerve roots. Contact of left greater than right traversing\nL3 nerve roots in the subarticular zones. Mild right neural foraminal\nnarrowing. Left neural foraminal narrowing appears mild-to-moderate on axial\nimages but is not fully assessed in the absence of sagittal images through the\nleft side.\n\nL3-L4: Disc bulge and moderate facet arthropathy, as well as infolding of the\nligamentum flavum. Moderate narrowing of the thecal sac with mild crowding of\nthe intrathecal nerve roots. Abutment of bilateral traversing L4 nerve roots\nin the subarticular zones. Mild-to-moderate right neural foraminal narrowing\nwith contact of the exiting right L3 nerve root. Left neural foraminal\nnarrowing appears either mild-to-moderate to moderate on axial images with\ncontact of the exiting left L3 nerve root; evaluation is incomplete in the\nabsence of sagittal images through the left side.\n\nL4-L5: Mild disc bulge and moderate facet arthropathy. No mass effect on the\nintrathecal nerve roots. Contact of left greater than right traversing L5\nnerve roots in the subarticular zones without evidence for impingement. Mild\nright neural foraminal narrowing. Left neural foraminal narrowing appears at\nleast mild-to-moderate on axial images but is not fully assessed in the\nabsence of sagittal images through the left side.\n\nL5-S1: Moderate to severe facet arthropathy. No spinal canal narrowing. Mild\nright neural foraminal narrowing. Left neural foraminal narrowing appears\nmild on axial images but is not fully assessed in the absence of sagittal\nimages through the left side.\n\nThere are degenerative changes of the partially imaged sacroiliac joints.\n\nOTHER:\nThere is a subcentimeter cystic lesion in the anterior mid right kidney on\nimage 20:11, as seen on prior CTs. Splenorenal varices are again partially\nimaged. Right intraperitoneal free fluid is again noted. Cirrhotic liver is\nbetter demonstrated on the prior abdominal CTs.", "output": "1. The lumbar spine is not fully included on the sagittal images, which only\ninclude its right side. However, the lumbar spine is fully included on the\naxial images.\n2. Recent T10 fracture including the vertebral body, left pedicle, and tip of\nthe spinous process, with marrow edema and mild-to-moderate retropulsion. \nMild associated spinal canal narrowing without spinal cord compression. \nSubstantial narrowing of T9-T10 and T10-T11 bilateral neural foramina.\n3. Compression deformities of T8, and T11 through L2 vertebral bodies appear\nchronic, allowing for incomplete inclusion of the lumbar spine on sagittal\nSTIR images. Compression deformity of L4 vertebral body is late subacute to\nchronic with minimal marrow edema along the small portion of the superior\nendplate.\n4. Mild T8 posterior inferior corner retropulsion, indenting the thecal sac\nwithout spinal cord compression. Substantial bilateral T8-T9 neural foraminal\nnarrowing.\n5. Minimal L2 superior posterior corner retropulsion without mass effect on\nthe intrathecal nerve roots.\n6. No evidence for epidural, intrathecal, or paraspinal mass to clearly\nindicate metastatic disease.\n7. Multilevel lumbar degenerative disease, causing moderate spinal canal\nstenosis at L3-L4 with mild intrathecal nerve root crowding, as well as mass\neffect on multiple traversing and exiting nerve roots in the subarticular\nzones or neural foramina, as detailed above.\n8. Splenorenal varices and right intraperitoneal fluid are again noted. \nCirrhotic liver is better demonstrated on the recent abdominal CTs.\n\nRECOMMENDATION(S): If there is a continued clinical concern for pathologic\netiology of the recent T10 fracture, consider follow-up MRI of the thoracic\nspine with and without contrast in 3 months for better assessment of bone\nmarrow signal at T10." }, { "input": "There is minimal 2 mm anterolisthesis of C2 on C3. There is minimal to 3 mm\nretrolisthesis of C3 on C4. Alignment is otherwise unremarkable. Vertebral\nbody heights are maintained. There is diffuse disc desiccation throughout the\ncervical spine. There is T1 hyperintense, T2 hyperintense degenerative change\nin the C3 and C4 vertebral body endplates, consistent with ___ changes. \nThere is no suspicious marrow signal. The visualized posterior fossa is\nunremarkable. There is no cord signal abnormality.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\nC3-C4: There is a right central disc protrusion with intervertebral\nosteophytes which results in a mild spinal canal narrowing, minimally\nremodeling the right ventral aspect of the cord. Uncovertebral and facet\narthropathy results in mild to moderate right and no significant left neural\nforaminal narrowing.\nC4-C5: Intervertebral osteophytes with possible ossification of the posterior\nlongitudinal ligament results in mild spinal canal narrowing, contacting and\nminimally remodeling the ventral aspect of the cord. Uncovertebral and facet\narthropathy results in moderate bilateral neural foraminal narrowing.\nC5-C6: A disc protrusion and intervertebral osteophytes results in moderate\nspinal canal narrowing, remodeling the ventral aspect of the cord without\nunderlying cord signal change. Uncovertebral and facet arthropathy results in\nsevere right and mild left neural foraminal narrowing.\nC6-C7: Small central protrusion does not significantly narrow the spinal\ncanal. On goal vertebral and facet arthropathy results in moderate right and\nmild left neural foraminal narrowing.\nC7-T1: No significant spinal canal or neural foraminal narrowing. \nIncidentally noted 0.4 cm left perineural cyst (___).\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable. Fatty\nsignal in the left parotid tail is unchanged from prior examination", "output": "1. Multilevel degenerative changes most prominent at C5-C6 where there is\nmoderate spinal canal narrowing remodeling the ventral aspect of the cord\nwithout underlying cord signal change. There is severe right neural foraminal\nnarrowing at this level.\n2. Additional degenerative changes as described above." }, { "input": "There is 5 mm of retrolisthesis at L2 on L3 and approximately 3 mm of\nretrolisthesis at L3 on L4. Mild height loss is present at the inferior\nendplate of the L2 vertebral body. There is hypointensity/indistinctness on\nT1 weighted imaging involving the anterior inferior L2 vertebral body endplate\nand anterosuperior L3 endplate. High T2/STIR signal involves the inferior\nendplate at L2 and superior endplate at L3.\n\nThe visualized spinal cord is normal in signal and caliber. There is crowding\nof the cauda equina nerve roots at L2-L3 secondary to moderate to severe\nspinal canal stenosis at this level.\n\nT12-L1: Patent canal and neural foramina.\n\nL1-L2: Diffuse disc bulging and ligamentum flavum hypertrophy results in mild\nspinal canal stenosis and mild right neural foraminal narrowing.\n\nL2-L3: A 5 mm retrolisthesis, diffuse disc bulging and ligamentum flavum\nredundancy results in moderate to severe spinal canal stenosis and crowding of\nthe nerve roots within the thecal sac (image 23, series 12), moderate right\nand moderate to severe left neural foraminal narrowing. Note is made of\nprevertebral soft tissue prominence at this level.\n\nL3-L4: Diffuse disc bulging and ligamentum flavum hypertrophy result in\nmoderate spinal canal stenosis, moderate right and severe left neural\nforaminal narrowing.\n\nL4-L5: Diffuse disc bulging and ligamentum flavum hypertrophy result in\nmoderate spinal canal stenosis, moderate right and severe left neural\nforaminal narrowing.\n\nL5-L6: A small diffuse disc bulge results in mild right and moderate to severe\nleft neural foraminal narrowing.\n\nOther:\nThere is a 5 mm partially exophytic left renal cyst (image 9, series 12).", "output": "1. Mild height loss at the inferior endplate of L2 in association with high\nT2/STIR signal and hypointensity/indistinctness of the anteroinferior endplate\nraises concern for acute compression fracture. Although, these findings may\nalso be explained by ___ type 1 degenerative endplate changes. Consider\nfurther evaluation with a CT lumbar spine study for better assessment of\nosseous detail.\n2. Similar signal characteristics without vertebral body height loss are\npresent at the superior endplate of L3, which may also indicate acute fracture\npathology.\n3. Spondylotic changes of the lumbar spine most prominent at L2/L3 level,\nwhere moderate to severe spinal canal stenosis results in focal crowding of\nthe cauda equina nerve roots.\n\nRECOMMENDATION(S): Critical findings were discussed with Dr. ___ by\nDr. ___ via telephone at 17:00 hours on ___, 20 minutes\nafter discovery of findings." }, { "input": "MR thoracic spine: The alignment is normal. The bone marrow is diffusely\nheterogeneous demonstrating multiple areas of T1 hypointensity. The T5 and T9\nvertebral bodies specifically demonstrate mild increased STIR signal\nabnormality as well as mild enhancement concerning for disease involvement of\nseen on the prior PET-CT. No definite discrete lesion is identified within\nthe bone marrow. No cord signal abnormalities are seen. There is no\nenhancement within the spinal cord. Diffuse loss of the normal T2 signal is\nseen throughout the discs of the thoracic spine. Diffuse areas of mild disc\nbulge is seen however no significant spinal canal or neural foraminal\nnarrowing is seen throughout the thoracic spine.\n\nMRI lumbar spine: Grade 1 retrolisthesis of L 2 on L3 is overall unchanged\ncompared to the prior exam. Grade 1 retrolisthesis of L3 on L4 is also\nunchanged compared to the prior exam. The bone marrow demonstrates diffuse\nheterogeneity with predominant T1 hypointensity throughout the lumbar spine,\nprogressed compared to the prior exam. No definite discrete bone marrow\nlesions are seen. The cord terminates at L1. No terminal cord signal\nabnormalities are seen. Diffuse loss of the normal T2 signal seen throughout\nthe intervertebral discs of the lumbar spine.\n\nT12-L1: There is no spinal canal or neural foraminal narrowing.\n\nL1-L2: Mild disc bulge, facet joint osteophytes and ligamentum flavum\nthickening is seen resulting in mild spinal canal narrowing.\n\nL2-L3: Disc bulge, facet joint osteophytes and ligamentum flavum thickening is\nseen resulting in moderate to severe spinal canal stenosis as well as crowding\nof the nerve roots overall progressed compared to the prior exam. Facet joint\nosteophytes contribute to moderate bilateral neural foraminal narrowing.\n\nL3-L4: Disc bulge, facet joint osteophytes and ligamentum flavum thickening is\nseen resulting in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to severe left and moderate to severe right neural foraminal\nnarrowing, slightly progressed compared to the prior exam.\n\nL4-L5: Disc bulge, facet joint osteophytes and ligamentum flavum thickening is\nseen resulting in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to moderate left and mild right neural foraminal narrowing, not\nsignificantly changed compared to the prior exam.\n\nL5-S1: There is no spinal canal narrowing. Facet joint osteophytes contribute\nto moderate left and mild right neural foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "Please note that the study is moderately degraded by motion artifact. However\nin the context of these limitations:\n\n-Overall, heterogeneous appearance of the bone marrow throughout the\nthoracolumbar spine as well as slight increased STIR signal abnormality and\nenhancement involving the T5 and T9 vertebral bodies corresponding to the\nareas of FDG avidity on the prior PET-CT from ___, raises concern\nfor myeloma thus involvement of the bone marrow.\n-Slight interval progression of moderate to severe degenerative changes, most\npronounced at L2-L3 with moderate to severe spinal canal stenosis as well as\nmoderate bilateral neural foraminal narrowing.\n-No cord signal abnormalities are identified." }, { "input": "Limited evaluation of the cervical spine reveal cervical spondylosis is seen\nwith disc bulges and bilateral facet uncovertebral arthropathy at C4-5 and\nC5-6 is causing moderate to severe central canal narrowing\n\nTHORACIC:\nAlignment is normal. There is subtle T1 hypointense signal involving T5 and\nT9, as stable. The spinal cord appears normal in caliber and configuration. \nSmall disc bulges are seen at T4-5, T5-6, T6-7, T7-8, T10-11 and T11-12\nwithout spinal canal or foraminal narrowing.\n\nLUMBAR:\nThere is mild retrolisthesis of L2-L3 and L3-L4. Mildly heterogeneous bone\nmarrow signal is seen without a discrete lesion, stable. The spinal cord\nappears normal in caliber and configuration. There is multilevel loss of disc\nheight and disc desiccation. Disc bulges, thickening the ligamentum flavum\nand bilateral facet arthropathies are seen at L1-2, L2-3, L3-4, L4-5 and\nL5-S1. Multilevel diffuse disc bulges. Posterior element hypertrophic\nchanges.\n\n T12-L1: No spinal canal or foraminal narrowing.\n\nL1-L2: Mild spinal canal narrowing without foraminal narrowing.\n\nL2-L3: Moderate spinal canal narrowing with moderate right and mild left\nforaminal narrowing. No change.\n\nL3-L4: Mild spinal canal narrowing with moderate bilateral foraminal\nnarrowing. No change.\n\nL4-L5: Mild spinal canal narrowing, mild mass effect on traversing both L5\nnerves by diffuse disc bulge, facet arthropathy. Moderate bilateral foraminal\nnarrowing. No change.\n\nL5-S1: No spinal canal narrowing with mild right and mild-to-moderate left\nforaminal narrowing.", "output": "-Moderate to severe central canal narrowing C4-C5, C5-C6, partially seen.\n-Unchanged degenerative changes thoracic, lumbar spine.\n-Moderate central canal narrowing L2-L3 level.\n-Multilevel foraminal narrowing lumbar spine, as above.\n-Stable marrow appearance." }, { "input": "Sagittal IDEAL, axial T2 weighted, axial gradient echo, and axial postcontrast\nT1 weighted images are limited by motion artifact.\n\nBackground bone marrow signal appears fatty compared to the heterogenous,\npredominantly low signal on the ___ MRI. T1 and T2 hypointense lesions with\nsubtle areas of enhancement are sclerotic on the ___ chest CT, more\nconsistent with metastatic disease than multiple myeloma. There is a 10 x 10\nmm in the inferior posterior aspect of the T1 vertebral body, 14 x 10 mm\nlesion centered in the right pedicle of T1, 13 x 11 mm in the right superior\nposterior aspect of the T2 vertebral body with extension to the pedicle, and\n13 x 11 mm in the posterior aspect of the T3 vertebral body. These appear\nincreased in size compared to the PET-CT examination from ___,\nthough unchanged compared to the chest from ___. A 5 mm lesion\nwithin the spinous process of C7 barely conspicuous on the ___ PET CT\ndue to differences in technique. There is no evidence for associated soft\ntissue masses.\n\nMild compression of T4 vertebral body with mild superior endplate deformity\nare unchanged compared to the ___ CTA chest, with unchanged mild\nsclerosis along the superior endplate on the ___ CT compared to the\n___ CT.\n\nC3 through T3 vertebral bodies demonstrate normal heights.\n\nThere is no evidence for epidural or leptomeningeal mass. Spinal cord signal\nis normal.\n\nThe cerebellar tonsils are normally positioned. Concurrent brain MRI is\nreported separately.\n\nEvaluation of multilevel degenerative disease is limited by motion artifact.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, central disc protrusion and ligamentum flavum thickening produce\nmoderate spinal canal narrowing with mild flattening of the ventral cord. \nFacet and uncovertebral osteophytes produce moderate to severe right and\nmoderate left neural foraminal narrowing.\n\nAt C4-C5, disc protrusion and ligamentum flavum thickening produce moderate\nspinal canal narrowing with flattening of the ventral cord. Facet and\nuncovertebral osteophytes produce at least moderate bilateral neural foraminal\nnarrowing.\n\nAt C5-C6, disc protrusion and ligamentum flavum thickening produce moderate\nspinal canal narrowing with flattening of the ventral cord. Facet and\nuncovertebral osteophytes produce moderate to severe bilateral neural\nforaminal narrowing.\n\nAt C6-C7, disc protrusion and ligamentum flavum thickening indent the thecal\nsac but do not contact or deform the spinal cord. Facet and uncovertebral\nosteophytes produce moderate left neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal narrowing. Facet and\nuncovertebral osteophytes produce mild bilateral neural foraminal narrowing.\n\nAt T1-T2, there is no significant spinal canal narrowing. Facet and endplate\nosteophytes produce mild right and moderate to severe left neural foraminal\nnarrowing.", "output": "1. Motion limited exam.\n2. Sclerotic lesions at C7 through T3, likely metastases, appear unchanged\ncompared to the chest CT from ___, though increased in size compared\nto the whole-body PET-CT from ___. no evidence for associated soft\ntissue extension.\n3. Unchanged chronic T4 superior endplate deformity with mild loss of height.\n4. No cord signal abnormality.\n5. Multilevel cervical spondylosis, as described above, with up to moderate\nspinal canal narrowing, and advanced multilevel neural foraminal narrowing." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow signal. A L1 inferior endplate Schmorl's node is\nslightly more conspicuous when compared to examination of ___. Minimal loss\nof disc height at L4-L5 and L5-S1 is similar to prior exam. The conus\nmedullaris terminates at the L1 vertebral level, within expected limits. \nThere is no signal abnormality of the visualized cord, conus medullaris or\ncauda equina. No evidence for traumatic fracture or malalignment.\n\nT11-T12 through L1-L2: There is no significant spinal canal or neural\nforaminal narrowing.\n\nL2-L3: A bilobed disc bulge and bilateral facet arthropathy does not\nsignificantly narrow the spinal canal, but results in mild bilateral neural\nforaminal narrowing. This is slightly worsened since ___.\n\nL3-L4: A disc bulge with annular fissure and superimposed left central disc\nprotrusion (series 8, image 22) crowds the left subarticular zone and\nposteriorly displaces the traversing L4 nerve root. In conjunction with facet\narthropathy, there is moderate left neural foraminal narrowing with possible\nflattening of the exiting L3 nerve root. These findings are new since the\nprior exam. There is mild right neural foraminal narrowing.\n\nL4-L5: A disc bulge and facet arthropathy does not significantly narrow the\nspinal canal. There is mild bilateral neural foraminal narrowing.\n\nL5-S1: A central protrusion does not significantly narrow the spinal canal. \nThere is no significant neural foraminal narrowing.\n\nThere is a 6 mm left midpole T2 hyperintense cystic renal lesion,\nstatistically most likely a simple cyst. There is STIR hyperintense signal of\nthe bilateral lumbar paraspinal muscles, likely representing muscle strain.", "output": "1. At L3-L4, a disc bulge with annular fissure and superimposed left central\ndisc protrusion crowds the left subarticular zone and likely impinges upon the\ntraversing L4 nerve root. In addition, there is moderate left neural\nforaminal narrowing with possible flattening of the exiting left L3 nerve\nroot. These findings are new/worsened from the prior examination.\n2. Additional degenerative findings as described above. No evidence for\ntraumatic fracture or subluxation.\n3. There is STIR hyperintense signal of the lumbar paraspinal muscles, likely\nrepresenting muscle strain." }, { "input": "There is a Schmorl's node of the inferior endplate of T11.\n\nThe lumbar vertebral body height and alignment is maintained. There is no\nsuspicious marrow signal abnormality. Intervertebral discs are preserved in\nheight but desiccated at L4-5.\n\nT12-L1: There is no disc herniation. There is no spinal canal or neural\nforaminal stenosis.\n\nL1-L2: There is no disc herniation. There is no spinal canal or neural\nforaminal stenosis.\n\nL2-L3: There is no disc herniation. There is no spinal canal or neural\nforaminal stenosis.\n\nL3-L4: There is a minimal disc bulge. There is no spinal canal or neural\nforaminal stenosis.\n\nL4-L5: There is a minimal disc bulge and minimal facet osteophytosis. There\nis no spinal canal or neural foraminal stenosis.\n\nL5-S1: There is no disc herniation. There is no spinal canal stenosis. There\nis mild facet osteophytosis but no neural foraminal stenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1-L2 level.\n\nThe paraspinal soft tissues are normal.", "output": "Minimal disc bulges at L3-4 and L4-5 with minimal facet osteophytosis at L4-5\nand L5-S1. No spinal canal or neural foraminal stenosis." }, { "input": "Vertebral body height and alignment is preserved. There is multilevel\ndegenerative disc disease, most pronounced at L2-L3, L4-L5 and L5-S1 with mild\ndisc space height loss. Bone marrow signal intensity is within normal limits.\nBone marrow signal intensity is within normal limits.\n\nThere are short pedicles along the lumbar spine, contributing to an overall\nnarrow spinal canal.\n\nAt T12-L1, there is facet joint arthropathy and mild ligamentum flavum\nthickening as well as mild posterior epidural lipomatosis which results in\nmild spinal canal stenosis but no neural foraminal narrowing.\n\nAt L1-L2, there is facet joint arthropathy and mild ligamentum flavum\nthickening as well as posterior epidural lipomatosis which results in mild\nspinal canal stenosis but no neural foraminal narrowing.\n\nAt L2-L3, there is a central disc protrusion, facet joint arthropathy and\nmoderate ligamentum flavum thickening as well as posterior epidural\nlipomatosis which results in moderate spinal canal stenosis with crowding of\nthe cauda equina nerve roots and likely minimal residual CSF between the\nindividual nerve roots. There is also moderate right and mild left neural\nforaminal narrowing.\n\nAt L3-L4, there is facet joint arthropathy and mild ligamentum flavum\nthickening which results in mild spinal canal stenosis as well as moderate\nright and mild left neural foraminal narrowing. There is remodeling of the\nright L3 nerve root in the neuroforamen (series 2, image 104).\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy and moderate\nligamentum flavum thickening which results in moderate spinal canal stenosis\nand moderate bilateral neural foraminal narrowing. There is mild remodeling\nof the right L4 nerve root in the neuroforamen (series 2, image 5).\n\nAt L5-S1, there is a shallow disc bulge and facet joint arthropathy which\nresults in mild spinal canal stenosis and moderate bilateral neural foraminal\nnarrowing with remodeling of the bilateral L5 nerve roots in the neuroforamen\n(series 2, image 72 and 117).", "output": "1. Short pedicles of the lumbar spine which contribute to an overall narrow\nspinal canal which in combination with degenerative changes results in\nmoderate spinal canal stenosis at L2-L3 and L4-5 levels crowding of the cauda\nequina nerve roots and some residual CSF between the individual nerve roots.\n2. Multilevel moderate and mild neural foraminal narrowing as detailed above\nwith remodeling of several nerve roots in the neuroforamen." }, { "input": "Numbering is based on the lowest rib-bearing vertebral body. Alignment is\nnormal. Mild anterior wedging of the T12 vertebral body. Otherwise,\nvertebral body height is preserved. There is relatively mild degenerative\ndisc disease throughout the lumbar spine with loss of disc signal, mild loss\nof disc height, and small Schmorl's nodes. Very mild ___ type 1 endplate\nchanges at the anterosuperior aspect of the L2 vertebral body and\nposterosuperior aspect of the L3 vertebral body. The spinal cord appears\nnormal in caliber and configuration, terminating normally at the inferior\nendplate of L1. Sacroiliac joints are preserved bilaterally.\n\nAt T10-11 through L1-2, there is no spinal canal or neural foraminal\nnarrowing.\n\nAt L2-3, there is a small broad-based disc bulge with thickening of the\nligamentum flavum, which causes mild narrowing of the spinal canal without\ncontact of the cauda equina nerve roots. Disc bulging and facet hypertrophy\ncauses mild left greater than right neural foraminal narrowing.\n\nAt L3-4, there is a broad-based disc bulge with thickening of the ligamentum\nflavum, which causes mild narrowing of the spinal canal without contact of the\ncauda equina nerve roots. Disc bulging and facet hypertrophy causes mild\nbilateral neural foraminal narrowing, slightly worse on the right.\n\nAt L4-5, there is a broad-based disc bulge slightly eccentric toward the left\nwith thickening of the ligamentum flavum and facet hypertrophy, which in\ncombination causes mild narrowing of the spinal canal. There is also moderate\nnarrowing of the lateral recesses bilaterally without definite contact of the\ntraversing L5 nerve roots. Disc bulging and facet hypertrophy causes mild to\nmoderate bilateral neural foraminal narrowing, worse on the left.\n\nAt L5-S1, mild broad-based disc bulging with a central disc protrusion, but no\nspinal canal or neural foraminal narrowing.\n\nMild subcutaneous edema overlying the lumbar spine, nonspecific. Eighth\nkidneys appear atrophic bilaterally with multiple small cysts.", "output": "1. No focal osseous lesions.\n2. Mild-to-moderate degenerative changes throughout the lumbar spine without\nhigh-grade spinal canal narrowing, as described above. Mild to moderate\nneural foraminal narrowing at L2-3 on the left, L3-4 and L4-5 bilaterally.\n3. There is no evidence of high-grade spinal canal or neural foraminal\nnarrowing." }, { "input": "4 mm anterolisthesis of C2 on C3 as well as mild 2 mm retrolisthesis of C5 on\nC6 and C6 on C7 with 2 mm anterolisthesis of C7 on T1 is degenerative. \nCervical alignment is otherwise anatomic. Vertebral body heights are\npreserved. Severe loss of disc height spanning C3-C4 through C7-T1 is\nassociated with ___ type 2 endplate changes. No suspicious marrow signal. \nThe visualized posterior fossa is unremarkable. There is no cord signal\nabnormality.\n\nC2-C3: No significant spinal canal narrowing. Uncovertebral and facet\narthropathy results in moderate left and mild right neural foraminal\nnarrowing.\n\nC3-C4: A central protrusion results in mild spinal canal narrowing. \nUncovertebral and facet arthropathy results in moderate bilateral neural\nforaminal narrowing.\n\nC4-C5: Intervertebral osteophyte with central protrusion and thickening of the\nligamentum flavum results in mild to moderate spinal canal narrowing. \nUncovertebral and facet arthropathy results in moderate bilateral neural\nforaminal narrowing.\n\nC5-C6: A central protrusion with intervertebral osteophytes and thickening of\nthe ligamentum flavum results in moderate spinal canal narrowing, minimally\nremodeling the cord without underlying cord signal change. Uncovertebral and\nfacet arthropathy results in moderate to severe bilateral neural foraminal\nnarrowing.\n\nC6-C7: Central protrusion with intervertebral osteophytes and thickening of\nligamentum flavum results in mild spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in moderate to severe left and moderate right neural\nforaminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nVisualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel cervical spondylosis most prominent at C5-C6 where there is\nmoderate spinal canal narrowing. There is moderate to severe bilateral neural\nforaminal narrowing at C5-C6 and moderate to severe left neural foraminal\nnarrowing at C6-C7.\n2. No cord signal abnormality.\n3. Additional findings as described above." }, { "input": "Alignment is normal. There is hyperintensity of the anterior superior portion\nof the L3 vertebral body on the STIR images. This area appears normal on the\nother images and there is no evidence of abnormal enhancement. There are mild\nchanges of degenerative disc disease at this level with anterior osteophyte\nformation. Together, these findings suggest the vertebral body signal\nabnormalities due to degenerative disc disease.\n\nThere is loss of signal of the L4-5 intervertebral disc on the T2 weighted\nimages and mild similar loss of signal of the L3-4 disc. These findings are\nlikely due to degenerative disc disease.\n\nAxial images from T11-L4 demonstrate no significant abnormalities.\n\nAt L4-5, there is bulging of the intervertebral disc that produces minimal\nencroachment on the spinal canal. A lateral component of disc protrusion\nextends into the right neural foramen and compresses the exiting right L5\nnerve root, likely the dorsal root ganglion.\n\nThere are no significant abnormalities at L5-S1\n.\n\nThere is no abnormal enhancement after contrast administration. There are no\nfindings to suggest epidural abscess or other infection.", "output": "1. Degenerative disc disease with no evidence of infection." }, { "input": "There is transitional anatomy at the lumbosacral junction with sacralization\nof L5. The lowest well-formed intervertebral disc is designated as L5-S1.\n\nLumbar vertebral body height and alignment appear normal.\n\nThe conus medullaris terminates at the T12 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nL3-4: There is mild bilateral neural foraminal narrowing due to a disc bulge\nand facet hypertrophy. There is no spinal canal narrowing.\n\nL4-5: There is a disc bulge and a right-sided protrusion (05:13) narrowing the\nright lateral recess which could affect the right L5 nerve root. There is no\nspinal canal narrowing. There is mild to moderate bilateral neural foraminal\nnarrowing due to the disc bulge and facet hypertrophy.\n\nRudimentary disc at L5-S1 level demonstrates degenerative changes without\nspinal stenosis or foraminal narrowing.\n\nThere is no spinal canal or neural foraminal narrowing at the remaining lumbar\nlevels.\n\nThe prevertebral and paraspinal soft tissues appear normal.", "output": "1. Transitional anatomy at the lumbosacral junction.\n2. Disc bulging and right-sided protrusion at L4-5 level which could affect\nthe right L5 nerve root.\n3. No spinal stenosis seen. No compression fracture noted." }, { "input": "Cervical spine: At C7-T1 there is a 11 x 5 x 10 mm (AP x TV x CC) epidural\nlesion which is hyperintense on T2 weighted images, consistent with a synovial\ncyst (9:8). The lesion causes severe compression of the spinal cord at this\nlevel. There is increased T2 signal within the spinal cord at this region,\nconsistent with cord edema (9:9). There is also disk bulging and ligamentous\nthickening contributing to the spinal stenosis.\n\nThe vertebral body height and alignment is maintained. There is a normal\ncurvature. The bone marrow has a normal signal intensity. The intervertebral\ndisc have normal height and signal intensities.\n\nThere are multilevel degenerative changes.\n\nC2-C3: There is no significant spinal canal or neural foraminal stenosis.\n\nC3-C4: There is no significant spinal canal or neural foraminal stenosis.\n\nC4-C5: The intervertebral disc at this level is hyperintense on T1 weighted\nimages, consistent with calcification (10: 9). There is no significant spinal\ncanal or neural foraminal stenosis.\n\nC5-C6: There is left paramedian posterior disc bulging causing moderate to\nsevere left neural foraminal stenosis.\n\nC6-C7: There is posterior disc protrusion indenting the spinal cord and\ncausing bilateral severe neural foraminal stenosis.\n\nC7-T1: There is severe canal narrowing caused by the lesion with cord\ncompression and severe bilateral neural foraminal stenosis.\n\nAside from the abnormality mentioned above, the cervical and included upper\nthoracic spinal cord, and posterior fossa demonstrate normal signal intensity\nand morphology.\n\nThe posterior elements and paraspinal soft tissues are normal.\n\nThoracic Spine: There is scoliosis of the upper thoracic spine. The\nintervertebral disc have normal height and signal intensities. There is no\ndisc herniation, or spinal canal or neural foraminal stenosis. The thoracic\nspinal cord and conus medullaris have normal morphology and signal\nintensities. The posterior elements and paraspinal soft tissues are normal.\n\nLumbar spine: The vertebral body height and alignment is maintained. The bone\nmarrow has a normal signal intensity. There is multilevel degenerative disc\ndisease with loss of disc height, disc desiccation, and mixed ___ endplate\nchanges, particularly at L3-L4 and L4-L5.\n\nAt T12-L1 and L1-2, there is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: There is posterior disc bulging causing mild to moderate canal stenosis\nand mild-to-moderate bilateral neural foraminal stenosis.\n\nL3-L4: Posterior disc bulging causes moderate severe canal stenosis and\nmild-to-moderate bilateral neural foraminal stenosis.\n\nL4-L5: Posterior disc bulging causes moderate canal stenosis and mild to\nmoderate bilateral neural foraminal stenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1 level.\n\nThe posterior elements and paraspinal soft tissues are normal.", "output": "Synovial cyst at the C7-T1 causing severe spinal cord compression and spinal\ncord edema. Multilevel degenerative changes at other levels including spinal\nstenosis in the lumbar region as described above." }, { "input": "Alignment is normal. Vertebral body heights are maintained. There is no\nsuspicious marrow signal. ___ type 1 endplate changes are present at the\nL3/L4 and L4/L5 levels. The conus terminates at the mid L1 level, within\nnormal limits. No suspicious signal is seen within the visualized cord. A\nTarlov cyst is noted posterior to the S2 level.\n\nAt L2/L3, there is a diffuse disc bulge causing mild flattening of the\nanterior thecal sac and mild bilateral neural foraminal narrowing.\n\nAt L3/L4, there is a diffuse disc bulge causing moderate spinal canal stenosis\nas well as moderate bilateral neural foraminal narrowing. There is also facet\nhypertrophy at this level.\n\nAt L4/L5, there is a diffuse disc bulge, ligamentum flavum thickening, and\nfacet hypertrophy causing moderate to severe spinal canal stenosis as well as\nsevere right and moderate left neural foraminal narrowing.\n\nAt L5/S1, there is a posterior disc bulge causing moderate to severe left and\nmoderate right neural foraminal narrowing. There is no spinal canal stenosis.\n\nThe partially visualized sacroiliac joints are preserved. Given the\nlimitations of this noncontrast enhanced study, there is no evidence of\ninfection or neoplasm. Multiple T2 hyperintense lesions are noted, likely\nsimple cysts, but not fully evaluated on this noncontrast enhanced study.", "output": "Multilevel degenerative changes of the lumbar spine, most prominent at L4/L5\namd L5/S1 levels as described above. There has been no significant interval\nchange since ___." }, { "input": "From T11-12 through T12-L1 level mild disc degenerative changes are\nidentified.\n\nAt L1-2 level, signal changes are seen along the endplates with increased\nsignal on inversion recovery images within the L1-2 disc. Following\ngadolinium there is epidural enhancement and in the anterior aspect of the\nthecal sac identified at this level. In addition, there is a small less than\n5 mm area of low signal seen within the enhancing soft tissues posterior to\nthe L2 vertebra indicative of a small epidural abscess. There is mild\nindentation on the thecal sac. There is also mild paraspinal soft tissue\nphlegmon and enhancement identified without evidence of paraspinal abscess.\n\nAt L2-3 and L3-4 disc bulging is identified without spinal stenosis.\n\nAt L4-5 level could mild anterolisthesis of L4 over L5 is seen. There is no\nspinal stenosis but mild to moderate bilateral foraminal narrowing is seen.\n\nAt L5-S1 level no abnormalities are seen.\n\nThe distal spinal cord shows normal intrinsic signal.", "output": "Findings suggestive of discitis osteomyelitis at L1-2 level with epidural\nphlegmon and a small less than 5 mm size epidural abscess on the right side of\nthe spinal canal at L2 level, anterior to the thecal sac. Multilevel\ndegenerative changes.\n\nNOTIFICATION: Findings discussed with Dr. ___ on ___ at 9:45\nAM." }, { "input": "CERVICAL:\nNo tumor in the cervical spine.\n\nThere is straightening of the cervical lordosis. Vertebral body height and\nalignment is grossly preserved. Posterior element hypertrophic change. There\nis multilevel degenerative disc disease, most pronounced at C3-C4 and C5-C6\nwith severe disc space height loss. Bone marrow signal intensity is within\nnormal limits. There is no abnormal enhancement after contrast\nadministration.\n\nDisc osteophyte complex C3-C4 through C6-C7 levels, mild effacement of the\nventral cord secondary to above, well preserved CSF dorsally, overall\nmild-to-moderate central canal narrowing. No cord T2 signal abnormality.\n\nMultilevel moderate foraminal narrowing cervical spine, most prominent at\nbilateral C3-C4, bilateral C5-C6 foramina\n\nTHORACIC:\nMetastasis involving T5 vertebral body, posterior elements, with epidural\ntumor extension, severe central canal narrowing, cord compression, cord edema.\nT4-T5, T5-T6 foraminal narrowing from tumor infiltration.\n\nMetastasis involving T9 vertebral body and posterior elements, T10 vertebral\nbody and left pedicle, T12 vertebral body and bilateral pedicles. Mild T12\nvertebral body height loss.\n\nEpidural tumor at T9 level, severe central canal narrowing, cord compression,\ncord edema.\n\nModerate central canal narrowing at T12 level, epidural tumor, minimal\nflattening of cord, incomplete effacement of CSF about cord, no cord edema.\n\nT8-T9, T9-T10 foraminal narrowing from tumor infiltration.\n\nBilateral lung nodules, worrisome for metastases, chest CT recommended further\nevaluation.\n\nMultilevel degenerative changes thoracic spine, patent central canal at other\nlevels.\n\n\nLUMBAR:\nL4 vertebral body metastasis, no epidural tumor. No other osseous\nabnormalities in the lumbar spine.\n\nMultilevel degenerative changes lumbar spine, diffuse disc bulges. Minimal\nanterolisthesis L2-L3, L5-S1 levels. Multilevel disc space narrowing,\nposterior element hypertrophic changes. Probable bilateral L5 pars\ninterarticularis defect.\n\nMild central canal narrowing L2-L3 level from degenerative changes. Otherwise\npatent central canal in the lumbar spine. Mild bilateral L2-L3, moderate left\nL3-L4, moderate bilateral L4-5, severe bilateral L5-S1 foraminal narrowing.\n\n1.8 cm left adrenal nodule, new since CT scan ___, likely metastasis.\n\n\nThere is a heterogeneous, predominantly T1/T2 dark lesion in the right aspect\nof the L4 vertebral body which demonstrates heterogeneous enhancement after\ncontrast administration, consistent with an other metastatic lesion.\n\nThere is 3 mm anterolisthesis of L5 on S1. Vertebral body height and\nalignment is otherwise preserved.\n\nAt L2-L3, there is a shallow disc bulge, facet joint arthropathy and moderate\nligamentum flavum thickening which result in mild spinal canal stenosis and\nmoderate left neural foraminal narrowing but no right neural foraminal\nnarrowing.\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening which results in moderate to severe left and moderate right neural\nforaminal narrowing no spinal canal stenosis.\n\nAt L5-S1, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening which results in moderate bilateral neural foraminal narrowing but\nno spinal canal stenosis.", "output": "1. Metastases thoracic spine. Severe central canal narrowing at T5, T9\nlevels, with epidural tumor, cord compression, cord edema.\n2. Moderate central canal narrowing T12 level.\n3. L4 vertebral body metastasis.\n4. Degenerative changes throughout spine.\n5. Bilateral L5 pars interarticularis defect.\n6. Probable lung metastases, chest CT recommended.\n7. Probable left adrenal metastases.\n8. Remainder as above." }, { "input": "The patient is status post anterior fusion and C6-7. Artifact from the fusion\nhardware obscures imaging at this level. Alignment is normal. Vertebral body\nand intervertebral disc signal intensity appear normal at the other levels. \nThe spinal cord appears normal in signal intensity.\nAxial imaging from C2 through C4 demonstrates no significant abnormalities.\nAt C4-5, minimal bulging of the disc slightly narrows the spinal canal and\ncontacts the anterior surface of the spinal cord without deforming it. The\nneural foramina appear normal.\nAt C5-6, there is minimal bulging of the disc with no compromise of the spinal\ncanal.\nAt C6-7, there is a suggestion of encroachment on the spinal canal. Due to\nartifact from the fusion hardware, it is impossible to determine whether this\nis bone, soft tissue, or both. The severity of canal encroachment also cannot\nbe adequately evaluated on these images. There is a suggestion of Ning of the\nanterior surface of the spinal cord.\nAt C7-T1 there are no significant abnormalities.\n\nThere is no evidence of infection or neoplasm.", "output": "1. The study is limited due to artifact arising from fusion hardware at C6-7.\n2. Imaging suggests spinal canal narrowing and encroachment on the spinal cord\nat C6-7. However, this appearance may be due to artifact. In the presence of\nthese artifacts, it is impossible to determine whether there is significant\nnarrowing of the spinal canal.\n3. The remainder of the spine demonstrates minimal degenerative disease with\nno cord nerve root compromise." }, { "input": "CERVICAL:\nThere is minimal retrolisthesis C3 on C4, likely degenerative. Cervical spine\nalignment is otherwise normal. Vertebral body and intervertebral disc heights\nand signal intensities appear normal. The spinal cord appears normal in\ncaliber and configuration. There is no abnormal enhancement postcontrast. \nMild multilevel degenerative changes of the cervical spine are detailed as\nfollows:\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: Posterior disc bulge impresses upon the anterior thecal sac resulting\nin mild spinal canal narrowing. No significant neural foraminal narrowing.\n\nC4-C5: Mild posterior disc bulge results in mild spinal canal narrowing. No\nappreciable neural foraminal narrowing.\n\nC5-C6: Minimal posterior disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nC6-C7: Left-sided ligamentum flavum hypertrophy. No significant spinal canal\nor neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\n\nTHORACIC:\nThere is compression deformity of the T5 vertebra which demonstrates T1 and T2\nhypointense signal characteristics with mild increased STIR signal intensity. \nThis extends into the bilateral pedicles, lamina, and facets; left greater\nthan right. Associated T2 hypointense, STIR hyperintense, enhancing soft\ntissue mass is seen extending into the spinal canal, spanning the T4-T6 levels\nand measuring 2.4 x 0.8 x 1.3 cm (SI by AP by TRV; 15:9, 18:18). There is\nover 180 degrees of soft tissue contact with the spinal cord which is\ndisplaced posteriorly and compressed laterally, resulting in severe cord\ncompression. No cord signal abnormality is demonstrated.\n\nThe mass also involves the left greater than right neural foramina at T4-T5\nand T5-T6 resulting in severe foraminal narrowing. There is an enhancing 2.9\nx 0.8 cm lesion along the left prevertebral body (AP by TRV; 12:19).\n\nThe remainder of the vertebral bodies and intervertebral disc spaces of the\nthoracic spine demonstrate normal signal intensity and height. Alignment is\notherwise normal. No additional areas of severe spinal canal or neural\nforaminal narrowing in the thoracic spine.\n\nLUMBAR:\nAlignment is normal. There is a 9 mm T2 hyperintense, T1 hypointense, STIR\nhyperintensity in the T12 vertebra, may reflect a small hemangioma versus\nsmall metastasis (8:9). Vertebral body and intervertebral disc signal\nintensity otherwise appear normal. The conus medullaris terminates at the\nlevel of L1. The spinal cord appears normal in caliber and configuration.\nMild multilevel degenerative changes lumbar spine:\n\nT12-L1: Mild ligamentum flavum hypertrophy. No spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Ligamentum flavum hypertrophy. No severe spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Ligamentum flavum hypertrophy. No spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: Ligamentum flavum hypertrophy. No spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: Posterior disc protrusion and ligamentum flavum hypertrophy results in\nmild spinal canal narrowing and moderate bilateral neural foraminal narrowing.\n\nL5-S1: Mild posterior disc protrusion impresses upon the anterior thecal sac\nwithout evidence of severe spinal canal narrowing. No severe neural foraminal\nnarrowing.\n\nOTHER: Multiple enhancing liver lesions measure up to 4.1 x 3.6 cm and are\nconcerning for metastatic involvement. There is moderate bilateral\nhydroureteronephrosis. Tubular cystic areas in the pelvis are not well\nevaluated. Probable prominent 1.7 x 0.7 cm paravertebral lymph node is\ndemonstrated at the T11 level (9:10, 13:23).", "output": "1. Compression deformity of the T5 vertebra is associated with an enhancing\nsoft tissue mass extending into the spinal canal resulting in severe cord\ncompression and stenosis of the bilateral neural foramina. Findings are\nconcerning for malignancy.\n2. Additional enhancing lesion along the left paravertebral soft tissues of\nthe T5 vertebra is concerning for tumor extension.\n3. 0.9 cm STIR hyperintensity in the T12 vertebra may reflect a small\nhemangioma versus metastasis. Attention on follow-up imaging is recommended.\n4. Multiple enhancing liver lesions are incompletely characterized but are\nconcerning for metastatic disease.\n5. Moderate bilateral hydroureteronephrosis.\n6. Tubular cystic areas in the pelvis are incompletely evaluated.\n\nNOTIFICATION: The updated findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 9:46 am, 5\nminutes after discovery of the findings." }, { "input": "Status post posterior fusion of T3, T4, T6, and T7 with T5 and partial T4\nlaminectomy with tumor resection. The inter pedicular screws on the left of\nT3-T4 and T6-T7 are again seen abutting into the vertebral canal. This was\nbetter assessed on prior CT ___ performed ___. Metal hardware\nartifact slightly limits evaluation at these levels. Within these confines:\n\nAgain demonstrated is a T5 vertebral compression deformity which demonstrates\npredominantly T2 hypointense signal characteristics with near circumferential\nill-defined postcontrast enhancement (for example 10:29), concerning for\nresidual tumor. Enhancing soft tissue along the anterior epidural space\nextending from the inferior endplate of the T4 vertebra to the superior\nendplate of the T6 vertebra measuring approximately 2.7 cm in craniocaudal\ndimension (11:10), and up to 0.4 cm in AP thickness (10:30) is also concerning\nfor residual tumor. At T4-T6, there is mild posterior epidural enhancement,\nsome of which may reflect granulation tissue in the setting of recent surgery,\nhowever, additional areas on the right appear somewhat bulkier and a component\nof residual tumor is not excluded (for example 10:28). T2 hyperintense fluid\nspanning in the posterior soft tissues T3-T8 is without appreciable\npostcontrast enhancement, and is most likely compatible with postsurgical\nseroma. Foramina are difficult to assess due to metallic artifact, but there\nis again tumor involving the left T4-T5 neural foramina best seen on the\nsagittal T2 images.\n\nThe thoracic spine alignment is otherwise anatomic. The remainder of the\nvisualized vertebral body and intervertebral disc heights are relatively well\nmaintained.\n\nFlattening and remodeling of the anterior spinal cord at the level of T5 is\nnoted without appreciable cord signal abnormality. Evaluation of the neural\nforamina at T3-T7 is limited secondary to extensive hardware artifact. \nOtherwise, there is no evidence of severe spinal canal or neural foraminal\nstenosis in the remainder of the visualized thoracic spine.\n\nTrace bilateral pleural effusions, right greater than left. Multiple\nbilateral pulmonary nodules are better assessed on prior CT chest performed ___. Numerous T2 hyperintense enhancing hepatic metastases were also\nbetter assessed on prior dedicated CT abdomen pelvis examinations, most\nrecently ___. There is again left anterior prevertebral tumor at\nthe T5 level, similar to previous MRI, seen for example on image 14 of series\n4.\n\nThere is possible upper mediastinal and left supraclavicular lymphadenopathy\nwhich is now more conspicuous than on previous CT seen for example on image 15\nof series 4, image 45 of series 10, and image 40 of series 10..", "output": "1. Status post tumor resection and posterior fusion of T3-T7.\n2. Persistent T5 compression deformity with ill-defined near circumferential\nsoft tissue enhancement concerning for residual tumor.\n3. Additional soft tissue along the anterior epidural space extending from the\ninferior endplate of T4 vertebra to the superior endplate of the T6 vertebra\nmeasures up to 0.4 cm in thickness is also concerning for residual tumor. \nLeft paravertebral soft tissue again noted consistent with tumor extension\nfrom the vertebral body, and although the neural foramina are partly obscured\nby metallic artifact, there is still tumor extending into the neural foramina\nmost conspicuously into the left T4-T5 neural foramen.\n4. Mild posterior epidural enhancement spanning T4-T6 may reflect granulation\ntissue in the setting of recent surgery, however tumor involvement is not\nentirely excluded.\n5. Flattening and remodeling of the anterior spinal cord at the level of T5\nwithout appreciable cord signal abnormality.\n6. Trace bilateral pleural effusions.\n7. Pulmonary and hepatic metastases are better assessed on prior dedicated CT\nimaging, most recently performed ___.\n8. There is possible upper mediastinal and left supraclavicular\nlymphadenopathy which is now more conspicuous than on previous exams." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow lesion. Disc heights are maintained. The visualized\nposterior fossa is unremarkable. There is no evidence of abnormal signal or\nenhancement of the cord.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\nC3-C4: A central protrusion results in mild spinal canal narrowing. There is\nno significant neural foraminal narrowing.\nC4-C5: A small central protrusion results in mild spinal canal narrowing. \nThere is no significant neural foraminal narrowing.\nC5-C6 through C7-T1: No significant spinal canal or neural foraminal\nnarrowing.\n\nWhen compared to prior MRI examination ___, there is left level 4\nconglomerate lymphadenopathy measuring approximately 1.7 x 3.7 cm (AP, SI),\nsignificantly increased in size from prior examination of ___. There\nis surrounding fluid extending along the internal jugular vein (series 9,\nimage 15). These lesions are seen but poorly evaluated on most recent\nthoracic MRI of ___.\n\nThe thyroid appears grossly unremarkable.\n\nTHORACIC:\nThe patient is status post laminectomy and posterior fusion spanning T3\nthrough T7. Thoracic alignment is anatomic.\n\nRe-identified is severe pathologic compression deformity of the T5 vertebral\nbody, with soft tissue tumor extending circumferentially along the epidural\nspace measuring up to 2.7 by 0.5 cm in SI and AP dimension, increased in size\nfrom MRI of ___ and similar to potentially slightly increased in size\nto recent exam of ___. The lesion exerts mass effect on the cord\nwith remodeling, however without definitive underlying cord signal change. \nThe epidural component extends from the T4 through T6 levels. There is also\ncircumferential prevertebral soft tissue enhancement spanning T4 through T5,\nsimilar to prior examination.\n\nRe-identified is a postoperative seroma within the surgical bed, overall\nsimilar to prior exam.\n\nNo definite evidence for high-grade spinal canal narrowing. The soft tissue\nmass likely results in some degree of neural foraminal narrowing at the T4-T5\nand T5-T6 levels, similar to prior exam.\n\nPresumed T12 vertebral body hemangioma is unchanged from prior exam\n\nUpper mediastinal lymphadenopathy is identified, increased since examination\nof ___.\n\nLUMBAR:\nLumbar alignment is anatomic. Vertebral body heights are preserved.\n\nThere are subtle new STIR hyperintense rounded 2-3 mm lesions of the L3\nvertebral body, not seen on prior examination, in this clinical context\nsuspicious for additional metastatic lesions (series 11, image 10 and 15). \nThere is a new 1.4 cm left L5 vertebral body T1 hypointense lesion not seen on\nprior exam, highly concerning for new metastatic lesion (series 11, image 13).\nThere are new osseous lesions in the sacrum and definitely in bilateral left\nworse than right iliac al a measuring up to 1.1 cm (e.g series 22, image 42).\n\nDegenerative loss of disc height is mild to moderate at L4-L5 and L5-S1,\nunchanged from prior exam.\n\nThere is no evidence of abnormal signal or enhancement of the terminal cord,\nconus medullaris or cauda equina.\n\nThere is no significant spinal canal or neural foraminal narrowing spanning\nT12-L1 through L3-L4. Small disc bulges at L4-L5 and L5-S1 do not\nsignificantly narrow the spinal canal. There is no neural foraminal\nnarrowing.\n\nDiffuse paraspinal muscle edema pattern is identified, nonspecific.\n\nOTHER: Diffuse pulmonary and hepatic metastatic disease is re-identified. \nThere also small right greater than left bilateral pleural effusions. \nHeterogeneous 13.5 by 9.5 cm (TRV, SI) pelvic mass (known ovarian carcinoma)\nresulting obstructive hydroureteronephrosis. Diffuse periaortic\nlymphadenopathy and ascites is noted.", "output": "1. Findings highly suspicious for new metastatic lesions in the L3 and L5\nvertebral bodies measuring up to 1.4 cm. There also suspected new metastatic\nlesions in the sacrum and definite new metastatic lesions in the bilateral\niliac alum measuring up to 1.1 cm. No evidence of cortical breakthrough from\nthese lesions into the spinal canal or neural foramina.\n2. Known T5 pathologic compression fracture with associated metastatic lesion\nwith soft tissue extension into epidural space measuring up to 5 mm in\nthickness spanning the T4 through T6 vertebral levels is slightly increased in\nsize to similar to most recent MRI T-spine of ___. This lesion\nremodels the cord without definitive underlying cord signal change. There is\nlikely soft tissue extension into the bilateral T4-T5 and T5 neural foramina.\n3. Allowing for impression 2, there is no other regions of high-grade spinal\ncanal or neural foraminal narrowing.\n4. No new metastatic lesions involving the cervical, thoracic and lumbar\nspinal canal.\n5. Diffuse paraspinal muscle edema of the lumbar spine, nonspecific. This\ncould represent and edema, myositis or strain.\n6. Additional findings as described above." }, { "input": "CERVICAL:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heightsare preserved. Diffusely reduced T2 signal within\nthe intervertebral discs likely on a degenerative basis.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is no vertebral canal or neural foraminal narrowing.\n\nAt C4-5 there is disc bulging and uncovertebral osteophytes resulting in mild\nspinal canal narrowing and severe bilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulging and uncovertebral osteophytes resulting in mild\nspinal canal narrowing and severe bilateral neural foraminal narrowing.\n\nAt C6-7 there is disc bulging and uncovertebral osteophytes resulting in mild\nspinal canal narrowing and moderate to severe right neural foraminal\nnarrowing.\n\nAt C7-T1 there is slight uncovering of the disc without vertebral canal or\nneural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.There is no evidence of infection or neoplasm allowing for lack\nof intravenous contrast.\n\nAt T5-T6 there is a small central disc protrusion causing mild ventral\nindentation of the cord without evidence of abnormal cord signal.\n\nAt T6-T7 a small left central disc protrusion causes mild\nflattening/remodeling of the left anterolateral aspect of the cord without\nevidence of abnormal cord signal.\n\nAt T8-T9 there is a central disc protrusion resulting in ventral indentation\nof the cord without evidence of abnormal cord signal.\n\nAt T9-T10 a left central disc protrusion causes mild left anterolateral cord\nflattening without evidence of abnormal cord signal.\n\nThe remaining levels of the thoracic spine are without significant spinal\ncanal or neural foraminal narrowing.\n\nLUMBAR:\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is a mild grade 1 anterolisthesis at L4 on L5. Vertebral body heights\nare preserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of T12-L1.\n\nIntervertebral disc heightsare preserved. Diffusely reduced T2 signal within\nthe intervertebral discs is likely on a degenerative basis.\n\nWithin the limits of this noncontrast study there is no definite paravertebral\nor paraspinal mass identified and there is no evidence of infection or\nneoplasm.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is disc bulging, ligamentum flavum thickening and facet\nosteophytes with mild spinal canal narrowing and moderate bilateral neural\nforaminal narrowing. There are small bilateral facet joint effusions.\n\nAt L2-3 there is disc bulging, ligamentum flavum thickening and facet\nosteophytes resulting in mild spinal canal narrowing, mild left and moderate\nright neural foraminal narrowing.\n\nAt L3-4 there is disc bulging, ligamentum flavum thickening and facet\nosteophytes with severe spinal canal stenosis and crowding of the cauda equina\nnerve roots. There is mild bilateral neural foraminal narrowing. There are\nsmall bilateral facet joint effusions.\n\nAt L4-5 there symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes resulting in moderate to severe spinal canal narrowing with\ncrowding of the cauda equina nerve roots. There is mild bilateral neural\nforaminal narrowing. There are small bilateral facet joint effusions.\n\nAt L5-S1 there is disc bulging and facet osteophytes resulting in mild\nbilateral neural foraminal narrowing. There are small bilateral facet joint\neffusions.\n\nOTHER: Subcutaneous edematous change of the lower back likely represent\ngravity dependent changes. There is a 1.1 cm T2 hyperintense lesion within\nthe right kidney compatible with a cyst.", "output": "1. Degenerative changes of the lumbar spine most significant at L3-L4 and\nL4-L5 where there is severe and moderate to severe (respectively) spinal canal\nstenosis resulting in crowding/compression of the cauda equina nerve roots.\n2. Degenerative changes of the thoracic spine resulting in multilevel mild\ncord indentation/flattening without evidence of abnormal cord signal as\ndetailed above.\n3. Degenerative changes of the cervical spine most significant at C4-C5 and\nC5-C6 where there is severe bilateral neural foraminal narrowing.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:10 am, 10 minutes after discovery\nof the findings." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nGrade 1 retrolisthesis of L1 on 2 and L2 on 3 is noted. Grade 1\nanterolisthesis of L4 on 5 is noted. Vertebral body heights are preserved.\nSchmorl's nodes are noted in the endplates of the L1-2, L2-3, L3-4, L4-5, and\nL5-S1 endplates. The visualized portion of the spinal cord is preserved in\nsignal and caliber.\n\nThere is loss of intervertebral disc height and signal at all levels of the\nlumbar spine.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is disc bulge, ligamentum flavum hypertrophy and facet joint\narthropathy withno vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is disc bulge, ligamentum flavum hypertrophy and facet joint\narthropathy withno vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is disc bulge which contacts bilateral L3 nerve roots within\nleft in right subarticular zones, ligamentum flavum hypertrophy and facet\njoint arthropathy withno vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is disc bulge with unroofing of intervertebral disc, ligamentum\nflavum hypertrophy and facet joint arthropathy resulting in moderate to severe\nvertebral canal and moderate bilateral neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge which contacts bilateral S1 nerve roots within\nthe left thyroid subarticular zones and facet arthropathy resulting in severe\nbilateral neural foraminal stenosis with no vertebral canal stenosis.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel degenerative changes as described, most pronounced at L4-5\nlevel, where there is moderate to severe vertebral canal and moderate\nbilateral neural foraminal stenosis.\n3. L5-S1 disc bulge contacts bilateral S1 nerve roots within the subarticular\nzones, and there is severe bilateral neural foraminal stenosis.\n4. L3-4 disc bulge contacts bilateral L3 nerve roots within the subarticular\nzones." }, { "input": "Some sequences are limited by motion artifact.\n\nThe localizer sequence, series 4, demonstrates 7 cervical, 12 rib-bearing, and\n5 lumbar-type vertebrae. Levoconvex curvature is noted in the region of the\nthoracolumbar junction.\n\nCERVICAL:\nThere is posterior instrumented fusion from C3 through C6. MRI does not\nassess the hardware and does not clearly demonstrate whether there is any bone\ngraft in the posterior elements. Alignment there is no significant\nspondylolisthesis. Vertebral body heights are preserved. Where not obscured\nby hardware related artifact, there is no evidence for bone marrow edema to\nsuggest osteomyelitis. There is no evidence for diskitis, epidural\ncollection, or paravertebral collection. There is mild edema/fluid in the\nposterior subcutaneous fat of the lower cervical spine, a nonspecific finding\nwhich is frequently related to body habitus, but could also be related to\npostsurgical change in this patient.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa\nand lower cerebrum appear unremarkable. No evidence for cervical spinal cord\nsignal abnormalities allowing for motion artifact.\n\nEvaluation of multilevel degenerative disease is limited by motion artifact,\nas well as by hardware related artifacts at the surgical levels.\n\nC2-C3: No spinal canal narrowing. Mild left neural foraminal narrowing by\nfacet osteophytes.\n\nC3-C4: Broad-based central disc protrusion versus endplate osteophytes without\nsignificant spinal canal narrowing. Severe bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Narrow based central disc extrusion extending below the disc space\nmildly indents the ventral thecal sac but does not contact the spinal cord. \nSevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC5-C6: Central disc extrusion extending slightly above and below the disc\nspace indents the ventral thecal sac but does not contact the spinal cord. \nModerate bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC6-C7: Central/right paracentral disc protrusion moderately narrows the spinal\ncanal and abuts the ventral spinal cord. Severe left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC7-T1: Small central disc protrusion. No significant spinal canal or neural\nforaminal narrowing.\n\nTHORACIC:\nThere is no evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection. Vertebral body heights are within normal limits. \nAlignment is normal. At T8-T9, small central disc protrusion mildly indents\nthe ventral spinal cord, but the cord remains surrounded by plentiful CSF\nlaterally and dorsally, and there is no significant spinal canal stenosis. \nSmall disc protrusions are present at multiple other thoracic levels without\nspinal cord contact or spinal canal stenosis. The thoracic spinal cord\ndemonstrates normal signal intensity.\n\nLUMBAR:\nThere is no evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection. Small amount of fluid/edema in the midline\nposterior subcutaneous fat at L2 and L3 is a finding commonly related to body\nhabitus. Vertebral body heights are preserved. There is grade 1\nanterolisthesis of L4 on L5. The conus medullaris demonstrates normal\nmorphology and signal intensity, terminating at L1.\n\nT12-L1: Mild disc bulge and mild left facet arthropathy. No spinal canal or\nneural foraminal narrowing.\n\nL1-L2: Mild disc bulge, tiny right paracentral disc protrusion, and minimal\nfacet arthropathy. No spinal canal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge and mild bilateral facet arthropathy. No spinal canal\nnarrowing. Small right foraminal disc protrusion without significant neural\nforaminal narrowing.\n\nL3-L4: Disc bulge and a right paracentral disc protrusion, as well as moderate\nfacet arthropathy, mildly indent the ventral thecal sac without mass effect on\nthe intrathecal nerve roots. The disc protrusion contacts the traversing\nright L4 nerve root in the subarticular zone. There is also mild bilateral\nneural foraminal narrowing without evidence for the exiting L3 nerve root\nimpingement.\n\nL4-L5: Grade 1 anterolisthesis with an uncovered and bulging disc, and severe,\nright greater than left facet arthropathy are present. The thecal sac is\nmildly narrowed without mass effect on the intrathecal nerve roots. \nSubarticular zones are slightly narrowed without clear compression of the\ntraversing L5 nerve roots. There is mild-to-moderate bilateral neural\nforaminal narrowing.\n\nL5-S1: There is a disc bulge, a small central/right paracentral disc\nprotrusion, and moderate facet arthropathy. There is no significant spinal\ncanal narrowing. There is mild left neural foraminal narrowing with abutment\nof the exiting left L5 nerve root by the disc bulge.", "output": "1. No evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection in the cervical, thoracic, or lumbar spine.\n2. Status post instrumented posterior fusion from C3 through C6, not well\nassessed by MRI.\n3. Multilevel cervical degenerative disease. At C6-C7, a central/right\nparacentral disc protrusion moderately narrows the spinal canal and abuts the\nventral spinal cord, without evidence for cord signal abnormalities allowing\nfor motion artifact. Severe multilevel neural foraminal narrowing.\n4. At T8-T9, a small central disc protrusion minimally remodels the ventral\nspinal cord. However, the cord remains surrounded by plentiful CSF laterally\nand dorsally, and there is no significant spinal canal stenosis. Thoracic\ncord signal is normal.\n5. Multilevel lumbar degenerative disease. Mild narrowing of the thecal sac\nat L3-L4 and L4-L5 without crowding of the intrathecal nerve roots. Mass\neffect on multiple traversing and exiting nerve roots from L3-L4 through\nL5-S1, as detailed above." }, { "input": "There are five lumbar-type vertebral bodies. There is grade 2 anterolisthesis\nof L4 on L5, similar to prior. Remaining vertebral bodies are maintained in\nalignment and they are preserved in height throughout. Bone marrow signal is\nheterogeneous without focal suspicious lesion. Intervertebral disc\ndesiccation spans L2-3 through L4-5 with significant associated disc height\nloss at L4-5. The conus terminates at L1, in normal anatomic position.\n\nAt T10-T11 through L1-2, there is no significant canal or foraminal narrowing.\n\nAt L2-3, there is a mild disc bulge without significant canal or foraminal\nnarrowing.\n\nAt L3-4, there is a mild disc bulge and facet joint hypertrophy with mild\nnarrowing of the subarticular recesses and minimal bilateral foraminal\nnarrowing, unchanged.\n\nAt L4-5, there is uncovering of the disc with a superimposed disc bulge and\nextensive facet joint hypertrophy. These changes result in severe canal\nnarrowing with minimal if any CSF surrounding the cauda equina nerve roots,\nsimilar compared to prior. There is moderate bilateral foraminal narrowing,\nunchanged.\n\nAt L5-S1, there is a mild disc bulge and facet joint hypertrophy without canal\nor foraminal narrowing.\n\nIncluded retroperitoneal soft tissues are unremarkable.", "output": "Grade 2 anterolisthesis of L4 on L5 with superimposed disc bulge and facet\njoint hypertrophy resulting in severe canal narrowing and moderate bilateral\nforaminal narrowing, unchanged since ___." }, { "input": "Thoracic and lumbar vertebral bodies are normal in height and alignment. \nMultiple scattered T1 and T2 hyperintense foci in the vertebral bodies, most\nprominent, largest in T8 measuring 1.5 cm, likely represent hemangiomas\n(series 12, image 9). ___ 1 endplate degenerative changes are most\nprominent at L5-S1. There is diffuse loss of height and normal T2 signal of\nintervertebral discs in the thoracic spine with relative sparing of the\nT10-11, T11-12, and T12-L1 discs. Loss of height and normal T2 signal of\nintervertebral discs in the lumbar spine is severe at L5-S1 and mild to\nmoderate at L3-4 and L4-5 levels.\n\nThe thoracolumbar spinal cord is normal in caliber and signal intensity. \nConus medullaris terminates at L1-2. Nerve roots of the cauda equina are\nwithin normal limits.\n\nAt T2-3, there is mild disc bulging that is eccentric to the left, resulting\nin mild left neural foraminal narrowing. Spinal canal narrowing is mild.\n\nAt T6-7, there is mild disc bulging that is eccentric to the left, resulting\nin mild left neural foraminal narrowing. There is no neural foraminal\nnarrowing.\n\nAt L3-4, there is mild diffuse disc bulging, ligamentum flavum thickening, and\nmild bilateral facet hypertrophy. There is mild bilateral neural foraminal\nnarrowing. Spinal canal narrowing is mild.\n\nAt L4-5, superimposed on diffuse disc bulging is a superiorly directed right\ncentral and paracentral disc extrusion that narrows the right lateral recess,\nmildly displaces the thecal sac and contacts the exiting right L4 nerve root\n(series 5, image 10; series 2, image 12). The disc in combination with\nligamentum flavum thickening results in mild narrowing of the spinal canal. \nDisc bulge and facet hypertrophy result in mild narrowing of the neural\nforamina bilaterally.\n\nAt L5-S1, a diffuse disc bulge extends into the neural foramina bilaterally\nand in combination with moderate bilateral facet hypertrophy results in\nmoderate narrowing of bilateral neural foramina. Spinal canal narrowing is\nmild.\n\n\nThere is no epidural or paraspinal mass or fluid collection.", "output": "1. Multilevel degenerative changes as described are most severe at L4-L5 and\nL5-S1.\n2. Superiorly directed right paracentral disc extrusion superimposed on\ndiffuse disc bulging at L4-5 narrows the right lateral recess and entrance to\nthe right neural foramen, contacting the exiting right L4 nerve root.\n3. There is moderate narrowing of the neural foramina bilaterally at L5-S1." }, { "input": "Study is moderately degraded by motion, especially on postcontrast imaging.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is transitional anatomy with partial sacralization of the L5 vertebral\nbody.\n\n0.8 and 1.3 cm ovoid T2 and T1 hyperintense structures in the T11 vertebral\nbody and the superior posterior L3 vertebral body respectively likely\nrepresent hemangiomas. T11 posterior superior endplate type ___ ___ changes\nare noted. Nonspecific heterogeneous marrow signal is noted throughout the\nvisualized osseous structures without definite focal enhancing mass\nidentified, which may be degenerative in nature.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal at L2-3, L3-4, L4-5,\nand L5-S1. Facet joint arthropathy is noted throughout the lumbar spine. \nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nThere is no evidence of infection or neoplasm. Multiple ovoid small T2\nhyperintense structures in the kidneys bilaterally are incompletely evaluated,\nbut likely represent cysts, and appear similar to ___ (see 4:84 on\nprior exam).\n\n9 mm ovoid T2 hypointense structure to the left of the L5 vertebral body\nlikely represents a lymph node (see 7:16, 3, 4, 5, 13:2) similar to ___ prior exam.", "output": "1. Study is moderately degraded by motion, especially on postcontrast imaging.\n2. Multilevel degenerative changes as described, without definite spinal canal\nor neural foraminal stenosis.\n3. Grossly stable probable renal cysts.\n4. Grossly stable nonspecific 9 mm left retroperitoneal probable lymph node at\napproximately L5 level, grossly similar to prior abdomen and pelvis CT." }, { "input": "Vertebral body and cervical spine alignment are preserved. There is no marrow\nsignal abnormality. There is no prevertebral soft tissue swelling.\n\nThe signal intensity throughout the cervical spinal cord is normal with no\nevidence of focal or diffuse lesions.\n\nIntervertebral disc heights and signal are preserved.\n\nFrom C2-C3 through C3-C4 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt C4-5, there is diffuse disc bulge with mild posterior disc protrusion,\ncausing mild anterior thecal sac deformity, bilateral uncovertebral\nhypertrophy causes mild left, and moderate right neural foraminal narrowing,\nthere is mild spinal canal stenosis.\n\nAt C5-6, there is no significant disc disease or spinal canal stenosis. There\nis small perineural cyst filling the right neural foramina, otherwise the\nright neural foramina is widely patent. There is no left neural foraminal\nstenosis.\n\nAt C6-7, there is no significant disc disease or spinal canal stenosis. There\nis small perineural cyst in the left neural foramina (8:31), otherwise the\nbilateral neural foramina are widely patent.\n\nAt C7-T1, there is no significant disc disease or spinal canal stenosis. \nThere is small perineural cyst in the right neural foramen (8:35), otherwise\nthe bilateral neural foramina are patent.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Mild multilevel cervical spondylosis, more pronounced at C4-C5 level, with\nmild posterior central disc protrusion, resulting in mild spinal canal\nstenosis.\n2. The signal intensity throughout the cervical spinal cord is normal with no\nevidence of focal diffuse lesions.\n3. Multiple small perineural cysts at right C5-C6, left C6-C7, and right C7-T1\nneural foramina" }, { "input": "There is marked degenerative disc disease at C4-C5 with anterolisthesis of C4\non C5 and increase narrowing of the disk space which has progressed compared\nto prior study with interval evolution of the previously noted ___ type 1\nchanges to type 2 changes on the present study. There is more mild loss of\nnormal intervertebral disc height at C5-C6.\nMinimal listhesis noted at multiple levels, from C7- T4.\nOn the STIR sequence, no suspicious mass like lesions are noted.\n\n\nAt C2-C3, there is a broad-based disc protrusion which is mildly indenting the\nventral thecal sac. There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nAt C3-C4, there is a broad-based disc protrusion. There is also thickening of\nthe left aspect of the ligamentum flavum which is defacing in the dorsal CSF\nspace and contacting the dorsal aspect of the spinal cord. There is a question\nof subtle hyperintense signal versus artifact in the cord at this level.\n\nAt C4-C5, there is anterolisthesis of C4 on C5 with mild spinal canal\nnarrowing, improved since the prior study of ___, with interval\ndecrease in the previously noted disc extrusion. There is bilateral\nuncovertebral joint pain and facet joint arthropathy resulting in bilateral\nmild neural foraminal stenosis.\n\nAt C5-C6, there is a diffuse bulge with broad-based disc protrusion/extrusion\nalong with thickening of the ligamentum flavum which is resulting in severe\nspinal canal stenosis and remodeling of the cervical spinal cord at this\nlevel. There is a question of subtle increased hyperintensity within the\nspinal cord at this level. There is bilateral uncovertebral joint and facet\njoint arthropathy. There is moderate to severe bilateral neural foraminal\nnarrowing.\n\nAt C6-C7, there is mild disc bulge with bilateral uncovertebral joint facet\njoint arthropathy resulting in mild bilateral neural foraminal narrowing.\nThere is no significant spinal canal stenosis.\n\nAt C7-T1, there is trace anterolisthesis with uncovering of the posterior\ndisc. There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nTiny disk bulges are again noted at T2-T3 and T3-T4.\n\nThe cervical spinal cord is normal in size and signal intensity without\nobvious significant focal cord lesions. There is a question of subtle\nhyperintense signal versus artifact in the cord at C3-4 and C5-6 levels.\n\nNo pre or paravertebral soft tissue swelling or masses noted.\nThe vertebral arterial flow voids are noted.\nThe craniovertebral junction is unremarkable.\nThe visualized soft tissues of the neck are unremarkable.", "output": "Multilevel degenerative changes as detailed above.\nFindings are most severe at C4-C5 and C5-C6.\nImprovement in the canal narrowing compared to the prior study of ___\nat C4-5 level, with decrease in the disc extrusion.\nModerate canal narrowing at C5-6 level, as before.\nThere is questionable increased T2 signal in the cervical spinal cord at C3-C4\nand\nC5-C6." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThere is no abnormal epidural collection. There is no abnormal focus of post\ncontrast enhancement.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are relatively\nwell preserved.\n\nThere is no evidence of infection or neoplasm. There is no prevertebral soft\ntissue swelling.. The visualized portion of the posterior fossa,\ncervicomedullary junction, paranasal sinuses and lung apicesare preserved.\n\n At C2-3 there is mild disc protrusion without significant spinal canal or\nneural foraminal narrowing.\n\nAt C3-4 there is mild disc protrusion without significant spinal canal or\nneural foraminal narrowing.\n\nAt C4-5 there is left paracentral disc bulge and ligamentum flavum thickening\nproducing mild spinal canal narrowing and mild flattening of the ventral cord.\nFacet and uncovertebral osteophytes produce minimal bilateral neural foraminal\nnarrowing.\n\nAt C5-6 there is disc bulge and ligamentum flavum thickening produce mild\nspinal canal narrowing with flattening of the ventral cord. Facet and\nendplate osteophytes produce minimal right neural foraminal narrowing. The\nleft neural foramen is patent.\n\nAt C6-7 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1 there is no significant spinal canal or neural foraminal narrowing.\n\nAt T1-T2, there is no significant spinal canal or neural foraminal narrowing.\n\nSagittal view of T2-T3 and T3-T4 demonstrate no significant spinal canal or\nneural foraminal narrowing\n\nThe thyroid gland is unremarkable.", "output": "1. Multilevel cervical spondylosis, as described, with most notable findings\nincluding mild spinal canal narrowing at C4-C5 and C5-C6, and only minimal\nneural foraminal narrowing at the bilateral C4-C5 and right C5-C6 levels. No\nhigh-grade spinal canal or neural foraminal narrowing.\n2. No cord signal abnormality or abnormal focus of post contrast enhancement." }, { "input": "At T11-12 disc degenerative changes are seen. From T12-L1 to L3-4 level\nminimal degenerative changes seen without spinal stenosis foraminal narrowing\nor significant disc bulge.\n\nAt L4-5 level, disc bulging is identified with a broad-based protrusion in the\nmidline on the right side with moderate right and mild left subarticular\nrecess narrowing. There is no foraminal narrowing.\n\nAt L5-S1 level degenerative disc disease and minimal bulging seen without\nspinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Degenerative disc disease with a broad-based central and right-sided\nprotrusion at L4-5 level with moderate right and mild left subarticular recess\nnarrowing.\n2. Minimal degenerative changes at other levels without spinal stenosis or\nforaminal narrowing." }, { "input": "Study is moderately degraded by motion. Within these confines: Vertebral\nbody alignment is preserved. Vertebral body heights are preserved. There is\nno marrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nIntervertebral disc heights and signal are preserved.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C6-7 there is a central disc protrusion with mildvertebral canaland mild\nrightneural foraminal narrowing.\n\nOtherwise, there is no definite evidence of cervical vertebral canal neural\nforaminal narrowing.\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.\n Scattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by size criteria.", "output": "1. Study is moderately degraded by motion.\n2. No definite evidence of cord compression, severe spinal canal stenosis,\nsignificant neural foraminal narrowing or syrinx.\n3. Minimal cervical spondylosis as described.\n4. Scattered subcentimeter cervical lymph nodes as described, which may be\nreactive." }, { "input": "There is no vertebral body height loss to suggest compression fracture. There\nis grade 1 anterolisthesis of L4 on L5 and minimal 2 mm retrolisthesis of L5\non S1. The remainder of the sagittal spinal alignment is maintained.\n\nThe marrow signal is mildly heterogeneous, without focal suspicious lesion. \nThe conus medullaris terminates at the level of L1. There is no abnormal\nsignal of the terminal cord.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2, L2-L3: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL3-L4: A posterior disc bulge flattens the ventral thecal sac and combines\nwith thickening of the ligamentum flavum and facet hypertrophy to result in\nmild canal stenosis with minimal bilateral neural foraminal narrowing.\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. A disc bulge with\nthickening of the ligamentum flavum and prominent epidural fat results in\nmoderate to severe spinal canal narrowing. There is crowding of the bilateral\nsubarticular zones. In combination with facet arthropathy, there is mild\nbilateral neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge with small annular tear results in mild canal\nstenosis with moderate right and mild left neural foraminal narrowing. These\nfindings are also minimally progressed.\n\nThe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most prominent at L4-L5 with moderate to severe canal stenosis and minimal\nbilateral neural foraminal narrowing. There is crowding of the subarticular\nzones. Findings at this level are mildly progressed as compared to the prior\nexamination.\n2. L4-L5 disc bulge contacting the bilateral descending L5 nerve roots, new\nfrom the previous exam.\n3. L5-S1 moderate right neural foraminal narrowing has also progressed.\n4. Additional findings as described above." }, { "input": "Vertebral body heights are preserved. Grade 1 anterolisthesis of L4 on L5 is\nunchanged. Multiple hemangiomas are again seen in the bone marrow. No\nsuspicious bone marrow signal abnormalities are seen. The conus medullaris\nappears unremarkable, terminating near the upper endplate of L1.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: Minimal facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nL2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: Disc bulge, mild infolding of the ligamentum flavum, and mild facet\narthropathy. Mild narrowing of the thecal sac without mass effect on the\nintrathecal nerve roots. Contact of bilateral traversing L4 nerve roots in\nthe subarticular zones. Mild bilateral neural foraminal narrowing. No\ninterval change.\n\nL4-L5: Grade 1 anterolisthesis, disc bulge, infolding of the ligamentum\nflavum, and severe facet arthropathy. Severe spinal canal stenosis with\ncrowding of the intrathecal nerve roots, as well as contact and likely\nimpingement of the traversing L5 nerve roots in the subarticular zones. \nModerate right neural foraminal narrowing with contact of the exiting right L4\nnerve root. Mild left neural foraminal narrowing. No interval change.\n\nL5-S1: Mild disc bulge, right paracentral annular tear, small right\nparacentral disc herniation, and moderate facet arthropathy. Traversing right\nS1 nerve root is displaced and likely impinged in the subarticular zone,\npossibly increased. Left subarticular zone is mildly narrowed. Mild\nnarrowing of the thecal sac without significant crowding of the intrathecal\nnerve roots, unchanged. Moderate to severe right neural foraminal narrowing\nwith contact and likely impingement of the exiting right L5 nerve root,\nunchanged. Moderate left neural foraminal narrowing with contact of the\nexiting left L5 nerve root, increased.", "output": "1. Lower lumbar degenerative disease is most extensive at L4-L5 with grade 1\nanterolisthesis, severe spinal canal stenosis, crowding of the intrathecal\nnerve roots, contact and likely impingement of the traversing L5 nerve roots\nin the subarticular zones, moderate right and mild left neural foraminal\nnarrowing, unchanged.\n2. At L5-S1, displacement and likely impingement of the traversing right S1\nnerve root in the subarticular zone by a a small right paracentral disc\nprotrusion and facet osteophytes may have slightly increased. Moderate left\nneural foraminal narrowing with contact of the exiting left L5 nerve root has\nprogressed. Mild narrowing of the thecal sac without significant intrathecal\nnerve root crowding, and moderate to severe right neural foraminal narrowing\nwith likely impingement of the right L5 nerve root, are unchanged.\n3. Unchanged mild degenerative changes at L3-L4 with contact of the traversing\nL4 nerve roots in the subarticular zones." }, { "input": "Alignment is normal. The vertebral body heights are preserved. No suspicious\nmarrow signal abnormalities are seen. There is reduced T2 signal within the\nL4-5 intervertebral disc, likely on a degenerative basis. The distal spinal\ncord demonstrates normal signal intensity. The conus medullaris terminates at\nL1.\n\nT12-L1 and L1-L2 levels appear unremarkable on sagittal images. No axial\nimages through these levels.\n\nL2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: Prominent epidural fat mildly narrows the thecal sac without mass\neffect on the intrathecal nerve roots. Mild disc bulge and facet arthropathy\nwithout significant neural foraminal narrowing.\n\nL4-L5: Mild disc bulge and moderate central disc protrusion, as well as mild\nto moderate facet arthropathy. The thecal sac is mildly narrowed without\nsignificant crowding of the intrathecal nerve roots. Bilateral traversing L5\nnerve roots are contacted and may be impinged in the subarticular zones. \nMinimal bilateral neural foraminal narrowing without nerve root impingement.\n\nL5-S1: Mild disc bulge and mild facet arthropathy without significant spinal\ncanal or neural foraminal narrowing.", "output": "1. At L4-L5, mild disc bulge, moderate central disc protrusion, and\nmild-to-moderate facet arthropathy cause subarticular zone narrowing with\nabutment and probable impingement of bilateral traversing L5 nerve roots, and\nmild narrowing of the thecal sac without significant crowding of the\nintrathecal nerve roots.\n2. At L3-L4, prominent posterior epidural fat mildly narrows the thecal sac\nwithout mass effect on the intrathecal nerve roots.\n3. The distal spinal cord appears unremarkable, with the conus medullaris\nterminating at L1." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. There is grade 1 anterolisthesis of L4 on L5 which has progressed\nsince the prior study. No suspect marrow lesions are seen. The conus is\nnormal in location and morphology.\n\nAxial images at L2-3 demonstrate no significant stenosis. At L2-3 there is a\nmild disk bulge without significant stenosis.\n\nAt L4-5 there is been significant interval worsening of the central\nbroad-based disc protrusion extending into both lateral recesses. There is\nmoderate canal stenosis and lateral recess narrowing. There is moderate\nbilateral foraminal narrowing. Bilateral facet and ligamentum flavum\nhypertrophy seen.\n\nAt L5-S1 is a mild disc bulge and annular tear that contacts both S1 nerve\nroots.\n\nThe pre and paravertebral soft tissues are unremarkable.", "output": "Progression of central disk protrusion at L4-L5. Moderate central canal\nstenosis at this level." }, { "input": "There is mild interval progression and slightly more pronounced grade 1\nanterolisthesis at L4 upon L5 level. The conus medullaris terminates at the\nlevel of T12-L1 and is unremarkable. Focus of high signal intensity\nidentified at L1 vertebral body appears unchanged and is consistent with fat\ndeposit versus small hemangioma.\n\nFrom T11-T12 through L1-L2 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L2-L3 level, there is main mild diffuse disc bulge, slightly more\npronounced on the left causing minimal left-sided neural foraminal narrowing,\nthere is no evidence of nerve compression, there is mild bilateral articular\njoint facet hypertrophy and ligamentum flavum thickening.\n\nAt L3-L4 level, there is diffuse disc bulge causing mild anterior thecal sac\ndeformity, contacting the traversing nerve roots bilaterally, there is mild\nbilateral articular joint facet hypertrophy and ligamentum flavum thickening\nresulting in mild spinal canal narrowing.\n\nAt L4-5 level, grade 1 anterolisthesis appears more pronounced since the prior\nexam as described above, there is diffuse disc bulge with uncovering disc\ncausing anterior thecal sac deformity and bilateral neural foraminal\nnarrowing, there is unchanged moderate to severe spinal canal narrowing with\ncrowding of the nerve roots within thecal sac. Moderate articular joint facet\nhypertrophy with articular joint effusion on the right remains unchanged.\n\nAt L5-S1 level, there is mild diffuse disc bulge causing mild anterior thecal\nsac deformity and contacting the traversing nerve roots bilaterally, unchanged\nsince the prior exam, there is mild bilateral articular joint facet\nhypertrophy, unchanged since the prior exam.\n\nThe sacroiliac joints and the visualized paravertebral structures are grossly\nunremarkable.", "output": "1. Grade 1 anterolisthesis at L4 upon L5 level appears slightly more\npronounced since the prior exam, causing moderate to severe spinal canal\nnarrowing and crowding of the nerve roots within thecal sac.\n\n2. Other multilevel, multifactorial degenerative changes throughout the\nlumbar spine appear relatively stable from L2-L3 to L5-S1 levels." }, { "input": "Lumbar alignment is anatomic. Lumbar spine numbering is based on that\nestablished on the prior examination. Vertebral body heights are preserved. \nThere is no suspicious marrow signal. There is mild loss of disc height and\nsignal spanning L3-L4 through L5-S1, similar in appearance to prior exam. The\nconus medullaris terminates at the L1 vertebral level, within expected limits.\nThere is no signal abnormality of the visualized cord, conus medullaris or\ncauda equina.\n\nT11-T12 through L2-L3: No significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: A disc protrusion and thickening of the ligamentum flavum does not\nresult in significant spinal canal narrowing. Facet arthropathy results in\nmild bilateral right greater left neural foraminal narrowing. Facet\nosteophyte and disc protrusion appears to contact the exiting right L3 nerve\nroot, unchanged from prior examination.\n\nL4-L5: A disc bulge with superimposed right central to lateral disc\nprotrusion and thickening of the ligamentum flavum does not result in\nsignificant spinal canal narrowing. Facet arthropathy in combination with the\ndisc protrusion results in moderate right neural foraminal narrowing, which\nappears to contact the exiting L4 nerve root (series 2, image 4), similar\nappearance to prior examination.\n\nL5-S1: A right central disc protrusion crowds the right greater than left\nsubarticular zone without significant spinal canal narrowing. There is no\nsignificant neural foraminal narrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, essentially unchanged from\nprior examination of ___, without significant spinal canal narrowing.\n2. At L3-L4, there is mild right neural foraminal narrowing with facet\nosteophyte and disc protrusion which appears to contact the exiting right L3\nnerve root.\n3. At L4-L5, a right central to lateral disc protrusion in combination with\nfacet arthropathy results in moderate right neural foraminal narrowing which\nappears to contact the exiting right L4 nerve root.\n4. At L5-S1 a right central protrusion crowds the right greater than left\nsubarticular zone." }, { "input": "There is a severe anterior compression deformity of the T5 vertebral body with\ndiffuse T2/STIR hyperintense marrow signal, compatible with a likely acute\ncompression fracture with marrow edema. The posterior cortex is slightly\nbuckled, worst along the inferior margin, with slight posterior bony\nretropulsion into the spinal canal measuring up to 4 mm (series 4, image 8),\nunchanged from recent CT. There is mild spinal canal narrowing due to the\nbony retropulsion without cord contact or cord signal abnormality. The T5\nspinous process fractures not well assessed by MRI, better seen on prior CT.\n\nElsewhere, vertebral body heights are preserved. There is mild (2-3 mm) T2-3\nanterolisthesis. Alignment is normal elsewhere. Probable intraosseous\nhemangioma is seen in T11. Focal fat is seen in the T12 vertebral body.\n\nThe thoracic spinal cord is normal in caliber and signal intensity. Multiple\nbilateral thoracic neural foraminal perineural cysts are noted. Mild signal\nand height loss of thoracic spine intervertebral discs is consistent with\ndegenerative change, worst at T8-9 and T9-10. Aside from mild narrowing due\nto bony retropulsion at T5-6, as above, there is no thoracic spinal canal\nnarrowing. There is no neural foraminal narrowing in the thoracic spine.\n\nThere are trace bilateral layering pleural effusions. The imaged prevertebral\nand paraspinal soft tissues are otherwise unremarkable", "output": "1. Acute severe compression fracture of T5 with 4 mm bony retropulsion into\nthe spinal canal of the buckled posterior cortex, causing mild spinal canal\nnarrowing however without cord contact.\n2. Known T5 spinous process fracture is not well seen by MRI, better assessed\non prior CT.\n3. No other thoracic spine fracture identified.\n4. Mild thoracic degenerative changes without additional area of spinal canal\nor neural foraminal narrowing at any level.\n5. Incidentally noted trace bilateral layering pleural effusions. Other\nincidental findings, as above." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nand intervertebral disc spaces are preserved. The bilateral C3 and C4\npedicles and facets, right greater than left, spinous process ease and to\nlesser degree the vertebral bodies demonstrate hyperintense STIR signal with\ncorresponding hypointense T1 signal without significant enhancement, likely\nrelated to degenerative process/facetitis with small amount of facet joint\neffusion. The remaining levels of the cervical spine bone marrow appear\nunremarkable.\n\nThe prevertebral and paraspinal soft tissues appear unremarkable. There is no\ndiscrete fluid collection or abnormal enhancement.\n\nC2-C3: There is a disc protrusion with bilateral facet and uncovertebral joint\narthropathy resulting in mild left and no significant right neural foraminal\nnarrowing, without spinal canal stenosis.\n\nC3-C4: There is a central left paracentral disc protrusion with ligamentum\nflavum thickening and bilateral facet and uncovertebral joint arthropathy\nresulting in severe spinal canal stenosis with effacement of the CSF space\nwith cord deformity and water sensitive hyperintense cord signal. There is\nsevere left and moderate right neural foraminal narrowing.\n\nC4-C5: There is a minimal central disc protrusion with ligamentum flavum\nthickening and bilateral facet and uncovertebral joint arthropathy resulting\nin mild left and no significant right neural foraminal narrowing, without\nspinal canal stenosis.\n\nC5-C6: There is a mild central disc protrusion with annular fissure,\nligamentum flavum thickening, bilateral facet and uncovertebral joint\narthropathy resulting in mild left and no significant right neural foraminal\nnarrowing, without spinal canal stenosis.\n\nC6-C7: There is a mild central disc protrusion with bilateral facet and\nuncovertebral joint arthropathy and ligamentum flavum thickening resulting in\nmild left and no significant right neural foraminal narrowing, without spinal\ncanal stenosis.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nTHORACIC: Axial T1 postcontrast sequences are severely motion degraded. \nWithin this confine:\nThe alignment of the thoracic spine is maintained. There are mild loss of\nvertebral body heights of T10, T11, and T12 vertebral bodies related to\nSchmorl's nodes with anterior wedging of the vertebral bodies. There is no\nsuspicious marrow replacing lesion or abnormal enhancement. The spinal cord\nis normal in caliber and morphology without abnormal signal intensity or\nenhancement. The prevertebral and paraspinal soft tissues appear\nunremarkable. There are small multilevel Schmorl's nodes. There is no\nsignificant spinal canal or neural foraminal stenosis.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare preserved. There are multilevel ___ type 2 endplate degenerative\nchanges. There are disc desiccations at L3-L4 and L4-L5. The intervertebral\ndisc heights are preserved. The conus medullaris terminates at L1-L2.\n\nThere is subcutaneous dependent edema of the lower back. Otherwise, the\nprevertebral and paraspinal soft tissues appear unremarkable. There is no\nabnormal enhancement.\n\nL1-L2: There is no spinal canal or neural foraminal stenosis.\n\nL2-L3: There is a disc bulge with ligamentum flavum thickening with prominent\ndorsal epidural fat contributing to mild spinal canal and bilateral neural\nforaminal narrowing.\n\nL3-L4: There is a disc bulge with ligamentum flavum thickening, bilateral\nfacet arthropathy, and prominent dorsal epidural fat resulting in mild spinal\ncanal stenosis with narrowing of bilateral subarticular zones. The bilateral\ntraversing nerve roots are impinged between the disc bulge and facet\narthropathy. There is mild bilateral neural foraminal narrowing, right\ngreater than left.\n\nL4-L5: There is a left eccentric disc bulge with ligamentum flavum thickening\nand bilateral facet arthropathy and prominent epidural fat resulting in\nmoderate spinal canal stenosis with narrowing of bilateral subarticular zones\nlikely impinging the traversing left nerve root. There is moderate left and\nmild-to-moderate right neural foraminal narrowing, where a facet osteophyte\nappears to flattening the left L4 exiting nerve root.\n\nL5-S1: There is no evidence of significant spinal canal or neural foraminal\nstenosis.", "output": "1. Severe spinal canal stenosis at C3-C4 with flattening of the spinal cord\nand abnormal spinal cord signal intensity, likely related to cord edema or\nmyelomalacia. Abnormal adjacent marrow signal with facet joint effusion,\nlikely related to degenerative process/facetitis, greater on the right.\n2. A left eccentric disc bulge at L4-L5 crowds the subarticular zones, likely\nimpinging on the traversing left L5 nerve root and results in moderate spinal\ncanal narrowing. Facet arthropathy at this level results in moderate left\nneural foraminal narrowing, where a facet osteophyte appears to flatten the\nexiting left L4 nerve root. Additional lumbar degenerative changes as\ndescribed above.\n3. Mild anterior wedging of T10 through T12 vertebral bodies related to\ndegenerative process. No evidence of thoracic spinal canal stenosis or neural\nforaminal narrowing.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:45 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "Evaluation of the posterior fossa demonstrates minimal tonsillar ectopia\n(image 10 of series 7), but is otherwise unremarkable. Cervical alignment is\nanatomic. The cervical vertebral body heights are maintained. The\nintervertebral disc heights are maintained with minimal desiccation at C4-C5\nand C5-C6.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nC2-C3 and C3-C4: Spinal canal and neural foramina are patent.\n\nC4-C5: Mild disc bulge and mild bilateral facet hypertrophy result in no\nsignificant spinal canal and mild bilateral neural foraminal narrowing.\n\nC5-C6: Disc bulge results in indentation of the ventral thecal sac with mild\nspinal canal and mild bilateral neural foraminal narrowing.\n\nC6-C7 and C7-T1: Spinal canal and neural foramina are patent.\n\nOther: Visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative disc disease at C4-C5 and C5-C6 with mild spinal canal\nnarrowing and mild bilateral neural foraminal narrowing.\n2. Additional findings described above." }, { "input": "The examination is moderately to severely motion degraded. In addition, no\nsagittal fat saturated T2 sequences or axial T2 sequences were obtained. \nAxial reformats from motion degraded sagittal 3D T2 images are available. \nWithin these confines:\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is T1 heterogeneous, slightly hyperintense to the disc, which\nmay represent any combination of marrow reconversion and underlying\nosteopenia. Clinical correlation with CBC values and clinical history is\nrecommended. There is mild loss of disc height at L5-S1. The conus\nmedullaris terminates at the L1 level, within expected limits. Allowing for\nmotion degradation, there is no evidence of high-grade spinal canal or neural\nforaminal narrowing. Small disc bulges at L4-L5 and L5-S1 are identified\nwhich do not result in significant neural foraminal narrowing.\n\nPoorly visualize is in anterior wall hernia, better evaluated on concurrent CT\nabdomen and pelvis. Visualized prevertebral paraspinal soft tissues are\notherwise unremarkable.", "output": "1. Moderately to severely motion degraded examination as well as examination\nwithout sagittal STIR or axial T2 sequences. Within these confines:\n2. There is no evidence of high-grade spinal canal or neural foraminal\nnarrowing.\n3. The marrow signal is T1 and T2 heterogeneous, with T1 signal slightly\nhyperintense to the disc. This may represent any combination of marrow\nreconversion or underlying osteopenia. Correlation with CBC values and\nclinical history is recommended.\n4. Recommend repeat examination when clinically feasible.\n5. Additional findings 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": "Alignment of the lower thoracic and lumbar spine is anatomic.\n\nThere is extensive heterogenous as well as geographic bone marrow abnormal\nsignal intensity involving included lower thoracic, lumbar and sacral osseous\nstructures which could be related to marrow reconversion superimposed osseous\ninfarctions. There is no associated paraspinal or epidural soft tissue\nabnormalities to suggest underlying superimposed inflammatory or neoplastic\nprocess. The vertebral body heights of lower thoracic and lumbar vertebrae\nare relatively preserved apart from mild central decreased height of L5\nvertebral body with less than 20% height loss.\n\nThere is abnormal longitudinal T2 STIR hyperintensity along the right sacral\nala nonspecific (series 300, image 77).\n\nIntervertebral disc heights and signal intensity appear unremarkable.\n\nThe included spinal cord appears normal in caliber and configuration. Conus\nmedullaris and cauda equina show normal shape and signal intensity. Conus\nmedullaris ends at the level of L1.\n\nThere is no evidence of significant spinal canal or neural foraminal\nnarrowing. There is mild exaggeration of the epidural fat downward starting\nfrom L5 level with capacious underlying intradural spinal canal.\n\nThere are bilateral renal cysts largest on the right side measuring 2.5 x 2\ncm.", "output": "1. Extensive marrow signal abnormality involving included osseous structures\nsuggestive of marrow reconversion with superimposed osseous infarctions.\n2. Right sacral ala signal T2 hyperintense signal, nonspecific. No evidence\nof abnormal lucency on recent CT abdomen and pelvis. Clinical correlation is\nrecommended as insufficiency fracture is a consideration although considered\nunlikely given lack of T1 hypointense signal through the region.\n3. No significant spinal canal or neural foraminal stenosis.\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": "From T10-T11 through L1-2 levels, disc degenerative changes identified. Mild\nbulging seen. There is no spinal stenosis.\n\nAt L2-3 disc bulging is identified. There is no spinal stenosis seen. Mild\nnarrowing of the foramina noted.\n\nAt L3-4 level, disc bulging and endplate degenerative change is seen. Mild\nnarrowing the foramina seen.\n\nAt L4-5 level, disk bulging identified. There is moderate-to-severe left\nforaminal narrowing secondary to disc bulging and facet degenerative changes\nas well as a small foraminal disc protrusion. There appears to be deformity of\nthe exiting left L4 nerve root within the foramen. There is mild narrowing of\nthe right foramen seen. There is mild bilateral subarticular recess narrowing\nwithout central canal stenosis.\n\nAt L5-S1 level mild disc bulging identified without spinal stenosis or\nforaminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Progression of degenerative changes since the previous MRI. \nModerate-to-severe left foraminal narrowing at L4-5 level secondary to disc\nbulging and protrusion with compression of exiting left L4 nerve root. \nMultilevel mild degenerative changes at other levels as described above. No\nevidence of high-grade central canal stenosis." }, { "input": "Minimal anterolisthesis C2-C3, C3-C4, likely degenerative. Multilevel\ndegenerative changes cervical spine, disc space narrowing C3-C4, C4-C5, C5-C6,\nC6-C7 levels. Disc osteophyte complex C3-C4 through T1-T2 levels. Posterior\nelement hypertrophic changes. No definite cord T2 signal abnormality,\nmultiple levels of artifact are seen..\n\nAt C2-C3 level central canal is patent. Mild-to-moderate left foraminal\nnarrowing. Mild right foraminal narrowing.\n\nAt C3-C4 level there is mild-to-moderate central canal narrowing, preserved\nCSF. Moderate left, mild right foraminal narrowing.\n\nAt C4-C5 level there is moderate central canal narrowing, nearly efface CSF. \nNo definite cord T2 signal abnormality. Moderate to severe left, moderate\nright foraminal narrowing.\n\nAt C5-C6 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nAt C6-C7 level there is mild central canal narrowing. Moderate left, mild\nright foraminal narrowing.\n\nAt C7-T1 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nAt T1-T2 level there is mild central canal, mild bilateral foraminal\nnarrowing.", "output": "1. Degenerative changes cervical spine.\n2. Moderate central canal narrowing C4-C5 level.\n3. Multilevel foraminal narrowing, as above.\n4. No definite cord T2 signal abnormality." }, { "input": "There is scoliosis of lumbar spine convex to the left in the lower lumbar\nregion.\n\nFrom T11-12 through L3-4 levels disc degenerative change and mild bulging\nseen. At L3-4 level mild narrowing of both foramina seen.\n\nAt L4-5 level, severe facet degenerative changes and flattening the facet\njoint seen. There is mild narrowing of both foramina. There is no spinal\nstenosis. Between the spinous processes of L4 and L5, degenerative changes\nare seen with small areas of fluid or related to the degenerative changes.\n\nAt L5-S1 level, there is grade 1 spondylolisthesis of L5 over S1 due to severe\nfacet degenerative changes. There is severe narrowing of both foramina with\ncompression of exiting L5 nerve roots. There is mild-to-moderate spinal\nstenosis.\n\nThe distal spinal cord is normal in appearance. The paraspinal soft tissues\nare unremarkable.", "output": "Multilevel degenerative changes and scoliosis. Grade 1 spondylolisthesis of\nL5 over S1 due to change degenerative facet disease with severe bilateral\nforaminal narrowing and compression of exiting L5 nerve roots. Mild to\nmoderate spinal stenosis at L5-S1 level." }, { "input": "Known fractures of the right C5 level are better evaluated on the CT of the\ncervical spine.\nIncreased T2/STIR signal within the spinal cord at C4-C5 level, concerning for\nspinal cord contusion (series 7, image 10), although chronic myelomalacia may\nhave a similar appearance. The known C4 anterior inferior endplate avulsion\nfractures better identified on the CT. There is prevertebral soft tissue\nedema spanning from C2 to T1-T2. A small amount of retrovertebral edema is\nseen posteriorly to C2 through C6. There is a small amount of fluid signal in\nthe anterior C5-C6 and C6-C7 discs which may represent traumatic injuries to\nthe disc spaces. There is also increased STIR signal intensity in the right\nC5-C6 facet joint (series 5, image 14) with mild joint space widening.\n\nThere is mild anterolisthesis of C3 on C4 and C7-T1. There is mild vertebral\nbody height loss at C3 and C4, likely chronic given no acute bone marrow\nedema. Vertebral body height and alignment is otherwise maintained.\n\nThere is bone marrow edema in the C5 spinous process and C4-C5 and C5-C6\ninterspinous regions, suggestive of ligamentous injury. Additional there is\nbilateral perispinal muscular edema, consistent with muscle strain.\n\nAt C2-C3 could, there is facet joint arthropathy and uncovertebral\nhypertrophy, ligamentum flavum thickening, mild spinal canal narrowing, mild\nbilateral neural foraminal narrowing.\n\nAt C3-C4, there is a posterior disc osteophyte complex with remodeling of the\nventral cord but no cord signal abnormality, facet joint arthropathy and\nuncovertebral hypertrophy, severe spinal canal stenosis, moderate bilateral\nneural foraminal narrowing.\n\nAt C4-C5, there is a posterior disc osteophyte complex with compression of the\nspinal cord with evidence of cord signal abnormality, Facet joint arthropathy\nand uncovertebral hypertrophy, severe spinal canal stenosis, severe right and\nmoderate left neural foraminal narrowing.\n\nAt C5-C6, there is a posterior disc osteophyte complex and left\ncentral/paracentral disc protrusion resulting in remodeling of the ventral\ncord but no cord signal abnormality, facet joint arthropathy and uncovertebral\nhypertrophy, severe spinal canal stenosis, mild bilateral neural foraminal\nnarrowing.\n\nAt C6-C7, there is a posterior disc osteophyte complex with disc bulge which\nslightly remodels the ventral cord but no cord signal abnormality, facet joint\narthropathy and uncovertebral hypertrophy, moderate spinal canal stenosis,\nsevere left and mild to moderate right neural foraminal narrowing.\n\nAt C7-T1, there is facet joint arthropathy and uncovertebral hypertrophy, no\nspinal canal stenosis, mild bilateral neural foraminal narrowing.", "output": "1. Multilevel degenerative changes of the cervical spine with severe spinal\ncanal stenosis at C3-C4, C4-C5 and C5 C6 resulting in remodeling and\ncompression of the spinal cord especially at C4-C5 where there is focal cord\nsignal abnormality. While this can be is seen chronically with myelomalacia,\nthis could also have been caused acutely in the setting of traumatic injury.\n2. Known cervical spine fractures a better evaluated on the CT of the cervical\nspine. Note is made of been marrow edema in the C5 spinous process with\nhigh-signal intensity also in the C4 and C5 interspinous regions, suggestive\nof ligamentous injury. Bilateral posterior paraspinal muscle edema is\nconsistent with muscle strain.\n3. Mild joint space widening and edema in the right C5-C6 facet joint as well\nas edema in the anterior aspect of the C4-C5 and C5-C6 discs.\n4. Prevertebral soft tissue edema spanning from C2-T1/T2 without definitive\nevidence of ligamentous injury. Small amount of retrovertebral edema spanning\nfrom C2 to C6 without definitive evidence of ligamentous injury.\n5. Multilevel neural foraminal narrowing as detailed above." }, { "input": "There are 7 cervical, 12 rib-bearing, and 5 lumbar-type vertebrae, as seen on\nthe localizer sequence images 4:3 and 4:4. The numbering is also documented\non sagittal T2 weighted images 5:8, 5:10, and 8:10. Localizer sequences\ndemonstrate a mild levoconvex curvature of the thoracic spine, not fully\nevaluated.\n\nCERVICAL:\nSagittal and axial images are mildly limited by motion artifact. There is a\nlarge Schmorl's node in the C7 superior endplate without definite marrow\nedema. C3 through C6 vertebral body heights are preserved. Alignment is\nnormal. No suspicious bone marrow signal abnormalities are seen. There is no\nevidence for spinal cord signal abnormalities. The craniocervical junction\nand the visualized posterior fossa appear unremarkable. There is no evidence\nfor significant spinal canal or neural foraminal narrowing. There are tiny\ncentral disc protrusions at C4-C5, C5-C6, and C6-C7.\n\nTHORACIC:\nThere are mild deformities of T1 through T5 superior endplate, without\nevidence for marrow edema allowing for motion artifact on STIR images. Other\nthoracic vertebral body heights are within normal limits. There is a small\nhemangioma in the posterior aspect of T8 vertebral body. No suspicious bone\nmarrow signal abnormalities are seen. There is no evidence for spinal cord\nsignal abnormalities allowing for motion artifact. There is no evidence for\nsignificant spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nVertebral body heights are preserved. No suspicious bone marrow signal\nabnormalities are seen. Alignment is normal. The conus medullaris terminates\nat L1 and appears unremarkable.\n\nFrom T12-L1 through L2-L3, there is no significant spinal canal or neural\nforaminal narrowing.\n\nAt L3-L4, mildly prominent posterior epidural fat causes minimal thecal sac\nnarrowing without mass effect on the intrathecal nerve roots. No significant\nneural foraminal narrowing.\n\nL4-L5: Minimal disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nL5-S1: No significant spinal canal or neural foraminal narrowing.", "output": "1. Images of the cervical and thoracic spine are mildly limited by motion\nartifact.\n2. Mild degenerative changes in the cervical spine without significant spinal\ncanal narrowing. No thoracic spinal canal narrowing. No evidence for spinal\ncord abnormalities.\n3. Mildly prominent posterior epidural fat at L3-L4 causes minimal thecal sac\nnarrowing without mass effect on the intrathecal nerve roots." }, { "input": "The patient has undergone suboccipital craniectomy. Small amount of fluid is\nseen in the suboccipital region which appears postoperative in nature. There\nis a syrinx identified in the upper cervical spinal cord extending from\nforamen magnum to C6 level. Although the syrinx has slightly decreased in\nsize compared to the preoperative MRI of ___, the upper portion of\nsyrinx, in particular, appears to have increased in dimension compared to the\npostoperative MRI of ___. Previously the upper portion of syrinx\nmeasured 7 mm compared to 13 mm on the current study. There remains some\nnarrowing of the CSF spaces at the foramen magnum.\n\nDegenerative changes are identified in the cervical region B disc bulging and\ndegenerative disc signal from C3-4 to C6-7 levels as before.\n\nFollowing gadolinium administration no abnormal intraspinal enhancement is\nseen.", "output": "Status post Chiari decompression. The upper cervical cord syrinx has\nincreased in size compared to the postoperative MRI of ___. No\nabnormal enhancement is seen." }, { "input": "There is suboccipital craniectomy and C1 laminectomy anatomy.\n\nThere is a large syrinx within the upper cervical cord measuring up to 1.2 cm\nTV by 1.1 cm AP by 5.8 cm SI and extending from the mid C2 to the mid C5\nlevels. The syrinx causes cord enlargement which effaces the CSF space. \nInferior to the large cystic syrinx there is a small central syrinx measuring\n2 mm in diameter extending to the C6-C7 level. There is no associated\nenhancement. Findings are relatively unchanged in comparison to ___.\n\nThere is a mild cervical kyphosis. The vertebral body heights are preserved. \nThe marrow signal is unremarkable. There is diffuse low intervertebral disc\nsignal, consistent with degeneration.\n\nAt C2-C3 there is a small central disc protrusion without spinal canal or\nneural foraminal stenosis.\n\nAt C3-C4 there is a small central disc protrusion without spinal canal neural\nforaminal stenosis.\n\nAt C4-C5 there is a small central disc protrusion without spinal canal neural\nforaminal stenosis.\n\nAt C5-C6 there is a right paracentral disc extrusion and uncovertebral\nosteophytes causing moderate spinal canal stenosis which contacts and mildly\ndeforms the right aspect of the cord, without associated cord signal\nabnormality (05:25). There is mild right neural foraminal stenosis. Findings\nare relatively unchanged.\n\nAt C6-C7 there is a central disc extrusion and uncovertebral osteophytes\ncausing mild spinal canal narrowing and mild right and moderate left neural\nforaminal stenosis, which is relatively unchanged.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.\n\nThere are foci of low signal in the posterior mid upper neck consistent with\npostsurgical changes. Otherwise the paravertebral soft tissues are\nunremarkable.", "output": "1. Unchanged expected postsurgical changes following a suboccipital\ncraniectomy and C1 laminectomy.\n2. Large syrinx within the upper cervical cord, as described, with smaller\nsyrinx extending more inferiorly, which are relatively unchanged comparison to\n___. No associated enhancement.\n3. Multilevel cervical spondylosis, as described, most advanced at C5-C6 where\nthere is moderate spinal canal stenosis. The degenerative changes are\nrelatively unchanged comparison to prior study." }, { "input": "Spine labeling is not provided on series 2, image 9. There is mild\nstraightening of the lumbar lordosis. Overall, there has been interval\nprogression of compression deformities involving the L1 and L4 vertebral\nbodies compared to the prior CT from ___. Additional increased STIR\nsignal involving the L1 and L4 vertebral bodies suggests a acute to subacute\netiology. Compression deformity of L5 is unchanged compared to the prior\nexam. Incidental note is made of subtle increased STIR signal abnormality\ninvolving the T11 vertebral body, incompletely evaluated on this exam.\n\nSubtle increased STIR signal along the superior endplate of L2 is likely a\nSchmorl's node.\n\nOn the precontrast T1 weighted images, the marrow signal involving the T12,\nL1-L5 and sacral vertebral bodies. Homogeneous enhancement of the marrow is\nseen involving the L1 and L4 vertebral bodies. There is no evidence of\ncortical expansion or soft tissue component. Minimal enhancement is seen\ninvolving the L2 and sacral marrow. The conus medullaris terminates at the L1\nlevel, within expected limits. There is no abnormal signal or enhancement of\nthe visualized cord, conus medullaris or cauda equina.\n\nMild degenerative changes are seen throughout the lumbar spine:\n\nL1/L2: Mild broad-based intervertebral disc bulge, however no significant\nevidence of neural foraminal narrowing.\n\nL2/L3: Mild left paracentral intervertebral disc bulge, with mild left neural\nforaminal narrowing.\n\nL3/L4: Mild central broad-based intervertebral disc bulge, with mild left\nneural foraminal narrowing.\n\nL4/L5: Mild central broad-based intervertebral disc bulge, with mild left\nneural foraminal narrowing.\n\nL5/S1: Mild broad-based central intervertebral disc space narrowing however\nno evidence of neural foraminal narrowing.\n\nModerate vascular calcifications are seen in the visualized portions of the\naorta. Mild bilateral sacroiliac joint degenerative changes are seen. \nOtherwise, the remainder the visualized prevertebral and paraspinal soft\ntissues are unremarkable.", "output": "1. Interval progression of acute to subacute compression deformities involving\nthe L1 and L4 vertebral bodies compared to the prior CT from ___. \nThere is also with likely compression fracture of T11, partially visualized.\n2. There is no soft tissue component, cortical expansion or focal abnormal\nenhancement associated with the fractures to suggest underlying neoplastic\nprocess and the constellation of findings would suggest insufficiency\nfractures. However, given the patient's underlying history of prostate\ncancer, followup examination in approximately 3 months to document resolution\nof postcontrast enhancement associated with the fractures.\n3. No cord signal abnormalities identified.\n4. Mild degenerative changes throughout the lumbar spine.\n5. Stable chronic compression deformity of L5.\n6. If there is further clinical concern for disease in the thoracic spine, a\ndedicated MRI of the thoracic spine would be helpful for further evaluation.\n\nRECOMMENDATION(S): Given the patient's underlying history of prostate cancer,\nfollowup examination in approximately 3 months to document resolution of\npostcontrast enhancement associated with the fractures." }, { "input": "Cervical spine alignment is maintained. Bone marrow signal is normal.\nVertebral body heights and disc spaces are preserved, other than mild loss of\ndisk space height at C5-C6.\n\nThe signal within the visualized cervical cord is normal. No abnormality is\nseen within the posterior fossa.\n\nC2-C3: No significant degenerative change is present.\n\nC3-C4: A disc bulge with a superimposed tiny central disc protrusion is\npresent which causes mild indentation on the thecal sac. The neural foramen\nare patent.\n\nC4-C5: A mild disc bulge is present with mild effacement of the ventral\nsubarachnoid space. Mild bilateral neural foraminal narrowing is secondary to\nuncinate process and facet osteophytes.\n\nC5-C6: A large central and left-sided disc osteophyte complex is present which\ncompletely effaces the ventral subarachnoid space causing moderate to severe\nspinal canal narrowing and flattening of the ventral aspect of the cord.\nSevere left and moderate right neural foraminal narrowing are secondary to\nuncinate process and facet osteophytes.\n\nC6-C7: And a central disc protrusion mildly effaces the ventral subarachnoid\nspace. The neural foramen are patent.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing is present.\n\nA small Thornwaldt cyst is noted within the posterior nasopharynx.", "output": "Multilevel cervical spine degenerative changes the worst at C5-C6 where there\nis moderate to severe spinal canal narrowing and severe left neural foraminal\nnarrowing. There is no substantial interval change." }, { "input": "C5 vertebral body demonstrates unchanged mild loss of height without marrow\nedema. Other vertebral body heights are preserved. Minimal anterolisthesis\nof C4 on C5 is unchanged. No evidence for osseous, epidural, or\nleptomeningeal metastatic disease. No evidence for spinal cord signal\nabnormalities allowing for motion artifact. The cerebellar tonsils are\nnormally positioned. Visualized posterior fossa is notable for ___\ncisterna magna, as seen on the ___ head CT.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: No spinal canal or neural foraminal narrowing.\n\nC4-C5: Small central disc protrusion without spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nC5-C6: Shallow posterior endplate osteophytes without spinal canal narrowing. \nModerate right and mild left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC6-C7: Shallow posterior endplate osteophytes without spinal canal narrowing. \nSmall right uncovertebral osteophytes with minimal, if any, right neural\nforaminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nT1-T2: No spinal canal or neural foraminal narrowing.\n\nThe extra-spinal soft tissues of the neck not adequately assessed on this\nexam. 8 mm T2 hyperintense, T1 hypointense right thyroid nodule is noted,\nimages 6:25, 9:25. A smaller T2 hyperintense, possibly enhancing left thyroid\nnodule is also noted, images 6:29, 9:29. There may also be a partially\nvisualized, at least 12 mm thyroid nodule in the left lower pole on image\n6:32.", "output": "1. No evidence for osseous, epidural, or leptomeningeal metastatic disease in\nthe cervical spine.\n2. Moderate right and mild left C5-C6 neural foraminal narrowing. Mild\ndegenerative changes several at other cervical levels, as detailed above.\n3. Partially visualized thyroid nodules, up to at least 12 mm. The\nextra-spinal soft tissues of the neck are otherwise not adequately assessed on\nthis exam, which is targeted for evaluation of the cervical spine.\n\nRECOMMENDATION(S): Thyroid ultrasound may be considered if clinically\nwarranted." }, { "input": "There is no evidence of an acute fracture or subluxation. There is no\nprevertebral soft tissue swelling.\n\nMultilevel multifactorial degenerative changes are seen throughout the\ncervical spine.\n\nC1/C2: There is no significant thecal sac narrowing. There is no evidence of\nsignificant neural foraminal narrowing.\n\nC2/C3: There is mild disc bulge with minimal thecal sac narrowing. There is\nmoderate right and mild left neural foraminal narrowing.\n\nC3/C4: There is no evidence of significant thecal sac narrowing. Mild\nbilateral neural foraminal narrowing is again seen.\n\nC4/C5: There is mild left paracentral disc bulge with mild to moderate\nleft-sided neural foraminal narrowing. Note is made of mild contact with the\nleft-sided nerve roots.\n\nC5/C6: There is a broad based disc bulge with mild to moderate canal stenosis.\nModerate bilateral neural foraminal narrowing is seen with evidence of contact\nwith the C5 nerve roots.\n\nC6/C7: There is no evidence of significant canal stenosis or neural foraminal\nnarrowing.\n\nThe thyroid is normal. The visualized apices of the lungs are clear.\nIncidental note is made of a left sided perineural cysts.", "output": "No evidence of a cervical spine fracture or subluxation." }, { "input": "CERVICAL:\n\n Vertebral body alignment is preserved. There is mild anterior wedging of C4\nvertebral body without surrounding edema likely degenerative in etiology\n(27:7). Otherwise, vertebral body heights are preserved. There is no marrow\nsignal abnormality. The visualized portion of the spinal cord is preserved in\nsignal and caliber.\n\nThere is multilevel spondylosis, most prominent at C4-T1. Intervertebral\nsignal intensity is relatively decreased in keeping with multilevel cervical\nspondylosis.\n\nWithin 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.\n\n At C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is there is a mild broad disc bulge causing mild narrowing of\nthe thecal sac without spinal cord deformity. Mild uncovertebral hypertrophy\nand facet arthropathy causes mild bilateral neural foraminal stenosis.\n\nAt C4-5 there is a moderate broad disc bulge causing moderate effacement of\nthe anterior thecal sac with mild spinal cord deformity. There is\nuncovertebral hypertrophy with facet arthropathy causing mild right neural\nforaminal stenosis.\n\nAt C5-6 there is a left paracentral disc protrusion and facet arthropathy\ncausing moderate left neural foraminal stenosis (20:24). No significant\nspinal canal stenosis.\n\nAt C6-7 there is broad-based disc bulge causing mild effacement of the thecal\nsac without spinal cord deformity. No significant neural foraminal stenosis..\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nOTHER: There are trace bilateral pleural effusions with associated compressive\natelectasis, right greater than left (26:15, 1; 31:9).", "output": "1. No evidence of severe spinal canal or neural foraminal stenosis. \nMultilevel cervical and thoracic degenerative changes as stated above, most\nprominent at C5-C6 with moderate left neural foraminal stenosis.\n2. Trace bilateral pleural effusions with associated compressive atelectasis,\nright greater than left." }, { "input": "There is mild bone edema in the region of the known right C1 vertebral body\nnondisplaced fracture (better characterized on the outside hospital CT\ncervical spine study). The remaining vertebral bodies do not demonstrate\nabnormal marrow signal. Vertebral body alignment is preserved. Vertebral\nbody heights are preserved.\n\nThe signal intensity in configuration of the cervical spinal cord is normal\nwith no evidence of focal or diffuse lesions.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is minimal disc bulging withoutvertebral canal or neural\nforaminal narrowing.\n\nFrom C3-4 to C7-T1 levels there is no vertebral canal or neural foraminal\nnarrowing.\n\nThe visualized paravertebral structures are grossly unremarkable.", "output": "1. Mild bone edema in the region of the known right C1 vertebral body\nnondisplaced fracture (better characterized on the outside CT cervical spine\nstudy).\n2. There is no evidence of spinal cord injury." }, { "input": "2 mm anterolisthesis of L4 on L5 is unchanged from prior examination. \nOtherwise, lumbar alignment is anatomic. Vertebral body heights are\npreserved. No focal suspicious marrow lesion identified. Mixed ___ 1 and 2\nL5-S1 endplate changes are identified. Degenerative loss of disc height and\nsignal spanning L1-L2 through L3-L4 is mild and is moderate L4-L5 and L5-S1. \nConus medullaris terminates at the L1 level, within expected limits. There is\nno signal abnormality of the terminal cord.\n\nT12-L1 and L1-L2: Mild degenerative changes do not narrow the spinal canal or\nneural foramina.\n\nL2-L3: A small disc bulge does not narrow the spinal canal. In combination\nwith facet arthropathy, there is mild left neural foraminal narrowing.\n\nL3-L4: A disc bulge eccentric to the left with thickening of the ligamentum\nflavum and epidural fat results in mild to moderate spinal canal narrowing. \nCrowding of the left-greater-than-right subarticular zones posteriorly\ndisplaces the traversing left L4 nerve root (series 12, image 22). In\ncombination with facet arthropathy, there is mild right and moderate left\nneural foraminal narrowing (series 9, image 6).\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. There is a disc\nbulge with prominent thickening of the ligamentum flavum resulting in moderate\nto severe spinal canal narrowing. In combination with facet arthropathy,\nthere is severe left and moderate right neural foraminal narrowing.\n\nL5-S1: A disc bulge does not significantly narrow the spinal canal but crowds\nthe subarticular zones contacting but not definitively displacing the\ntraversing nerve roots. In conjunction with facet arthropathy, there is\nsevere bilateral neural foraminal narrowing.\n\nMultiple T2 hyperintense cystic lesions of both kidneys are statistically most\nlikely simple cysts, similar appearance to prior examination. Unchanged is\ndilatation of the common bile duct and intrahepatic bile ducts, compatible\nwith history of cholecystectomy. The remainder the visualized prevertebral\nand paraspinal soft tissues are unremarkable.", "output": "1. Multilevel lumbar spondylosis most prominent at L5-S1 where there is severe\nbilateral neural foraminal narrowing and at L4-L5 where there is moderate to\nsevere spinal canal narrowing and severe left neural foraminal narrowing.\n2. Additional findings as described above." }, { "input": "Examination is mildly limited by motion artifact. Within the limitations:\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nFat containing lesions in the C7, T2 and T3 vertebral bodies likely represent\nhemangioma. There is otherwise no focal bone marrow signal abnormality. The\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of T2 signal of all visualized intervertebral discs. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling.. Areas of\npunctate susceptibility artifact are again seen in the visualized portion of\nthe cerebellum, likely representing amyloidosis. The visualized portion of\nthe posterior fossa, and cervicomedullary junction are otherwise preserved.\n\n At C2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is trace right paracentral disc protrusion without significant\nspinal canal narrowing. Facet and uncovertebral arthropathy produce severe\nright and mild left neural foraminal narrowing.\n\nAt C4-5 there is small disc protrusion indenting the ventral thecal sac\nwithout significant spinal canal narrowing facet and uncovertebral arthropathy\nproduce severe bilateral neural foraminal narrowing.\n\nAt C5-6 there is small disc protrusion, osteophytes and ligamentum flavum\nthickening produce mild spinal canal narrowing without contacting the cord. \nFacet and uncovertebral arthropathy produce moderate left-greater-than-right\nneural foraminal narrowing.\n\nAt C6-7 there is central disc protrusion and osteophytes indent the ventral\nthecal sac without significant spinal canal narrowing. Facet and\nuncovertebral arthropathy produce severe left and mild right neural foraminal\nnarrowing.\n\nAt C7-T1 there is minimal disc protrusion indents the ventral thecal sac\nwithout significant spinal canal narrowing. The neural foramina are patent.\n\nLimited sagittal views of the T1-T2 through T4-T5 levels demonstrate no\nsignificant spinal canal or neural foraminal narrowing", "output": "1. Examination is mildly limited by motion artifact.\n2. Cervical spondylosis, as described, notable for mild spinal canal narrowing\nat C5-C6 with multiple levels of moderate to severe neural foraminal\nnarrowing.\n3. No definite moderate to severe spinal canal stenosis.\n4. Within limits of study, no definite cervical spinal cord lesion\nidentified.\n5. Partial visualization of punctate areas of susceptibility artifact in the\nposterior fossa, suggestive of amyloidosis." }, { "input": "CERVICAL:\nAt the craniocervical junction and C2-3 and C3-4 mild degenerative changes\nidentified without spinal stenosis. In the C3 vertebra an incidental\nhemangioma is seen.\n\nAt C4-5 level, mild disc bulging and mild narrowing of the left foramen seen.\n\nAt C5-6 posterior disc osteophyte and disc bulge results in moderate spinal\nstenosis with disc bulging contacting the spinal cord with minimal\nindentation. There is no abnormal signal within the spinal cord. There is\nmoderate right-sided and severe left-sided foraminal narrowing.\n\nAt C6-7 there is mild disc bulging and moderate left-sided and mild\nright-sided foraminal narrowing.\n\nFrom C7-T1 to T3-4 no abnormalities are identified. Following gadolinium no\nabnormal enhancement is seen.\n\n\nLUMBAR:\nFrom T11-12 through L3-4 levels mild disc degenerative changes seen without\nsignificant bulge. At L4-5 level mild bulging and mild narrowing of the\nforamina seen without high-grade spinal stenosis. Mild facet degenerative\nchanges seen. At L5-S1 level mild disease seen without spinal stenosis or\nforaminal narrowing following gadolinium no abnormal enhancement is tissues\nand distal spinal cord shows normal appearances.\n\nOTHER: There is no evidence of discitis osteomyelitis or epidural abscess in\nthe cervical or lumbar region.", "output": "1. Degenerative changes in the cervical spine most pronounced at C5-6 level\nwhere moderate spinal stenosis and moderate right-sided and severe left-sided\nforaminal narrowing is seen. Other degenerative changes in the cervical\nregion as described.\n2. Mild degenerative changes in the lumbar spinal stenosis or high-grade\nthecal sac compression.\n3. No evidence of discitis osteomyelitis or epidural abscess in the cervical\nor lumbar region.\n4. Mild spinal cord deformity by spinal stenosis at C5-6 level without\nabnormal signal within the spinal cord." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is 2 mm of C5-6 retrolisthesis, without definite evidence of\nprevertebral soft tissue swelling, likely degenerative. Vertebral body\nheights are maintained. Probable small Schmorl's node is seen in the\nsuperior, posterior endplate of C6.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. There is no definite evidence of epidural collection.\n\nThere is loss of intervertebral disc height and signal throughout cervical\nspine. Nonspecific facet joint fluid is noted at multiple levels of the\ncervical spine.\n\nAt C2-3 there is uncovertebral hypertrophy with no vertebral canal or neural\nforaminal narrowing.\n\nAt C3-4 there is bulge, uncovertebral hypertrophy, facet joint hypertrophy,\nligamentum flavum thickening, with mild vertebral canal and mild bilateral\nneural foraminal narrowing.\n\nAt C4-5, there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, ligamentum flavum thickening, deformation of the ventral thecal\nsac and spinal cord without definite associated cord signal abnormality, with\nmild-to-moderate vertebral canal, mild left and moderate right neural\nforaminal narrowing.\n\nAt C5-6 there is disc bulge, uncovertebral hypertrophy, right paracentral disc\nprotrusion, deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, with moderate vertebral canal,\nmild left and moderate right neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, with mild vertebral canal and mild bilateral neural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal neural foraminal narrowing.\n\n OTHER:\n\nThere is no paravertebral or paraspinal mass identified.\n\nRight mastoid effusion is partially visualized.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of cervical spinal cord\nenhancing mass or abscess.\n3. Multilevel cervical spondylosis as described, most pronounced at C5-6,\nwhere there is moderate vertebral canal, mild left and moderate neural\nforaminal narrowing with deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality.\n4. Within limits of study, no definite focal cervical spinal cord lesion\nidentified.\n5. Nonspecific right mastoid effusion, partially visualized, as seen on CT\ntemporal bone from ___." }, { "input": "At T4 vertebral body there is a non expansile geographic area of T1 and T2\nhyperintense signal, that suppresses on STIR sequence, and may represent fat\nassociated intraosseous hemangioma (series 6, image 12; series 7, image 18). \nThe vertebral bodies are normal in height and alignment. The intervertebral\ndisc heights are relatively preserved. There is no disc herniation, spinal\ncanal narrowing, or neural foraminal stenosis in the thoracic spine.\n\nThe visualized spinal cord is normal in caliber and signal intensity. There\nis no cord compression.\n\nThere is no epidural or paraspinal fluid collection or soft tissue\nabnormality.", "output": "1. Non expansile geographic area identified at T4 vertebral body is consistent\nwith hemangioma.\n2. Normal caliber and signal intensity of the thoracic spinal cord,\n3. There is no evidence of spinal canal stenosis or neural foraminal\nnarrowing.\n\nRECOMMENDATION(S): Since no prior examinations of the thoracic spine are\navailable for comparison, long-term follow-up with MRI of the thoracic spine\nin ___ year is recommended to demonstrate stability or any further changes at T4\nvertebral body." }, { "input": "3 mm retrolisthesis of C5 on C6 is identified. Otherwise, cervical alignment\nis anatomic. Vertebral body heights are preserved. No focal suspicious\nmarrow lesion. Degenerative loss of disc height at C4-C5 and C5-C6 is mild. \nThe visualized posterior fossa is unremarkable. There is no cord signal\nabnormality. The craniocervical junction and anterior atlantodental interval\nare within expected limits.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: No significant spinal canal narrowing. Uncovertebral and facet\narthropathy results in moderate left and no significant right neural foraminal\nnarrowing.\n\nC4-C5: A small central protrusion with thickening of the ligamentum flavum\nresults in mild spinal canal narrowing. Uncovertebral and facet arthropathy\nresults in moderate left and mild right neural foraminal narrowing.\n\nC5-C6: A disc bulge and retrolisthesis of C5 on C6 with thickening of the\nligamentum flavum results in mild spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in mild to moderate right and mild left neural\nforaminal narrowing.\n\nC6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.\n\nThere is no abnormality of the visualized prevertebral or paraspinal soft\ntissues. There is no cervical lymphadenopathy by size criteria.", "output": "1. Multilevel cervical spondylosis, with 3 mm retrolisthesis of C5 on C6. \nThere is moderate left C3-C4, C4-C5 and mild to moderate right C5-C6 neural\nforaminal narrowing. Mild spinal canal narrowing spanning C4-C5 and C5-C6.\n2. There is no cord signal abnormality.\n3. Additional findings as described above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is grade 1 retrolisthesis of L2 on L3. There is mild anterior\ncompression deformity of T12 vertebral body with no associated edema or\nepidural collection. Type 1 into ___ changes with no associated epidural\ncollection are noted along the L2 vertebral body inferior endplate. The\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc signal at L2-3, L4-5, and L5-S1. There\nis loss of intervertebral disc height at L2-3.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of neoplasm. The\nvisualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is disc bulge with facet joint arthropathywith no vertebral\ncanal or neural foraminal stenosis.\n\nAt L3-4 there is facet joint arthropathy and ligamentum flavum hypertrophy\nwithno vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is disc bulge with ligamentum flavum hypertrophy and facet joint\narthropathy resulting in moderate vertebral canal and moderate left neural\nforaminal stenosis.\n\nAt L5-S1 there is an asymmetric disc bulge to the right, with facet joint\narthropathy and ligamentum flavum hypertrophy resulting in severe right neural\nforaminal stenosis within no vertebral canal stenosis.", "output": "1. Multilevel degenerative changes as described, most pronounced at L5-S1\nwhere there is severe right neural foraminal stenosis.\n2. L4-5 moderate vertebral canal and moderate left neural foraminal stenosis.\n3. Chronic T12 vertebral body anterior wedge compression deformity." }, { "input": "Alignment is normal. There are mild changes of degenerative disc disease with\nloss of signal of the intervertebral discs on the T2 weighted images. \nVertebral body signal intensity appears normal. The spinal cord appears\nnormal in caliber and configuration.\nThere is a tiny midline protrusion of the C3-4 intervertebral disc that\ncontacts and slightly indents the anterior surface of the spinal cord. Facet\nand uncovertebral osteophytes produce mild left neural foraminal narrowing at\nthis level.\n\nAt C4-5, a tiny midline protrusion of the disc encroaches on the spinal canal\nand contacts the right anterior surface of the spinal cord. The neural\nforamina appear normal.\n\nAt C5-6, small intervertebral osteophytes encroach on the spinal canal and\nslightly indent the anterior surface of the spinal cord. There is moderate\nbilateral neural foraminal narrowing.\n\nAt C6-7, intervertebral osteophytes encroach on the spinal canal and flatten\nthe left anterior aspect of the spinal cord. Uncovertebral and facet\nosteophytes produce mild bilateral neural foraminal narrowing.\n\nThe C7-T1 level and the included portions of the upper thoracic spine\ndemonstrate no spinal canal or neural foraminal compromise.\nThere is no evidence of infection or neoplasm.", "output": "1. Mild degenerative disc disease with small disc protrusions and\nintervertebral osteophytes encroaching on the spinal cord and narrowing the\nneural foramina at several levels." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nLevoscoliosis of the lumbar spine is again noted. Grossly stable grade 1 L4\non L5 anterolisthesis is again seen.\n\nThere is a Schmorl's node seen along the superior endplate of L2 with mild\nanterior chronic wedging. Otherwise, vertebral body heights are grossly\nmaintained.\n\nL4-5 endplate type ___ ___ changes are noted.\n\nThe conus medullaris terminates at the level of L2. The visualized portion of\nthe spinal cord is grossly preserved in signal and caliber.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1: There is a right paracentral disc protrusion which indents the ventral\nthecal sac resulting in mild canal narrowing with right subarticular recess\nnarrowing. No frank neural foraminal narrowing is seen.\n\nL1-L2: Minimal posterior disc bulging flattens the ventral thecal sac without\ndefinite vertebral canal narrowing or neural foraminal narrowing.\n\nL2-L3: Mild left asymmetric posterior disc bulging is noted, with thickening\nof ligamentum flavum, trace bilateral joint facet effusions, and facet\narthropathy. This results in no significant canal narrowing, but left greater\nthan right subarticular recess narrowing and neural foraminal narrowing is\nmild on the right and moderate on the left. Nonspecific bilateral facet fluid\nis noted.\n\nL3-L4: A posterior disc bulge flattens the ventral thecal sac with mild canal\nnarrowing, bilateral subarticular recess narrowing, and moderate bilateral\nneural foraminal narrowing. Nonspecific bilateral facet fluid is noted.\n\nL4-L5: There is uncovering of the intervertebral disc with posterior disc\nbulging and a superimposed left foraminal disc protrusion. This combines with\nfacet arthropathy and thickening of ligamentum flavum to result in mild canal\nnarrowing with left subarticular recess narrowing, and moderate to severe\nbilateral neural foraminal narrowing. The disc bulge at this level contacts\nthe exiting left L4 nerve root. Nonspecific bilateral facet fluid is noted.\n\nL5-S1: A posterior disc bulge indents the ventral thecal sac without\nsignificant canal narrowing. There is bilateral subarticular recess narrowing\nand moderate left-sided neural foraminal narrowing. The disc bulge at this\nlevel contacts the exiting left L5 nerve root. Nonspecific bilateral facet\nfluid is noted.\n\nA portion of the described pelvic mass extends towards the exiting right S1\nnerve root (06:43) without distant contact. The more inferior nerve roots are\nbetter assessed on subsequent pelvic MRI examination.\n\nMultiple bilateral sacral Tarlov cysts are seen at the level of S2-S3.\n\nOTHER:\nThe patient's known, large, heterogeneous, irregular, partially cystic and\nhemorrhagic pelvic mass is incompletely imaged. Similarly, known venous\ninvasion and extends in involving the bilateral iliac veins and IVC is also\npartially imaged. Chronic severe right-sided hydronephrosis is partially\nimaged. T2 left-sided renal cysts are noted.", "output": "1. Study is moderately degraded by motion.\n2. Extensive heterogeneous irregular, partially cystic and partially\nhemorrhagic intrapelvic mass with extension to the bilateral iliac veins and\nIVC, better assessed on prior CT abdomen pelvis and subsequent MR pelvis\nexamination.\n3. Known extension and involvement of the right exiting sacral nerve roots is\nalso better assessed on pelvic MRI, not completely imaged on the lumbar spine\nportion of the examination.\n4. No definite evidence for osseous metastatic disease within the lumbar\nspine.\n5. Spondylosis of the lumbar spine, as detailed above, most notable at L4-L5\nwith mild canal narrowing, moderate to severe bilateral neural foraminal\nnarrowing, and disc bulge contacting the exiting left L4 nerve root.\n6. Please see concurrently obtained contrast pelvis MRI for description of\npelvic and sacral structures." }, { "input": "There is no evidence of ligamentous disruption identified.\n\nAt the craniocervical junction and C2-3 mild degenerative change seen. At\nC3-4 disc bulging and moderate left-sided and mild right-sided foraminal\nnarrowing.\n\nAt C4-5 disc bulging and bilateral mild-to-moderate foraminal narrowing seen.\n\nAt C5-6 level, disc and uncovertebral degenerative changes seen with moderate\nbilateral foraminal narrowing.\n\nAt C6-7 disc bulging and bilateral moderate foraminal narrowing seen.\n\nAt C4 and C5 level marrow edema is seen within the left articular processes\nsecondary to degenerative change.\n\nAt C7-T1 level, disc bulging and facet degenerative changes seen with marrow\nedema within the left C7 and T1 pedicles. There is severe narrowing of the\nleft foramen seen. There appears to be compression of the exiting left C8\nnerve root. Mild-to-moderate right foraminal narrowing is seen.\n\nAt T1-2 and T2-3 mild disc bulging seen without spinal stenosis.\n\nThe evaluation of the spinal cord signal is somewhat limited due to motion but\nthere is no obvious large area of intrinsic signal abnormality seen. No\nabnormal enhancement is identified.", "output": "1. Severe left foraminal narrowing at C7-T1 level which could compress the\nexiting is left C8 nerve root. Although the changes appear to be due to\nadvanced degenerative disease, CT can help for better characterization of bony\nstructures if clinically indicated.\n2. Multilevel degenerative changes at other levels with predominantly\nleft-sided foraminal narrowing.\n3. No signs of ligamentous disruption or intraspinal mass. No cord\ncompression.\n\nRECOMMENDATION(S): Cervical spine CT for better characterization of bony\nstructures if clinically indicated." }, { "input": "CERVICAL:\nThe craniocervical junction appears normal. The cervical cord is normal in\nmorphology and signal intensity. No myelopathic signal changes. No abnormal\nenhancing lesions. There is no compromise of the cervical cord in the spinal\ncanal. The vertebral body alignment is normal. Mild degenerative changes of\nthe cervical spine.\n\nAt the level C3-4: Facet joint arthropathy of the left C3-4 facet joint with a\nsmall associated facet joint effusion and adjacent extra-spinal synovial cyst.\nThis facet joint arthropathy with mild broad-based disc bulge results in\nmoderate narrowing of the left C3-4 neural foramina.\n\nThe rest of the neural foramina are patent.\n\nTHORACIC:\nThe thoracic cord is normal in signal intensity and morphology. No\nmyelopathic signal changes. No cord enhancement.\nVertebral body alignment is normal. Bone marrow signal intensity is normal.\nCentral posterior disc protrusions at the T2-3, T3-4 level and most prominent\nat the T6-7 levels result in effacement of the anterior CSF space and mild\ndeformation of the anterior aspect of the thoracic cord, but no obvious\nmyelopathic signal change.\nThe neural foramina patent.\n\nLUMBAR:\nThe cord terminates at the T12-L1 level. Normal signal intensity. No conus\nmasses.\n\nPlease note that the lumbar spine was not imaged in its entirety. The L1-L3\nvertebral bodies are normal in alignment. Small hemangioma in the L2\nvertebral body. There is no compromise of the conus or cauda equina nerve\nroots in the spinal canal or neural foramina.\n\nOTHER: Small to moderate gastric hiatal hernia. Small bilateral dependent\npleural effusions.", "output": "1. The cervicothoracic and lumbar cord are normal in morphology and signal\nintensity. No myelopathic signal changes. No abnormal enhancing cord\nlesions.\n2. Mild spondylotic changes of the cervical and thoracic spine as described\nabove.\n3. Small to moderate gastric hiatal hernia.\nFor brain findings please refer to the respective MR brain report." }, { "input": "There is mild 2 mm retrolisthesis of C5 on C6. Disc desiccation and loss of\ndisc height spanning C4-5 thru C6-7 is noted. Remainder of the disc heights\nare preserved. ___ type 2 endplate changes at C4-5 is noted. There is no\nsuspicious marrow signal. Vertebral body heights are maintained. There is no\nsignal abnormalities of the visualized cord. The visualized posterior fossa is\nunremarkable. The craniocervical junction and anterior atlantodental interval\nis unremarkable.\n\nC2-3 and C3-4: Unremarkable.\n\nC4-5: There is a prominent posterior disc osteophyte complex as well as\nbilateral uncovertebral arthropathy and facet arthropathy. There is mild\nspinal canal narrowing with minimal remodeling the ventral aspect of the cord\nas well as moderate bilateral neural foraminal narrowing.\n\nC5-6: There is a large posterior disc osteophyte complex slightly eccentric to\nthe left. Left greater than right uncovertebral arthropathy is noted. The disc\nosteophyte complex contacts and remodels the left ventral aspect of the cord\nresults in mild spinal canal narrowing. There is moderate left neural\nforaminal narrowing and no significant right neural foraminal narrowing.\n\nC6-7: There is a small posterior disc osteophyte complex as well as mild\nbilateral uncovertebral arthropathy. There is mild spinal canal narrowing and\nmild bilateral neural foraminal narrowing.\n\nC7-T1 through T3-4: There is no significant spinal canal or neural foraminal\nnarrowing. Perineural cysts in the right T3-4 and T5-6 neural foramen is\nnoted.\n\nOther: Prevertebral and paraspinous soft tissues are unremarkable.", "output": "At C5-6 there is a large disc osteophyte complex which remodels the left\nventral aspect of the cord resulting in mild spinal canal narrowing. In\naddition, there is moderate left neural foraminal narrowing\nAt C4-5, there is bilateral neural foraminal narrowing." }, { "input": "Numbering used a shown on series 2, image 8.\n\nLevoscoliosis on localizing images.\n\nMild disc desiccation and loss of height at L2-3 and L4-5 is noted. Remainder\nof the disc spaces are preserved.\nThere is 3 mm anterolisthesis of L4 on 5 is identified without evidence of\nspondylolysis.\n\nFat deposit/ hemangiomas of the L2 and L4 vertebral body noted with only\nsubtle STIR hyperintense signal. No suspicious marrow signal.\n\nThe conus terminates at the superior endplate of L1, within expected limits.\nThere is no signal abnormality of the visualized lower cord.\n\nT10-11 and T11-12: On sagittal images, no significant spinal canal or neural\nforaminal narrowing.\n\nT12-L1: On sagittal images, there appears to be a very small concentric disc\nbulge without significant spinal canal or neural foraminal narrowing.\n\nL1-2: Very small concentric disc bulge with suggestion of a small annular\nfissure without significant spinal canal or neural foraminal narrowing.\n\nL2-3: There is a small concentric disc bulge, mild bilateral facet arthropathy\nwithout significant spinal canal or neural foraminal narrowing.\n\nL3-4: There is a small concentric disc bulge slightly eccentric to the left\nwith annular fissure as well as mild to moderate bilateral facet arthropathy,\ndemonstrating 1-2 mm synovial cyst projecting posteriorly into the paraspinal\nsoft tissues on the right.\nThere is mild spinal canal narrowing and mild left-greater-than-right neural\nforaminal narrowing.\n\nL4-5:\nAnterolisthesis of L4 over L5, likely related to degenerative facet changes.\nThere is uncovering of the disc secondary to the anterolisthesis. There is\nsevere bilateral facet arthropathy as well as moderate unfolding ligamentum\nflavum. There is disc bulge, with posterior tendon left-sided component of\nextrusion.\nThe combination of findings results in moderate spinal canal narrowing and\nmoderate left greater than right neural foraminal narrowing.\nThe extra foraminal disc may contact the bilateral exiting L4 nerve roots as\nwell.\nThere is crowding of the bilateral subarticular recesses which contacts and\nmildly displaces the bilateral traversing L5 nerve roots, worse on the left.\n\nL5-S1: Small posterior disc bulge and moderate bilateral facet arthropathy.\nThere is no significant spinal canal or neural foraminal narrowing.\nThe disc bulge results in mild crowding of the subarticular recesses which\ncontacts but does not definitively displace the traversing nerve roots.\n\nPrevertebral soft tissues are unremarkable. Paraspinal soft tissues are also\nunremarkable. No evidence of ligamentous injury.", "output": "1. Multilevel, multifactorial degenerative changes in the lumbar spine from\nL2-S1 levels, most prominent at L4-5.\n2. L3-4: Diffuse disc bulge, with left-sided component, bilateral facet\ndegenerative changes, mild canal and left foraminal narrowing.\nL4-5: Gr 1 Anterolisthesis Diffuse disc bulge, with posterior and left-sided\nextrusion, causing indentation on the thecal sac outline, with moderate spinal\ncanal narrowing and moderate left greater than right neural foraminal and\nsubarticular zone narrowing.\n3. Additional findings as above.\nOsseous details could be better assessed with plain radiograph or CT if needed\ngiven the h/o fall." }, { "input": "Thoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc heights and signal are preserved. There\nis equivocal 4 mm T2 hyperintense nonenhancing signal of the anterior T4-T5\ncord (series 4, image 9) which may represent a demyelinating plaque. No other\nT2 hyperintense lesions are identified. There is no abnormal enhancement. \nThere is no spinal canal or neural foraminal narrowing. Visualize prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. A single 4 mm T2 hyperintense nonenhancing lesion of the anterior T4-T5\ncord, which may represent a demyelinating plaque. No other lesions\nidentified." }, { "input": "Alignment is maintained. There is a fracture through the C6 vertebral body\nwith a fluid cleft of edema. When comparing with CT from ___, the\nfracture is noted to traverse anterior bridging ossification. No additional\nfractures are identified. There is mild widening of the right C5-6 facet\njoint. There is prevertebral edema extending from the C2-T3. The spinal cord\nis normal in course and caliber except for indentation at C5-6 due to\nintervertebral osteophytes and ligamentum flavum thickening. There is no cord\nsignal abnormality. There is no definite epidural hematoma. There is edema in\nthe interspinous ligaments at C3-4 and C4-5. There is edema throughout the\nposterior paraspinal muscles.\n\nThere are uncovertebral and facet osteophytes causing neural foraminal\nnarrowing at left C3-4, left C4-5, bilateral C5-6 levels. The most severe\ndegree of stenosis is severe on the right at C5-6.", "output": "1. Fracture through anterior bridging ossification and the vertebral body of\nC6. No cord signal abnormality or definite epidural hematoma. There is\nmoderate deformity of the spinal cord\n2. Buckling of ligamentum flavum may be post-traumatic but no disruption is\nseen. Edema in the C3-4 and C5-6 interspinous ligaments is suggestive of mild\nligamentous injury without disruption. Mild widening of the right C5-6 facet\njoint. Normal cervical spinal alignment.\n3. Degenerative disc and joint disease causing moderate C5-6 spinal canal\nstenosis and varying levels of neural foraminal stenosis." }, { "input": "CERVICAL:\nAxial T2 weighted images are degraded by motion artifact. Postcontrast axial\nT1 weighted images are mildly limited by motion.\n\nThere are multiple small T2 hyperintense foci in the cord from C2 through C4\nlevels, with questionable punctate focus of faint contrast enhancement in the\ndorsal cord at C3 seen on sagittal postcontrast images only (16:8). There is\na punctate T2 hyperintense focus in the midline anterior cord at mid C6 level\nwith punctate associated contrast enhancement (6:8, 16:8, 18:27). There is a\nlinear T2 hyperintense lesion in the right lateral cord at C6-C7 (9:24, 6:7),\nwithout contrast enhancement. There is no evidence for cord expansion or\natrophy. These findings are new compared to the ___ MRI and\ncompatible with demyelinating disease.\n\nCerebellar tonsils are normally positioned. The brain parenchyma is better\nassessed on the brain MRI from approximately 13 hours earlier.\n\nVertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are seen. There are small central disc\nprotrusions at C3-C4, C4-C5, and C5-C6, slightly progressed since the ___ MRI, without significant spinal canal narrowing. There is no significant\nneural foraminal narrowing.\n\nTHORACIC:\nThere are 11 rib-bearing vertebrae and apparent transitional vertebra at the\nthoracolumbar junction. The conus medullaris terminates near the lower\nendplate of the transitional vertebra, which is labeled T12 for the purposes\nof this report. Detailed evaluation of spinal cord signal is limited by the\nlarge field of view. However, there are numerous small foci of T2\nhyperintensity throughout the thoracic cord, without atrophy or expansion. \nPostcontrast axial images are limited by motion artifact. Small foci of\ncontrast enhancement in the cord are seen on sagittal postcontrast images in\nthe midline at T6 and dorsally at T8 (images 17:8, 17:7).\n\nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. Alignment is normal. There is a prominent nerve root\nsleeve diverticulum in the left T1-T2 neural foramen. There is no appreciable\nspinal canal narrowing. At T9-T10, there is facet arthropathy with mild\nbilateral neural foraminal narrowing.\n\nOTHER:\nThere is a 4 mm right thyroid nodule on image 18:28, which does not warrant\nsonographic evaluation according to the ACR guidelines.", "output": "Numerous small T2 hyperintense foci in the cervical and thoracic spinal cord. \nPunctate associated foci of contrast enhancement is seen in the dorsal cord at\nC3, midline anterior cord at mid C6 level, midline cord at T6, and dorsal cord\nat T8. These findings are new compared to the cervical spine MRI from ___ and compatible with demyelinating disease." }, { "input": "MRI thoracic spine: The thoracic spine alignment is maintained. The signal\nintensity throughout the thoracic spinal cord is normal with no evidence of\nfocal or diffuse lesions. There is minimal spinal canal narrowing at the T7-8\nlevel due to a disc osteophyte complex (image 9, series 4, and image 3, series\n7). There is mild right T10-11 facet osteophytosis causing minimal\nright-sided neural foraminal narrowing (image 19, series 7 and image 5, series\n9). Otherwise, there is no significant spinal canal or neural foraminal\nnarrowing elsewhere. The spinal cord appears normal in caliber and\nconfiguration with no evidence of focal or diffuse lesions, the conus\nmedullaris terminates at the level of T12-L1 and is unremarkable.\n\nMRI of the lumbar spine: Increased signal within the L3 and L5 vertebrae with\ninternal low signal in a trabecular pattern is consistent with intraosseous\nhemangiomas (05: 6, 10). There is no evidence of infection or neoplasm.\nCord or cauda equina compression: no\nCord signal abnormality: no\nEpidural collection: no\nPlease note that imaging can make the anatomic diagnosis of cauda equina\nCOMPRESSION, but that cauda equina SYNDROME is a clinical diagnosis based on\nthe patient examination. Imaging can never make a diagnosis of cauda equina\nSYNDROME.\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 bilateral articular joint facet hypertrophy\ncausing minimal bilateral neural foraminal narrowing, there is no evidence of\nspinal canal stenosis.\n\nAt L4-5 level, there is desiccation and diffuse disc bulge causing mild\nanterior thecal sac deformity, contacting the traversing nerve roots\nbilaterally, more significant towards the left, there is mild spinal canal\nnarrowing, and additionally moderate bilateral articular joint facet\nhypertrophy.\n\nAt L5-S1 level, there is mild central disc bulge with no evidence of neural\nforaminal narrowing or spinal canal stenosis, there is mild bilateral\narticular joint facet hypertrophy.\n\nThe sacroiliac joints and the visualized paravertebral structures are grossly\nunremarkable.", "output": "1. No evidence of acute thoracic spinal cord compromise.\n2. Intraosseous hemangiomas within the L3 and L5 vertebrae.\n3. Minimal degenerative changes at the T7-8 and T10-11 vertebral levels.\n4. Degenerative changes identified at L4-5 level, more significant towards the\nleft." }, { "input": "Focus of increased signal is seen in the posterior aspect of the spinal cord\nat the craniocervical junction. (C1 level). A second focus of increased\nsignal is identified within the right side of the spinal cord at C3 level. No\nother foci of increased signal identified within the cervical spinal cord. \nFocus of increased signal is identified within the partially visualized pons\nand medulla. This findings are consistent with demyelinating disease. \nMultilevel mild degenerative changes identified with mild bulging from C3-4 to\nC6-7 level. There is no spinal stenosis or extrinsic spinal cord compression.", "output": "Focal signal abnormalities in the upper cervical spinal cord at C1 and C3\nlevels with the distribution suggestive of demyelinating disease. Mild\ndegenerative changes are seen." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. There are mild multilevel\nvertebral body height and intervertebral disc space loss with disc\ndesiccation. There is no suspicious marrow replacing lesion.\n\nC2-C3: There is a central disc protrusion with bilateral facet and\nuncovertebral joint osteophytes. There is no spinal canal stenosis. There is\nmild bilateral neural foraminal narrowing.\n\nC3-C4 There is a short segment STIR hyperintense spinal cord lesion measuring\n0.9 cm (7:8), which is present on the prior study, but better delineated on\nthe current exam. There is a central disc protrusion with bilateral facet and\nuncovertebral joint osteophytes. There is indentation of the ventral thecal\nsac without spinal canal stenosis. There is moderate left and mild right\nneural foraminal narrowing.\n\nC4-C5: There is a disc bulge with bilateral facet and uncovertebral joint\nosteophytes. There is mild spinal canal stenosis with spinal cord remodeling.\nThere is mild bilateral neural foraminal narrowing.\n\nC5-C6: There is a central left paracentral disc protrusion with mild spinal\ncord stenosis and cord remodeling. There is bilateral facet and uncovertebral\njoint osteophytes. There is no neural foraminal narrowing.\n\nC6-C7: There is a disc bulge with bilateral facet and uncovertebral joint\nosteophytes. There is mild spinal canal stenosis with cord remodeling, with\nmild right and no left neural foraminal narrowing.\n\nC7-T1: There is a disc bulge with bilateral facet and uncovertebral joint\nhypertrophy. There is mild spinal canal stenosis with moderate left and no\nright neural foraminal narrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. There arm all the\nmultilevel vertebral body height and intervertebral disc space loss. There is\nno suspicious marrow replacing lesion.\n\nThere are multiple short segment STIR hyperintense spinal cord lesions,\nmeasuring 1.2 cm at T2-T3 and 0.8 cm at T3-T4. There are mild multilevel\ndegenerative changes, most prominent at T11-T12 with a disc bulge, ligamentum\nflavum thickening, and facet osteophytes, with mild spinal canal stenosis,\nsevere right and no left neural foraminal narrowing.\n\nLUMBAR:\nThere are 6 lumbar type vertebral bodies with lumbarization of S1. For\ncounting purposes, the last well-formed vertebral body is designated as S1.\n\nThe alignment of the lumbar spine is maintained. There are minus multilevel\nloss of vertebral body heights and intervertebral disc space with disc\ndesiccation, and ___ type 2 endplate degenerative changes. There is no\nsuspicious marrow replacing lesion.\n\nThe conus terminates at L1-L2. There is no spinal cord compression or\ndeformity.\n\nT12-L1: There is no spinal canal or neural foraminal stenosis.\n\nL1-L2: There is a disc bulge with annular fissure, bilateral facet\nosteophytes, and ligamentum flavum thickening. There is a mild spinal canal\nstenosis, without neural foraminal narrowing.\n\nL2-L3: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet osteophytes, left greater than right. There is a mild spinal canal\nstenosis. There is no neural foraminal narrowing.\n\nL3-L4: There is a disc bulge with bilateral facet osteophytes, left greater\nthan right, which joint effusion. The bilateral traversing nerve roots are\ncompressed between the disc bulge and the facet osteophytes. There is\nmoderate to severe spinal canal stenosis, with severe left and moderate right\nneural foraminal narrowing, with impingement of the left exiting nerve root.\n\nL4-L5: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet osteophytes. The bilateral traversing nerve roots are compressed\nbetween the disc bulge and facet osteophytes. There is severe spinal canal\nstenosis with moderate left and mild right neural foraminal stenosis.\n\nL5-S1: There is a midline disc protrusion, larger on the right with annular\nfissure. There are bilateral facet osteophytes and ligamentum flavum\nthickening. The bilateral traversing nerve roots are compressed by this disc\nprotrusion. There is severe spinal canal stenosis. There is mild bilateral\nneural foraminal narrowing.", "output": "1. Multiple short-segment spinal cord lesions at C3-C4, T2-T3 and T3-T4\nlevels. Findings are suggestive of demyelinating process. If clinically\nconcerned for an acute demyelinating process, a follow up contrast-enhanced\nstudy could be obtained.\n2. No evidence of cord compression.\n3. Multilevel degenerative changes of the spine, with moderate lumbar spinal\ncanal stenosis and multilevel neural foraminal stenosis, as detailed above.\n\nNOTIFICATION: The above findings not in the residents overnight preliminary\nreport were emailed to ED QA nurses by ___, M.D. on\n___ at 1:25 ___, 5 minutes after discovery of the findings." }, { "input": "The study was performed as a follow-up to the recent noncontrast MRI findings\nperformed on ___.\n\nThere is diffuse enhancement corresponding to the T2-T3 spinal cord lesion\n(11:8, 13:12). The additional STIR hyperintense C3-C4 and T3-T4 spinal cord\nlesions seen on the prior study do not demonstrate enhancement.\n\nPlease refer to recent entire spine study for additional findings, including\nmultilevel degenerative changes of the spine, which are not adequately\nevaluated on this study.", "output": "1. Corresponding enhancement of the T2-T3 spinal cord lesion, suggestive of\nacute demyelinating lesion.\n2. Additional C3-C4 and T3-T4 spinal cord lesions seen on the prior study do\nnot demonstrate corresponding enhancement.\n3. Please refer to dedicated spine MRI dated ___ for additional\ndetails, including multilevel degenerative changes." }, { "input": "Sequence and prior imaging studies demonstrated there are 7 cervical vertebrae\nwith bilateral cervical ribs at C7, 12 rib-bearing vertebrae with short ribs\nat T12, and 5 lumbar-type vertebrae. The numbering is documented on images\n2:7, 8:11, and 10:10.\n\nTHORACIC SPINE:\n\nThere has been T11 vertebrectomy with cage graft placement, and instrumented\nposterior fusion of T9 through L1, as seen previously. The hardware is not\nassessed by MRI. Evaluation of marrow signal, alignment, spinal canal and\nneural foramina at the surgical levels is markedly limited by hardware related\nartifacts.\n\nFrom C7 through T8: There is no concerning bone marrow signal abnormality,\nand no pathologic contrast enhancement. Alignment is preserved. Spinal cord\nsignal intensity is normal.\n\nAt C6-7, a left paracentral disc protrusion indents the ventral thecal sac but\ndoes not contact the spinal cord.\n\nAt C7-T1, a small left paracentral disc protrusion minimally indents the\nventral thecal sac.\n\nAt T1-T2, there is a mild disc bulge without spinal canal narrowing.\n\nFrom T2-T3 through T5-T6, there is no spinal canal or neural foraminal\nnarrowing.\n\nAt T6-T7, there is a left paracentral disc protrusion which does not contact\nthe spinal cord. However, the left ventral spinal cord is mildly remodeled.\n\nAt T7-T8, there is no spinal canal or neural foraminal narrowing.\n\nAt T8-T9, there is mild facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nLUMBAR SPINE:\n\nVertebral body heights are preserved. Minimal retrolisthesis of L1 on L2 was\nmore conspicuous on the ___ CT. Grade 1 anterolisthesis of L5 on S1\nis unchanged, with bilateral L5 pars interarticularis defects which were\nbetter demonstrated on prior CTs. Discogenic bone marrow changes are present\nin the endplates at L1-2 and L2-3. No concerning bone marrow signal\nabnormalities are seen.\n\nThe conus medullaris terminates at T12-L1.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-2, there is a mild disc bulge and mild to moderate facet arthropathy. \nThere is no significant spinal canal narrowing. Evaluation of the neural\nforamina is limited by hardware related artifacts. Mild neural foraminal\nnarrowing is not excluded, without evidence for nerve root compression.\n\nAt L2-3, there is a disc bulge and moderate facet arthropathy. There is a 1.4\nx 0.7 x 2.6 (AP, transverse, craniocaudad) extradural lesion in the left\naspect of the spinal canal, abutting the left lamina, left facet joint, and\nthe left paracentral aspect of the intervertebral disc. It appears to have a\nsmall tail extending inferiorly below the left L3 lamina, images 10:9 and\n12:9. This lesion demonstrates low signal on T2 weighted images, intermediate\nsignal on precontrast T1 weighted images, and no contrast enhancement. It\nappeared hyperdense, but not calcified, on the ___ CT. This is most\nsuggestive of a synovial cyst of the left facet joint, with inspissated\nsecretions. A free disc fragment is less likely, given the extension below\nthe left L3 lamina. The left subarticular zone is obliterated with\ncompression of the traversing L3 nerve root. The thecal sac is displaced to\nthe right and moderately to severely narrowed with crowding of the intrathecal\nnerve roots. The left neural foramen is severely narrowed with impingement\nand compression of the exiting L2 nerve root. The right neural foramen is\nmildly narrowed without evidence for neural impingement.\n\nAt L3-4, there is a disc bulge and moderate facet arthropathy. There is no\nspinal canal narrowing. There is mild to moderate bilateral neural foraminal\nnarrowing.\n\nAt L4-5, there is a disc bulge and right greater than left moderate facet\narthropathy. There is no spinal canal narrowing. There is moderate bilateral\nneural foraminal narrowing with abutment of bilateral exiting L4 nerve roots.\n\nAt L5-S1, the disc is uncovered by the anterolisthesis with a bulge. There is\nmoderate, right greater than left facet arthropathy. The traversing right S1\nnerve root is abutted by the disc bulge without compression. The remainder of\nthe spinal canal is not significantly narrowed. The neural foramina are\nforeshortened and moderately narrowed with impingement of the exiting right L5\nnerve root and abutment of the exiting left L5 nerve root.\n\nOTHER:\n\nIn the interpolar left kidney, there a 1.1 cm round exophytic lesion with low\nsignal on T2 weighted images, intermediate signal on precontrast T1 weighted\nimages, and heterogeneous signal on postcontrast T1 weighted images. Its size\nappears stable dating back to ___ thoracic spine CT, suggesting\nhemorrhagic or otherwise complicated cyst.\n\nThere are 2 medially projecting lesions in the lower pole of the left kidney. \nThe more anterior oval 2 cm lesion corresponds to a simple cyst. The more\nposterior 0.9 cm round lesion has low signal on T2 weighted images,\nintermediate to low signal on precontrast T1 weighted images, and no clear\nevidence for contrast enhancement on postcontrast T1 weighted images. Its\nsize is stable dating back to ___ lumbar spine CT, suggesting a\nhemorrhagic or otherwise complicated cyst.\n\nMultiple T2 hyperintense lesions in the right kidney are compatible with\ncysts.", "output": "1. 7 cervical vertebrae with bilateral cervical ribs at C7, 12 rib-bearing\nvertebrae with short ribs at T12, and 5 lumbar-type vertebrae are present.\n2. Status post T11 vertebrectomy and instrumented posterior fusion of T9\nthrough L1. Evaluation at surgical levels is almost entirely degraded by\nhardware related artifacts.\n3. At T6-T7, there is a left paracentral disc protrusion which does not\ncontact the spinal cord. However, the ventral surface of the cord is\nremodeled, without cord signal abnormality.\n4. At L2-3, there is a large nonenhancing, T2 hyperintense and hyperdense\nextradural lesion in the left aspect of the spinal canal, abutting the left\nlamina, facet joint, and left paracentral aspect of the intervertebral disc. \nThe lesion appears to have a tail extending inferiorly below the left L3\nlamina, suggesting that it represents a synovial cyst related to the left L2-3\nfacet joint, rather than a free disc fragment.\n5. The left epidural lesion at L2-3 moderately to severely compresses thecal\nsac with crowding of the intrathecal nerve roots, and it also obliterates the\nleft subarticular zone with compression of the left L3 nerve root. Disc bulge\nand facet arthropathy at L2-3 result in severe left neural foraminal narrowing\nwith impingement of the exiting left L2 nerve root.\n6. Mild-to-moderate neural foraminal narrowing at L3-4 and moderate neural\nforaminal narrowing at L4-5, with abutment of bilateral exiting L4 nerve roots\nat L4-5.\n7. Unchanged grade 1 anterolisthesis at L5-S1 with bilateral L5 pars defects,\nwhich in combination with a disc bulge and facet arthropathy causes moderate\nneural foraminal narrowing with impingement of the exiting right L5 nerve root\nand abutment of the exiting left L5 nerve root.\n8. 2 indeterminate lesions in the left kidney, in the lateral interpolar\nregion and medial lower pole, which appears stable in size dating back to ___\nand ___, respectively, most likely hemorrhagic or otherwise complicated\ncysts." }, { "input": "The exam is suboptimal secondary to motion artifact. Incidentally noted is a\nhemangioma within the T12 vertebral body as seen on the previous examination.\nBone marrow signal is otherwise normal. There is no abnormal enhancement. The\nvertebral body heights and disc spaces in the lumbar spine are preserved.\nThere is loss of disc space height, multiple Schmorl's nodes and anterior\nwedging of multiple thoracic vertebral bodies as seen on the previous\nexamination. There is no high-grade spinal canal or neural foraminal narrowing\nand no evidence for cord compression.\n\nNonspecific edema is seen in the soft tissues overlying the lower lumbar\nspine. There is a small amount of pelvic free fluid.", "output": "1. No evidence for discitis- osteomyelitis.\n2. Small amount of pelvic free fluid." }, { "input": "There is 3 mm anterolisthesis of L4 on L5. Vertebral body height and\nalignment is otherwise preserved. There is mild degenerative disc disease,\nmost pronounced at L5-S1 where there is mild-to-moderate disc space height\nloss with ___ type 2 degenerative endplate changes. Bone marrow signal\nintensity is otherwise within normal limits.\n\nThe terminal cord is normal in caliber and configuration. The conus\nterminates normally at the L1 level.\n\nAt T12-L1, L1-L2 and L2-L3, there is no spinal canal stenosis or neural\nforaminal narrowing.\n\nAt L3-L4, there is a disc bulge which partially effaces lateral recesses\nbilaterally and at least contacts the traversing L4 nerve roots (series 7,\nimage 25). In addition, there is, Facet joint arthropathy with small left\nfacet joint effusion and moderate ligamentum flavum thickening which results\nin mild right neural foraminal narrowing but no spinal canal stenosis or left\nneural foraminal narrowing.\n\nAt L4-L5, there is the previously mentioned anterolisthesis, a disc bulge with\nsevere facet joint arthropathy and small left facet joint effusion as well as\nsevere ligamentum flavum thickening which results in moderate to severe spinal\ncanal stenosis with a minimal amount of CSF still visualized between the\nindividual nerve roots. In addition, there is severe bilateral neural\nforaminal narrowing with compression of the right and at least remodeling of\nthe left L4 nerve roots within the neuroforamen. There is also effacement of\nthe lateral recesses bilaterally with compression of the traversing L5 nerve\nroots.\n\nAt L5-S1, there is a disc bulge which contacts the traversing S1 nerve root\n(series 6, image 18). In addition, there is facet joint arthropathy and mild\nligamentum flavum thickening which results in severe left and moderate right\nneural foraminal narrowing with at least remodeling of the left L5 nerve root\nwithin the neuroforamen.\n\nSubcentimeter T2 hyperintense lesion in the left kidney most likely represents\na renal cyst.", "output": "1. 3 mm anterolisthesis at L4-L5 with moderate to severe spinal canal stenosis\nand only a minimal amount of CSF still visualized between the individual nerve\nroots, compression of the bilateral traversing L5 nerve roots and severe\nbilateral neural foraminal narrowing with compression of at least the right L4\nnerve root.\n2. Disc bulges at L3-L4 and L5-S1 as at least contact if not compress the\ntraversing nerve roots.\n3. L5-S1 severe left and moderate right neural foraminal narrowing with at\nleast remodeling if not compression of the left L5 nerve root." }, { "input": "CERVICAL:\n2 mm anterolisthesis of C3 on C4 is identified likely degenerative in nature. \nOtherwise, the remainder the cervical alignment is anatomic. Mild ___ type\n2 C5-C6 endplate changes are identified. Otherwise, there is no suspicious\nmarrow signal. Loss of disc height is moderate to at C5-C6. The visualized\nposterior fossa is unremarkable. There is no prevertebral soft tissue\nswelling. Allowing for motion artifact, the anterior and posterior\nlongitudinal ligaments, ligamentum flavum and interspinous ligaments appear\nintact.\n\nT2 and STIR hyperintense signal of the C4-C5 cord is identified.\n\nC2-C3: A small central protrusion does not narrow the spinal canal. There is\nno significant neural foraminal narrowing.\n\nC3-C4: A central protrusion and thickening of the ligamentum flavum results\nin moderate spinal canal narrowing, remodeling the ventral aspect of the cord.\nUncovertebral and facet arthropathy results in mild to moderate bilateral\nneural foraminal narrowing.\n\nC4-C5: A large central protrusion results in severe spinal canal narrowing,\ncompressing the cord. There is T2/STIR hyperintense cord signal, concerning\nfor edema pattern versus myelomalacia. Uncovertebral and facet arthropathy\nresults in mild bilateral neural foraminal narrowing.\n\nC5-C6: A central protrusion with intervertebral osteophytes results in\nmoderate spinal canal narrowing, remodeling the ventral aspect of the cord. \nUncovertebral and facet arthropathy results in what appears to be severe\nbilateral neural foraminal narrowing.\n\nC6-C7: A central protrusion with intervertebral osteophytes results in\nmoderate to severe spinal canal narrowing, remodeling the cord. Uncovertebral\nand facet arthropathy results in moderate right and mild left neural foraminal\nnarrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc heights are maintained. There is\nno signal abnormality of the thoracic cord. There is no evidence for\nligamentous injury. Mild multilevel degenerative changes do not result in\nsignificant spinal canal or neural foraminal narrowing. Visualize\nprevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR:\nLumbar alignment is anatomic. Vertebral body heights are preserved. \nDegenerative loss of disc height and signal is severe at L5-S1 with endplate\nsclerosis as well as mixed ___ 1 and 2 endplate changes. The conus\nmedullaris terminates at inferior endplate of L1, within expected limits. \nThere is no signal abnormality of the terminal cord.\n\nL1-L2: Mild degenerative changes do not result in significant spinal canal or\nneural foraminal narrowing.\n\nL2-L3 through L4-L5: Disc bulges and thickening of the ligamentum flavum\nresults in mild spinal canal narrowing. In combination with facet\narthropathy, there is mild left-greater-than-right bilateral neural foraminal\nnarrowing.\n\nL5-S1: A disc bulge does not significantly narrow the spinal canal. Facet\narthropathy in conjunction with loss of disc height results in moderate to\nsevere bilateral neural foraminal narrowing (series 11, image 15 and 5).\n\nThere is an incompletely characterize 7 mm T2 hyperintense cysts exophytic\ncystic lesion of the left superior renal pole (series 12, image 16),\nstatistically likely representing a simple cyst. Nodular thickening of the\nanterior limb of the left adrenal gland (series 12, image 15) is also\nincompletely characterized. The remainder of the visualize prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. There is a large C4-C5 disc protrusion, which results in severe spinal\ncanal narrowing, compressing the cord, resulting in cord edema pattern.\n2. Additional degenerative changes including moderate to severe C6-C7 spinal\ncanal narrowing, remodeling the cord without underlying cord signal change,\nsevere C5-C6 neural foraminal narrowing and moderate to severe bilateral L5-S1\nneural foraminal narrowing.\n3. Incidental note of nodular thickening of the anterior limb of the left\nadrenal gland, incompletely characterize. This could be further evaluated\ndedicated adrenal mass protocol.\n\nRECOMMENDATION(S): Incidental note of apparent nodular thickening of the\nanterior limb of the left adrenal gland, incompletely characterize. While\nthis could simply represent nodular hyperplasia, further evaluation could be\nperformed with dedicated adrenal mass protocol.\n\nNOTIFICATION: The findings of impression 1 was discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 9:50 AM, 3 minutes\nafter discovery of the findings." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. Vertebral body heights are\nmaintained. There is loss of disc height and signal at multiple levels in\nkeeping with disc degeneration. The posterior fossa structures are\nunremarkable. There is a focal area of T2 signal abnormality in the cervical\nspinal cord at the level of C4-C5 vertebrae, new compared to the prior MRI\nfrom ___. This is most likely in keeping with myelomalacia. There are ___\ntype 1 changes at C6-C7. The marrow signal is otherwise unremarkable.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt C2-C3, neural foramen and spinal canal are patent.\n\nAt C3-C4, there is central disc protrusion causing moderate spinal canal\nstenosis. Also seen is bilateral uncovertebral and facet arthropathy causing\nmoderate to severe right and mild left neural foramen narrowing.\n\nAt C4-C5, there is central disc protrusion causing moderate to severe spinal\ncanal stenosis. Also seen is bilateral uncovertebral and facet arthropathy\ncausing moderate bilateral neural foramen narrowing.\n\nAt C5-C6, there is central disc protrusion causing severe spinal canal\nstenosis. Also seen is bilateral uncovertebral and facet arthropathy causing\nmoderate to severe bilateral neural foramen narrowing.\n\nAt C6-C7, there is central disc protrusion indenting the ventral thecal sac\ncausing mild-to-moderate spinal canal stenosis. Also seen is bilateral\nuncovertebral and facet arthropathy causing mild right and moderate left\nneural foraminal narrowing.\n\nAt C7-T1, there is central disc protrusion with superimposed left paracentral\ndisc protrusion indenting the ventral thecal sac causing cord remodeling. \nAlso seen is bilateral uncovertebral and facet arthropathy causing mild\nbilateral neural foraminal narrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained. The prevertebral, paravertebral and paraspinal soft tissues\nappear unremarkable. The mediastinum appears unremarkable. Visualized lung\nparenchyma is clear. The visualized thoracic spinal cord appears\n\nThere is mild right paracentral disc protrusion at T5-T6 indenting the ventral\nthecal sac. The neural foramen and spinal canal are patent at all levels. \nThere is no abnormal enhancement or epidural abscess.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained. There is a focal area of low T1/T2 signal in the body of L2,\nin keeping with a bone island, unchanged compared to prior study from ___. \nThe marrow signal is otherwise unremarkable. There is loss of disc height and\nsignal at L4-L5 and L5-S1 in keeping with disc degeneration.\n\nThe visualized lower thoracic spine appears unremarkable. The conus\nterminates at L1-L2. The prevertebral, paravertebral and paraspinal soft\ntissues appear unremarkable.\n\nAt T12-L1 to L3-L4, neural foramen and spinal canal are patent.\n\nL4-L5, there is loss of disc height and signal with broad-based disc bulge and\nsuperimposed central disc protrusion indenting the ventral thecal sac. Also\nseen is mild bilateral facet arthropathy. Bilateral neural foramen are\npatent.\n\nAt L5-S1, there is broad-based disc bulge with bilateral facet arthropathy\nwithout neural foramina or spinal canal stenosis.\n\nThere is no evidence of abnormal enhancement, epidural abscess or phlegmon.", "output": "1. No evidence of epidural abscess or abnormal enhancement. No findings to\nindicate underlying infection.\n2. New focal area of cord signal abnormality at C4-C5 , likely secondary to\nmyelomalacia as described above.\n3. Multilevel multifactorial degenerative disease of the cervical spine, most\nsevere at C5-C6 with moderate to severe neural foramen narrowing and severe\nspinal canal stenosis as described above.\n4. Minimal degenerative disc disease involving the thoracic and lumbar spine\nwithout neural foramina or spinal canal stenosis at any level." }, { "input": "There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation. The signal intensity in the bone marrow is slightly\nheterogeneous consistent with bone marrow replacement for fat ___ type 2\nendplate changes). The conus medullaris terminates at the level of L1-L2.\nThere is no spinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: There is a mild posterior disc bulge combining with thickening of the\nligamentum flavum and facet arthropathy to result in minimal canal stenosis\nwith mild right and mild-to-moderate left neural foraminal narrowing.\n\nL3-L4: There is disc desiccation and mild diffuse disc bulge, causing mild\nbilateral neural foraminal narrowing, with no significant spinal canal\nstenosis.\n\nL4-L5: There is a posterior disc bulge flattening the ventral thecal sac and\nresulting in mild canal stenosis with moderate to severe right and moderate\nleft neural foraminal narrowing. Of note, the disc bulge at this level\ncontacts the extraforaminal bilateral L4 exiting nerve roots, left greater\nthan right.\n\nL5-S1: There is a posterior disc bulge indenting the ventral thecal sac\nwithout significant canal stenosis. However, there is moderate to severe\nright and moderate left neural foraminal narrowing. The disc bulge at this\nlevel contacts the bilateral exiting L5 nerve roots.\n\nAn exophytic T2 hyperintense left renal cyst is incidentally noted.", "output": "1. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most significant at L4-L5 and L5-S1 with moderate to severe right and\nmoderate left neural foraminal narrowing identified at both levels." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nare maintained at all levels. The marrow signal is unremarkable.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable. There is fatty atrophy of the right parotid gland. No abnormal\nenhancement is seen on postcontrast images.\n\nThere is a focal area of T2/stir hyperintensity in the cervical spinal cord at\nthe level of C7-T1, nonspecific, could be secondary to myelomalacia or cord\nedema.\n\nThere is a multiloculated cystic structure of occupying the extra-axial space\npresent along the dorsal aspect of the spinal cord extending from the level of\nC6 vertebrae (image 11:30 to the level of T3-T4 vertebrae (series 12:16). \nThere is linear filling form enhancement within this multiloculated cystic\nstructure extending from the lower cervical to the upper thoracic spine,\nfavored to be ___. This cystic multiloculated lesion exerts mass effect on\nthe cervical and upper thoracic spinal cord displacing it anteriorly. This is\nfavored to be a multiloculated arachnoid cyst. Comparison with prior studies\nif available would be helpful.\n\nThe diffusion weighted imaging is markedly limited given the motion artifact\nbut no definite gross cord infarct is seen.\n\nAt C2-C3, there is central disc osteophyte complex indenting the ventral\nthecal sac. Uncovertebral and facet arthropathy results in mild bilateral\nneural foramen narrowing.\n\nAt C3-C4, central disc osteophyte complex indents the ventral thecal sac and\nventral aspect of the cord. Bilateral uncovertebral and facet arthropathy\nresults in moderate right and mild left neural foramen narrowing.\n\nAt C4-C5, there is central disc osteophyte complex indenting the ventral\naspect of the cord. Bilateral uncovertebral and facet arthropathy results in\nsevere right and moderate left neural foraminal narrowing.\n\nAt C5-C6, central disc osteophyte complex indents the ventral aspect of the\ncord remodeling it. Bilateral uncovertebral and facet arthropathy results in\nmoderate bilateral neural foramen narrowing.\n\nAt C6-C7, the spinal cord assessed displaced anteriorly given the presence of\ndorsal multiloculated cystic structure. In addition, bilateral uncovertebral\nand facet arthropathy results in moderate right and severe left neural foramen\nnarrowing.\n\nAt C7-T1, there is mass effect on the cervical spinal cord given the dorsal\ncystic multiloculated lesion. Bilateral neural foramen are patent.\n\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. No abnormal marrow signal is seen. The\nmultiloculated cystic lesion along the dorsal aspect of the spinal cord\nextends down up to the level of T3-T4 vertebrae as described above. There is\nassociated mass effect on the thoracic spinal cord. However, no abnormal cord\nsignal or enhancement is seen.\n\nAortic dissection is partly visualized and better evaluated on recent prior\noutside chest CT. There is atelectasis in bilateral visualized upper lung\nzones. Also seen are trace bilateral pleural effusions.\n\nThere is a small central disc protrusion at T3-T4 indenting the ventral thecal\nsac. The neural foramen and spinal canal are otherwise patent at all other\nlevels.\n\n\nLUMBAR:\nThe numbering of the lumbar spine is based on the cone-down from the level of\nC2 vertebrae. The alignment of the lumbar spine is maintained. The vertebral\nbody heights are maintained at all levels. No abnormal marrow signal is seen.\n\nThe visualized lower spinal cord appears unremarkable with the conus\nterminating at T12-L1. There is clumping of the nerve roots posteriorly with\nenhancement on postcontrast images raising the possibility of arachnoiditis.\n\nPartly visualized is cholelithiasis. There are multiple simple cysts in\nbilateral kidneys, the largest in the interpolar region of right kidney\nmeasuring approximately 2.3 cm. The visualized bilateral sacroiliac joints\nappear unremarkable.\n\nAt T12-L1, there is mild loss of intervertebral disc height and signal. \nBilateral neural foramen and spinal canal are patent.\n\nAt L1-L2, there is mild loss of intervertebral disc height and signal with\nbroad-based disc bulge. Bilateral neural foramen and spinal canal are patent.\n\nAt L2-L3: , there is loss of intervertebral disc height and signal with\nbroad-based disc bulge, bilateral facet arthropathy and ligamentum flavum\nthickening causing mild bilateral neural foramen narrowing. The spinal canal\nis patent.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc bulge,\nbilateral facet arthropathy and ligamentum flavum thickening resulting in\nmoderate to severe bilateral neural foramen narrowing. The spinal canal is\npatent.\n\nAt L4-L5, there is loss of disc height and signal with broad-based disc bulge\nand bilateral facet arthropathy resulting in moderate bilateral neural foramen\nnarrowing. The spinal canal is patent.\n\nAt L5-S1, there is loss of disc height and signal with broad-based disc bulge.\nBilateral neural foramen and spinal canal are patent", "output": "1. No evidence of cord markedly limited diffusion weighted imaging given the\npresence of motion artifact. No definite gross cord infarct is seen.\n2. Focal cord signal abnormality at the level of C6-C7 vertebrae, a\nmyelomalacia versus cord edema. Comparison with prior studies can be helpful\nif available.\n3. Multiloculated cystic structure on the dorsal aspect of the spinal cord\ndisplacing the cord anteriorly causing mass effect and cord compression. \nThere is a linear filling form enhancement within this multiloculated cystic\nstructure, favored to be vascular in etiology. This is in indeterminate but\nfavored to be an an arachnoid cyst.\n4. Mildly thickened and enhancing nerve roots in the lumbar spine which appear\nclumped posteriorly along the thecal sac suggestive of mild arachnoiditis.\n5. Aortic dissection, partly visualized and better evaluated on recent prior\noutside chest CT.\n6. Multilevel multifactorial degenerative disease of the cervical, thoracic\nand lumbar spine, worst at L3-L4 with moderate to severe bilateral neural\nforamen narrowing as described above.\n7. Incidentally seen is cholelithiasis and renal cysts.\n\nNOTIFICATION: The primary team was aware of these findings before these\ninterpretation (Dr. ___ and ___, ACNP-BC pg ___." }, { "input": "MRI CERVICAL AND THORACIC SPINE:\n\nAxial gradient echo images, and post and postcontrast sagittal and axial T1\nweighted images, are moderately limited by motion. Precontrast sagittal T1\nand T2 weighted images from C5 through T4 are mildly limited by motion.\n\nCervical and visualized upper thoracic vertebral body heights are preserved. \nNo concerning bone marrow signal abnormalities are seen. There is minimal\nanterolisthesis of C7 on T1.\n\nAgain seen is a loculated extra-axial collection posterior and lateral to the\ncord from C5-C6 through T3-T4 levels. Axial images suggest that this\ncollection is intradural, rather than extradural. Previously, this collection\ndemonstrated high signal on T2 weighted images. Currently, it demonstrates\npredominantly low signal on T2 weighted images and low signal on gradient echo\nimages. While gradient echo images are limited by motion, some blooming\nartifact may be present. The collection is isointense to the spinal cord on\nprecontrast T1 weighted images. The right aspect of the collection at C3\ndemonstrates contrast enhancement which appear slightly more confluent than on\nthe prior MRI, though evaluation is limited by motion artifact.\n\nThe above described collection displaces the spinal cord anteriorly and\nremodels at dorsal lateral surfaces. The collection is largest at the level\nof T2, where the cord is compressed. The previous MRI raises the question of\ncord hyperintensity at the level of C7-T1, but this was likely artifactual, as\nit is not seen on the present MRI. Sagittal T2 weighted images of the present\nMRI appear to demonstrate T2 hyperintensity within the cord at the level of\nT3, image 10:10, more conspicuous than on the prior MRI; this may also be\nartifactual. Axial T2 weighted images do not cover the level of T3.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa is unremarkable.\n\nThe craniocervical junction and C1-C2 levels are unremarkable.\n\nC2-C3: Small central disc protrusion without spinal canal narrowing. Mild\nbilateral facet arthropathy without neural foraminal narrowing. 3 mm synovial\ncyst projects posteriorly from the right facet joint into the right posterior\nparavertebral fat.\n\nC3-C4: Small central disc protrusion without spinal canal narrowing. \nBilateral facet and uncovertebral osteophytes without significant neural\nforaminal narrowing.\n\nC4-C5: Shallow broad-based disc protrusion with endplate osteophytes the\nventral thecal sac but does not contact the spinal cord. Moderate right and\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC5-C6: Broad-based disc protrusion with endplate osteophytes indent the\nventral thecal sac. While they do not contact the spinal cord, the ventral\nsurface of the cord appears minimally flattened. Moderate right and severe\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Broad-based endplate osteophyte ridge indents the ventral thecal sac\nbut does not contact the spinal cord. Mild to moderate bilateral neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nC7-T1: There is a minimal anterolisthesis with a mild disc bulge. There is\nno mass effect on the ventral spinal cord or neural foraminal narrowing.\n\nAt T1-T2, T3-T4, and T4-T5, there are mild disc bulges without mass effect on\nthe ventral spinal cord.\n\n\nMRI THORACIC SPINE:\n\nImages are somewhat limited by motion artifact. There is an apparent vascular\nloop at the level of the intradural collection in the right aspect of the\nspinal canal at T3, image 16:87, as seen on the ___ postcontrast\nMRI images. This appears to be related to a right-sided vein. No evidence\nfor an arteriovenous malformation is seen on limited evaluation.\n\nOTHER:\n\nThe known thoracic aortic dissection is again partially visualized.", "output": "1. Loculated intradural collection posterior and lateral to the spinal cord\nfrom C5-C6 through T3-T4 levels appear stable in size. It now demonstrates\nlow T2 signal compared to high T2 signal previously, with some evidence of\nblooming on motion limited gradient echo images, suggesting evolution of blood\nproducts. Postcontrast images appear to demonstrate slightly more solid\ncontrast enhancement of the right aspect of the collection at T3, but this is\nmost likely related to motion artifact, as the postcontrast images of the\nprior MRI, as well as the present MRA, suggest a vascular loop in this\nlocation related to a right-sided vein. These findings suggest a hematoma. \nNo conclusive evidence for an arteriovenous malformation is seen on the motion\nlimited MRA.\n2. The above-described collection displaces the spinal cord anteriorly and\ndeforms in its posterolateral surfaces. The collection is largest at T2,\nwhere it compresses the spinal cord. Previously suspected cord signal\nabnormality at C7-T1 is not confirmed. Sagittal T2 weighted images suggest a\nmore conspicuous cord signal abnormality at T3 than on the prior MRI, but this\nmay be related to motion artifact; there are no axial T2 weighted images\nthrough the level of T3.\n3. Multilevel cervical and upper thoracic degenerative disease.\n4. The known thoracic aortic dissection is again partially visualized.\n\nRECOMMENDATION(S): The motion limited MRA is not sufficient for definitively\nexcluding an arteriovenous malformation or fistula. If there is a high\nclinical concern for an arteriovenous malformation or fistula, then\nconventional angiography should be considered." }, { "input": "MRI CERVICAL AND THORACIC SPINE:\n\nAxial gradient echo images, and post and postcontrast sagittal and axial T1\nweighted images, are moderately limited by motion. Precontrast sagittal T1\nand T2 weighted images from C5 through T4 are mildly limited by motion.\n\nCervical and visualized upper thoracic vertebral body heights are preserved. \nNo concerning bone marrow signal abnormalities are seen. There is minimal\nanterolisthesis of C7 on T1.\n\nAgain seen is a loculated extra-axial collection posterior and lateral to the\ncord from C5-C6 through T3-T4 levels. Axial images suggest that this\ncollection is intradural, rather than extradural. Previously, this collection\ndemonstrated high signal on T2 weighted images. Currently, it demonstrates\npredominantly low signal on T2 weighted images and low signal on gradient echo\nimages. While gradient echo images are limited by motion, some blooming\nartifact may be present. The collection is isointense to the spinal cord on\nprecontrast T1 weighted images. The right aspect of the collection at C3\ndemonstrates contrast enhancement which appear slightly more confluent than on\nthe prior MRI, though evaluation is limited by motion artifact.\n\nThe above described collection displaces the spinal cord anteriorly and\nremodels at dorsal lateral surfaces. The collection is largest at the level\nof T2, where the cord is compressed. The previous MRI raises the question of\ncord hyperintensity at the level of C7-T1, but this was likely artifactual, as\nit is not seen on the present MRI. Sagittal T2 weighted images of the present\nMRI appear to demonstrate T2 hyperintensity within the cord at the level of\nT3, image 10:10, more conspicuous than on the prior MRI; this may also be\nartifactual. Axial T2 weighted images do not cover the level of T3.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa is unremarkable.\n\nThe craniocervical junction and C1-C2 levels are unremarkable.\n\nC2-C3: Small central disc protrusion without spinal canal narrowing. Mild\nbilateral facet arthropathy without neural foraminal narrowing. 3 mm synovial\ncyst projects posteriorly from the right facet joint into the right posterior\nparavertebral fat.\n\nC3-C4: Small central disc protrusion without spinal canal narrowing. \nBilateral facet and uncovertebral osteophytes without significant neural\nforaminal narrowing.\n\nC4-C5: Shallow broad-based disc protrusion with endplate osteophytes the\nventral thecal sac but does not contact the spinal cord. Moderate right and\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC5-C6: Broad-based disc protrusion with endplate osteophytes indent the\nventral thecal sac. While they do not contact the spinal cord, the ventral\nsurface of the cord appears minimally flattened. Moderate right and severe\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Broad-based endplate osteophyte ridge indents the ventral thecal sac\nbut does not contact the spinal cord. Mild to moderate bilateral neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nC7-T1: There is a minimal anterolisthesis with a mild disc bulge. There is\nno mass effect on the ventral spinal cord or neural foraminal narrowing.\n\nAt T1-T2, T3-T4, and T4-T5, there are mild disc bulges without mass effect on\nthe ventral spinal cord.\n\n\nMRI THORACIC SPINE:\n\nImages are somewhat limited by motion artifact. There is an apparent vascular\nloop at the level of the intradural collection in the right aspect of the\nspinal canal at T3, image 16:87, as seen on the ___ postcontrast\nMRI images. This appears to be related to a right-sided vein. No evidence\nfor an arteriovenous malformation is seen on limited evaluation.\n\nOTHER:\n\nThe known thoracic aortic dissection is again partially visualized.", "output": "1. Loculated intradural collection posterior and lateral to the spinal cord\nfrom C5-C6 through T3-T4 levels appear stable in size. It now demonstrates\nlow T2 signal compared to high T2 signal previously, with some evidence of\nblooming on motion limited gradient echo images, suggesting evolution of blood\nproducts. Postcontrast images appear to demonstrate slightly more solid\ncontrast enhancement of the right aspect of the collection at T3, but this is\nmost likely related to motion artifact, as the postcontrast images of the\nprior MRI, as well as the present MRA, suggest a vascular loop in this\nlocation related to a right-sided vein. These findings suggest a hematoma. \nNo conclusive evidence for an arteriovenous malformation is seen on the motion\nlimited MRA.\n2. The above-described collection displaces the spinal cord anteriorly and\ndeforms in its posterolateral surfaces. The collection is largest at T2,\nwhere it compresses the spinal cord. Previously suspected cord signal\nabnormality at C7-T1 is not confirmed. Sagittal T2 weighted images suggest a\nmore conspicuous cord signal abnormality at T3 than on the prior MRI, but this\nmay be related to motion artifact; there are no axial T2 weighted images\nthrough the level of T3.\n3. Multilevel cervical and upper thoracic degenerative disease.\n4. The known thoracic aortic dissection is again partially visualized.\n\nRECOMMENDATION(S): The motion limited MRA is not sufficient for definitively\nexcluding an arteriovenous malformation or fistula. If there is a high\nclinical concern for an arteriovenous malformation or fistula, then\nconventional angiography should be considered." }, { "input": "The examination is moderately motion degraded. Within these confines:\n\nCervical alignment is grossly anatomic. Vertebral body heights are preserved.\nThere is no suspicious marrow signal. Disc heights are preserved.\n\nPatient is status post C7-T3 laminectomies and evacuation of intradural spinal\nhematoma with small post-operative fluid in the operative bed. However, there\nis an enlarging T2 dark, T1 bright likely subdural collection throughout the\nmid thoracic and partially imaged upper lumbar spine.\n\nFrom T5 through T12 the collection is predominantly posterior and posterior\nlateral maximally measuring 10 mm in thickness at T9-T10 (12:16 and 6:9). The\ncollection tapers posteriorly becoming anterior from T11 through the partially\nvisualized L1 level maximally measuring 11 mm at T12. The collection causes\ndiffuse scalloping of the thoracic spinal cord and moderate to severe spinal\ncanal narrowing. In comparison, on the next most recent study the collection\nmaximally measured 7 mm at T7-T8 and approximately 5 mm at T10.\n\nAlthough evaluation is limited by motion artifact there is elevated T2 and\nwater sensitive hyperintense signal signal in the spinal cord at T3-4 (series\n8, image 16; series 5, image 6). There is no definite focus abnormal\nenhancement.\n\nADDITIONAL FINDINGS: \n\nKnown dissection of the thoracic aorta is partially imaged but incompletely\nevaluated on this study. There is bibasilar atelectasis.", "output": "1. Enlarging subdural hemorrhage from the mid thoracic to the partially imaged\nupper lumbar spine causing compression and scalloping of the thoracic spinal\ncord with moderate to severe spinal canal narrowing.\n2. Previous hemorrhage in the lower cervical/upper thoracic spine has been\nsurgically evacuated with expected post-operative fluid in the operative bed.\n3. Evaluation of the spinal cord is severely limited by motion artifact,\nhowever there is apparent abnormal signal in the spinal cord at T3-T4, which\nmay represent edema, seen on prior examination.\n\nNOTIFICATION: The findings were telephoned to ___ by ___ at\n13:50, ___, 5 min after discovery." }, { "input": "There is a 1 mm anterolisthesis of L4 on L5. The bone marrow is\nheterogeneous, related to for patchy, fatty marrow deposition. There is no\nmarrow edema or fractures. The height of the vertebral bodies are maintained.\nThe conus medullaris terminates at L1-L2. The spinal cord is normal in\nsignal. No fluid collections or masses are identified. The paraspinal soft\ntissues are normal.\n\nAt T10-T11 and T11-T12, there is no spinal canal or neural foraminal stenosis.\n\nAt T12-L1, there is right paracentral disc protrusion with annular fissure and\nno spinal canal or neural foraminal stenosis.\n\nAt L1-L2, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt L2-L3, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt L3-L4, disc bulge and bilateral facet arthropathy cause mild to moderate\nspinal canal and mild left neural foraminal stenosis. A left facet osteophyte\nabuts the exiting left L3 nerve root.\n\nAt L4-L5, bilateral facet arthropathy causes mild spinal canal and mild\nbilateral neural foraminal stenosis.\n\nAt L5-S1, bilateral facet arthropathy without spinal canal or neural foraminal\nstenosis.\n\nA round T2 hypointense lesion in the left interpolar kidney measures 7 mm.", "output": "1. No fractures.\n2. Multilevel degenerative changes of the lumbar spine, most advanced at\nL3-L4, where there is mild-to-moderate spinal canal and mild left neural\nforaminal stenosis with abutment of the left exiting L3 nerve root by a facet\nosteophyte.\n3. Seven mm round T2 hypointense lesion in the left interpolar kidney, which\nis not consistent with a simple renal cyst. Renal ultrasound is recommended\nfor further evaluation.\n\nRECOMMENDATION(S): Seven mm round T2 hypointense lesion in the left\ninterpolar kidney, which is not consistent with a simple renal cyst. Renal\nultrasound is recommended for further evaluation." }, { "input": "There are 5 lumbar type vertebral bodies which are maintained in height and\nalignment. A T1 and T2 hyperintense lesion of the posterior aspect of L1\nvertebral body is compatible with a hemangioma. No focal suspicious marrow\nlesions identified. There is disk desiccation at L4-5 with minimal associated\ndisc height loss. The conus terminates at L1-L2, in normal anatomic position.\n\nThe T12-L1 and L1-L2, there is no significant canal or foraminal narrowing.\n\nAt L2-3, there is facet joint hypertrophy and bilateral foraminal protrusions\nwithout significant canal or foraminal narrowing.\n\nAt L3-4, there is a mild disc bulge and facet joint hypertrophy with\nthickening of the ligamentum flavum. Minimal bilateral foraminal and\nsubarticular recess narrowing is seen without significant canal narrowing.\n\nAt L4-5, there is a posterior disk bulge with central disk protrusion with\nassociated annular fissure. There is mild facet joint hypertrophy and\nthickening of the ligamentum flavum. In combination, these changes narrow the\nsubarticular recesses and result in mild to moderate bilateral foraminal\nnarrowing.\n\nAt L5-S1, there is posterior disc bulge and mild facet joint hypertrophy.\nThere is mild to moderate bilateral foraminal narrowing.\n\nIncluded retroperitoneal paraspinal soft tissues are unremarkable.", "output": "Mild degenerative changes most notably at L4-5 with a central disc protrusion\nand annular fissure. In combination with facet joint hypertrophy there is mild\nto moderate bilateral foraminal narrowing. Other details as above." }, { "input": "From T11-12 through L2-3 mild degenerative disc disease seen.\n\nAt L3-4 level, disc degenerative mild bulging seen with facet degenerative\nchanges without spinal stenosis. There is mild-to-moderate left foraminal\nnarrowing seen due to disk bulging and mild scoliosis.\n\nAt L4-5 there is diffuse disc bulge and disc protrusion predominantly on the\nleft side. There is mild to moderate spinal stenosis and severe left-sided and\nmoderate right-sided subarticular recess narrowing. There is mild to moderate\nleft-sided and mild right-sided foraminal narrowing.\n\nAt L5-S1 level disk bulging identified with moderate right foraminal narrowing\nand deformity of the exiting right L5 nerve roots within the foramina. There\nis no spinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Multilevel degenerative changes with mild to moderate spinal stenosis at L4-5\nrelated to disc protrusion predominantly on the left resulting in severe left\nsubarticular recess narrowing. Other findings as described above." }, { "input": "Grade 1 anterolisthesis of L4-5 is seen. Intraosseous hemangiomas are seen at\nL1-L4. Otherwise, the bone marrow signal is within normal limits. The cord\nterminates at T12-L1 and is unremarkable. Mild multilevel disc desiccation\nloss of disc height are seen involving the lower lumbar spine:\n\nFrom T11-T12 through L2-L3 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nL3-L4: Disc bulge, bilateral facet hypertrophy, thickening of the ligamentum\nflavum, no spinal canal narrowing, mild bilateral foraminal narrowing,\nunchanged.\n\nL4-L5: Anterolisthesis, disc bulge, bilateral facet osteophytes, thickening of\nthe ligamentum flavum, moderate spinal canal narrowing, moderate bilateral\nforaminal narrowing, unchanged.\n\nL5-S1: Disc bulge, left paracentral annular fissure, no spinal canal\nnarrowing, mild right and moderate left foraminal narrowing, unchanged.\n\nA 2.4 cm cystic lesion is seen in the right ovary. Diverticula are seen\ninvolving the visualized sigmoid colon.", "output": "1. Grossly unchanged mild degenerative changes of the lower lumbar spine,\nworst at L4-5 level, with mild spinal canal narrowing and moderate bilateral\nforaminal narrowing.\n2. Diverticulosis coli.\n3. 2.4 cm cystic lesion right ovary, likely a simple ovarian cyst." }, { "input": "The lumbar vertebral body heights and alignment are well maintained without\nfracture or malalignment. The prevertebral soft tissue is unremarkable. Areas\nof high T1 and T2 signal intensity are again noted in the T10, L1 and L3\nvertebral bodies as well as the left sacrum and right iliac bone. Increased\nsignal saturates out on the sagittal STIR sequence and is these areas are\ncompatible with focal fat. Bone marrow signal is otherwise normal.\n\nThe terminal cord signal and morphology is normal with the conus medullaris at\nthe level of T12/L1. There is no epidural collection. The visualized\nthoracic spine is without significant degenerative change.\n\nL1-L2: Intervertebral disk spaces well-preserved without protrusion. There is\nno stenosis. Neural foramina appear patent.\n\nL2-L3: Intervertebral disk spaces well-preserved without protrusion. There is\nno stenosis. Neural foramina appear patent.\n\nL3-L4: There is re- demonstration of mild intervertebral disk space narrowing\nwith decreased T2 signal with a biconvex posterior disk protrusion,\nleft-greater-than-right minimally indenting the thecal sac without significant\nstenosis. Concomitant facet and ligamentum flavum hypertrophy is present with\nmild narrowing of the left neural foramen with focal contact of the exiting\nnerve roots. The right neural foramen is minimally narrowed.\n\nL4-L5: The intervertebral disc space is relatively well preserved. There is\nre- demonstration of a mild posterior disk bulge. There is re- demonstration\nof a moderate facet and ligamentum flavum hypertrophy with mild bilateral\nneural foraminal narrowing, similar to the prior study.\n\nL5-S1: There is mild narrowing of the intervertebral disc space with re-\ndemonstration of decreased T2 signal of the disc. There is a mild left\nparacentral posterior disc protrusion mildly indenting the ventral thecal sac\nwithout significant canal stenosis. In combination with facet and ligamentum\nflavum hypertrophy, there is trace narrowing of the right neural foramen and\nmild narrowing of the left neural foramen focally contacting the nerve root.", "output": "1. Overall mild multilevel degenerative changes of the lumbar spine appearing\nsimilar to the prior examination. No significant spinal stenosis.\n2. Re- demonstration of focal areas of T1 shortening/T2 prolongation\ndemonstrating suppression on the STIR sequence in the vertebral bodies, sacrum\nand right iliac bone compatible with focal fat." }, { "input": "At L4-5, there is re-demonstration of a minimally bulging, mildly narrowed and\nmild-to-moderately desiccated disc, with type 1 degenerative endplate change\non either side of the disc space now identified. The disc bulge contacts the\nL5 nerve root sleeves and ventral thecal sac margin.\n\nAt L5-S1, since the prior study, there has been apparent removal of the\npreviously seen large left paracentral disc herniation. What remains is a\nmildly bulging, moderately narrowed and mild-to-moderately desiccated disc\nwith type II degenerative endplate change on either side of the disc space.\nThere is mild left neural foraminal stenosis. There is a laminectomy defect.\n\nFollowing the intravenous infusion of a gadolinium based contrast agent, there\nis mild enhancement along the posterior annulus of L4-5. At L5-S1, there is\nalso mild enhancement of the posterior annulus. These findings suggest\ningrowth of granulation tissue. There is also enhancing soft tissue spanning\nthe laminectomy defect and extending towards the S1 nerve root sleeves. These\nfindings indicate postsurgical scarring.\n\nThe imaged distal spinal cord, conus medullaris, cauda equina, as well as\nlimited lumbar paraspinal soft tissue imaging does not disclose additional new\nabnormalities.", "output": "Postsurgical study. Please review the above report for findings." }, { "input": "Please note the study is mildly degraded by motion.\n\nThere is grade 1 anterolisthesis of C3 on C4 and C7 on T1. Minimal T2/STIR\nhyperintense signal is seen in the dens. Vertebral body heights are\npreserved. Mild STIR hyperintense signal is seen within the superior\nendplates of T8 to and T3 with no significant loss of height of the vertebral\nbodies. Diffusely decreased marrow signal is noted throughout the vertebral\nbodies. There is a T1 hyperintense lesion in the T1 vertebral body, likely\nrepresenting a hemangioma. There is T2/STIR hyperintense signal within the\nspinal cord at the level of C6 extending caudally throughout the upper\nthoracic cord. There is loss of intervertebral disc height and signal at\nmultiple levels. Within the limits of this noncontrast study there is no\nevidence of infection or neoplasm. There is no prevertebral soft tissue\nswelling.. The visualized portion of the posterior fossa, cervicomedullary\njunction, paranasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is central disc protrusion and facet arthropathy effacing the\nventral thecal sac with mild remodeling of the spinal cord. Mild to moderate\nspinal canal a stenosis is seen with probable mild bilateral neural foraminal\nstenosis, difficult to definitively evaluate given degree of motion.\n\nAt C4-5 there is central disc protrusion and facet arthropathy resulting in\nmild-to-moderate spinal canal stenosis with effacement of the ventral thecal\nsac and remodeling of the spinal cord. Mild-to-moderate bilateral neural\nforaminal stenosis.\n\nAt C5-6 there is central disc protrusion, ligamentum flavum hypertrophy and\nfacet arthropathy effacing the ventral thecal sac and resulting in moderate\nspinal canal stenosis and mild-to-moderate bilateral neural foraminal\nstenosis.\n\nAt C6-7 there is disc protrusion and facet arthropathy with ligamentum flavum\nhypertrophy mildly remodeling the spinal cord resulting in mild-to-moderate\nspinal canal stenosis. The degree of neural foraminal stenosis difficult to\nevaluate given motion artifact.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.", "output": "1. Motion degraded study which limits evaluation.\n2. Multilevel degenerative changes throughout the cervical spine, worse at\nC3-C7, resulting in spinal canal and neural foraminal stenosis, as described\nabove.\n3. Degenerative changes with subarticular cysts at the craniocervical junction\nwithout definite increased signal to indicate an acute fracture of the\nodontoid process. The review of outside CT indicates degenerative changes\nwith subarticular cysts and no definite fracture.\n4. Mild high signal in the superior endplate of T2 and T3 with no significant\nloss of height which may represent early compression fractures versus\ndegenerative changes.\n5. Abnormal signal within the spinal cord at the level of C6, extending\ncaudally throughout the upper thoracic cord, likely secondary to myelomalacia\nfrom chronic stenosis.\n6. No evidence for ligamentous injury." }, { "input": "The sagittal sequences are motion degraded. Within these confines:\n\n2 mm retrolisthesis of C5 on C6 and C6 on C7 is identified. There is no\nsuspicious marrow signal although evaluation is limited secondary to motion\nartifact. Multilevel loss of disc height and disc desiccation is seen\ninvolving the entire cervical and visualized thoracic spine. Allowing for\nmotion artifact, the visualized posterior fossa is within expected limits. On\naxial sequences, there is T2 hyperintense signal of the cord at C3-C4 (series\n6, image 14) and C4-C5 (series 6, image 20) .\n\nC2-C3: A small posterior disk osteophyte complex does not result in\nsignificant spinal canal narrowing. Mild bilateral facet arthropathy results\nin mild neural foraminal narrowing.\n\nC3-C4: A prominent disc osteophyte complex and bilateral thickening of the\nligamentum flavum results in moderate to severe spinal canal narrowing with\nflattening of the cord. Bilateral uncovertebral facet arthropathy results in\nthe left greater than right severe neural foraminal narrowing.\n\nC4-C5: A large disc osteophyte complex and thickening of the ligamentum flavum\nresults in severe spinal canal narrowing, flattening and deforming the cord.\nThere is left greater than right uncovertebral and facet arthropathy resulting\nin severe left neural foraminal narrowing and moderate to severe right neural\nforaminal narrowing.\n\nC5-C6: A large posterior disc osteophyte complex and bilateral thickening of\nthe ligamentum flavum results in severe spinal canal narrowing and\ndeforming/compressing the cord. Bilateral uncovertebral and facet arthropathy\nresults in bilateral moderate-severe neural foraminal narrowing, left more\nthan right.\n\nC6-C7: A disc osteophyte complex results in mild spinal canal narrowing.\nBilateral uncovertebral arthropathy results in severe neural foraminal\nnarrowing, left more than right.\n\nC7-T1: There is no significant spinal canal narrowing. Mild bilateral neural\nforaminal narrowing is noted.\n\nOn sagittal sequences the following is noted:\nT1-T2: There is a disc bulge resulting in mild spinal canal narrowing.\nBilateral facet arthropathy results in severe bilateral neural foraminal\nnarrowing.\n\nT2-T3: There is a rigth sided mdoerate sized disc extrusion, resulting in mild\nspinal canal narrowing. In combination with facet arthropathy there is severe\nright neural foraminal narrowing and moderate left neural foraminal narrowing.\n\nT3-T4: There is a disc bulge, resulting in mild spinal canal narrowing. In\ncombination with facet arthropathy.\nThere is moderate right neural foraminal narrowing and mild left neural\nforaminal narrowing.\n\nT4-T5: A disc bulge and thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing. Facet arthropathy and degenerative changes\nresults in severe right neural foraminal narrowing and moderate left neural\nforaminal narrowing.\n\nPrevertebral paraspinal soft tissues are unremarkable allowing for motion\nartifact.\nLeft vertebral artery is dominant and right is diminutive.\nTiny cyst in the adenoids.", "output": "1. Severe cervical spondylosis, spanning C2-C3 through C5-C6 resulting in\nmoderate to severe spinal canal narrowing with multilevel compression and\nflattening and deforming of the cord with some compression.\n2. There is equivocal T2 hyperintense signal of the cord at C3-C4 and C4-C5\nwhich may represent myelomalacia or edema.\n3. Multilevel moderate to severe neural foraminal narrowing as described\nabove.\n4. Degenerative changes in upper thoracic spine with mild canal and\nmoderate-severe foraminal narrowing from T1-T4 levels as above\n5. Spine/Neurosurgery consult as needed.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:13 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Since the previous MRI examination, the patient has undergone laminectomies\nfrom C3-C6 levels. There is slightly increased signal at the laminectomy site\nindicating postoperative change. There is no fluid collection seen. The\npreviously seen spinal stenosis and deformity of the spinal cord has resolved.\nMultilevel disc bulging from C3-4 to C6-7 and also in the upper thoracic\nregion again identified. There is no change in previously noted foraminal\nnarrowings. There is increased signal within the spinal cord on the left side\nat C5 level indicating myelomalacia which is better appreciated on the current\nstudy. There is no evidence of bone marrow edema or traumatic malalignment. \nPrevertebral soft tissue thickness is maintained.", "output": "Status post laminectomies from C3-C6 level. Spinal canal is now patent and\nthe deformity of the spinal cord has resolved. Myelomalacia is visualized at\nC5 level with atrophy of the spinal cord predominantly on the left side. \nMultilevel degenerative changes are again noted as on the previous MRI." }, { "input": "CERVICAL SPINE: Vertebrae are normal in height and alignment. There is no\nfracture. There is no suspicious regional bone marrow signal abnormality.\nIntervertebral discs are normal in height but desiccated at multiple levels.\nAt C4-5 and C5-6, there are disc protrusions that indent the ventral thecal\nsac, but there is no significant spinal canal or foraminal stenosis. The\nspinal cord is normal in caliber and signal intensity. There is no hemorrhage\nor slow diffusion within the cord. There is no epidural hematoma.\n\nTHORACIC SPINE: There is no epidural or significant paraspinal soft tissue\nhematoma. There are acute superior endplate fractures of T1, T2, T3, and T5. \nThese are consistent with impaction injuries that are inconspicuous on the CT\nfrom ___. There are fractures with visible fracture lines at T8,\nT9, and T12. There is mild T8 and moderate T9 vertebral body height loss.\nThere is no significant height loss at T12. The fracture at T9 demonstrates\nmild retropulsion measuring 1-2 mm with near effacement of the ventral thecal\nsac, but no contact of the spinal cord. The fracture line disrupts the dorsal\ncortex of the vertebral body, but the posterior longitudinal ligament appears\nintact. The conus medullaris is normal in appearance and position, terminating\nat L2.\n\nThere are large left and small right pleural effusions. Rib fractures are\nbetter seen on the concurrent CT.", "output": "1. Normal cervicothoracic spinal cord with no evidence of cord injury.\n2. No cervical spine fracture.\n3. Fracture of the T9 vertebral body with mild retropulsion, effacing the\nventral thecal sac. While the fracture line appears to involve the dorsal\nmargin of the vertebral body (middle column of ___, the posterior\nlongitudinal ligament appears intact and there is no cord contact.\n4. Additional fractures of the T8 and T12 vertebrae, with no retropulsion at\nthese levels.\n5. Impaction trabecular microfractures of the superior endplates of T1, T2,\nT3, and T5.\n6. Left larger than right pleural effusions." }, { "input": "Alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. The marrow signal is diffusely slightly T1\nheterogeneous but unchanged since examination of ___, likely representing\nmarrow reconversion with chronic anemia. Clinical correlation is recommended.\nThe conus medullaris terminates at the T12-L1 level, within expected limits. \nThere is no abnormal signal or enhancement of the terminal cord, conus\nmedullaris or cauda equina.. There is no evidence of spinal canal or neural\nforaminal narrowing. Minimal facet degenerative changes bilaterally at L5-S1\nwith small facet joint effusions. There is no evidence of infection or\nneoplasm. There are a couple foci of fatty marrow signal within the right\niliac wing. There is a mild-to-moderate amount of edema within the posterior\nsubcutaneous fat.", "output": "1. No evidence of paraspinal abscess/phlegmon.\n2. Otherwise, unremarkable lumbar spine." }, { "input": "Motion artifact renders evaluation of several sequences suboptimal. Within\nthese confines, cervical, thoracic and lumbar spine alignment is maintained.\nBone marrow signal is normal. The signal within the visualized cord is normal.\nThere is no evidence for discitis-osteomyelitis or epidural abscess. No\nabnormal enhancement is present. No abnormality is seen within the visualized\nparaspinal soft tissues.", "output": "No evidence for epidural abscess or discitis-osteomyelitis." }, { "input": "There is no abnormal signal seen within the spinal cord or spinal cord\ncompression noted from skullbase to T3 level.\n\nFrom C3-4 to ___ levels disc degenerative change and mild bulging seen\nwithout spinal stenosis or foraminal narrowing. No intraspinal fluid\ncollection is identified.", "output": "No abnormal signal within the spinal cord or spinal cord compression. Mild\ndegenerative changes." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no abnormal enhancement after contrast administration.\n\nMultilevel spondylosis of the cervical spine is most prominent at levels of\nC4-5 and C5-6, with posterior disc bulges resulting in mild to moderate canal\nstenosis. Additionally, there is mild bilateral neural foraminal narrowing at\nthe level of C4-5. No abnormal cervical spinal cord signal is identified.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno abnormal enhancement after contrast administration. No abnormal spinal\ncord signal within the thoracic spine.\n\nLUMBAR:\nThe conus medullaris terminates at the level of L1. There is no abnormal cord\nsignal seen within the distal thoracic and upper lumbar spine. Alignment is\nnormal. Vertebral body and intervertebral disc signal intensity appear normal.\nThe spinal cord appears normal in caliber and configuration.Mild multilevel\nspondylosis of the lumbar spine is most notable at L3-L4 and L4-L5 with mild\ndisc bulges and facet hypertrophy resulting in mild canal stenosis. No\nsignificant neural foraminal narrowing is identified. There is no abnormal\nenhancement after contrast administration.\n\nOTHER: Mild fatty atrophy is noted in the lower paraspinal musculature. \nOtherwise, unremarkable appearance of the paraspinal soft tissues.", "output": "1. No abnormal cord signal or postcontrast enhancement within the cervical,\nthoracic, or lumbar spinal cord to suggest dural AV fistula or AVM by MRI\nexamination.\n2. No evidence for spinal canal mass, epidural collection, or hematoma.\n3. Mild multilevel spondylosis of the cervical and lumbar spine, as detailed\nabove. No resultant severe spinal canal stenosis or neural foraminal\nnarrowing." }, { "input": "There is 1 mm posterior subluxation of C3-4. The bone marrow signal is within\nnormal limits. There is no abnormal enhancement. The visualized posterior\nfossa and cord are unremarkable. There is mild multilevel loss of disc\nheight.\n\nC2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Bilateral uncovertebral and facet osteophytes, focal thickening of the\nligamentum flavum abutting the dorsal cord without cord signal abnormality,\nmild spinal canal narrowing, mild bilateral foraminal narrowing.\n\nC4-C5: Posterior and bilateral facet uncovertebral osteophytes, no spinal\ncanal narrowing, mild bilateral foraminal narrowing.\n\nC5-C6: Posterior and bilateral facet and uncovertebral osteophytes, focal\nthickening of the ligamentum flavum abutting the dorsal cord without cord\nsignal abnormality, no spinal canal narrowing, mild bilateral foraminal\nnarrowing.\n\nC6-C7: Bilateral facet and uncovertebral osteophytes, no spinal canal or\nforaminal narrowing.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\nThere is no spinal canal or foraminal narrowing involving the visualized upper\nthoracic spine. Endotracheal and oroenteric tubes are partially visualized. \nThere is a 2.5 cm T2 hyperintense nodule of the right lobe of the thyroid.", "output": "1. Cervical spondylosis with mild spinal canal narrowing at C3-C4 and mild\nbilateral foraminal narrowing at C3-4, C4-5 and C5-6.\n2. There is no abnormal signal were enhancement of the cord.\n3. 2.5 cm T2 hyperintense right lobe of the thyroid nodule.\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": "Thoracic spine:\n\nVertebral body height and alignment is maintained. There is multilevel\ndegenerative disc disease with grossly preserved disc space heights. Note is\nmade of hemangiomas in the T6 and T10 vertebral bodies. Bone marrow signal\nintensity is otherwise within normal limits.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nabnormal enhancement after contrast administration.\n\nThere is no evidence of cord compression, severe spinal canal stenosis or\nsignificant neural foraminal narrowing along the thoracic levels.\n\nLumbar spine:\n\nVertebral body height and alignment is preserved. There is mild multilevel\ndegenerative disc disease with grossly preserved disc space heights. Note is\nmade of hemangiomas in the L2, L3 and S1 vertebral bodies. Bone marrow signal\nintensity is otherwise within normal limits.\n\nThe spinal cord and cauda equina nerve roots appear normal in caliber and\nconfiguration. There is no abnormal enhancement after contrast\nadministration. The conus terminates normally at the L1-L2 level.\n\nAt L1-L2, there is no spinal canal stenosis or neural foraminal narrowing.\n\nAt L2-L3, there is a shallow disc bulge but no spinal canal stenosis or neural\nforaminal narrowing.\n\nAt L3-L4, there is a shallow disc bulge and minimal facet joint arthropathy\nwhich results in mild right neural foraminal narrowing but no spinal canal\nstenosis or left neural foraminal narrowing.\n\nAt L4-L5, there is a shallow disc bulge with minimal facet joint arthropathy\nwhich results in mild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is a central disc protrusion, mild facet joint arthropathy and\nligamentum flavum thickening which results in moderate left and mild right\nneural foraminal narrowing. There is also effacement of the lateral recesses\nbilaterally with the disc herniation contacting the traversing left S1 nerve\nroot (series 14, image 33).\n\nOther: Note is made of a right lower lobe atelectasis and left pleural\neffusion.", "output": "1. No spinal lesions or abnormal enhancement identified\n2. Minimal degenerative changes along the thoracic spine without evidence of\ncord compression, severe spinal canal stenosis or significant neural foraminal\nnarrowing.\n3. Mild multilevel lumbar spondylosis as described above but without evidence\nof cord compression, severe spinal canal stenosis or significant neural\nforaminal narrowing.\n4. Right lower lobe atelectasis and left pleural effusion." }, { "input": "CERVICAL SPINE:\nThe vertebral body heights and alignment are maintained. The bone marrow\nsignal is normal. The craniocervical junction is unremarkable. The cervical\ncord is normal in morphology and signal intensity. There is no abnormal\nenhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing.\nTHORACIC SPINE: The vertebral body heights and alignment are maintained.\nThere is a hemangioma within the T2 vertebral body. The bone marrow signal is\notherwise unremarkable. There are multiple Schmorl's nodes. The thoracic cord\nis normal in morphology and signal intensity. There is no abnormal\nenhancement.\n\nThere is congenital stenosis of the thoracic spine due to short pedicles and\nprominent epidural fat.\n\nThere is bilateral dependent atelectasis.\nLUMBAR SPINE: The vertebral body heights and alignment are maintained. There\nis a prominent Schmorl's node at the inferior endplate of L4 with mild\nadjacent edema. The bone marrow signal is otherwise unremarkable. The conus is\nnormal in appearance and terminates at L1-L2 level. There is no abnormal\nenhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nOnly seen on the axial T2 images there are incompletely characterized T2\nhyperintense lesions within the right hepatic lobe.", "output": "No evidence of discitis osteomyelitis or epidural collection.\n\nCongenital spinal stenosis with prominent epidural fat especially in the\nthoracic spine.\n\nIncompletely characterized T2 hyperintense right hepatic lesions. Recommend\nright upper quadrant ultrasound for further evaluation as clinically\nwarranted." }, { "input": "Normal lumbar lordosis. Grade 1 anterolisthesis of L4 on L5. Vertebral body\nheights are preserved without acute fracture or osseous lesion. Fatty signal\nchange at the articulating T11-12 articulating endplates consistent with\nchronic ___ type 2 degenerative change. Conus demonstrates normal\nmorphology and signal, ending appropriately at the L1-L2 level.\n\nLens shaped mass within the left central ventral epidural space just dorsal to\nthe T12 vertebral body measuring 1.5 x 0.4 x 0.7 cm in CC, AP, and with\n___ which demonstrates mild T2 hyperintensity and T1 isointensity best\nseen on series 4, image 11 and series 7 and, image 3. This does not compress\nor marginate the traversing spinal cord.\n\n3.4 cm right-sided likely renal cyst.\n\nIntervertebral disc spaces as follows:\nL1-2: Normal.\nL2-L3: Normal.\nL3-L4: Disc desiccation and thickening of the ligamentum flavum.\nL4-L5: Disc desiccation and small broad-based disc bulge. Thickening of the\nligamenta flavum and mild to moderate facet joint hypertrophy with right facet\nsynovitis. Mild spinal canal narrowing. Mild bilateral neuroforaminal\nnarrowing with effacement of the inferior foramen.\nL5-S1: Disc desiccation and mild disc bulge. Mild facet arthropathy.", "output": "1. Small lens shaped mass within the ventral epidural space just dorsal to the\nT12 vertebral body which may represent soft tissue mass or epidural hematoma. \nThis does not have the appearance of herniated disc or abscess. No associated\ncord compression or significant canal stenosis. Recommend clinical\ncorrelation and further characterization with a dedicated contrast enhanced\nMRI of the lumbar spine.\n2. Degenerative changes greatest at L4-L5, as described, causing mild spinal\ncanal narrowing and mild bilateral neuroforaminal stenosis. No spinal cord or\nnerve root compression.\n\nRECOMMENDATION(S): Contrast enhanced MRI of the lumbar spine and clinical\ncorrelation.\n\nNOTIFICATION: Final results and recommendations discussed with Dr ___\n___ by Dr ___ via telephone ___ minutes following discovery." }, { "input": "Thoracic spine: Normal thoracic kyphosis. Preserved vertebral body heights. \nMild degenerative disc disease greatest at T11-T12 with associated anterior\ndisc bulge chronic fatty metaplasia particularly T11-T12 endplates consistent\nwith ___ type 2 changes. Mild disc bulges at T7-T8 and T8-T9. Normal cord\nmorphology signal without abnormal postcontrast enhancement. Right STIR\nsignal hyperintensity within the thoracic spinal cord at T2-T3 is not present\non sagittal or axial T2 sequences, likely representing artifact.\n\nLumbar spine:\n1.1 x 0.5 x 1.0 cm lens shaped lesion marginating the left central dorsal\naspect of the T12 vertebral body within the ventral epidural space which\ndemonstrates T1 signal isointensity, mild T2 signal hypointensity, and no\npostcontrast enhancement. This is best visualized on series 17, image 8 and\nseries 16, image 58. This does not significantly narrow the spinal canal or\naffect the traversing spinal cord. Findings are relatively unchanged compared\nto prior study.\n\nNormal lumbar lordosis. Grade 1 anterolisthesis of L4 on L5. Vertebral body\nheights are preserved without fracture or osseous lesion. Conus demonstrates\nnormal\nmorphology and signal, ending appropriately at the L1-L2 level.\n\nIntervertebral disc spaces as follows:\nL1-2: Normal.\nL2-L3: Normal.\nL3-L4: Disc desiccation and thickening of the ligamentum flavum.\nL4-L5: Disc desiccation and small broad-based disc bulge. Thickening of the\nligamenta flavum and mild to moderate facet joint hypertrophy with right facet\nsynovitis. Mild spinal canal narrowing. Mild bilateral neuroforaminal\nnarrowing with effacement of the inferior foramen.\nL5-S1: Disc desiccation and mild disc bulge. Mild facet arthropathy.\n\nOther: 4.1 x 4.4 x 4.5 cm submucosal fibroid distorting the endometrial\ncavity. A 3.3 cm T2 hyperintense likely cyst within the inferior right renal\npole.", "output": "1. Small lens shape mass within the ventral epidural space just dorsal to the\nT12 vertebral body which does not demonstrate postcontrast enhancement. \nFindings may represent a migrated herniated disc versus a small ventral\nepidural hematoma. No significant canal narrowing or involvement of the\noverlying cord.\n2. Degenerative changes of the thoracic and lumbar spine as described.\n3. Large submucosal fibroid." }, { "input": "Lumbar spine numbering is based on the lowest rib-bearing vertebra. Disc and\nvertebral body heights are maintained. There is no suspicious marrow signal.\nThe conus terminates at the inferior endplate of T12, within expected limits.\nNo cord signal abnormalities.\n\nT11-12 through L2-3: Unremarkable.\n\nL3-4: There is a small disc protrusion as well as mild bilateral facet\narthropathy without significant spinal canal or left neural foraminal\nnarrowing. Mild right neural foraminal narrowing.\n\nL4-5: There is trace posterior disk protrusion demonstrating an annular\nfissure along its left foraminal segment. The disc contacts but does not\ndisplace the traversing nerve roots. There is no significant neural foraminal\nnarrowing.\n\nL5-S1: No significant spinal canal or neural foraminal narrowing.\n\nNo prevertebral or paraspinal soft tissue abnormalities. Mild subcutaneous\ndependent edema of the lumbar spine is noted.", "output": "1. No significant spinal canal narrowing.\n2. Mild degenerative changes described above." }, { "input": "CERVICAL: The study is moderately degraded by motion.\n\nAlignment is normal.Decreased T1/increased STIR signal throughout the majority\nof the cervical spine is most consistent with metastatic disease. There is\ndisc height loss throughout the cervical spine.The spinal cord appears normal\nin caliber and configuration.\n\nThere is mild to moderate canal narrowing at C4-C5 due to posterior\nosteophytes and disc bulges. There are multilevel uncovertebral and facet\nosteophytes. Evaluation of the neural foramina is significantly limited due\nto motion. There is probably moderate to severe neural foraminal narrowing at\nC3-4 on the left and at C4-5 and C5-6 bilaterally.\n\nSTIR hyperintensity within the posterior paraspinal musculature bilaterally\nmay be due to muscle strain. There is no prevertebral fluid or evidence of\nligamentous injury.\n\nTHORACIC:\nAlignment is normal.As in the cervical spine, there is relatively diffuse low\nT1 signal and increased STIR signal compatible with infiltrative osseous\nmetastasis. There is a linear focus of increased T2/STIR signal in the T8\nvertebral body, consistent with an acute pathologic fracture (5:9, 6:9). \nEdema in the prevertebral soft tissues noted at these levels.\n\nThere is also linear STIR hyperintensity paralleling the inferior endplate of\nT9 anteriorly suspicious for additional fracture.\n\nFrom T1-T2 through T6-T7, there is no significant canal or neural foraminal\nnarrowing. There is lack of expected fact signal within the neural foramen at\nT8-T9, T9-T10 T10-T11 bilaterally worrisome for foraminal narrowing in the\nsetting of metastatic disease.\n\nBeginning at T7-8, T1 hypointense and T2/STIR intermediate intensity soft\ntissue seen within the canal in the epidural space and appears to encase the\nthoracic cord and essentially extends from T7-8 through T12 (for example\n11:12). Complete assessment of the canal is not possible due to the absence\nof intravenous contrast and the absence of axial imaging inferior to T9. On\nthe sagittal image, there appears to be increased cord signal particularly at\nT10-11 (11:12) and also potentially at T8 as well..\n\nLUMBAR:\nAlignment is normal.As with the cervical and thoracic spine, there is\nextensive low T1 high STIR signal diffusely throughout L1 with patchy areas\nthroughout the remainder of the lumbar spine and imaged sacrum and iliac\nbones.Complete assessment of the lumbar canal is limited due to the absence of\nintravenous contrast and axial images. Within this limitation, infiltrative\ntumor is not definitely seen in the canal of the lumbar spine.\n\nMetastatic disease at the right pedicles of T12 and L1 result in severe right\nforaminal narrowing at this level. There is a disc bulge at L4-5 that results\nin moderate canal narrowing. There is also moderate bilateral neural\nforaminal narrowing at this level. Moderate neural foraminal narrowing is\nalso present bilaterally at L4-5 and L5-S1 due to facet joint hypertrophy and\ndisc bulges..\n\nOTHER: Please refer to the recent CT for additional incidental findings,\nincluding hepatic metastases and pleural effusions. Lipoma noted in the\nposterior subcutaneous tissues in the right.", "output": "1. Incomplete exam which is also limited secondary to motion, the absence of\npostcontrast images and absence of axial images inferior to T8.\n2. Diffuse metastatic disease throughout the entire spine, sacrum and iliac\nbones.\n3. Recent fractures at the T8 and T9 vertebral bodies as above.\n4. Abnormal signal within the epidural region extending from approximately T7\nthrough T12, with compression of the cord and cord signal abnormality. This\nepidural abnormality is likely in part due to extra osseous extension of\ndisease. Given associated fractures at the related levels, a component of\nhematoma is difficult to exclude. Complete evaluation of the cord and canal\nat these levels is limited due to the absence of intravenous contrast and\naxial images which could further delineate. Suggest repeating the study at\nthe thoracic level with sedation.\n5. Additional 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.\n\nRECOMMENDATION(S): Repeat MRI of the thoracic spine with and without\ncontrast.\n\nNOTIFICATION: The updated findings were discussed with ___, m.D.\nby ___, M.D. on the telephone on ___ at 10:20 am, 15 minutes\nafter discovery of the findings." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\n\nC2-C3:\nThere is a small left subarticular disc bulge. No significant central canal\nstenosis. Mild left neural foraminal narrowing. No significant right neural\nforaminal narrowing.\n\nC3-C4:\nMinimal central disc bulge. Mild central canal stenosis. There is\nuncovertebral and facet arthropathy with moderate left and mild right neural\nforaminal narrowing.\n\nC4-C5:\nSmall central disc protrusion favoring the right with mild central canal\nstenosis partially effacing the anterior thecal sac. There is uncovertebral\nand facet joint hypertrophy with mild right and moderate to severe left neural\nforaminal narrowing.\n\nC5-C6:\nMild disc desiccation with mild diffuse central disc protrusion with mild\nnarrowing of the central canal and effacement of the anterior thecal sac. \nThere is uncovertebral and facet hypertrophy with mild to moderate right and\nmoderate to severe left neural foraminal narrowing.\n\nC6-C7:\nNo significant disc bulge. There is mild narrowing of the central canal. \nRight greater than left uncovertebral and facet hypertrophy with mild\nbilateral neural foraminal narrowing.\n\nC7-T1:\nThere is a focal subarticular disc extrusion on the left. No significant\ncentral canal stenosis. There is severe narrowing of the left neural foramen,\nwhere the disc extrusion appears to contact the exiting left C8 nerve. No\nsignificant right neural foraminal narrowing.\n\nThere is no abnormal enhancement after contrast administration. There is no\nevidence of infection or neoplasm.\n\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Other than the above mentioned findings at the C7-T1 level,\nthere is no evidence of thoracic spinal canal or neural foraminal narrowing.\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\n\nOTHER: Subcentimeter T2 bright, T1 dark nonenhancing circumscribed lesion left\nupper pole kidney compatible with simple cyst. Subcentimeter circumscribed T1\nand T2 isointense nonenhancing lesion in the lateral right lower neck soft\ntissues may reflect small sebaceous cyst. Incidentally noted small lipoma in\nthe region of the left posteromedial diaphragmatic slip.", "output": "-At C7-T1, there is a focal left subarticular disc extrusion with to severe\nnarrowing of the left C7-T1 neural foramen and apparent contact of extruded\ndisc with the exiting left C8 nerve root.\n-Moderate to severe narrowing of the left C5-C6 neural foramen.\n-The remainder of the cervical spine demonstrates multilevel spondylitic\nchanges with varying degrees of mild to moderate central canal and neural\nforaminal narrowing, as described above.\n-Other than the above mentioned findings at the C7-T1 level, there is no\nevidence of thoracic spinal canal or neural foraminal narrowing." }, { "input": "There is mild prevertebral edema from C1-C2 through the included upper\nthoracic spine.\n\nThere is edema in the anterior aspect of the C4-5 disc and minimal edema in\nthe anterior longitudinal ligament at this level. This is associated with the\nC5 superior anterior corner fracture on the preceding CT. Alignment of C4 and\nC5 is preserved.\n\nThere is also edema in the anterior aspect of the C6-7 disc and in the\nposterior aspect of the C7 superior endplate, as well as edema and possible\nsmall focal disruption of the anterior longitudinal ligament at this level. \nThis is associated with the C6 anterior inferior corner fracture on the\npreceding CT. There is minimal retrolisthesis of C6 on C7, slightly more\nconspicuous than on the preceding CT, though this could be related to\ndifferences in modalities.\n\nThere is interspinous ligament edema from C1-C2 through C6-C7.\n\nThere is edema throughout the mildly compressed T4 vertebral body, which\ndemonstrates an acute fracture parallel to the superior endplate on the\npreceding CT. Edema extends into the pedicles bilaterally, in the preceding\nCT demonstrates bilateral nondisplaced pedicle fractures. There is apparent\nbuckling of the posterior longitudinal ligament at this level. There is no\nevidence for posterior ligamentous complex edema at this level.\n\nThere is no evidence for an epidural hematoma. Spinal cord signal is within\nnormal limits.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa demonstrates no acute abnormalities.\n\nAt the craniocervical junction and C1-C2, there is no spinal canal narrowing.\n\nAt ___, there is a central disc protrusion which approaches but does not\ncontact the spinal cord. There is no neural foraminal narrowing.\n\nAt C3-4, there is a broad-based central disc osteophyte complex which abuts\nand mildly remodels the ventral spinal cord. There is mild bilateral neural\nforaminal narrowing by uncovertebral osteophytes.\n\nAt C4-5, there is a shallow broad-based disc osteophyte complex which does not\ncontact the spinal cord. There is moderate to severe right and mild to\nmoderate left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nAt C5-6, there is a broad-based disc osteophyte complex, larger on the right,\nwhich does not appear to contact the spinal cord. There is moderate to severe\nbilateral neural foraminal narrowing by uncovertebral osteophytes.\n\nAt C6-7, there is a broad-based central disc protrusion which does not contact\nthe spinal cord. There is severe right and mild left neural foraminal\nnarrowing by uncovertebral osteophytes.\n\nAt C7-T1, no significant spinal canal or neural foraminal narrowing is seen.\n\nMucosal thickening is noted in the partially visualized sphenoid and maxillary\nsinuses.", "output": "1. Edema in the anterior aspect of the C4-5 disc and minimal edema in the\nanterior longitudinal ligament at this level, associated with C5 superior\nanterior corner fracture. C4-5 alignment is preserved.\n2. Edema in the anterior aspect of the C6-7 disc and posterior aspect of the\nC7 superior endplate, as well as edema and possible small focal disruption of\nthe anterior longitudinal ligament at C6-7, associated with C6 anterior\ninferior corner fracture. Minimal retrolisthesis of C6 on C7 is slightly more\nconspicuous than on the CT from up approximately 12 hr earlier.\n3. Interspinous ligament edema from C1-C2 through C6-C7.\n4. Fracture of the T4 vertebral body and bilateral pedicles, with mild loss of\nvertebral body height and associated buckling of the posterior longitudinal\nligament. No evidence for posterior ligamentous complex injury at this level.\n5. Multilevel degenerative disease. The ventral spinal cord is minimally\nremodeled at C3-4, but maintains normal signal." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is no acute\nfracture. The visualized portion of the spinal cord is preserved in signal\nand caliber. Mild degenerative changes are seen, with mild neural foraminal\nnarrowing at the C4-5 level on the right due to uncovertebral hypertrophy. No\nother sites of neural foraminal narrowing are seen. There is no central canal\nnarrowing. ___ type 1 degenerative disc disease with enhancement and\nassociated endplate sclerosis is seen at the C6-7 level, most prominent on the\nleft, without associated central canal or neural foraminal narrowing. The\nremaining intervertebral discs demonstrate normal signal intensity andheights.\nThere is no evidence of infection or neoplasm.", "output": "1. No cord signal changes or central canal narrowing.\n\n2. Mild degenerative changes with mild neural foraminal narrowing at the C4-5\nlevel on the right due to uncovertebral hypertrophy. No other sites of neural\nforaminal narrowing.\n\n3. ___ type 1 degenerative disc disease with enhancement and associated\nendplate sclerosis is seen at the C6-7 level, most prominent on the left,\nwithout associated neural foraminal narrowing.\n\nNOTIFICATION: Findings were communicated to Dr. ___ at 3:01 p.m. on ___ by phone." }, { "input": "Thoracic Spine:\n\nThere is severe dextroscoliosis of the mid thoracic spine. Compression\nfracture of the superior endplate of T12 shows marrow edema but no\nretropulsion. There is no spinal cord impingement or signal abnormality. \nThere is no abnormal enhancement post-contrast.\n\n\nLumbar Spine:\n\nThere is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. There is no concerning focal marrow signal\nabnormality.The intervertebral discs are normal in height and signal\ncharacteristics.\n\nThe conus medullaris is at level L1-L2. There is no spinal cord signal\nabnormality.\n\nThere are multilevel degenerative changes as follows:\n\nAt T12-L1, there is a disc bulge, but no significant spinal canal or neural\nforaminal stenosis.\nAt L1-L2, there is a disc bulge, but no significant spinal canal or neural\nforaminal stenosis.\nAt L2-L3, there is a disc bulge, but no significant spinal canal or neural\nforaminal stenosis.\nAt L4-L5, there is a disc bulge, but no significant spinal canal or neural\nforaminal stenosis.\nAt L5-S1, there is a disc bulge, but no significant spinal canal or neural\nforaminal stenosis.\n\nIncidental note is made of several uterine fibroids (13:6). There is a 4.6 x\n4.1 cm right ovarian cyst, enlarging since ___ (11:17).", "output": "1. T12 superior endplate compression fracture, age indeterminate, likely\nsubacute. No posterior retropulsion or cord impingement.\n2. Mild multilevel degenerative disc disease of the lumbar spine.\n3. Incidental right ovarian cyst has been slowly enlarging since ___. Further\nevaluation with dedicated pelvic ultrasound is recommended.\n4. Fibroid uterus.\n\nNOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___\n___ the phone." }, { "input": "There is mild anterolisthesis of C3 on C4, C4 on C5 and C7 on T1, similar in\nappearance to the prior radiograph. There is mild loss of height of C5 and C6\nvertebral bodies which appears similar to the prior radiograph without\nretropulsion.There is no suspicious focal marrow lesion. The spinal cord\nappears normal in caliber and configuration. There are moderate multilevel\ndegenerative changes:\n\nAt C3-4 of a disc protrusion and infolding of the ligamentum flavum causes\nmild canal narrowing and mild left neuroforaminal narrowing.\nAt C4-5 a disc protrusion causes and infolding of the ligamentum flavum mild\ncanal narrowing and with facet arthropathy causes mild right neuroforaminal\nnarrowing. The disc is uncovered secondary to anterolisthesis.\nAt C5-6 there is loss of disc height and a small protrusion with\nretrolisthesis of C5 on C6 without significant canal narrowing or\nneuroforaminal stenosis.\nAt C5-6 a small disc protrusion is present without significant canal stenosis\nor neuroforaminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Moderate multilevel degenerative changes causing mild canal narrowing at\nC3-4 and C4-5 and mild neuroforaminal narrowing on the left at C3-4 and on the\nright at C4-5.\n\n2. Unchanged mild anterolisthesis of C3 on C4, C4 and C5 and C7 on T1.\n3. Unchanged mild chronic compression deformities of height of C5 and C6." }, { "input": "On the localizer images, there is slight dextroscoliosis of the thoracic spine\nand levoscoliosis of the lumbar spine.\n\nTHORACIC:\nAt the level of the T5 vertebral body, there is a 1.0 x 0.9 cm T2 mildly\nhyperintense/T1 isointense rounded right posterior-lateral extramedullary\nintradural lesion with displacement of the cord and cord flattening (5; 10).\nThere is no intrinsic spinal cord signal abnormality. This lesion in\nretrospect was also previously seen on CT chest ___, when it\nmeasured 1.0 cm on axial plane series 2, image 41..\n\nAt T8-T9 there is diffuse disc bulge, endplate hypertrophic change with\nhypertrophy of the ligamentum flavum, facet arthropathy resulting in severe\nspinal canal stenosis, mild cord flattening with subtle increased T2 signal in\nthe central spinal cord at this level.\n\nThere is mild anterolisthesis of C7 on T1. Otherwise alignment is anatomic in\nthe thoracic spine. Vertebral body signal intensity and height appear\nnormal. There is multilevel degenerative changes with loss of intrinsic\nintervertebral disc signal, disc height, intervertebral osteophyte formation,\nand Schmorl's nodes as well as posterior disc bulges resulting. There is\nmildly increased signal of the disc at T8-T9 level, small volume fluid in the\nfacet joints at this level, and similar less marked findings at T7-T8 level,\nfindings are likely degenerative, extensive degenerative changes at this level\nare seen dating back to ___ CT chest scan. There is multilevel\ncentral canal narrowing at the levels, mild at T1-T2, T7-T8, moderate at\nT9-T10, T10-T11, T11-T12, T12-L1 levels. The small right paramedian, superior\ndisc protrusion at T12-L1 level. There is multilevel mild-to-moderate\nforaminal narrowing, most prominent at T8-T9 level. There are secretions\nwithin lower trachea, mainstem bronchi. There are bilateral pleural\neffusions, more prominent on the right. There are bibasilar opacities,\nlargely atelectasis, component of aspiration or pneumonia cannot be excluded. \nThere is small benign sebaceous cyst anterior to the sternum measuring 1.5 cm.\n\nLUMBAR:\nAlignment is anatomic. Vertebral body signal intensity and height appear\nnormal. There are multilevel advanced degenerative changes in the lumbar\nspine. There is congenital narrowing of the lumbar spinal canal. There\nmultilevel diffuse disc bulges, endplate hypertrophic changes, lumbar facet\narthritis. There is multilevel mildly increased intervertebral disc signal,\nlikely degenerative, without and plate erosions or vertebral body edema.\n\nT12-L1 level there is small right paramedian disc protrusion, moderate central\ncanal narrowing. There is mild bilateral foraminal narrowing.\nAt L1-L2 level there is left paramedian, superior disc extrusion, which\nextends 1.2 cm above disc space, measures 0.7 cm in AP diameter, and has\ncentral area of increased signal, which favors subacute disc protrusion. \nThere is undulation of the nerve roots above this level. There is diffuse\ndisc bulge, posterior element hypertrophic changes, and overall moderate to\nsevere central canal narrowing, with near complete effacement of CSF\nintrathecally. There is moderate to severe right foraminal narrowing,\nmild-to-moderate left foraminal narrowing.\nAt L2-L3 level there is moderate to severe central canal narrowing, with\nincomplete effacement of CSF. There is moderate right, and mild-to-moderate\nleft foraminal narrowing.\nAt L3-L4 level there is moderate to severe central canal narrowing, with\nincomplete effacement of CSF. There is moderate bilateral foraminal\nnarrowing.\nAt L4-5 level there is moderate central canal narrowing, and significant\nnarrowing of both lateral recesses. There is moderate bilateral foraminal\nnarrowing, more prominent on the left\nAt L5-S1 level there is moderate central canal narrowing, and significant\nnarrowing of both lateral recesses, with encroachment on both traversing S1\nnerves. There is severe left, and moderate to severe right foraminal\nnarrowing.", "output": "1. 1.0 cm extramedullary intradural lesion at T5 level causing cord\ncompression, without intrinsic cord signal abnormality, most likely\ndifferential considerations include meningioma, neurogenic tumor. Lymphoma,\nsystemic or CNS drop metastases are very unlikely given stability since ___.\n2. Multilevel degenerative changes most severe at T8-T9 with severe spinal\ncanal stenosis, mild cord flattening, mild cord signal abnormality.\n3. There are multilevel advanced degenerative changes in the lumbar spine. \nThere are disc protrusions at T12-L1, L1-L2 levels.\n4. There is multilevel moderate to severe central canal narrowing in the\nlumbar spine, and multilevel significant foraminal narrowing.\n5. There are secretions within tracheobronchial tree, and bibasilar opacities,\nwhich may represent atelectasis, aspiration, pneumonia or combination. Small\npleural effusions are seen.\n6. Remainder as above\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 12:28 pm, 15 minutes after discovery of\nthe findings." }, { "input": "The study is moderately degraded by motion artifact.\n\n\nCERVICAL:\n\nThere is minimal anterolisthesis of C7 on T1. Vertebral body heights are\npreserved. Aside from endplate degenerative changes, most prominent at C5-6\nand C6-C7, there is no bone marrow signal abnormality.\n\nAt C2-C3, there is no spinal canal or neural\n\nAt C3-C4, osteophytes indent the left anterior cord. There is moderate\nnarrowing of the spinal canal. Neural foraminal narrowing is mild.\n\nAt C4-C5, posterior disc protrusion and osteophytes flatten the cord and\nresults in moderate narrowing of the spinal canal. There is mild-to-moderate\nleft and mild right neural foraminal narrowing.\n\nAt C5-C6, the posterior disc and osteophytes flatten the anterior cord results\nin mild narrowing of the spinal canal. There is probably moderate bilateral\nneural foraminal narrowing.\n\nAt C6-C7, posterior disc and osteophytes flatten the cord and results in\nmoderate narrowing of the spinal canal. There is also likely moderate\nnarrowing of bilateral neural foramina.\n\nAt C7-T1, there is no spinal canal narrowing. There is no neural foraminal\nnarrowing.\n\nThe cervicomedullary junction is within normal limits. There is no signal\nabnormality in the cervical spinal cord within limitations of motion artifact.\nThere is no abnormal enhancement.\n\n\n\nTHORACIC:\n\nThere is severe compression fracture of the T5 vertebral body with\napproximately 5 mm of retropulsion into the spinal canal, similar to the\nrecent chest CT. The retropulsed bone fragment mildly indents the anterior\nspinal cord resulting in at least moderate narrowing of the spinal canal. \nThere is no cord signal abnormality at this level.\n\nThe collapsed T5 vertebral body is very hypointense on precontrast T1 weighted\nimages and shows central areas of STIR hyperintense signal with avid\nenhancement. The abnormal T2 signal and enhancement extends into the left T5\npedicle and pars interarticularis (series 6, image 13). The enhancement in\nthe vertebral body is contiguous with enhancing soft tissue in the right\nprevertebral space measuring approximately 21 x 35 x 37 mm and spanning\napproximately T4 to T6 (series 18, image 13; series 15, image 8). Enhancing\nsoft tissue also extends into the epidural space and surrounds the thecal sac\nposterior to T5 (series 18, image 16).\n\nThere is no evidence of edema or abnormal enhancement in the adjacent\nintervertebral discs. There is no evidence of discontinuity or disruption in\nthe anterior and posterior longitudinal ligaments. There is increased STIR\nsignal in the T4-T5 and T5-T6 interspinous ligaments and ligamentum flavum\nposterior to T5, consistent with injury to the posterior ligamentous complex\n(series 6, image 9).\n\nOverall, these findings suggest a pathologic fracture with soft tissue,\npresumably neoplasm, in the paraspinal space on the right and epidural space\nwithin the spinal canal. The relatively normal appearance of the\nintervertebral discs and the homogeneous enhancement of the abnormal soft\ntissue argue against infection as the cause of the pathologic fracture.\n\nA 7 mm focus of T2/STIR hyperintense signal in the T9 vertebral body that is\nmildly hypointense with respect to the background marrow fat on T1 weighted\nimages but mildly hyperintense with respect to the intervertebral disc with\npossible subtle enhancement could represent a metastatic focus or a small\nhemangioma (series 5, image 16). The thoracic vertebral body heights and\nalignment are otherwise preserved.\n\nMultiple small posterior disc protrusions in the thoracic spine not result in\nsignificant narrowing of the spinal canal. There is no high-grade neural\nforaminal stenosis in the thoracic spine.\n\nThe thoracic spinal cord is normal in caliber and signal intensity.\n\nLUMBAR:\n\nThe lumbar vertebral bodies are normal in height and alignment. Schmorl's\nnodes and endplate degenerative changes are noted. There is no suspicious bone\nmarrow signal abnormality.\n\nAt L1-L 2, disc bulge and vertebral body osteophytes result in mild narrowing\nof the spinal canal and bilateral neural foramina.\n\nAt L2-L3, there is severe loss of disc height. Disc bulging and vertebral\nbody osteophytes result in mild narrowing of the spinal canal and\nmild-to-moderate narrowing of bilateral neural foramina.\n\nAt L3-L4, disc bulge and vertebral body osteophytes result in mild narrowing\nof the spinal canal and mild bilateral neural foraminal narrowing.\n\nAt L4-L5, disc bulge and vertebral body osteophytes result in mild narrowing\nof the spinal canal and bilateral neural foramina.\n\nAt L5-S1, there is no spinal canal or neural foraminal narrowing.\n\nThere is no definite abnormality the cauda equina nerve roots and there is no\ndefinite abnormal enhancement although evaluation is limited by extensive\nmotion artifact.\n\n\nOTHER: Bilateral renal cysts are noted.", "output": "1. compression fracture of the T5 vertebral body with enhancing soft tissue\nextending into the right prevertebral space from approximately T4 to T6 and\nenhancing soft tissue surrounding the thecal sac posterior to T5. This is\nlikely a pathologic fracture.\n2. Bony retropulsion and epidural soft tissue result in moderate narrowing of\nthe spinal canal and remodeling of the anterior cord at T5, unchanged. There\nis no cord signal abnormality.\n3. STIR hyperintense signal in the T4-5 and T5-6 interspinous ligaments and\nfocal signal abnormality in ligamentum flavum at T5 are concerning for injury\nto the posterior ligamentous complex. There is no definite evidence of\nanterior or posterior longitudinal ligament disruption.\n4. A 7 mm T2 hyperintense focus in the T9 vertebral body may represent\nmetastasis or a hemangioma.\n5. Multilevel degenerative changes as described. Evaluation is suboptimal due\nto moderate motion artifact.\n\nRECOMMENDATION(S): A spine surgery consult decayed to mechanical stability at\nthe level of the fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:19 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "The patient is status post posterior spinal fusion with orthopedic hardware\nextending from the level of C6 caudally through the visualized portions of the\nthoracic spine. There is extensive susceptibility artifact from this hardware\nwhich limits evaluation of the adjacent structures, particularly beginning at\nthe level of C7-T1.\n\nThe T5 vertebral body is incompletely imaged, but appears diffusely\nhypointense on T1 and T2 sequences, with increased signal on the IDEAL\nsequence.\n\nOtherwise, within the cervical spine, there is gross maintenance of the\nvertebral body heights. There is minimal, 1-2 mm retrolisthesis of C6 on C7,\nand 1 mm anterolisthesis of C7 on T1. The remainder of the sagittal spinal\nalignment is grossly maintained.\n\nThe bone marrow signal is mildly heterogeneous without focal suspicious\nlesion. There is homogeneous T1/T2 hyperintensity throughout the visualized\nupper thoracic vertebral bodies, with low signal on ideal sequence, which may\nrepresent post radiation changes.\n\nMultilevel degenerative changes are as follows:\n\nC2-C3: A left asymmetric posterior disc bulge indents the ventral thecal sac\nwithout significant canal stenosis. Uncovertebral joint hypertrophy results\nin minimal right but moderate left neural foraminal narrowing.\n\nC3-C4: Left asymmetric posterior disc bulging indents the ventral thecal sac\nwith mild canal stenosis, combining with uncovertebral joint hypertrophy to\nresult in moderate bilateral neural foraminal narrowing.\n\nC4-C5: A posterior disc bulge flattens the ventral thecal sac causing minimal\ncanal stenosis. There is uncovertebral joint hypertrophy however which\nresults in minimal right but moderate left neural foraminal narrowing.\n\nC5-C6: A posterior disc bulge flattens the ventral thecal sac and nearly\ncontacts the ventral cord, with mild-to-moderate canal stenosis. There is\nsuperimposed uncovertebral joint hypertrophy resulting in mild right and\nmoderate left neural foraminal narrowing.\n\nC6-C7: A posterior disc bulge indents the ventral thecal sac resulting in mild\ncanal stenosis, with uncovertebral joint hypertrophy contributing to mild to\nmoderate left and moderate right neural foraminal narrowing.\n\nC7-T1: There is mild posterior disc bulging noted at this level, with no\nevidence for severe canal stenosis on the sagittal sequences. Note that the\nposterior elements and dorsal epidural spaces obscured secondary to\nsusceptibility artifact. There is probable mild right and minimal left neural\nforaminal narrowing at this level.\n\nThe T1-T2 level is evaluated predominantly on sagittal sequences alone. \nAlthough there is no significant spondylosis, a focus of susceptibility\nartifact within the canal is noted on both sagittal and axial sequences (3:8,\n6:34).", "output": "1. Limited evaluation due to extensive susceptibility artifact from posterior\nspinal fusion hardware. No evidence of high-grade spinal stenosis or cord\ncompression in the cervical region.\n2. Large focus of susceptibility artifact within the spinal canal at the level\nof T1-2, limiting evaluation of canal stenosis or cord compression at this\nlevel.\n3. Multilevel cervical spondylosis, as detailed above.\n4. Mildly heterogeneous cervical bone marrow signal without focal suspicious\nlesion. Evidence of prior radiation therapy is noted throughout the upper\nthoracic vertebral bodies." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nTHORACIC:\nThe alignment of the thoracic spine is normal. The bone marrow is diffusely\nT1 hypointense in signal. There is no marrow edema. The spinal cord is\nnormal in caliber and signal. The height of the vertebral bodies are\nmaintained. A Schmorl's node is noted at the superior endplate of T2. The\nintervertebral discs from T2-T3 to T9-T10 are desiccated. No irregularity of\nthe endplates are identified. There are no epidural fluid collections. There\nis no spinal canal or neural foraminal stenosis. Disc bulges are noted at\nT1-T2, T4-T5, and T6-T7. The paraspinal soft tissues are normal.\n\nLUMBAR:\nThe alignment of the lumbar spine is normal. The bone marrow is diffusely T1\nhypointense. There is no marrow edema. The conus medullaris terminates at\nT12-L1. The spinal cord is normal in signal. The height of the vertebral\nbodies are maintained. The intervertebral disc spaces from L2-3 to L5-S1 are\nmildly narrowed and desiccated. There is no T2 hyperintense signal within the\nintervertebral discs. No epidural fluid collections are identified. The\nparaspinal soft tissues are normal.\n\nAt L1-L2, there is no spinal canal or neural foraminal stenosis.\n\nAt L2-L3, there is disc bulge and ligamentum flavum thickening without spinal\ncanal or neural foraminal stenosis.\n\nAt L3-L4, disc bulge and ligamentum flavum thickening cause mild bilateral\nneural foraminal stenosis. There is no spinal canal stenosis.\n\nAt L4-L5, disc bulge with superimposed central disc protrusion and annular\nfissure as well as bilateral facet arthropathy cause mild spinal canal and\nmild bilateral neural foraminal stenosis.\n\nAt L5-S1, disc bulge and bilateral facet arthropathy cause mild bilateral\nneural foraminal stenosis. There is no spinal canal stenosis.\n\nOTHER: The right lower lobe is partially atelectatic. The small to moderate,\nloculated right pleural effusion is unchanged. The spleen is enlarged,\nmeasuring up to 16.9 cm in greatest dimension.", "output": "1. Limited examination due to moderate motion and absence of intravenous\ncontrast.\n2. Within limits of study, no evidence of diskitis/osteomyelitis or epidural\nfluid collection.\n3. Multilevel degenerative changes of the thoracolumbar spine, most advanced\nat L4-L5, where there is mild spinal canal and mild bilateral neural foraminal\nstenosis.\n4. Small to moderate, loculated right pleural effusion.\n5. Splenomegaly." }, { "input": "There is motion artifact greatest on the sagittal T2 and STIR sequences of the\nthoracic spine which limits spatial resolution.\n\nThoracic: There is normal thoracic alignment. The vertebral body heights are\npreserved. There is marked T2 signal hyperintensity marginating the T1-T2\nendplates with associated T2 hyper and intensity at the intervertebral disc\nspace. There is T2 hyperintensity within the adjacent pre and paravertebral\nsoft tissues. There is no definite cortical defect. There is mild focal\neffacement of the ventral thecal sac at the disc level which may represent\nbone, disc, or phlegmon. Findings at the vertebral endplate and adjacent\nvertebral body have increased in comparison to prior MR from ___. \nThere is no definite cord signal abnormality or significant spinal canal\nstenosis.\n\nThe vertebral body heights are preserved. There is diffuse low T1 marrow\nsignal. The cord demonstrates normal signal morphology.\n\nThere is significant pulsation artifact within the spinal canal on axial and\nsagittal T2 and sagittal STIR sequences. There is no significant neural\nforamina or spinal canal stenosis. There is right upper and right lower lobe\nT2 hyperintensity with dependent atelectasis. There is a small right-sided\npleural effusion. There is a small amount of layering fluid within the distal\ntrachea. There is a 7.6 cm TV x 4.6 cm AP septated T2 hyperintense lesion\nwith layering T2 hypointensity at the right lung base (09:21).\n\nLumbar: There is normal lumbar alignment. The vertebral body heights are\npreserved. There is diffuse low marrow signal. There is mild T2\nhyperintensity marginating L2-L3 and L3-L4 endplates likely representing type\n___ ___ change. There is diffuse low signal on the T2 weighted images within\nthe intervertebral disc spaces with focal T2 hyperintensity within the L2-L3\nand L4-L5 disc spaces. The conus demonstrates normal signal morphology,\nterminating appropriately at the L1-L2 level.\n\nAt L1-L2 there is no significant neural foramina or spinal canal stenosis.\n\nAt L2-L3 there is a disc bulge with a superimposed right sided disc protrusion\ncausing mild spinal canal narrowing and contacting the traversing right L3\nnerve root in the subarticular zone (13:18) there is mild right neural\nforaminal stenosis.\n\nAt L3-L4 there is no significant neural foramina or spinal canal stenosis.\n\nAt L4-L5 there is disc bulge with a superimposed midline and right sided disc\nprotrusion and facet osteophytes causing moderate spinal canal narrowing which\ncompresses the traversing right L5 nerve root in the subarticular zone\n(13:30). There is moderate right and mild left neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge and facet osteophytes without significant neural\nforaminal or spinal canal stenosis.\n\nThere is edema throughout the visualized soft tissues. There is a nodular\nappearance of the liver surface with focal T2 hyperintense lesions. There is\npartially visualize splenomegaly. There is a partially visualized T2\nhyperintense structure in the right upper quadrant with layering T1\nhypointensity, likely representing the gallbladder (13:11).", "output": "1. Edema at the T1-T2 articulating endplates with associated disc space fluid\nsignal and paraspinal edema which have worsened in comparison to prior study. \nGiven the worsening in comparison to prior study and history of bacteremia,\nfindings are suspicious for discitis and osteomyelitis. Mild effacement of\nthe ventral thecal sac at this level which is limited in evaluation due to\nmotion artifact, large field of view, and the absence of postcontrast imaging.\nThis may represent a small osteophyte, disc, or epidural phlegmon. This could\nbe further characterized with repeat imaging with a small field-of-view. \nThere is no associated significant spinal canal stenosis or definite cord\nsignal abnormality. Stable degenerative changes of the lumbar spine, as\ndescribed.\n2. Likely airspace disease at the right upper and right lower lobes which may\nrepresent aspiration, alveolar filling pulmonary edema, atelectasis and/or\npneumonia.\n3. 7.6 cm septated T2 hyperintensity at the right lung base with layering T2\nhypointensity likely representing loculated intra pleural fluid.\n4. Nodular liver surface and splenomegaly consistent with cirrhosis.\n5. Likely enlarged gallbladder with layering sludge within the right upper\nquadrant.\n6. T2 hyperintense lesions within the liver parenchyma may represent cysts\nversus masses in could be further characterized with a dedicated\ncontrast-enhanced CT or MRI.\n\nRECOMMENDATION(S): Dr ___\n\n___: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 12:10 ___, 30 minutes after discovery\nof the findings." }, { "input": "CERVICAL:\nThere is 2 mm anterolisthesis of C4 on C5. The alignment of the cervical\nspine is otherwise maintained. The vertebral body heights are maintained at\nall levels. The visualized cervical spinal cord appears grossly unremarkable\nwithout focal cord signal abnormality though evaluation is limited given the\nmotion artifact.\n\nNo abnormal marrow signal is seen.\n\nThe visualized posterior fossa structures appear unremarkable. There is fluid\nin the nasopharynx and oropharynx, likely related to intubation. Endotracheal\nand enteric tubes are partially visualized. The prevertebral, paravertebral\nand paraspinal soft tissues are otherwise grossly unremarkable.\n\nAt C2-C3, there is central disc osteophyte complex indenting the ventral\nthecal sac. Bilateral neural foramen are patent.\n\nAt C3-C4, there is loss of disc height and signal with central disc osteophyte\ncomplex indenting the ventral thecal sac. Bilateral uncovertebral and facet\narthropathy results in moderate bilateral neural foramen narrowing.\n\nAt C4-C5, there is loss of disc height and signal with central disc osteophyte\ncomplex indenting the ventral thecal sac. Bilateral uncovertebral and facet\narthropathy results in mild right and moderate left neural foramen narrowing.\n\nAt C5-C6, there is loss of disc height and signal with central disc osteophyte\ncomplex indenting the ventral aspect of the spinal cord. Bilateral\nuncovertebral and facet arthropathy results in moderate bilateral neural\nforamen narrowing.\n\nAt C6-C7, there is loss of disc height and signal with central disc osteophyte\ncomplex indenting the ventral thecal sac. Bilateral uncovertebral and facet\narthropathy results in mild-to-moderate bilateral neural foramen narrowing.\n\nAt C7-T1, bilateral neural foramen and spinal canal are patent though\nevaluation is limited given the motion artifact.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized thoracic spinal cord appears\ngrossly unremarkable without focal cord signal abnormality or cord expansion.\n\nThere is persistent T2 hyperintensity marginating the T1-T2 endplates with\nassociated T2 hyperintensity in the intervertebral disc space. This is\nrelatively unchanged compared to the prior study. Also seen is edema within\nthe paraspinal and paravertebral soft tissues at this level. This is most\nlikely in keeping with discitis osteomyelitis and is unchanged compared to the\nprior study.\n\nThere is a thin epidural collection measuring approximately 2 mm extending\nfrom the level of C7 vertebrae to the level of T3 vertebrae as seen on image\n5:10 centered along the T1-T2 endplate. The absence of postcontrast images\nlimits the evaluation but this is most likely in keeping with epidural\nphlegmon/abscess given the discitis osteomyelitis at T1-T2.\n\nAlso seen is prevertebral fluid collection measuring approximately 4 mm on\nimage 6:8 centered at T1-T2 intervertebral disc space extending from the\ninferior aspect of C7 vertebrae to the inferior aspect of T2 vertebrae, most\nlikely in keeping with the prevertebral phlegmon/abscess given the discitis\nosteomyelitis.\n\nNo abnormal marrow signal is seen at any other level.\n\nThere is mild loss of disc height and signal at multiple levels. Neural\nforamina and spinal canal are however patent at all levels.\n\nPartly visualized is atelectasis in bilateral lower lung lobes, right greater\nthan left with small bilateral pleural effusions.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized lower spinal cord appears\nunremarkable with the conus terminating at L1-L2. Again seen are ___ type 1\nchanges at L2-L3 and L3-L4. The marrow signal is otherwise unremarkable.\n\nThere is edema within the paraspinal and paravertebral soft tissues from the\nlevel of T12-L5 vertebrae. Partially visualized is splenomegaly with nodular\nconfiguration of the liver, likely secondary to underlying cirrhosis. There\nis layering sludge in the gallbladder. The remaining visualized\nretroperitoneal, paravertebral and paraspinal soft tissues appear\nunremarkable. The visualized upper bilateral sacroiliac joints appear\nunremarkable.\n\nAt T12-L1, the intervertebral disc height and signal is maintained. Bilateral\nneural foramen and spinal canal are patent.\n\nAt L1-L2, the intervertebral disc height and signal are maintained. Bilateral\nneural foramen and spinal canal are patent.\n\nAt L2-L3, there is loss of intervertebral disc height and signal with\nbroad-based disc bulge with superimposed right central and foraminal disc\nprotrusion and a small annular fissure and bilateral facet arthropathy\nresulting in mild bilateral neural foramen narrowing. The spinal canal is\npatent. Also seen is narrowing of the right subarticular zone impinging the\ntraversing L3 nerve root.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc bulge\nasymmetric towards the left and bilateral facet arthropathy resulting in\nmoderate bilateral neural foraminal narrowing and narrowing of left\nsubarticular zone impinging the traversing left L4 nerve root.\n\nAt L4-L5, there is loss of disc height and signal with broad-based disc bulge\nand superimposed right central and paracentral disc protrusion resulting in\nmild left and moderate right neural foraminal narrowing and narrowing of right\nsubarticular zone displacing the traversing right L5 nerve root.\n\nAt L5-S1, there is loss of disc height and signal with broad-based disc bulge\nand bilateral facet arthropathy. Bilateral neural foramen and spinal canal\nare patent.", "output": "1. Findings suggestive of discitis/osteomyelitis involving T1-T2 vertebrae\nwith edema in the paravertebral and paraspinal soft tissues, relatively\nunchanged compared to the prior study.\n2. Prevertebral and epidural fluid collection centered at T1-T2 extending from\nC7-T2 vertebrae in the prevertebral space and C7-T3 vertebrae in the epidural\nspace, incompletely evaluated in the absence of intravenous contrast. However\ngiven the presence of discitis osteomyelitis, these are favored to be\nprevertebral and epidural phlegmon/abscess.\n3. Multilevel multifactorial degenerative disease of the cervical spine, worst\nat C3-C4 and C5-C6 with moderate bilateral neural foramen narrowing.\n4. No neural foramina or spinal canal narrowing involving the thoracic spine.\n5. Stable multilevel multifactorial degenerative disease of the lumbar spine,\nworst at L4-L5 with moderate right neural foramen narrowing and impingement of\nright traversing L5 nerve root in the subarticular zone as described above." }, { "input": "There is scoliosis, convex to the right in the upper lumbar spine with its\napex at L1-2 and convex to the left in the lower lumbar spine with its apex at\nL4-5. There is anterior subluxation of L4 on L5. There are ___ type 1 and\ntype 2 signal intensity changes of the vertebral endplates at L1-2, L4-5 and\nL5-S1. There is a hemangioma in the T12 vertebral body. there is loss of\nheight of the intervertebral discs and loss of signal on the T2 weighted\nimages. These are due to degenerative disease.\n\nAt T10-11 there is a bulge of the disc with no contact with the spinal cord. \nThe neural foramina are incompletely evaluated.\nAt T11-12 there is a disc bulge and a small midline protrusion that along with\nfacet osteophytes encroach mildly on the conus medullaris. The neural\nforamina appear normal.\nAt T12-L1, there is a mild bulge of the disc with no spinal canal or neural\nforaminal compromise.\nAt L1-2, bulging of the disc and left-sided facet osteophytes compress the\ntraversing left L2 nerve root. The left neural foramen is narrowed. The\nright neural foramina appears normal.\nAt L2-3, there is severe spinal canal narrowing due to ligamentum flavum\nthickening, facet osteophytes, intervertebral osteophytes and a disc bulge and\nmidline disc protrusion.\nAt at L3-4, disc bulging, ligamentum flavum thickening and facet osteophytes\nproduce moderate spinal canal narrowing with compression of the traversing\nright L3 nerve root between the disc bulge and the superior facet.\nAt L4-5, there is moderate spinal canal narrowing due to facet osteophytes,\nligamentum flavum thickening, disc bulge and subluxation. The traversing L5\nnerve roots are compressed between the facet osteophytes and the disc bulge\nbilaterally. There is severe right and mild left neural foraminal narrowing.\nAt L5-S1, there is a prominent disc bulge as well as a protrusion with\nsuperior migration of the fragment posterior to the L5 vertebral body. This\nand facet osteophytes produce moderate spinal canal narrowing but severe\nnarrowing of the neural foramina bilaterally. There is also compression of\nthe traversing S1 nerve roots between the disc bulge and protrusion and the\nsuperior facets.", "output": "1. Degenerative disease with severe spinal canal narrowing at L2-3 and several\nlevels of moderate canal narrowing.\n2. Multiple levels of severe neural foraminal narrowing.\n3. Disc bulge and protrusion at T11-12 encroaching on the conus." }, { "input": "Comparison with the prior study reveals no significant interval change in the\nextent of the multilevel degenerative abnormalities involving both lower\nthoracic and lumbar spine. Please refer to Dr. ___ detailed\npreceding report for all findings.\n\nThere is no new abnormality of the visualized distal spinal cord, conus\nmedullaris, cauda equina, or limited lumbar paraspinal soft tissue imaging..", "output": "No interval change in the extensive lower thoracic and lumbar degenerative\nabnormalities, described in the preceding report from ___.\n\nComment: CT scanning of the lumbar spine is more sensitive than MR scanning in\ndetecting nondisplaced fractures that do not manifest bone edema. These\ncomments are made in light of the patient noting three falls in the last six\nmonths." }, { "input": "Mild straightening of the cervical lordosis is similar. Subtle\nanterolisthesis of C7 on T1 is noted. The spinal cord appears normal in\ncaliber and configuration. C6-7 endplate edema is likely degenerative.\n\nC2-3: Uncovertebral spurring is seen with similar mild approaching moderate\nleft foraminal narrowing. No significant central stenosis seen.\n\nC3-4: Disc bulge uncal spurring are present with mild central stenosis,\nmoderate right and severe left foraminal narrowing which have increased.\n\nC4-5: Disc bulge uncal spurring are present with mild approaching moderate\ncentral stenosis, mild to moderate right and severe left foraminal narrowing\nwhich have increased.\n\nC5-6: Central disc protrusion uncal spurring are present. Moderate central\nstenosis, severe right and moderate left foraminal narrowing have increased. \nThere is ventral cord flattening.\n\nC6-7: Disc bulge uncal spurring are seen with mild to moderate central\nstenosis and severe right greater than left foraminal narrowing which have\nincreased.\n\nC7-T1: Subtle anterolisthesis of C7 on T1 seen without significant central\nstenosis or foraminal narrowing", "output": "1. Multilevel cervical spondylosis with mild to moderate central stenosis and\nmild to severe foraminal narrowing as detailed above." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. \nDegenerative loss of disc height and signal at C5-C6 and C6-C7 is mild. Mixed\n___ changes at C5-C6 and C6-C7 has progressed since ___. The visualized\nposterior fossa is unremarkable. There is no cord signal abnormality.\n\nThere is borderline spinal canal narrowing at baseline secondary to congenital\nshortening of the pedicles.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: A small central protrusion results mild spinal canal narrowing,\ncontacting the ventral aspect of the cord without effacement. Uncovertebral\nand facet arthropathy results in mild bilateral neural foraminal narrowing.\n\nC4-C5: A central protrusion and thickening of the ligamentum flavum results\nin mild spinal canal narrowing, minimally remodeling the cord. Uncovertebral\nand facet arthropathy results in mild bilateral neural foraminal narrowing.\n\nC5-C6: A central protrusion with intervertebral osteophytes and ossification\nof the posterior longitudinal ligament results in moderate spinal canal\nnarrowing, remodeling the cord. Uncovertebral and facet arthropathy results\nin moderate to severe bilateral neural foraminal narrowing.\n\nC6-C7: A central protrusion with intervertebral osteophytes in mild\nossification of the posterior longitudinal ligament results in moderate spinal\ncanal narrowing, remodeling the cord. Uncovertebral and facet arthropathy\nresults in moderate bilateral neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nThe above degenerative changes has slightly progressed from examination of\n___.\n\nDependent nonspecific fluid is noted in the pharynx. Otherwise, the\nvisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial cervical spondylosis most prominent at C5-C6 and\nC6-C7 where there is moderate spinal canal narrowing, remodeling the cord\nwithout underlying cord signal change. This appears to slightly progressed\nsince examination of ___.\n2. Neural foraminal narrowing is moderate to severe C5-C6 and moderate at\nC6-C7.\n3. Additional findings as described above." }, { "input": "Thoracic spine alignment is anatomic. Again demonstrated is\nincreased T1 and T2 signal within the inferior T8, T9, T10, T11, T12 and L1\nvertebral bodies compatible with post-radiation change. Abnormal increased\nsignal within the spinal cord at the T10, T11 levels, with associated\nenhancement, is similar to ___ as well, compatible with an\nintramedullary metastasis. The enhancing lesion on the right at T7-T8\ninvolving the costochondral junction and paraspinal soft tissues is similar to\nprior.\n\nAgain partially visualized are numerous hepatic, pulmonary, parenchymal and\npleural-based masses. These are grossly similar to ___.", "output": "1. Intramedullary metastasis at the T11 level, similar to ___.\n\n2. Right paraspinal metastasis at T7-T8, similar to ___.\n\n3. Post-radiation changes involving the T8 through L1 vertebral bodies with\nno evidence of new vertebral body metastasis.\n\n4. Numerous pulmonary and hepatic metastases partially evaluated but grossly\nsimilar to the ___." }, { "input": "MRI THORACIC SPINE: S-shaped scoliosis of the thoracolumbar spine,\ndextroconvex in the lower thoracic spine and levoconvex in the lumbar spine,\nis again demonstrated. Sagittal alignment is near anatomic. Mild\ndegenerative changes are again demonstrated with disc desiccation and\nscattered Schmorl's nodes, most prominent at the inferior endplate of T11 and\nT12. Regions of abnormal increased T1 signal within the vertebral bodies, most\nprominent in the lower thoracic spine, likely post-radiation changes are\nsimilar to prior.\n\nThere has been interval decrease in the amount of enhancement within the\nlesion in the distal thoracic spinal cord at the level of T11, with very faint\nresidual enhancement within the left aspect of the cord at this level. The\nassociated mild expansion and increased T2 signal is similar to prior.\n\nThe small amount of abnormal soft tissue adjacent to the large osteophyte\ninvolving the costochondral junction and paraspinal soft tissues is similar to\n___.\n\nLUMBAR SPINE: There is no suspicious osseous, intrathecal or epidural lesion\nin the lumbar spine to suggest metastasis. Extensive degenerative changes are\nsimilar to prior with 6 mm anterolisthesis of L5 on S1 and of L5 on L4. \nDiffuse loss of disc space height and disc desiccation with multilevel disc\nbulge and facet arthropathy is also similar to prior. This causes findings at\nnumerous levels, the most significant of which is severe bilateral foraminal\nnarrowing at L5-S1.\n\nThe large right renal mass, with pulmonary and adrenal metastasis, are all\nbetter evaluated on the ___ CT thorax. The right pleural effusion has\nincreased slightly in size compared to that examination.", "output": "1. Slight interval decrease in the intensity of enhancement in the medullary\nlesion at the T11 level.\n2. Right paraspinal metastatic focus involving the right T7-T8 costovertebral\njunction, also similar to prior.\n3. Interval increase in the size of the right pleural effusion when compared\nto ___ chest CT. The large right renal mass with adrenal and pulmonary\nmetastases are all partially evaluated and better seen on that prior\nexamination." }, { "input": "The alignment is normal. There is mild rotatory scoliosis.\n\nVertebral bodies maintain normal morphology. No evidence of acute fracture. \nNo suspicious marrow replacing lesion.\n\nIntervertebral discs are preserved.\n\nNo focal cord signal abnormality. No distortion of the thoracic spinal cord,\nor visualized exiting nerve roots.\n\nNo significant posterior disc pathology, spinal canal stenosis, or neural\nforaminal narrowing.\n\nParaspinal soft tissues are unremarkable.", "output": "Mild scoliotic curvature. Otherwise, unremarkable MR thoracic spine." }, { "input": "Moderate-to-severe levoconvex scoliosis of the lumbar spine is similar to\nprior. Heterogeneous marrow signal on T1- and T2-weighted images is similar to\nprior. There are no suspicious osseous lesions; STIR sequence reveals only\nendplate degenerative changes most prominent at L5-S1.\n\nThe conus medullaris terminates at the level of the L1 vertebral body with\nnormal signal.\n\nSusceptibility artifact from the patient's ___ rods obscure much of the\nposterior spinal canal and structures adjacent to the L3 vertebral body. This\nis similar to prior.\n\nAt L1-L2, ligamentum flavum thickening, facet hypertrophy and the scoliotic\ndeformity, mildly deforms the left aspect of the spinal canal, abutting\ndescending dorsal nerve roots. There is no significant foraminal narrowing.\n\nAt L2-L3, broad-based disc bulge and bilateral facet arthropathy mildly narrow\nthe spinal canal. Susceptibility artifact limits evaluation of the foramina\nat this level. \n\nAt L3-L4, a broad-based disc bulge, ligamentum flavum thickening, and facet\nhypertrophy combine with the scoliotic curvature to mildly narrow the spinal\ncanal with mild crowding of the cauda equina. The foramina are difficult to\nassess due to susceptibility artifact from the spinal hardware.\n\nAt L4-L5, endplate osteophytes combine with a broad-based disc bulge and facet\narthropathy to mildly deform the posterolateral spinal canal. This combines\nwith a scoliotic deformity to moderately narrow the right and mildly narrows\nthe right neural foramen. \n\nAt L5-S1, endplate osteophytes and mild anterolisthesis has progressed\ncompared to the prior examination with marked interval loss of disc space\nheight, particularly on the right. Posterior osteophytes and facet\narthropathy moderately narrow the spinal canal at this level with crowding of\nthe cauda equina. There is CSF visualized along the nerve roots. In\naddition, this process creates severe left and mild to moderate right \nforaminal narrowing. The degeneration at this level has significantly\nworsened compared to the ___ MRI.", "output": "Continued interval progression of L5-S1 degenerative disc greater\nthan facet disease with moderate spinal canal and severe left foraminal\nnarrowing at this level." }, { "input": "Small amount of prevertebral edema is centered at C4-5. The anterior\nlongitudinal ligament itself appears intact. The posterior longitudinal\nligament, ligamentum flavum are also intact. Edema within the interspinous\nligaments from C3 through 6 is consistent with ligamentous strain. Nuchal\nligament appears intact.\n\nNo focal cord signal abnormality. No intradural collection. The previously\nnoted right C4 transverse process fracture is better visualized on the\ncorresponding CT. The major vascular flow voids are preserved.\n\nThe patient's spinal canal is congenitally small. There is a small posterior\ndisc bulge at C4-5. Otherwise, there is no significant posterior disc\npathology, spinal canal stenosis, or neural foraminal narrowing.", "output": "1. No focal cord signal abnormality or intradural collection.\n2. Prevertebral edema centered at C4-5. The anterior longitudinal ligament\nremains intact.\n3. Interspinous ligament strain from C4 through 7.\n4. Right C4 transverse process fracture better visualized on prior CT." }, { "input": "When compared to examination of ___, there may be minimal increased\nanterolisthesis of C4 on C5, now measuring approximately 4 mm. Retrolisthesis\nof C6 on C7 is unchanged. The remainder of the cervical alignment is\nanatomic. Vertebral body heights are preserved. Degenerative loss of disc\nsignal and height at C5-C6 and C6-C7 is moderate to severe, also unchanged\nfrom prior exam. STIR hyperintense signal of the C4-C5 left facets is similar\nto prior examination, potentially representing facetitis. There is no focal\nsuspicious marrow lesion. The visualized posterior fossa is unremarkable. \nThere is no cord signal abnormality.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: There is no significant spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in mild bilateral neural foraminal narrowing.\n\nC4-C5: A small central protrusion does not significantly narrow the spinal\ncanal. Uncovertebral and facet arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nC5-C6: Intervertebral osteophytes results in mild spinal canal narrowing. \nThere is mild bilateral neural foraminal narrowing.\n\nC6-C7: Intervertebral osteophytes and C6 on C7 retrolisthesis results in mild\nspinal canal narrowing. Uncovertebral and facet arthropathy results in at\nleast mild to moderate right and mild left neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nVisualize prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Possible minimal progression of C4 on C5 anterolisthesis from examination\nof ___. Otherwise, the remainder of the findings are unchanged\nfrom the prior examination.\n2. The degenerative changes are most prominent at C5-C6 where there is mild\nspinal canal narrowing and at least mild to moderate right and mild left\nneural foraminal narrowing.\n3. There is no cord signal abnormality." }, { "input": "Unchanged 3 mm retrolisthesis of C6 on C7. Otherwise, cervical alignment is\nanatomic. Vertebral body heights are preserved. A prominent C6 endplate\nSchmorl's node is identified. Otherwise, there is no suspicious marrow\nsignal. Disc desiccation and severe loss of disc height at C5-C6 and C6-C7 is\nsimilar in appearance to examination of ___. The visualized posterior fossa\nis unremarkable. There is no cord signal abnormality.\n\nC2-C3: Unremarkable.\n\nC3-C4: A very small central protrusion does not significantly narrow the\nspinal canal. Bilateral facet and uncovertebral arthropathy results in mild\nneural foraminal narrowing.\n\nC4-C5: Very small central protrusion does not significantly narrow the spinal\ncanal. There is mild bilateral neural foraminal narrowing secondary to facet\nand uncovertebral arthropathy.\n\nC5-C6: A central protrusion minimally narrows the spinal canal. \nUncovertebral and facet arthropathy results in mild bilateral neural foraminal\nnarrowing.\n\nC6-C7: A left eccentric intervertebral osteophyte and disc the along with\nthickening of the ligamentum flavum results in moderate to severe spinal canal\nnarrowing similar appearance to prior exam. There is minimal remodeling of\nthe ventral aspect of the cord. Uncovertebral and facet arthropathy results\nin mild bilateral neural foraminal narrowing.\n\nC7-T1 and T1-T2: No significant spinal canal or neural foraminal narrowing.\n\nPrevertebral paraspinal soft tissues are unremarkable.", "output": "1. Cervical spondylosis as described above similar in appearance to prior exam\nof ___ most prominent at C6-C7 where there is 3 mm\nretrolisthesis of C6 on C7 and moderate spinal canal narrowing with minimal\nremodeling of the ventral aspect of the cord. There is no underlying cord\nsignal change. There is mild bilateral neural foraminal narrowing at this\nlevel.\n2. No prevertebral paraspinal soft tissue abnormalities." }, { "input": "CERVICAL:\nThere is abnormal STIR hyperintensity involving the posterior paraspinal\nmuscles extending from C2 through T2 levels with involvement of the bilateral\ninterspinalis, multifidus, and longissimus paraspinal musculature with\ncorresponding intense enhancement. There is preservation of the midline fat\nplane on the pre contrast sagittal T1 images. Although infectious process is\na possibility, it would be unusual for extensive bilateral final muscle\ninfection to spare the midline. Alternatively possibility is posttraumatic,\npossibly from whiplash injury or muscle edema from direct trauma. There are\nnonspecific foci of T2 hyperintensity in the bilateral interspinalis muscles\n(08:23) which may represent muscle necrosis.\n\nThe alignment of the cervical spine is maintained. The vertebral body heights\nand intervertebral disc space preserved. There is no suspicious bone marrow\nsignal abnormality. The spinal cord is normal in caliber morphology without\nabnormal enhancement. There is no discrete fluid collection or evidence of\nepidural abscess. The prevertebral soft tissues appear unremarkable.\n\nThere is a disc bulge at C5-C6 indenting the ventral spinal canal without\ncontacting the spinal cord. The remaining levels of the cervical spine appear\nunremarkable without spinal canal stenosis or neural foraminal narrowing. \nThere is no evidence of cord edema.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand intervertebral disc space and signal are preserved. There is no\nsuspicious bone marrow signal abnormality. The spinal cord is normal in\ncaliber and signal. There is no abnormal enhancement. There is no discrete\nfluid collection. The prevertebral and paraspinal soft tissues appear\nunremarkable. There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nand intervertebral disc space and signal are preserved. There is no\nsuspicious bone marrow signal abnormality. The conus medullaris terminates at\nT12. There is no abnormal fluid collection or suspicious enhancement. The\nprevertebral and paraspinal soft tissues appear unremarkable. There is no\nspinal canal stenosis or neural foraminal narrowing.", "output": "1. Abnormal signal and intense enhancement involving the bilateral posterior\nparaspinal muscles including the interspinalis, multifidus, and longissimus\nmusculature, extending from C2 through T2 levels with preservation of the\nmidline fat. Although finding may be related to an underlying infectious\netiology, it is felt unusual for infection to spare the midline. Other strong\ndifferential to consider is posttraumatic etiology such as whiplash injury or\ndirect trauma causing muscle edema. Nonspecific superimposed intraspinous\nfoci of T2 signal abnormality may represent muscle necrosis.\n2. No evidence of discitis or osteomyelitis. No evidence of epidural abscess\nor other evidence of abnormal enhancement.\n\nNOTIFICATION: The additional consideration to trauma described in impression\n1 not described in the overnight preliminary report were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at\n11:23 am, 10 minutes after discovery of the findings." }, { "input": "Images are mildly to moderately motion degraded.\n\nIncidentally noted is 1.6 cm x 1.0 cm x 1.0 cm bright T2, low T1 signal lesion\nat the root of the tongue, slightly more to the right from midline, situated\nbetween genioglossus muscles. No appreciable enhancement on post gadolinium\nimages, although this area is suboptimally seen.\n\nAlignment is normal. Evaluation of the cord is indeterminate on sagittal\nimages secondary to motion, there is equivocal T2 signal abnormality extending\nfrom C3 through C6 seen on sagittal images, without definite correlate on\naxial images; axial images are less motion degraded. Findings are likely\nartifact in the absence of clinical symptoms of myelopathy. If there is any\nconcern, exam should be repeated if patient can tolerate.\n\nDegenerative changes cervical spine, disc osteophyte complex C4-C5, C5-C6,\nC6-C7 levels. Posterior element degenerative changes.\n\nAt C2-C3 level central canal, foramina are patent\n\nAt C3-C4 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nAt C4-C5 level there is mild central canal narrowing. Mild left, moderate\nright foraminal narrowing.\n\nAt C5-C6 level there is moderate central canal narrowing, with mild flattening\nof the cord, effaced CSF about cord. Moderate to severe bilateral foraminal\nnarrowing.\n\nAt C6-C7 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nAt C7-T1 level central canal is patent mild right, moderate left foraminal\nnarrowing.\n\nNo abnormal enhancement", "output": "1. 1.6 cm well-circumscribed lesion at the root of the tongue, suboptimally\nseen, likely benign, may represent epidermoid cyst. Consider MRI of the oral\ncavity in further evaluation.\n2. Degenerative changes cervical spine.\n3. Equivocal long segment cord signal, likely related to moderate motion\nartifact in the absence of symptoms of myelopathy. If there is clinical\nconcern, exam should be repeated if patient can tolerate.\n4. Moderate central canal narrowing C5-C6 level.\n5. Multilevel foraminal narrowing, as above.\n\nRECOMMENDATION(S): Consider MRI of the oral cavity / nasopharynx protocol." }, { "input": "Laminectomies are again seen from C3 through C6. No hardware is visualized on\nthe current or prior MRI, but this could be better assessed by plain\nradiography.\n\nMild retrolisthesis of C3 on C4 is unchanged. Mild kyphotic curvature\ncentered at C5-6 is also unchanged. No new alignment abnormalities seen in\nthe cervical spine. The localizer sequence again demonstrates an incompletely\nevaluated levoconvex curvature involving the thoracic spine. Vertebral body\nheights are within normal limits. No concerning bone marrow signal\nabnormalities are seen. Discogenic bone marrow changes are again noted in the\nendplates at multiple levels. No abnormal/unexpected contrast enhancement is\nseen in the cervical spine.\n\nThe cerebellar tonsils are normally positioned. Mild parenchymal volume loss\nis again seen in the visualized portions of the cerebellum and occipital\npoles.\n\nC2-C3: Small central disc protrusion indents the ventral thecal sac but does\nnot contact the spinal cord. There is advanced bilateral facet arthropathy is\nwell as right uncovertebral osteophytes, with mild to moderate right and mild\nleft neural foraminal narrowing. These findings are unchanged since the ___\nMRI.\n\nC3-C4: Mild retrolisthesis and a large central disk protrusion are present,\ndisplacing and flattening the ventral spinal cord, unchanged. Posteriorly,\nthe spinal canal is decompressed by laminectomies, with CSF surrounding the\ncord, unchanged. The cord is mildly atrophic at this level, as before, with\nfoci of myelomalacia, more extensive on the right than left, which appear\nbetter defined than in ___ on sagittal T2 weighted images, but not\nsignificantly change in axial T2 weighted images. The difference in\nappearance on sagittal images is likely related to motion artifact on the\nsagittal images of the prior MRI. There is severe right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes, unchanged.\n\nC4-C5: Small central disc protrusion indents the ventral thecal sac but does\nnot contact the spinal cord. Moderate right and severe left neural foraminal\nnarrowing by uncovertebral and facet osteophytes. No interval change.\n\nC5-C6: Broad-based central disc protrusion with overlying endplate\nosteophytes indents the ventral thecal sac. While it does not contact the\nspinal cord, the ventral surface of the cord is mildly remodeled. No definite\ncord signal abnormality seen at this level. The neural foramina are\nmoderately severely narrowed by uncovertebral and facet osteophytes. No\ninterval change is seen.\n\nC6-C7: No significant spinal canal or neural foraminal narrowing.\n\nC7-T1: No significant spinal canal narrowing. The left neural foramen is\nmildly narrowed by uncovertebral and facet osteophytes, unchanged.\n\nSagittal images through T1-T2, T2-T3, T3-T4, and T4-T5 levels demonstrate disk\nbulges +/-protrusions indenting the ventral thecal sac but not contacting the\nspinal cord. There are no axial images through these levels. Neural foramina\nappear moderately narrowed at T1-T2 bilaterally, and mildly narrowed at T2-T3\nbilaterally and at T3-T4 on the right. There are no axial images through\nthese levels. No significant change is seen compared to the sagittal images\nof the prior MRI.\n\nThe thyroid gland appears diffusely prominent, as before. There is a 5 mm T2\nhyperintense and contrast enhancing nodule in the left lower pole, images 2:15\nand 7:15, not included in the field of view of the ___ cervical\nspine MRI and not seen on the ___ cervical spine MRI. ___ chest CT reports a nodule in the thyroid isthmus, but this is not\nidentified on the present exam.", "output": "1. Laminectomies from C3 through C6. No hardware is visualized on the current\nor prior MRI, but this could be better assessed by plain radiography.\n2. Unchanged alignment of the cervical spine with mild retrolisthesis of C3 on\nC4.\n3. Large central disc protrusion at C3-4 flattens the ventral spinal cord, but\nthe spinal canal is decompressed by laminectomies, in the cord is surrounded\nby CSF. The cord is mildly atrophic at this level with right greater than\nleft myelomalacia. Allowing for motion artifact on the ___ MRI, no\nsignificant interval change is seen.\n4. Degenerative disease at other cervical levels is also unchanged compared to\n___.\n5. 5 mm enhancing nodule in the left lower pole of the diffusely prominent\nthyroid gland, not seen on prior cervical spine MRIs.\n\nRECOMMENDATION(S):\nThyroid sonography is recommended, if not recently performed elsewhere.\n\nNOTIFICATION: The impression item 5 and recommendation above were entered by\nDr. ___ on ___ at approximately 10:40 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." }, { "input": "There are bone marrow reactive changes at T1-2, likely related to degenerative\ndisc disease. No signal abnormality on T1 weighted images or paravertebral\nedema to suggest acute fracture. Vertebral body height appears preserved.\n\n2 mm retrolisthesis of C3 on C4 appears similar to the prior MRI. Vertebral\nbody alignment is otherwise preserved.\n\nThere is volume loss and abnormal signal within the spinal cord at C3-4 level\nconsistent with spondylotic myelomalacia. The degree of volume loss appears\nsimilar to, or slightly more advanced from the prior MRI. The spinal cord\notherwise appears normal in morphology and signal intensity. C3-C6\nlaminectomy.\n\nMultilevel degenerative changes in the cervical spine. Narrowed disc space\nC3-C4. Multilevel disc osteophyte complexes, posterior mid hypertrophic\nchanges.\n\nAt C2-3, a central small shallow disc protrusion results in mild spinal canal\nnarrowing, stable. Stable mild bilateral foraminal narrowing.\n\nAt C3-4, prominent disc osteophyte complex, a broad-based shallow disc\nprotrusion contacts the ventral surface of the spinal cord, however the spinal\ncanal is only mildly narrowed post laminectomy, stable. Severe bilateral\nforaminal narrowing, greater on the right, stable since prior bilateral neural\nforaminal narrowing.\n\nAt C4-5, laminectomy changes with a widely patent spinal canal. There is\nmoderate right and severe left neural foraminal narrowing, stable.\n\nAt C5-6, laminectomy changes, mild spinal canal narrowing, stable, from disc\nosteophyte complex. Mild-to-moderate right, moderate left foraminal\nnarrowing, similar. Bilateral neural foraminal narrowing, right worse than\nleft.\n\nAt C6-7, there is mild right, moderate left foraminal narrowing, mildly\nworsened on the left compared to prior. There is no spinal canal narrowing.\n\nAt C7-T1, there is no spinal canal or right neural foraminal narrowing. There\nis moderate left foraminal narrowing, similar to prior.\nIn the upper thoracic spine, there is mild-to-moderate bilateral T1-T2\nforaminal narrowing, T1-T2 foraminal narrowing, and mild T2-T3 foraminal\nnarrowing, central canal is patent, similar to prior.\n\nThe thyroid gland is enlarged and contains nodules, better seen on prior\nlargest thyroid nodule seen today measures 0.6 cm, no further follow-up is\nindicated according to guidelines..\n\nThe prevertebral and paraspinal soft tissues are otherwise unremarkable.", "output": "1. C3-6 laminectomy changes with a widely patent spinal canal, aside from mild\nspinal canal narrowing at C3-C4, C5-C6 levels..\n2. Multilevel moderate to severe neural foraminal narrowing at multiple levels\nas detailed above.\n3. Disc osteophyte complex at C3-4 contacts the ventral surface of the cord,\nsimilar to the ___ MRI. The degree of spondylotic myelomalacia,\nassociated atrophy at C3-4 appears similar to, or slightly more advanced. No\nnew cervical spinal cord signal abnormalities." }, { "input": "There is approximately 6 mm posterior subluxation of the left lateral mass of\nC1 with respect to C2. There are small bilateral effusions at the C1-C2\narticulations. There is marrow edema in the odontoid process and in the right\nlateral masses of C1 and C2 with superimposed enhancement. Erosive changes\nare seen along the anterior aspect of the odontoid process with enhancing soft\ntissue between the anterior arch of C1 and the dens. There is no significant\npannus posterior to the dens. The craniocervical junction is otherwise within\nnormal limits and there is no significant narrowing at the foramen magnum or\nthe upper cervical canal.\n\nThe vertebral bodies are normal in height and alignment. There is no bone\nmarrow signal abnormality otherwise. The intervertebral disc heights are\nrelatively preserved except for mild loss of height at C4-5 and C5-6 levels.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, a central posterior disc protrusion does not contact the spinal cord.\nThere is mild narrowing of the spinal canal. No neural foraminal narrowing.\n\nAt C4-5, there is no spinal canal or neural foraminal narrowing.\n\nAt C5-6, there is no spinal canal or neural foraminal narrowing.\n\nAt C6-7, a posterior disc protrusion does not contact the spinal cord. There\nis mild narrowing of the spinal canal. There is mild narrowing of the right\nneural foramina. A small right perineural cyst noted.\n\nThe visualized upper thoracic spine from C7-T1 through T3-T4, shows no disc\nherniation, spinal canal narrowing, or neural foraminal stenosis.\n\nThe spinal cord is normal in caliber and signal intensity.\n\nThere is no paraspinal or epidural fluid collection.", "output": "1. Erosion of the anterior odontoid process with enhancing soft tissue between\nthe odontoid process and the anterior arch of C1, bone marrow edema and\nenhancement in the odontoid process and the right lateral masses of C1 and C2,\nsmall effusions in bilateral C1-C2 articulations, and anterolisthesis of the\nleft lateral mass of C1 on C2, are consistent with sequelae of rheumatoid\narthritis affecting the atlantoaxial joint.\n2. There is no significant soft tissue pannus posterior to the odontoid\nprocess or at the craniocervical junction to encroach on the upper cervical\ncord.\n3. Multilevel degenerative changes as described above do not result in\nsignificant spinal canal or neural foraminal stenosis.\n4. Normal caliber and signal intensity of the cervical spinal cord." }, { "input": "There is increased signal in the odontoid corresponding to the fracture\ndemonstrated on the CT scan. There is canal posterior angulation of the\nfracture fragment, mildly encroaching on the spinal canal.\n\nThe STIR images demonstrate abnormal hyperintensity in the C5, C7, T1, T3 and\nT5 vertebral bodies, all suggesting fractures. There is mild hyper intensity\nin the facet joints bilaterally at C3-4 and C4-5 suggesting joint capsule\ndisrruption. There is hyperintensity in the interspinous ligaments on the\nSTIR images at C 2 through C5. These suggest edema in these ligaments due to\ntrauma. The implications or mechanical integrity are uncertain.\n\nThere is prominent prevertebral soft tissue swelling, substantially increased\nsince the CT scan extending from inferior C4 to the skullbase. This finding\nis compatible with the fracture of the odontoid.\n\nThere is disruption of the anterior longitudinal ligament, best seen on image\n8 of series 5 and series 6.\n\nThere is spinal cord edema extending into the medulla and inferiorly to the\nC3-4 level. These reflecting cord contusion. There is a focal hematoma in\nthe spinal cord at the mid C2 level.\n\nThere is a small amount of epidural material encroaching slightly on the\nspinal canal from C2 to inferior C3. This is likely a hematoma related to the\nfracture.\n\nThere are changes of degenerative disc disease at C5-6 and C6-7. At C5-6,\ndisc bulging and in intervertebral osteophyte slightly indents the anterior\nsurface of the spinal cord just to the right of midline. There is mild neural\nforaminal narrowing.\n\nThere are no other findings of spinal cord signal intensity abnormality or of\ncord compression. It is unclear whether the lower cervical and the thoracic\nfractures involve the posterior cortex of the vertebral bodies. However,\nthere is no deformity of the vertebral bodies at these levels.\n\n\nBilateral pulmonary atelectasis is again seen, better characterized on the\nchest CT.", "output": "1. Spinal cord contusion and hematoma.\n\nFractured odontoid now with posterior angulation.\n\nDisruption of the anterior longitudinal ligament.\n\nPossible bilateral facet joint capsule disruption and interspinous ligament\ndisruption in the cervical spine.\n\nMultiple compression fractures in the thoracic and lower cervical spine.\n\nNOTIFICATION: These findings were discussed with Dr. ___ CCU\nresident, at 10:50 5 min after noting them." }, { "input": "There is fusion of C6 and C7. Otherwise, disc spaces are preserved and\nvertebral body heights are maintained. There is no suspicious marrow signal;\nnoting a T2 vertebral body hemangioma. The visualized posterior fossa is\nunremarkable. No cord signal abnormality.\n\nC2-3: There is no significant right neural foraminal narrowing. There is\nleft-sided facet arthropathy, which results in moderate left neural foraminal\nnarrowing.\n\nC3-4: There is mild bilateral left slightly greater than right uncovertebral\narthropathy and a mild facet arthropathy. This results in moderate left worse\nthan right neural foraminal narrowing. No spinal canal narrowing.\nC4-5: There is a small posterior disc protrusion as well as bilateral\nuncovertebral osteophyte formation and facet arthropathy. There is no\nsignificant spinal canal narrowing. There is moderate right neural foraminal\nnarrowing and severe left neural foraminal narrowing.\n\nC5-6: There is a large left uncovertebral and posterior osteophytes as well as\nmore moderate right uncovertebral osteophyte. There is severe left facet\narthropathy and no significant) facet arthropathy. There is mild spinal canal\nnarrowing eccentric to the left secondary to the large left-sided osteophytes.\nThere is moderate-to-severe right neural foraminal narrowing and severe left\nneural foraminal narrowing.\nC6-7: Small posterior osteophytes are noted, there is mild spinal canal\nnarrowing. There is mild bilateral neural foraminal narrowing.\n\nC7-T1: There is a small central disc protrusion as well as mild to moderate\nbilateral uncovertebral osteophyte formation and the left greater than right\nfacet arthropathy. There is no significant spinal canal narrowing or right\nneural foraminal narrowing. There is moderate to severe left neural foraminal\nnarrowing.\nT1-2: No significant neural foraminal or spinal canal narrowing.\nT2-3: There is bilateral facet osteophyte formation resulting in bilateral\nleft greater than right moderate neural foraminal narrowing.\nThe paraspinal soft tissues are unremarkable.", "output": "1. At C5-6, a large left uncovertebral and posterior osteophytes as well as\nsevere left sided facet arthropathy is noted. This results in severe left\nneural foraminal narrowing as well as mild spinal canal narrowing is eccentric\nto the left.\n2. At C7-T1, degenerative changes results in moderate severe left neural\nforaminal narrowing.\n3. Additional superimposed degenerative changes as described above. There is\nfusion of C6-7." }, { "input": "Thoracic spine: T9 vertebral body demonstrates T1 hypointensity with T2 and\nSTIR hyperintensity at the superior half of the vertebral body, as well as\napproximately 30% vertebral body height loss. These findings are consistent\nwith an acute to early subacute vertebral body compression fracture. There is\nno evidence of retropulsion into the spinal canal. The mild vertebral body\nheight loss is also seen in the T8 vertebral body, without evidence of bone\nmarrow edema and most consistent with chronic fracture.\n\nThe vertebral body alignment and height are otherwise preserved. No other\nevidence of bone marrow edema or suspicious osseous lesions. The cord\ndemonstrates normal signal intensity and morphology. The prevertebral and\nparaspinal soft tissues are unremarkable. There is generalized mild\ndegenerative disc disease with disc desiccation and mild disc bulges (for\nexample at T7-T8 and T8-T9). There is no spinal canal or neural foraminal\nstenosis.\n\nPartially visualized lower cervical spine demonstrates degenerative disc\ndisease with disc protrusions and mild spinal canal narrowing.\n\nLumbar spine: Vertebral body alignment and height are preserved. The conus\nmedullaris demonstrates normal signal and morphology and terminates at the\nlevel of T12-L1. The cauda equina nerve roots demonstrate normal morphology\nand distribution within the thecal sac. Bone marrow signal is unremarkable,\nwithout evidence of edema or suspicious osseous lesions. There is generalized\ndisc desiccation with intervertebral disc height loss, particularly at L4-L5\nand L5-S1.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.\n\nL2-L3: There is a mild diffuse disc bulge without spinal canal narrowing.\nThere is mild left neural foraminal narrowing. There is a small amount of\nfluid in the facet joints.\n\nL3-L4: There is minimal diffuse disc bulge, mild facet arthropathy with small\namount of fluid in the facet joints, resulting in mild subarticular zone\nnarrowing (left greater than right) but no significant neural foraminal\nnarrowing. There is no spinal canal stenosis.\n\nL4-L5: There is mild diffuse disc bulge, mild facet arthropathy with small\namount of fluid in the facet joints and mild ligamentum flavum thickening,\nresulting in bilateral subarticular zone narrowing with the disc bulge common\nin close contact with the bilateral traversing L5 nerve roots. There is no\nsignificant neural foraminal or spinal canal narrowing.\n\nL5-S1: There is mild to moderate central and right paracentral disc protrusion\nwith a focus of T2 hyperintensity within the posterior intervertebral disc\n(___), most consistent with an annular fissure. This protrusion comes in\nclose contact with the right greater than left traversing S1 nerve roots.\nThere is minimal spinal canal narrowing. No significant neural foraminal\nnarrowing is identified.\n\nThere is increased inversion recovery signal identified in the second and\nthird segment of the sacrum suspicious for marrow edema or fracture. Clinical\ncorrelation recommended.", "output": "1. T9 vertebral body without evidence of edema and approximately 30% vertebral\nbody height loss, without evidence of retropulsion into the spinal canal or\nspinal cord compression. Findings are most consistent with acute vertebral\nbody compression fracture.\n2. Mild degenerative changes throughout the thoracic spine with chronic\npartial compression of the T8 vertebral body.\n3. Mild to moderate degenerative disc disease of the lumbar spine,\nparticularly at L4-L5 and L5-S1, with an annular fissure at L5-S1 and disk\nbulges/protrusions resulting in subarticular zone narrowing. No evidence of\nsignificant spinal canal or neural foraminal narrowing.\n4. The increased signal in the second and third segments of the sacrum on\ninversion recovery images could be secondary to marrow edema or fracture.\nClinical correlation recommended." }, { "input": "At the craniocervical junction and C2-3 level mild degenerative change seen. \nAt C3-4 disc bulging and a small central protrusion identified without spinal\nstenosis with moderate narrowing of both foramina.\n\nAt C4-5 level disc bulging and mild narrowing of both foramina seen.\n\nAt C5-6 left paracentral disc protrusion and disc osteophyte indents the left\nside of the spinal cord (6:15). There is mild-to-moderate narrowing of the\nleft foramen.\n\nAt C6-7 level, disc bulging and uncovertebral degenerative change seen. There\nis a shallow left paracentral disc protrusion mildly indenting the thecal sac\n(6:18). Mild narrowing of the left foramen seen.\n\nAt C7-T1 level left-sided disc herniation is identified (6:21) which severely\nnarrows the left foramen and could affect the left C8 nerve root. There is no\nspinal stenosis.\n\nAt T1-2 and T2-3 mild degenerative change seen.\n\nThere are no focal bony abnormalities suspicious for metastatic disease. \nThere is no intraspinal mass identified.", "output": "1. Changes of cervical spondylosis without high-grade spinal stenosis.\n2. Left-sided disc herniation at C7-T1 level severely narrowing the left\nforamen which could affect the left C8 nerve root.\n3. Moderate narrowing of both foramina at C3-4 level with other foraminal\nchanges as above.\n4. No evidence of extrinsic spinal cord compression or intrinsic spinal cord\nsignal abnormalities. No abnormal enhancement.\n5. No focal bony abnormalities suspicious for metastatic disease." }, { "input": "Alignment is normal. ___ type marrow changes are seen along the endplates\nof C3-C4, otherwise the bone marrow signal is unremarkable. No cord signal\nabnormalities are identified. Diffuse degenerative disc disc is seen\nthroughout the cervical spine.\n\nSubtle increased STIR signal abnormality is seen involving the interspinous\nligaments of C6/C7 concerning for injury, series 4, image 6. However,\nspecifically at C4/C5, there is no evidence of anterior longitudinal\nligamentous disruption. There is no prevertebral soft tissue swelling.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3-C4: Central disc bulge is seen resulting an moderate canal narrowing at\nthis level. Uncovertebral and facet joint osteophytes contribute to severe\nright and moderate left neural foraminal narrowing.\n\nC4-C5: There is no significant spinal canal or neural foraminal narrowing.\n\nC5-C6: Central disc bulge is seen resulting in mild spinal canal narrowing. \nUncovertebral and facet joint osteophytes contribute to mild right neural\nforaminal narrowing. The left neural foramen is patent.\n\nC6-C7: Central disc bulge is seen, resulting in mild spinal canal narrowing. \nThere is no significant neural foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nIncidental note is made of a small amount of fluid inferior to the right\ncoraco-clavicular joint, incompletely evaluated on this exam, likely sequelae\nof patient's trauma. No other paravertebral or paraspinal soft tissue\nabnormalities are identified.", "output": "1. No evidence of ligamentous injury at C4-C5. Subtle increased STIR signal\nabnormality involving the interspinous ligaments of C6-C7 on the left may be\nsecondary to injury. No marrow signal abnormalities are identified.\n2. Cervical spondylosis, most prominent at C3-C4 and C6-C7, as described in\ndetail above.\n3. Incidental note is made of a small amount of fluid inferior to the right\ncoraco-clavicular joint, incompletely evaluated on this exam, likely sequelae\nof patient's trauma." }, { "input": "THORACIC:\n\nAlignment is normal. There is a disc bulge at T12-L1 with minimal\nencroachment into the spinal canal. There is a small disc bulge at T7-T8 and\nT10-T11. There is a right disc protrusion at T8-T9. The spinal cord appears\nnormal in caliber and configuration.\n\nLUMBAR:\n\nThere is mildly increased signal in the superior aspect of L1 with faint\nenhancement which may be due to infection, but is commonly found in\ndegenerative disease. There is no other abnormal enhancement in nearby\nstructures including the T12-L1 disc or the T12 vertebral body. Vertebral body\nand intervertebral disc signal intensity otherwise appear normal. There are\nbilateral pars defect at L5. There is anterior subluxation of L5 on S1 with\nsymmetric disc bulge encroaching on the L5-S1 neural foramen and resulting in\nsevere neural foraminal narrowing bilaterally. The spinal cord appears normal\nin caliber and configuration. The lumbar paraspinal muscles demonstrate\nmildly increased T2 signal, which may represent edema or inflammation.\n\nOTHER: There is extensive opacificatIon of the lungs, better characterized on\nchest CT. Bilateral renal cysts are noted.", "output": "1. Mildly increased signal at the superior aspect of L1 with faint\nenhancement, may be due to infection but is commonly found in degenerative\ndisease. No other abnormal enhancement in nearby structures.\n2. Increased T2 signal in the lumbar paraspinal muscles may represent edema or\ninflammation, again the etiology of which may be infectious but may also be\ndue to trauma or prolonged bedrest.\n3. No evidence of abnormal cord signal or epidural abscess.\n4. Multilevel degenerative disease, noting bilateral L5 pars defect and a disc\nbulge at L5-S1 resulting in severe bilateral neuro 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%\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: Wet read was communicated with Dr. ___ on ___\nat 1416.\nFinal read was communicated with Dr. ___ on ___ at 1539." }, { "input": "From skullbase to T3 level there are no focal bony abnormalities within the\nvertebral bodies suspicious for metastatic disease. There is no epidural mass\nor spinal cord neoplastic compression seen.\n\nAt the craniocervical junction and C2-3 levels mild degenerative change seen.\n\nAt C3-4 diffuse disc bulge and predominantly left-sided uncovertebral\ndegenerative changes are seen. There is mild spinal stenosis with severe left\nforaminal narrowing.\n\nAt C4-5 level, disc and uncovertebral degenerative changes seen with a central\ndisc protrusion. There is mild-to-moderate spinal stenosis and extrinsic\nindentation on the spinal cord. Moderate-to-severe right and mild-to-moderate\nleft foraminal narrowing is seen.\n\nAt C5-6 level, disc bulging and uncovertebral degenerative changes seen with\nmoderate to severe left and mild right foraminal narrowing with mild spinal\nstenosis.\n\nAt C6-7 level, disc bulging and uncovertebral degenerative changes seen with\nmoderate left and mild right foraminal narrowing without spinal stenosis.\n\nAt C7-T1 mild disc bulging seen without spinal stenosis or foraminal\nnarrowing.\n\nFrom T1-2 to T3-4 mild degenerative changes are identified.\n\nThe spinal cord shows normal intrinsic signal. Extrinsic indentation on the\nspinal cord is seen at C4-5 level by disc protrusion. No abnormal intraspinal\nenhancement is seen.", "output": "1. A focal bony abnormalities are seen suspicious for metastatic disease. No\nepidural mass is seen.\n2. Multilevel changes of cervical spondylosis from C3-4 to C6-7.\n3. Severe left foraminal narrowing at C3-4 moderate-to-severe left foraminal\nnarrowing at C5-6 and moderate left foraminal narrowing at C6-7 level. Due to\nsevere right foraminal narrowing at C4-5 level. Other changes as above.\n4. Disc bulging and protrusion indents the spinal cord at C4-5 level.\n5. No abnormal signal within the spinal cord or abnormal enhancement." }, { "input": "There is grade 1 anterolisthesis of the L4 on L5. T1 and T2 hyperintense\nlesions in the L3 and T10 vertebral bodies are compatible with hemangiomas. \n___ I changes are noted at the L5-S1 disc space. No evidence of osseous\nmalignancy or infection. The cord terminates at with L2.\n\nT12-L1: A mild broad-based posterior disc bulge mildly narrows the anterior\nspinal canal. There is no significant neural foraminal narrowing.\n\nL1-L2: A mild broad-based posterior disc bulge mildly narrows the anterior\nspinal canal. Bilateral neural foraminal narrowing is mild on the right and\nmoderate on the left.\n\nL2-L3: No significant spinal canal or neural foraminal narrowing.\n\nL3-L4: A mild broad-based posterior disc bulge and facet hypertrophy results\nin moderate spinal canal narrowing with clumping of the traversing nerve\nroots. Bilateral neural foraminal narrowing is mild.\n\nL4-5: A moderate broad-based posterior disc bulge, facet hypertrophy and\nligamentum flavum thickening result in severe canal narrowing with clumping of\nthe traversing nerve roots at L4-5. Neural foraminal narrowing on the left is\nmoderate and on the right is severe. The spinal canal narrowing has\nprogressed since ___.\n\nL5-S1: A mild broad-based posterior disc bulge results in mild anterior canal\nnarrowing with contact of the traversing S1 nerve roots. Bilateral neural\nforaminal narrowing is moderate to severe. Neural foraminal narrowing has\nprogressed since ___.\n\nT2 hyperintense renal lesions are compatible with cysts.", "output": "1. Severe spinal stenosis at L4-5 secondary to spondylosis and grade 1\nanterolisthesis of L4 on L5. this has progressed since ___.\n2. No evidence of metastatic disease.\n3. Additional multilevel degenerative change, including moderate canal\nnarrowing at L3-L4 and multilevel neural foraminal narrowing, worse at L4-5\nand L5-S1." }, { "input": "Alignment is normal. Vertebral bodies are normal in height and in signal. \nThere is diffuse loss of T2 signal in the intervertebral disc, with mild loss\nof intervertebral disc height noted at C5-C6 and C6-C7 levels.\n\nThere is possibly a retro cerebellar arachnoid cyst versus ___ cisterna\nmagna, sagittal image 7, series 5. Please refer to the separate internal\nauditory canal protocol MRI for posterior fossa findings. Normal\ncervicomedullary junction. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm.\n\nC2-C3: There is no spinal canal or neural foraminal stenosis.\n\nC3-C4: There is no spinal canal or neural foraminal stenosis.\n\nC4-C5: Minimal posterior endplate osteophytes are noted causing no significant\nnarrowing of the spinal canal. There is no neural foraminal stenosis.\n\nC5-C6: Posterior endplate osteophytes cause no significant narrowing of spinal\ncanal. Uncovertebral joint osteophytes cause mild left and no right neural\nforaminal narrowing.\n\nC6-C7: Disc protrusion and posterior endplate osteophytes causes no\nsignificant narrowing of the spinal canal. Facet arthropathy and\nuncovertebral joint osteophytes cause mild bilateral neural foraminal\nnarrowing. A right perineural cyst is noted.\n\nC7-T1: No spinal canal or neural foraminal stenosis.\n\nThe paraspinal and prevertebral soft tissues are unremarkable. The major\nvascular flow voids are preserved.", "output": "1. Mild degenerative changes of the cervical spine as described above, with no\nevidence of spinal cord or nerve root compression." }, { "input": "The conus terminates at the L1 level. Normal signal intensity. No conus\nmass.\nThe lumbar vertebral bodies are normal in alignment. Desiccation of the\nT12-L1, L4-5 and L5-S1 intervertebral discs.\n\nAt the level T12-L1, L1-2, L2-3 and L3-4: No no nerve root compromise in the\nspinal canal or neural foramina.\n\nAt the level L4-5: Broad-based disc bulge with a more focal posterior central\nprotrusion results in mild narrowing of the lateral recesses bilateral\n(contacting the L5 nerve roots in the lateral recesses). The neural foramina\nare patent.\n\nAt the level L5-S1: Broad-based disc bulge with a more focal central posterior\nprotrusion contact the in the left S1 nerve root in the lateral recess. The\nneural foramina are patent.\n\nNo extra-spinal findings of note.", "output": "1. Degenerative changes of the lumbar spine as described above.\n2. Contact between the L4-5 disc and bilateral L5 nerve roots in the L4-5\nlateral recesses (left more prominent than right).\n3. Mild contact between the L5-S1 disc and the left S1 nerve root in the left\nL5-S1 lateral recess." }, { "input": "Thoracic spine:\n\nDiffuse foci of T1 hypointensity and stir and T2 hyperintensity within the\nthoracic vertebral body is indicate diffuse metastatic disease. There is mild\nwedging and compressions of T6-T8 and T10 vertebral bodies. There is no\nretropulsion. T8 vertebra demonstrates mild anterior epidural enhancement\n(17:10) without significant indentation on the thecal sac. There is no spinal\ncord compression in the thoracic region. There is no abnormal signal within\nthe spinal cord.\n\nThere is enlargement and soft tissue changes adjacent to the right transverse\nprocess and rib adjacent to the third vertebra (16:17). Diffuse changes\nwithin the bilateral ribs are also visualized and not completely evaluated.\n\nLumbar spine:\n\nDiffuse and patchy marrow signal abnormalities are suggestive of metastatic\ndisease involving the lumbar vertebrae and sacrum up to S2 level. There is\nmild pathologic compression of L3 vertebra with anterior epidural disease\n(19:11) predominantly on the left side (13:22 and 14:22 which narrows the left\nsubarticular recess. Given the presence of enhancement this likely due to\nepidural disease than discogenic disease. There is no evidence of high-grade\nthecal sac compression seen to indicate cauda equina compression.\n\nThere is expansion and enhancement of the right transverse process of L1\nvertebra indicative of bony and soft tissue metastatic disease (13:9 and\n14:9). Diffuse metastatic disease is seen within the sacrum and visualized\niliac bones.", "output": "1. Diffuse bony metastatic disease involving the thoracic and lumbar as well\nas sacral vertebral bodies and ilium.\n2. Mild epidural disease at T8 level with mild compressions of T6, T8 and T10\nvertebral bodies. No evidence of spinal cord compression or high-grade spinal\nstenosis.\n3. Bony and soft tissue metastatic disease involving the right transverse\nprocess of T3 and and right third rib. Diffuse bony disease is also seen\ninvolving multiple ribs not fully evaluated.\n4. Mild compression of L3 vertebra with a soft tissue epidural disease within\nthe left side of the spinal canal at L3-4 level which could affect the left L4\nnerve root. No evidence of cauda equina compression.\n5. Bony and soft tissue disease involving the right L3 transverse process." }, { "input": "Alignment is normal. There are changes of degenerative disc disease with loss\nof signal of the intervertebral discs on the T2 weighted images at every\nimaged level. There is no evidence of fracture. There are no findings to\nsuggest ligamentous injury.\n\nThere is no spinal canal or neural formaina encroachment at C2-3.\n\nAt C3-4, there is a left sided disk protrusion that touches the left anterior\naspect of the spinal cord. Uncovertebral and facet osteophytes produce\nmoderate left neural foraminal narrowing.\n\nAt C4-5 there is mild left neural foraminal narrowing due to facet\nosteophytes.\n\nAt C5-6 intervertebral osteophytes narrow the spinal canal and flatten the\nanteior surface of the cord. There is bilateral neural foraminal due to\nuncovertebral osteophytes.\n\nAt C6-7 there is a small midline disk protrusion that touches the anterior\nsurface of the spinal cord.\n\nAt C7-T1 there is no evidence of spinal canal or neural foraminal narrwoing.\n\nThere are two large fat containing collections in the left posterior\nsubcutaneous tissues. The more inferior lesion measures 62 x 47 x 79mm. The\nmore superior lesion measures 42 x 27 x 44mm. These follow fat intensity on\nall images and contain a few sparse internal septations. These are likely\nlipomas and appear unchanged since the CT of ___.\n\nAgain seen is a left pleural effusion, incompletely imaged but appearing\nunchanged since the CTA of ___.\n\nIncompletely imaged is a 10 x 18 x 16 mm fluid collection adjacent to the left\nlevator scapulae muscle. This may be a consequence of prior trauma. There\nare no adjacent signs of inflammation to suggest infection such as an abscess.\nThe finding is incompletely evaluated, included on T2 weighted images only. \nIt is better demonstrated on an MRI than on CT. However, it appears likely to\nhave been present on the CT of ___.", "output": "1. Degenerative disc disease with a left-sided disc protrusion at C3-4 and\nosteophytes producing spinal canal and foraminal narrowing at multiple levels.\n2. Likely left posterior neck lipoma is. If further evaluation is indicated,\nimaging with T1 weighted technique before and after contrast may be helpful.\n\n3. Left pleural effusion unchanged since the prior study.\n4. Fluid collection adjacent to the left levator scapulae muscle of uncertain\netiology as discussed above." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen. The conus is normal in location\nand morphology.\n\nAxial images at T12-L1 demonstrate a diffuse disc bulge with effacement of the\nventral thecal sac and mild central stenosis.\n\nAt L1-L2 there is no significant abnormality.\n\nAt L2-L3 there is a mild disk bulge without significant stenosis.\n\nAt L3-L4 there is mild disc bulge without significant stenosis.\n\nAt L4-L5 is mild disc bulge and mild bilateral ligamentum flavum thickening.\nNo significant foraminal narrowing or central stenosis.\n\nAt L5-S1 there is a mild disc bulge without significant stenosis.\n\nThe pre and paravertebral soft tissues are unremarkable.", "output": "Mild stenosis at T12-L1." }, { "input": "There has been no significant change since ___. Multilevel mild degenerative\nchanges cervical spine. Mild disc osteophyte complex C3-C4 through C6-C7. No\ncord T2 signal abnormality. No worrisome osseous lesions. Mild posterior\nelement hypertrophic changes. Mild congenital narrowing spinal canal.\n\nAt C2-C3 level central canal, foramina patent.\n\nAt C3-C4 level, patent central canal, patent foramina.\n\nAt C4-C5 level patent central canal. Patent left foramen. Mild right\nforaminal narrowing.\n\nAt C5-C6 level, mild central canal narrowing. Mild left foraminal narrowing. \nModerate right foraminal narrowing.\n\nAt C6-C7 level, mild-to-moderate central canal narrowing, preserved CSF about\ncord. Mild left, moderate right foraminal narrowing.\n\nAt C7-T1 level, patent central canal. Patent foramina.", "output": "Degenerative changes cervical spine.\nMild congenital narrowing spinal canal.\nMild-to-moderate central canal narrowing C6-C7 level.\nModerate foraminal narrowing, as above." }, { "input": "Preceding lumbar spine radiographs confirm that there are 5 lumbar-type\nvertebrae. Vertebral body heights are preserved. Alignment is normal. Prior\nlumbar spine radiographs demonstrated minimal retrolisthesis of L3 on L4, but\nthis is not seen on the present MRI, which may indicate instability. No\nconcerning bone marrow signal abnormalities are identified. The distal spinal\ncord appears unremarkable, with the colon is visualized terminating near the\nlower end plate of L1.\n\nSagittal images through the T10-11, T11-12, T12-L1, and L1-2 levels are\nunremarkable. There are no axial images through these levels.\n\nAt L2-3, there is mild bilateral facet arthropathy without spinal canal or\nneural foraminal narrowing.\n\nAt L3-4, there is a minimal disc bulge, thickening of the ligamentum flavum,\nand mild bilateral facet arthropathy. The spinal canal is mildly narrowed\nwithout crowding of the intrathecal nerve roots. Subarticular zones are\nslightly narrowed. The right neural foramen is mildly narrowed.\n\nAt L4-5, there is a mild disc bulge with a possible central annular tear,\nthickening of the ligamentum flavum, and mild bilateral facet arthropathy.\nThere is mild spinal canal narrowing without crowding of the intrathecal nerve\nroots. Bilateral traversing L5 nerve roots are abutted in the subarticular\nzones without clear evidence of compression. There is mild right and\nmild-to-moderate left neural foraminal narrowing.\n\nAt L5-S1, the there is a disc bulge and facet arthropathy. They traversing\nright S1 nerve root is abutted and appears impinged in the subarticular zone.\nThe traversing left S1 nerve root is abutted in the subarticular zone without\nclear evidence for impingement. The remainder of the spinal canal is minimally\nnarrowed without crowding of the intrathecal nerve roots. There is moderate\nright neural foraminal narrowing with abutment of the exiting right L5 nerve\nroot by a facet osteophyte. There is mild to moderate left neural foraminal\nnarrowing.", "output": "Degenerative disease from L3-4 through L5-S1, as detailed above." }, { "input": "At the craniocervical junction and C2-3 and C3-4 mild degenerative changes\nseen.\n\nAt C4-5 level, posterior disc osteophyte and a central disc protrusion results\nin moderate-to-severe spinal stenosis with deformity of the spinal cord. \nThere is mild-to-moderate bilateral foraminal narrowing.\n\nAt C5-6 level, posterior disc osteophyte indents the spinal cord and results\nin moderate spinal stenosis and moderate severe left foraminal narrowing\nwithout compromise of the right foramen.\n\nAt C6-7 level, there is a central disc osteophyte resulting in moderate spinal\nstenosis with left-sided disc osteophyte resulting in moderate-to-severe\nleft-sided and moderate right-sided foraminal narrowing.\n\nAt C7-T1 and inferiorly to T3-4 mild degenerative change seen. At T2-3 level\nmild to moderate spinal stenosis is visualized on the sagittal images.\n\nThe spinal cord shows normal intrinsic signal.", "output": "1. Moderate-to-severe spinal stenosis at C4-5 and moderate spinal stenosis at\nC5-6 and C6-7 levels is due to posterior disc osteophytes and disc\nprotrusions. Deformity of the spinal cord is seen at this levels.\n2. Foraminal changes most pronounced on the left side at C5-6 and C6-7 levels\nwith other changes as above.\n3. The degenerative changes have considerably increased since the MRI of ___." }, { "input": "Examination is limited by hardware artifact from C4 through C7 ACDF with\nintervertebral disc spacers. Vertebral body alignment is preserved. \nVertebral body heights are preserved. There is no marrow signal abnormality.\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nThere is no prevertebral soft tissue swelling.. The visualized portion of the\nposterior fossa, and cervicomedullary junction are preserved.\n\n At C2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is mild disc protrusion without significant spinal canal or\nneural foraminal narrowing..\n\nAt C4-5 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6 there is minimal posterior endplate osteophyte without significant\nspinal canal or neural foraminal narrowing.\n\nAt C6-7 there is minimal posterior endplate osteophyte without significant\nspinal canal or neural foraminal narrowing. A perineural cyst is noted on the\nright.\n\nAt C7-T1 there is no significant spinal canal or neural foraminal narrowing.\n\nLimited sagittal views of the T1-T2 through T3-T4 levels demonstrate minimal\nright paracentral disc protrusions without significant spinal canal narrowing.\nFacet and endplate osteophytes produce at least moderate neural foraminal\nnarrowing at the left the T1-T2 level and mild neural foraminal narrowing at\nthe left T2-T3 level. The remainder of the neural foramina at these levels\ndemonstrate no significant narrowing.\n\nCervical spondylosis has improved since ___.\n\nThere is partial visualization of at least moderate polypoid bilateral\nmaxillary sinus mucosal wall thickening.", "output": "1. Postsurgical changes from C4 through C7 ACDF.\n2. No significant spinal canal narrowing.\n3. At least moderate neural foraminal narrowing at the left T1-T2 level and\nmild neural foraminal narrowing at the left T2-T3 level. Remainder of the\nneural foramina are widely patent without significant narrowing.\n4. No cord signal abnormality.\n5. At least moderate polypoid bilateral maxillary sinus mucosal wall\nthickening." }, { "input": "Again, there is susceptibility artifact from C4 through C7 ACDF with artifact\nlimiting localized evaluation. Alignment is normal. Vertebral body heights\nare preserved. There is no definite focal bone marrow signal abnormality. \nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is mild disc bulge indenting the ventral thecal sac without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt C4-C5, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-C6, there is minimal posterior endplate osteophyte formation without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt C6-C7, there is minimal posterior endplate osteophyte formation without\nsignificant spinal canal or neural foraminal narrowing. A small perineural\ncyst is noted on the right.\n\nAt C7-T1, there is no significant spinal canal narrowing. Facet and\nuncovertebral osteophytes produce mild left-greater-than-right neural\nforaminal narrowing.\n\nSagittal view of the T1-T2, T2-T3, and T3-T4 levels demonstrate minimal disc\nbulges and endplate osteophytes without significant spinal canal narrowing. \nFacet and endplate osteophytes produce at least moderate neural foraminal\nnarrowing at the left T1-T2 and T2-T3 levels. The remainder of the neural\nforamina appear grossly patent.\n\nThe degree of degenerative changes appears unchanged since ___.", "output": "1. Postsurgical changes from C4 through C7 ACDF.\n2. Multilevel cervical spondylosis, as described, unchanged since ___, without significant spinal canal narrowing and up to at least moderate\nneural foraminal narrowing at the left T1-T2 and T2-T3 levels.\n3. There is no evidence of cord signal abnormality." }, { "input": "There is mild levoscoliosis of the upper thoracic spine. There is\napproximately 2 mm anterolisthesis of T4 on 5. Alignment is otherwise\nanatomic. There is disc desiccation between all thoracic vertebral bodies,\nwith relative sparing at T10-11 and T11-12. There is disc desiccation at L3-4\nand L4-5. Vertebral body and intervertebral disc signal intensities otherwise\nappear normal. The spinal cord appears normal in caliber and configuration. \nThe cord terminates at the L1 level, within expected limits.\n\nSpinal fusion hardware is seen from C4-C7.\n\nAt C7-T1, there is mild right uncovertebral hypertrophy which causes mild\nright neural foraminal narrowing and mild left facet arthropathy which causes\nmild left neural foraminal narrowing.\n\nAt T1-2, there is mild left facet arthropathy which causes mild left neural\nforaminal narrowing. A 3 mm right neural foraminal perineural cyst is noted.\n\nAt T2-3, there is mild left facet arthropathy which causes mild left neural\nforaminal narrowing.\n\nAt T3-4, there is mild right facet arthropathy which causes mild right neural\nforaminal narrowing.\n\nIn the remainder of the T-spine, there is no significant neural foraminal\nnarrowing. There is minimal disc bulge at T11-12. At T11-12, there is a 4 mm\nright perineural root cyst.\n\nAt L1-2, there is minimal diffuse disc bulge, without significant spinal canal\nor neural foraminal stenosis.\n\nAt L2-3, there is minimal diffuse disc bulge without significant spinal canal\nor neural foraminal stenosis.\n\nAt L3-4, there is mild diffuse disc bulge with focal left foraminal to\nextraforaminal protrusion which causes minimal left neural foraminal\nnarrowing, potentially contacting the exiting nerve root.\n\nAt L4-5, there is moderate diffuse disc bulge which causes mild to moderate\nright and mild left neural foraminal narrowing. There is mild-to-moderate\nspinal canal stenosis. There is crowding of the bilateral subareolar zones\nwhich contacts the traversing nerve roots.\n\nAt L5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nIn the right adnexa, there is a incompletely characterized presumed ovarian\ncyst measuring up to 3 cm in greatest measurable dimension. If this is the\nlargest diameter the patient is of reproductive age, this is almost certainly\nbenign and no further followup is recommended. This could be completely\nevaluated with ultrasound.", "output": "1. Multilevel mild left neural foraminal narrowing in the upper thoracic spine\nas described above.\n2. Degenerative changes in the lumbar spine are worst at L4-5 as described\nabove.\n3. A incompletely characterize presumed ovarian cysts in the right adnexa\nmeasuring up to 3.0 cm in greatest measurable dimension. If this is in the\nlargest diameter, and the patient is of reproductive age, the cyst would be\nconsidered benign and no further follow-up recommended. However the presume\ncyst is not completely within the field of view. Furthermore, if the patient\nis not of reproductive age, then further evaluation with ultrasound is\nrecommended." }, { "input": "T10-T11 through L3-4 levels disc degenerative change and mild bulging seen.\n\nAt L4-5 level, mild disc bulging and facet degenerative changes seen without\nspinal stenosis or foraminal narrowing.\n\nAt L5-S1 level facet degenerative changes and mild spondylolisthesis of L5\nover S1 seen. There is moderate right and moderate-to-severe left foraminal\nnarrowing seen with the disc bulging in contact with exiting left L5 nerve\nroot without deformity.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. \nIncidental perineural cysts are seen within the lumbar neural foramina in the\nupper lumbar region.", "output": "Multilevel degenerative changes most pronounced at L5-S1 level where mild\nspondylolisthesis is seen secondary to facet degenerative changes with\nmoderate-to-severe left and moderate right foraminal narrowing. Disc bulging\ncontacts the exiting left L5 nerve root within the L5-S1 foramen without\ndeformity." }, { "input": "Alignment is normal. There are wedge deformities within the lumbar and lower\nthoracic spine. Mild anterior wedging of L4 with minimal height loss is\nunchanged. There is a severe wedge deformity of T12 which is unchanged, with\nfocal Schmorl's node through the superior endplate, nearly extending to the\ninferior endplate, also unchanged. Prominent Schmorl's nodes are seen within\nthe superior endplates of L 2, L3, and L5-4. Small Schmorl's node in the\nsuperior endplate of L5. There is slight height loss of the superior endplate\nof L1 without overall vertebral body height loss. More mild but similar\ndeformity is seen involving the superior endplate of T11, unchanged.\n\nThere is slight STIR hyperintense signal surrounding the superior endplate L5\nSchmorl's node, likely mild edema. There are ___ type 1 degenerative\nendplate changes seen anteriorly at L5-S1. Marrow signal is otherwise\nunremarkable. The distal spinal cord and conus medullaris is normal and\nterminates at L1-2. The cauda equina nerve roots are unremarkable.\n\nTrace bilateral facet joint effusions at multiple levels are likely\ndegenerative. Signal and height loss of lumbar spine intervertebral discs is\nconsistent with degenerative change. Specifically:\n\nT12-L1: Unremarkable.\nL1-2: Unremarkable.\nL2-3: Broad-based posterior disc bulge, ligamentum flavum thickening and facet\nosteophytes cause mild spinal canal and subarticular zone narrowing\nbilaterally. There is mild bilateral neural foraminal narrowing.\nL3-4: Broad-based posterior disc bulge, ligamentum flavum thickening and small\nfacet osteophytes cause moderate spinal canal narrowing with slight crowding\nof the cauda equina nerve roots, narrowing of the subarticular zones\nbilaterally. There is mild bilateral neural foraminal narrowing.\nL4-5: Broad-based posterior disc bulge, ligamentum flavum thickening and facet\nosteophytes cause mild-to-moderate spinal canal narrowing. There is mild left\nand mild-to-moderate right neural foraminal narrowing.\nL5-S1: Disc bulge, mild ligamentum flavum thickening and facet osteophytes are\nnoted. No spinal canal narrowing. There is mild bilateral neural foraminal\nnarrowing.\n\n Prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel chronic wedge deformities, worst (severe) at T12, are not\nappreciably changed from prior studies. No evidence of new or recent\nfracture.\n2. Multilevel prominent Schmorl's nodes, including 1 within the superior\nendplate of L5 which demonstrates mild surrounding marrow edema, possibly a\nmore recent (e.g. subacute) Schmorl's node.\n3. Moderate lumbar spondylosis. Spinal canal narrowing is worst (moderate) at\nL3-4 with slight crowding of the cauda equina nerve roots. Neural foraminal\nis worst (mild-to-moderate) on the right at L4-5. No definite nerve root\nimpingement within the narrowed subarticular zones or neural foramina." }, { "input": "This is a limited examination without contrast. The patient is status post\nthoracic epidural drainage and debridement from T2 through T6 level, with\nabscess tracking into the thoracic cavity, more significant towards the left.\nIn comparison with the prior MRI examination on ___, postsurgical\nchanges are present consistent with laminectomies from T12 through T6 levels.\nFluid collection is identified along the surgical cavity posteriorly as well\nas fluid in the superficial soft tissues. There examination is partially\nlimited due to patient motion, grossly there is no evidence of high-signal\nintensity throughout the thoracic spinal cord to suggest edema or cord\nexpansion. Note is made of an ellipsoid fluid collection attached to the\npleura on the left, which appears larger and measures approximately 15 x 30 mm\nin transverse dimension and previously 10 x 13 mm, the possibility of a\nloculated non encapsulated abscess formation in this area is a consideration.\nThe conus medullaris and the inferior aspect of the thoracic spinal cord is\nnormal as well as the lower thoracic intervertebral disk spaces.", "output": "1. The patient is status post thoracic epidural drainage and debridement from\nT2 through T6 levels.\n\n2. Expected postsurgical changes are present with fluid in along the surgical\ncavity, the examination is partially limited due to patient motion, however,\ngrossly there is no evidence of spinal cord edema or cord compression.\n\n3. There is persistent involvement of the infectious process is in the left\nside of the thorax, with a ellipsoid fluid formation on the left posterior\npleural region, which appears larger and apparently encapsulated, measuring\napproximately 30 x 15 mm in transverse dimension.\n\nNOTIFICATION: These findings were discovered and communicated via phone call\nto Dr. ___ by Dr. ___ on ___ at 19:50 hr." }, { "input": "Alignment is normal. Nonenhancing T2 hypointense lesion replaces and mildly\nexpands the right pedicle of L2 (04:17, 13:20). There is mild adjacent\nincreased T2/FLAIR signal, consistent with edema. The lesion was noted to be\nFDG avid on PET-CT dated ___. Given the patient's history, this is\ncompatible with metastatic disease. However, there is no associated spinal\ncanal stenosis at that level.\n\nThere is heterogeneous signal in the left posterior body of L1 with partial\nfatty component, compatible with a hemangioma.\n\nAfter contrast, there is vague enhancement of the nerve roots in the thecal\nsac (13:9), which is nonspecific but raises possibility of arachnoiditis.\n\nL1-2: There is desiccation of the disc. No significant spinal canal stenosis\nor neural foraminal narrowing.\n\nL2-3: There is desiccation of the disc as well as disc bulge results in mild\nnarrowing of the bilateral neural foramina and contacts the bilateral\ntraversing nerve roots. There is no significant spinal canal narrowing.\n\nL3-4: Desiccation of the disc with disc bulge contacts the bilateral\ntraversing nerve roots. Mild bilateral articular facet joint hypertrophy and\nthickening of the ligamentum flavum results in mild narrowing of the spinal\ncanal.\n\nL4-5: There is disc desiccation, diffuse disc bulge causing anterior thecal\nsac deformity and contacting the bilateral traversing nerve roots. There is\nmoderate to severe spinal canal stenosis with crowding of the nerve roots in\nthe thecal sac. Bilateral articular facet hypertrophy and thickening of\nligamentum flavum also contribute to moderate to severe spinal canal\nnarrowing.\n\nL5-S1: Curvilinear high signal in the disc compatible with an annular fissure.\nThere is disc bulge and left paracentral disc protrusion causing anterior\nthecal sac deformity. Additionally, there is extrusion of the disc fragment\ntoward the left neural foramen, causing S1 nerve root impingement (07:41). \nThere is bilateral, left greater than right neural foraminal narrowing\nimpinging the exiting nerve root. There is bilateral articular joint\nhypertrophy and mild thickening of the ligamentum flavum causing mild to\nmoderate spinal canal narrowing.\n\nMultiple bilateral renal cysts are noted, measuring up to 4.3 x 3.7 cm the\nright (8:9) and 2.4 x 2.1 cm on the left (08:31).", "output": "1. Metastatic disease involving and expanding the right pedicle at L2 with\nassociated edema.\n2. Multilevel degenerative change throughout the lumbar spine, most notably at\nL2-3 through L5-S1 with severe narrowing of the spinal canal at L4-5.\n3. Left paracentral disc protrusion with extrusion of disc material toward the\nleft neural foramina at L5-S1.\n4. Vague enhancement of the nerve roots in the thecal sac after contrast are\nnonspecific, but raise possibility of arachnoiditis.\n5. Heterogeneous signal in the left posterior aspect of L1 suggestive of\nhemangioma." }, { "input": "From T11-12 through L2-3 levels, minimal degenerative changes seen.\n\nAt L3-4 level, there is mild disk bulging and annular tear in the midline with\nthickening of the ligaments resulting in mild spinal stenosis. There is no\nforaminal narrowing seen.\n\nAt L4-5 level, disk bulging is seen with a broad-based central and left-sided\ndisc protrusion with moderate to severe narrowing of the left subarticular\nrecess and mild to moderate narrowing of the right subarticular recess. There\nis minimal spinal canal narrowing. There is mild narrowing of both foramina.\n\nAt L5-S1 level mild disc bulging seen. There is mild narrowing of the\nforamina. There is no spinal stenosis.\n\nThe distal spinal cord is unremarkable. Atrophic changes are visualized\nwithin the left psoas muscle and the left iliacus muscle which could be\nrelated to remote left hip fracture", "output": "1. Central protrusion extending to both sides at L4-5 level with moderate to\nsevere left subarticular recess narrowing and minimal spinal canal narrowing.\n2. Mild spinal stenosis at L3-4 level." }, { "input": "There is preservation of the normal cervical lordosis. There is a 2 mm\nretrolisthesis of C4 /5 and 1 mm retrolisthesis of C5/C6, similar in\nappearance to prior exam. There is a inferior endplate Schmorl's node at C5,\nwhich can be seen on prior exam of ___, which appears more sclerotic\non today's exam and calcified. Disc desiccation at C5-6 through C6-7 with mild\nloss of disc height is noted. The remainder of the disc heights are preserved.\nVertebral body heights are maintained. No prevertebral or paraspinal soft\ntissue abnormalities. The visualized posterior fossa is unremarkable. No cord\nsignal abnormalities are noted. No suspicious marrow signal.\n\nC2-3 and C3-4: No significant spinal canal or neural foraminal narrowing.\n\nC4-5: There is a small disc bulge as well as posterior marginal and bilateral\nmoderate uncovertebral osteophytes. This results in mild bilateral neural\nforaminal narrowing without significant spinal canal narrowing.\n\nC5-6: There is moderate sized posterior marginal osteophyte and disc bulge as\nwell as right much worse than the left bilateral uncovertebral osteophytes. \nThis results in moderate spinal canal narrowing, with mild remodeling of the\nventral aspect of the cord as well as moderate to severe right greater than\nleft bilateral neural foraminal narrowing. There is no underlying is cord\nsignal abnormality.\n\nC6-7: There is a small disc bulge as well as mild bilateral uncovertebral\nosteophytes, which results in mild spinal canal narrowing, with minimal\nremodeling of the ventral aspect of the cord and mild bilateral neural\nforaminal narrowing.\n\nC7-T1 through T3-4: No significant spinal canal or neural foraminal\nnarrowing.", "output": "Multilevel degenerative changes described above, most prominent at C5-6,\nsimilar in appearance to prior exam of ___. No evidence for underlying cord\nsignal abnormality." }, { "input": "Levoconvex curvature of the lumbar spine with apex at L4 is identified. 2 mm\nretrolisthesis of L2 on L3 and L3 on L4 is similar appearance to prior\nexamination. Otherwise, the remainder the lumbar alignment is anatomic. \nVertebral body heights are preserved. The marrow signal is slightly\nheterogeneous compatible with degenerative changes and marrow reconversion\nwithout focal suspicious lesion, similar appearance to prior exam. ___ type\n1 L5-S1 endplate changes has progressed from prior exam. Loss of disc height\nand signal spanning L2-L3 through L5-S1 is moderate, similar appearance to\nprior exam. The conus medullaris terminates at the L1 vertebral level, within\nexpected limits. There is no signal abnormality of the visualized cord or\nconus.\n\nT12-L1 and L1-L2: Small disc bulges do not result in significant spinal canal\nor neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. Facet arthropathy with the disc results in mild right\ngreater than left neural foraminal narrowing.\n\nL3-L4: A disc bulge with intervertebral osteophytes and thickening of the\nligamentum flavum results in mild spinal canal narrowing. Facet arthropathy\nand scoliosis results in moderate right and mild left neural foraminal\nnarrowing.\n\nL4-L5: A disc bulge and thickening of ligamentum flavum does not\nsignificantly narrow the spinal canal. Intervertebral osteophytes with facet\narthropathy results in moderate bilateral neural foraminal narrowing. \nMinimally progressed from prior exam.\n\nL5-S1: A disc protrusion does not significantly narrow the spinal canal. \nFacet arthropathy results in moderate left and mild to moderate right neural\nforaminal narrowing. Findings are similar to prior exam.\n\n7 mm left T2 hyperintense mid renal cystic lesion is similar in appearance to\nprior exam statistically most likely representing a simple cyst. The\nremainder the visualized prevertebral and paraspinal soft tissues are\nunremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, most prominent at L4-L5 where\na facet arthropathy results in moderate bilateral neural foraminal narrowing,\nsimilar appearance to prior exam. At L5-S1, facet arthropathy results in\nmoderate left and mild-to-moderate right neural foraminal narrowing.\n2. No high-grade spinal canal narrowing." }, { "input": "Again seen is bilateral C4-C5 facet dislocation, anterior subluxation of C4 on\nC5 by approximately ___ of the vertebral body length, and C4 posterior\ninferior corner fracture. Fracture fragments anterior to the C5 vertebral\nbody, better seen on the preceding CT, are likely related to the anterior\nsuperior corner of C5, as the present MRI demonstrates marrow edema along the\nanterior superior endplate of C5. There is associated disruption of the\nanterior longitudinal ligament, intervertebral disc, posterior longitudinal\nligament, and the posterior ligamentous complex at C4-C5, with extensive\nprevertebral and posterior paravertebral edema. There is also interspinous\nligament edema from C1-C2 through C4-C5. There is epidural hematoma dorsal to\nthe C4 vertebral body. The spinal cord is compressed at C4-C5 with suspected\nshearing injury, and expanded from lower C3 through mid C4 levels, with\nextensive T2 hyperintensity/edema from the lower C2 through mid C5 levels.\n\nC2-C3: No significant spinal canal narrowing. Mild facet arthropathy without\nsignificant neural foraminal narrowing.\n\nC3-C4: Anterior epidural hematoma and expansion of the spinal cord cause CSF\neffacement around the cord. Mild right and moderate left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Severe spinal canal narrowing with cord compression and cord edema, as\ndetailed above. The neural foramina are distorted by the bilateral facet\ndislocation and anterolisthesis.\n\nC5-C6: Small central disc protrusion without spinal cord contact. Moderate\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Shallow broad-based disc protrusion with overlying endplate\nosteophytes, which indent the ventral thecal sac without spinal cord contact. \nSevere right and moderate left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nRight vertebral artery flow void is absent essentially throughout the V2 and\nV3 segments.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\ngrossly unremarkable. There is fluid in the nasopharynx.", "output": "1. Complete transsection of the cervical spine at C4-C5 with disruption of the\nanterior longitudinal ligament, intervertebral disc, posterior longitudinal\nligament, and posterior ligamentous complex, as well as bilateral facet\ndislocation and anterolisthesis of C4 on C5 by ___ of the vertebral body\nlength.\n2. Cord compression at C4-C5 with cord expansion at C4, and cord edema from\nthe lower C2 through the mid C5 levels.\n3. Ventral epidural hematoma at C4.\n4. In addition to the posterior ligamentous complex disruption at C4-C5, there\nis also interspinous edema from C1-C2 through C3-C4 with extensive posterior\nparavertebral edema. Extensive prevertebral edema is also present.\n5. Absence of the right vertebral artery V2 and V3 segment flow void,\nsuggesting dissection/intramural hematoma in the setting of trauma.\n\nNOTIFICATION: The following preliminary report was provided on ___\nat 02:25 by Dr. ___: \"\nCord or cauda equina compression: yes\nCord signal abnormality: yes\nEpidural collection: yes\nOther: There is complete facet joint dislocation at C4-C5 with significant\nretropulsion of the C5 vertebral body posteriorly into the canal with\nimpingement on the spinal cord, resulting in significant cord signal\nabnormality and cord compression. There is also associated epidural collection\nmost prominently at the levels of C4-C5. Prevertebral soft tissue edema is\nalso noted.\nFinal read pending dedicated review by the neuroradiology team.\n\n The additional finding of right vertebral artery dissection/intramural\nhematoma was discussed with ___, P.A. by ___, M.D. on the\ntelephone on ___ at 9:36 am, 10 minutes after discovery of the findings." }, { "input": "Single acquired sagittal T2 sequence is mildly degraded by motion.\n\nAlignment is preserved. There is bony fusion from C5 through C7. There is\nprobable endplate degenerative signal at C3-C4. The bone marrow signal is\notherwise normal.\n\nThere is disc desiccation at multiple levels. There are large anterior\nbridging osteophytes at C2-C3, C3-C4 and C4-C5.\n\nThere is a mild posterior disc bulge with ligamentum flavum thickening at\nC2-C3 producing mild spinal canal narrowing. There is a large posterior disc\nbulge with ligamentum flavum thickening producing severe spinal canal stenosis\nat C3-C4 with impingement of the underlying cord and possible underlying cord\nsignal abnormality, though this is not well characterized on the single\ninclude sequence (5:9). Otherwise, there are small disc protrusions and\nbulges spanning from the C6-C7 through T3-T4 levels, with mild spinal canal\nnarrowing at the T1-T2 and T2-T3 levels. Limited sagittal view demonstrates\nneural foraminal narrowing at multiple levels, though not optimally\ncharacterize on the single included sequence. Neural foraminal narrowing is\nsevere at least at the right T1-T2 level and appears at least moderate at\nmultiple cervical levels.\n\nThe remainder of the cord signal appears unremarkable.", "output": "1. Incomplete examination with acquisition of only the 3 plane localizer and\nsagittal T2 sequence spanning the C1 through T10 levels due to patient pain.\n2. Focally severe cervicothoracic spondylosis, as described, most notable for\nsevere spinal canal narrowing and impingement at C3-C4 with possible\nunderlying cord signal abnormality, not well assessed on the single included\nsequence.\n3. No frank evidence of infection, though this is incompletely evaluated.\n\nRECOMMENDATION(S): Recommend repeating the examination when patient is better\nable to tolerate." }, { "input": "There is marrow heterogeneity within the clivus which is unchanged when\ncompared to ___. The vertebral body height, alignment, and marrow signal\nwithin the cervical spine are normal.\n\nThe cervical spinal cord is normal in signal and morphology. There is no\ncerebellar tonsillar ectopia.\n\nThere is increased STIR signal within the posterior paraspinous soft tissues\nat the C5-C6 and C6-C7 levels compatible with reported history of C6-C7\nmicrodiscectomy, foraminotomy, medial facetectomy and left C5-C6 foraminotomy.\nThe remaining paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the C2-C3 level, there is uncovertebral and facet arthropathy, as well as a\nshallow broad-based disc osteophyte complex which causes mild left neural\nforaminal narrowing. The spinal canal appears normal.\n\nAt the C3-C4 level, there is bilateral uncovertebral facet arthropathy, as\nwell as a shallow broad-based posterior disc osteophyte complex, which cause\nmild spinal canal narrowing without significant mass effect on the spinal\ncord, as well as severe left and moderate right neural foraminal narrowing.\n\nAt the C4-C5 level, there is bilateral facet and uncovertebral arthropathy,\nalong with a shallow broad-based posterior disc osteophyte, which cause mild\nspinal canal narrowing without significant mass effect on the spinal cord, as\nwell as moderate right and severe left neural foraminal narrowing.\n\nAt the C5-C6 level, there is bilateral uncovertebral and facet arthropathy, as\nwell as a shallow broad-based posterior disc osteophyte complex which cause\nmild spinal canal narrowing without significant mass effect on the spinal\ncord, as well as severe left and moderate to severe right neural foraminal\nnarrowing. Some of the signal abnormality in the left neural foramen could be\nrelated to postsurgical granulation tissue.\n\nAt the C6-C7 level, there is bilateral facet and uncovertebral arthropathy, as\nwell as a broad-based posterior disc osteophyte complex, larger on the left,\nwhich cause moderate spinal canal narrowing with some flattening of the cord\non the left, although without signal abnormality. Some of the signal\nabnormality in the left anterior epidural space and left neural foramen could\nbe related to postoperative granulation tissue. There is severe bilateral\nneural foraminal narrowing, left greater than right.\n\nAt the C7-T1 level, there is bilateral uncovertebral and facet arthropathy\nwhich cause some degree of foraminal narrowing although evaluation of this\nlevel is limited secondary to motion artifact.\n\nWhen compared to prior exam, the degenerative changes throughout the cervical\nspine are not significantly changed.\n\nThere is bilateral mastoid fluid, right greater than left, which is similar\nwhen compared to prior exam. There is also left maxillary sinus mucosal\nthickening and fluid.", "output": "Unchanged appearance of multilevel degenerative disease compared to ___. Some of the signal abnormalities in the left C5-6 and C6-7 neural\nforamina, and in the left anterior epidural space at C6-7, could be related to\npostsurgical granulation tissue. This could be better assessed with contrast\nenhanced MRI." }, { "input": "Alignment is normal. There is loss of signal intensity of the intervertebral\ndiscs on the T2 weighted images, a manifestation of degenerative disease. \nThere is patchy inhomogeneous vertebral body signal intensity on the T1\nweighted images. This is a nonspecific finding but may be seen in the setting\nof smoking. A Schmorl's node in the superior endplate of the T12 vertebral\nbody appears larger than on the prior study. The T10-11 and T11-12 levels\ndemonstrate no spinal canal or neural foraminal narrowing.\nAt L1-2 there is a mild bulge of the disc with no spinal canal or neural\nforaminal narrowing.\nThere are no significant abnormalities at L2-3.\nAt L3-4 there is severe spinal canal narrowing caused by disc bulging, facet\nosteophytes, and thickening of the ligamentum flavum. Disc bulge and facet\nosteophytes also produce moderate bilateral neural foraminal narrowing.\nAt L4-5 there is moderate spinal canal narrowing due to a mild disc bulge but\nlarge facet osteophytes and marked thickening of the ligamentum flavum. These\nfactors produce moderate bilateral neural foraminal narrowing.\nAt L5-S1 there is no spinal canal or neural foraminal narrowing in spite of\nbilateral facet osteophytes.\n\nThe spinal cord appears normal in caliber and configuration.", "output": "1. Degenerative disc disease with severe spinal canal narrowing at L3-4.\n2. Inhomogeneous marrow signal of uncertain etiology.\n\nNOTIFICATION: The finding of severe spinal stenosis at L3-4 was entered in\nthe Radiology department non urgent critical imaging findings system 20:00 ___ immediately upon reviewing the images by Dr. ___" }, { "input": "The acute right L1 transverse process fracture is better depicted in the prior\nCT from an outside institution dated ___.\n\nThere is mild lumbar degenerative disc disease, most advanced at L4-5 and\nL5-S1 with associated degenerative endplate change and vacuum disc phenomenon.\nThere is no spinal canal narrowing. There is mild right and moderate left\nneural foraminal narrowing at L5-S1.\n\nThe bone marrow signal appears diffusely low on T1 weighted images. T11\nvertebral body hemangioma is noted. There is no abnormal bone marrow or\nparaspinal enhancement.\n\nThe conus medullaris terminates at the T12-L1 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nThere is mild edema within the dorsal subcutaneous soft tissues. There are\nfew bilateral renal cysts. A few tiny lesions within the kidney that appear\nhyperintense on T2 weighted images are indeterminate although likely reflect\nsimple cysts.", "output": "1. Mild lumbar degenerative disc disease, with mild right and moderate left\nneural foraminal narrowing at L5-S1. Otherwise no spinal canal or neural\nforaminal narrowing.\n2. The acute right L1 transverse process fracture is much better appreciated\non recent CT.\n3. Low signal intensity within the bone marrow on T1 weighted images. The\ndifferential includes smoking, anemia, metabolic disease, and/or infiltrative\nprocess." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nC7 vertebral body probable hemangioma is noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc signal throughout the cervical spine. \nThere is loss of intervertebral disc height at C4-5, C5-6, C6-7, and C7-T1.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction and\nlung apicesare preserved. Minimal bilateral maxillary sinus mucosal\nthickening is present.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is asymmetric left disc bulge, ligamentum flavum hypertrophy,\nmildvertebral canaland mild leftneural foraminal narrowing.\n\nAt C4-5 there is disc bulge, central disc protrusion with deformation of\nventral thecal sac and spinal cord, and no definite associated cord signal\nabnormality, ligamentum flavum hypertrophy, mildvertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt C5-6 there is central disc extrusion with cranial extension to the mid C5\nvertebral body, uncovertebral hypertrophy, deformation of ventral thecal sac\nspinal cord without definite associated cord signal abnormality, ligamentum\nflavum hypertrophy, mild to moderatevertebral canal and no neural foraminal\nnarrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, central disc\nprotrusion, facet joint hypertrophy, ligamentum flavum hypertrophy,\nmildvertebral canal and mild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is disc bulge, mildvertebral canal and no neural foraminal\nnarrowing.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical spondylosis as described, most pronounced at C5-6,\nwhere there is central disc extrusion, mild-to-moderate vertebral canal\nnarrowing with deformation of ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality.\n3. C4-5 mild vertebral canal and mild bilateral neural foraminal narrowing\nwith deformation of ventral thecal sac and spinal cord without definite\nassociated cord signal abnormality.\n4. Within limits of study, no definite evidence of cervical spinal cord\nlesion.\n5. Paranasal sinus disease , as described." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMinimal dextroscoliosis of the lumbar spine is noted. There is transitional\nanatomy with partial sacralization of L5. Schmorl's nodes seen at multiple\nlevels throughout the lumbar spine. Vertebral body heights are preserved. L1\ninferior and L2-3 endplate probable type ___ ___ changes are seen. L4 and S1\nvertebral body probable hemangiomas are noted. L2 inferior endplate type 1\n___ changes seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc signal at L2-3 through L4-5. There is\nloss of intervertebral disc height at L2-3. Otherwise, intervertebral\ndischeightsandsignalare preserved. Nonspecific facet joint fluid is noted at\nmultiple levels of the lumbar spine.\n\nAt T12-L1 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with no vertebral canaland no neural foraminal narrowing.\n\nAt L1-2 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canaland no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\ndural fat, with mild-to-moderate vertebral canaland mild bilateral neural\nforaminal narrowing.\n\nAt L3-4 there is disc bulge with suggested contact of bilateral descending L4\nnerve roots, facet hypertrophy, ligamentum flavum thickening, fat, with mild \nvertebral canaland mild bilateral neural foraminal narrowing.\n\nAt L4-5 there is disc bulge with suggested contact the bilateral descending L5\nnerve roots, facet hypertrophy, with mild vertebral canal, mild right and\nmoderate left neural foraminal narrowing.\n\nAt L5-S1 there is central disc protrusion, facet joint hypertrophy, with no \nvertebral canal , mild right and moderate left neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.\n\n Limited imaging of the kidneys demonstrate bilateral at least partially T2\nhyperintense structures, incompletely characterized.\n\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.\n\nLimited imaging of the abdomen demonstrates proximal 1.3 cm para-aortic\nretroperitoneal lymph node (see 05:16). An additional approximately 1.9 cm\nprevertebral probable lymph node is seen (see 100:105). Additional\nretroperitoneal and pelvic subcentimeter nonspecific lymph nodes are also\nnoted.", "output": "1. Study is mildly degraded by motion.\n2. Interval progression of multilevel lumbar spondylosis and epidural fat as\ndescribed compared to ___ prior exam, most pronounced at L2-3 where there is\nmild-to-moderate vertebral canal and mild bilateral neural foraminal\nnarrowing.\n3. L4-5 and L5-S1 moderate left neural foraminal narrowing.\n4. Limited imaging of the kidneys demonstrate bilateral at least partially\ncystic structures, incompletely characterized.\n5. Nonspecific 1.3 cm para-aortic, 1.9 cm prevertebral retroperitoneal lymph\nnode and additional retroperitoneal and pelvic subcentimeter lymph nodes." }, { "input": "There is a moderate severity central compression deformity involving the L2\nvertebral body which demonstrates heterogeneous hyperintense signal on\nT2/IDEAL sequences, heterogeneous predominantly hypointense signal on T1\nprecontrast with areas of hyperintense signal as well, and heterogeneous\nhyperenhancement within it (series ___, image 7). Focal hyperintense T1 and\nT2 signal again involves the left L2 pedicle (series 8, image 18). There is\nno retropulsion although the anterior aspect of L2 vertebral body extends\nslightly anterior to L1. Alignment is otherwise normal.\n\nAn 11 mm focus of hyperintense signal on T1 and T2 weighted images within the\nL3 vertebral body appears unchanged, with CT appearance compatible with\nhemangioma.. A 5 mm focus involving the left L3 pedicle demonstrates\nhyperintense signal on T2 and T1 precontrast images, without definite CT\ncorrelate, unchanged prior MRI (series ___, image 25) and also typical of a\nhemangioma. No additional fractures or lesions identified within the lumbar\nspine.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nsignificant of spinal canal or neural foraminal narrowing.\n\nEvolving bilateral perinephric hematomas and multifocal bilateral renal\nlesions are redemonstrated corresponding to findings on prior CT performed\nyesterday.", "output": "1. Unchanged L2 vertebral body compression fracture with heterogeneous marrow\nand enhancement as well as left pedicle involvement suggesting pathologic\nfracture related to melanoma metastasis, overall similar from MRI in ___. No definite other fracture or lesions in the lumbar spine.\n3. Evolving bilateral perinephric hematomas and multifocal bilateral renal\nlesions are redemonstrated corresponding to findings on prior CT." }, { "input": "There are 5 lumbar-type vertebrae. There is instrumented posterior fusion of\nL5 and S1, laminectomies at L5-S1, and instrumented posterior fusion at L5-S1.\nThe hardware is not assessed by MRI. Mild anterolisthesis of L5 on S1 is\nunchanged. No concerning bone marrow signal abnormalities are seen.\n\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating at T12. No abnormal intrathecal contrast enhancement is seen.\n\nFrom T12-L1 through L3-4 there is mild bilateral facet arthropathy without\nspinal canal or neural foraminal narrowing.\n\nAt L4-5, there is severe bilateral facet arthropathy with fluid in the facet\njoints and a moderate disc bulge, both progressed since the ___ MRI. The\nspinal canal is moderately narrowed with crowding of the intrathecal nerve\nroots and impingement of the traversing L5 nerve roots, worse than on the ___\nMRI. There is moderate bilateral neural foraminal narrowing with abutment of\nbilateral exiting L4 nerve roots, also worse than on the ___ MRI.\n\nAt L5-S1, the spinal canal is well decompressed. There is a disk bulge without\nevidence for a disc herniation. The right neural foramen is moderately\nnarrowed by disc bulge with abutment of the exiting right L5 nerve root,\nfairly similar to ___. Evaluation of the left neural foramen is limited by\nhardware related artifacts on both sagittal and axial sequences.", "output": "1. At L5-S1, there is instrumented anterior and posterior fusion, and\nunchanged mild anterolisthesis. The spinal canal is well decompressed without\nevidence for a disk herniation. A disc bulge abuts the exiting right L5 nerve\nroot in the moderately narrowed right neural foramen, similar to the ___ MRI.\nEvaluation of the left neural foramen is limited by hardware related artifact\non sagittal and axial sequences.\n2. At L4-5, there is progression of a disc bulge and facet arthropathy since\n___, resulting in moderate spinal canal stenosis with crowding of the\nintrathecal nerve roots and impingement of the traversing L5 nerve roots,\nworse than in ___, as well as moderate bilateral neural foraminal narrowing\nwith abutment of the exiting L4 nerve roots, worse than in ___." }, { "input": "THORACIC:\nInterval improvement at T9 level. There is residual enhancement involving the\nvertebral body, posterior elements, with increased interval sclerosis within\nvertebral body. Epidural component of the tumor has significantly improved. \nCentral canal narrowing has resolved. Mild residual T2 signal abnormality\ninvolving the cord at this level with mild cord atrophy since prior. There is\nresidual mild paraspinal enhancement laterally, improved since prior. \nModerate bilateral T9-T10 foraminal narrowing.\n\nNo new mass. No new marrow abnormality.\n\nThoracic spine curve. Multilevel degenerative changes. No significant\ncentral canal narrowing in the thoracic spine. Mild central canal narrowing\nin the visualized cervical spine. Remaining foramina are patent. No other\nareas of cord T2 signal abnormality. No areas of cord enhancement.\n\nLUMBAR:\nNo mass. No marrow signal abnormality. Normal spinal alignment. \nDegenerative changes lumbar spine. Narrowed L5-S1 disc space. No significant\ncentral canal narrowing at the lumbar spine. Mild epidural lipomatosis at\nL5-S1 level mildly effaces thecal sac. Bilateral L5 pars interarticularis\ndefect, similar. Normal spinal alignment. Normal visualized cord.\nMild left, mild-to-moderate right foraminal narrowing, similar.\nNo abnormal enhancement.\n\nOTHER: None", "output": "1. Improvement at T9 level, with nearly resolved epidural, paraspinal\nenhancement. Patent central canal. Small area of nonenhancing T2 signal\nabnormality of the cord at this level.\n2. No new mass or marrow signal abnormality.\n3. Mild degenerative changes." }, { "input": "THORACIC:\nThere is reverse S shaped thoracolumbar spine scoliosis, unchanged. \nOtherwise, the thoracic vertebral bodies are normally aligned, without\nanterior or posterior spondylolisthesis. Vertebral body heights are\npreserved. Again seen is a T1 hypointense, T2/STIR hyperintense lesion within\nthe T9 vertebral body, involving the posterior elements bilaterally including\nthe pedicles, laminae, and base of the spinous process, as well as the\nproximal bilateral ninth ribs. There is again seen bilateral paraspinal soft\ntissue enhancing tumor infiltration, as well as posteriorly into the epidural\nspace and into the anterior aspects of the neural foramina bilaterally (series\n17, image 12 and 13). Overall appearance is unchanged from prior exam. There\nis no significant spinal stenosis at this level.\n\nA Schmorl's node and superimposed ___ type 2 degenerative endplate changes\nare seen in the inferior aspect of T8, unchanged. There are 2 foci of focal\nfat or small hemangiomas within T8. No additional/new concerning focal marrow\nsignal abnormalities are seen in the thoracic spine.\n\nThere is no epidural collection. There is possibly faint abnormal high\nT2/STIR weighted signal at the level of T9, as seen previously. Otherwise,\nnormal thoracic spinal cord.\n\nThere are mild thoracic spine degenerative changes, with multilevel mild disc\nheight and signal loss. There is no thoracic spine along canal narrowing. \nThere is unchanged at least moderate bilateral, right worse than left T9-10\nneural foraminal stenosis due to tumor infiltration. No other area of\nsignificant neural foraminal stenosis in the thoracic spine.\n\nLUMBAR:\nThere are 5 non-rib-bearing lumbar type vertebral bodies. Alignment is\nnormal. Vertebral body heights are preserved. There are ___ type 2\ndegenerative endplate changes at L5-S1. There is no lumbar spine epidural\ncollection. The distal spinal cord and conus medullaris is unremarkable and\nterminates at L1. The cauda equina nerve roots are within normal limits. \nThere is multilevel disc and signal height loss, worst at L5-S1, compatible\ndegenerative changes. Specifically:\n\n\n-At T12-L1, no disc herniation, spinal canal, or neural foraminal narrowing.\n-At L1-2, no disc herniation, spinal canal or neural foraminal narrowing.\n-At L2-3, there is mild posterior disc bulge and ligamentum flavum thickening\nwithout spinal canal or neural foraminal narrowing.\n-At L3-4, there is mild posterior disc bulge, ligamentum flavum thickening,\nand small facet osteophytes without significant spinal canal or neural\nforaminal narrowing.\n-At L4-5, there is a minimal posterior disc bulge, ligamentum flavum\nthickening and facet osteophytes without spinal canal or neural foraminal\nnarrowing.\n-At L5-S1, there is marked disc height loss, a right foraminal and\nextraforaminal disc bulge, and facet osteophytes as well as epidural\nlipomatosis causing mild spinal canal narrowing and mild to moderate right and\nmild left neural foraminal narrowing, unchanged.\nOTHER: Aside from involvement by tumor infiltration at the level of T9, as\nabove, the imaged prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Unchanged thoracolumbar spine MRI demonstrating enhancing lesion diffusely\ninvolving the T9 vertebral body and adjacent paraspinal soft tissues and\nepidural space, again seen to cause at least moderate bilateral neural\nforaminal narrowing. Faint T2/STIR hyperintense cord signal at this level is\nnot appreciably changed.\n2. No new thoracolumbar spine lesions.\n3. Mild lumbar spondylosis worst at L5-S1, unchanged." }, { "input": "THORACIC SPINE: Reverse S shaped thoracolumbar scoliosis is unchanged. \nOtherwise, the thoracic vertebral bodies demonstrate anatomic alignment. \nVertebral body heights and intervertebral disc spaces are relatively well\npreserved. Again seen is T1 hypointense, T2/IDEAL hyperintense, lesion within\nthe T9 vertebral body involving the bilateral posterior elements including the\npedicles and lamina. Bilateral paraspinal soft tissue enhancing tumoral\ninfiltration is again seen with extension into the epidural space and anterior\naspects of the bilateral neural foramina (19:11, 12). This is not appreciably\nchanged compared to the prior exam of ___. There may be faint\nT2/IDEAL hyperintense signal in the spinal cord at this level without\npostcontrast enhancement, unchanged. Otherwise, the spinal cord appears\nnormal in caliber and configuration. There is no evidence of significant\nspinal canal stenosis at this level. Moderate bilateral neural foraminal\nstenosis at T9-T10 is unchanged. Otherwise no evidence of severe spinal canal\nstenosis or neural foraminal narrowing in the thoracic spine.\n\n___ type 2 degenerative endplate changes along the inferior aspect of the T8\nvertebra is unchanged. There are 2 foci of focal fat versus small hemangiomas\nin the T8 vertebra, also unchanged. No new marrow signal abnormalities are\ndetected.\n\nLUMBAR SPINE: There are 5 non rib-bearing lumbar type vertebral bodies. \nAlignment is normal. Vertebral body heights are well preserved. ___ type 2\ndegenerative changes of the L5-S1 endplate is noted with intervertebral disc\ndesiccation and height loss, similar to the prior exam. The conus medullaris\nterminates at the level of L1. The distal spinal cord is unremarkable. No\nconcerning marrow lesions are identified.\n\nAt T12-L1: No spinal canal or neural foraminal narrowing.\n\nAt L1-L2: No spinal canal or neural foraminal narrowing.\n\nAt L2-L3: Mild posterior disc bulge and ligamentum flavum thickening without\nsignificant spinal canal or neural foraminal stenosis.\n\nAt L3-L4: Mild posterior disc bulge, ligamentum flavum thickening, and facet\nosteophytes without significant spinal canal or neural foraminal stenosis.\n\nAt L4-L5: Posterior disc bulge, ligamentum flavum thickening, and small facet\nosteophytes without spinal canal or neural foraminal stenosis.\n\nAt L5-S1: Right foraminal and extraforaminal disc bulge, facet osteophytes,\nand epidural lipomatosis results in mild spinal canal narrowing and mild to\nmoderate right and mild left neural foraminal narrowing, unchanged.\n\nRemainder of the paraspinal soft tissues aside from the T9 level are\nunremarkable.", "output": "1. Redemonstration of a T9 marrow lesion with soft tissue involvement of the\nadjacent paraspinal soft tissues with extension into the epidural space\nresulting in at least moderate bilateral neural foraminal narrowing. Faint\nT2/IDEAL hyperintense cord signal at this level is not appreciably changed.\n2. No new concerning thoracolumbar lesions.\n3. Stable mild lumbar spondylosis, worse at L5-S1." }, { "input": "CERVICAL:\n\nNo suspicious bone marrow lesion is identified.\n\nThere are degenerative endplate changes at C5-6 and C6-7, without spinal canal\nnarrowing. There is mild neural foraminal narrowing at several levels.\n\nThe cervical cord appears normal in morphology and signal intensity.\n\nThe prevertebral and paraspinal soft tissues appear normal.\n\nTHORACIC:\n\nThere is an enhancing destructive lesion within the T9 vertebral body with\nparaspinal extension and epidural invasion with flattening the thoracic cord. \nThere is no signal abnormality or abnormal enhancement within the cord. There\nis slight extension of the enhancing epidural and paraspinal component into\nthe T8 and T10 levels. There is a thin fat plane between the paraspinal\nenhancement and the left-sided thoracic aorta.\n\nNo other lesions are identified within the thoracic spine.\n\nVertebral body height and alignment are preserved. There is otherwise no\nspinal canal or neural foraminal narrowing.\n\nThere is a 14 mm probable lymph node within the posterior mediastinum adjacent\nto the descending thoracic aorta at the T5 level.\n\nLUMBAR:\n\nThe conus medullaris terminates at the T1 vertebral body. The conus\nmedullaris and cauda equina appear normal in morphology and signal intensity.\n\nNo suspicious bone marrow lesion is identified.\n\nThere is a small disc bulge and degenerative endplate change at L5-S1 with\nmild right neural foraminal narrowing. There is otherwise no spinal canal or\nneural foraminal narrowing.", "output": "T9 vertebral body lesion with epidural and paraspinal invasion. The epidural\ncomponent flattens the cord T9. No associated cord edema is identified. No\nother bone marrow lesions are identified within the cervical, thoracic, or\nlumbar spine. This is most suspicious for a malignant neoplasm or invasive\nhemangioma. Infection cannot be entirely excluded. There is a 14 mm presumed\nlymph node posterior to the descending thoracic aorta at the T5 level.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:08 am, 5 minutes after\ndiscovery of the findings." }, { "input": "At the craniocervical junction and at C2-3 level, no significant abnormalities\nare seen. At C3-4 and C4-5 minimal disc degenerative change without\nsignificant bulging.\n\nAt C5-6 level, there is mild disc bulging identified with mild to moderate\nnarrowing of the left foramen without compromise of the right foramen or\nspinal stenosis.\n\nAt C6-7, C7-T1 and inferiorly to T4-5 level, minimal degenerative changes\nseen without spinal stenosis.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression.", "output": "Mild degenerative changes are identified. There is no spinal stenosis. Mild\nto moderate left foraminal narrowing at C5-6 level." }, { "input": "Disc and vertebral body heights are maintained. No suspicious marrow signal is\nidentified. The conus terminates at the inferior endplate of T12, within\nexpected limits. There is no signal abnormality of the visualized cord. Mild\ndisc bulges at L2-3, L3-4 and L4-5 is noted with associated minimal facet\narthropathy without significant spinal canal or neural foraminal narrowing.\n\nL5-S1: There is a small posterior disc protrusion as well as mild bilateral\nfacet arthropathy, resulting in moderate right neural foraminal narrowing\nwhich impinges on the exiting right L5 nerve root and mild left neural\nforaminal narrowing. There is mild spinal canal narrowing.\n\nIncidental note is made of a retro aortic course of the left renal vein. The\nkidneys are slightly atrophic and demonstrate multiple incompletely\ncharacterized cystic subcentimeter lesions, which were previously seen on\nprior CT of ___, essentially unchanged and likely simple cysts.\nProminent bilateral extrarenal pelves are noted.", "output": "1. At L5-S1, there is a posterior disc protrusion with bilateral facet\narthropathy resulting in moderate right neural foraminal narrowing which\nimpinges on the exiting right L5 nerve root.\n2. Additional chronic findings as described above." }, { "input": "There is redemonstration of a mild compression fracture of the L2 vertebral\nbody with a transversely oriented T1 hypointense fracture line and associated\nSTIR hyperintensity, suggestive of an acute process. Minimal retropulsion\ninto the canal is present without nerve root compromise. Diffuse\nheterogeneous appearance of the bone marrow on T1 and T2 is slightly more\nprominent compared to ___, and could be related to osseous\ndemineralization and bone marrow reconversion. A possible non expansile\nhemangiomas identified on the right side at T11 vertebral body (series 301,\nimage 22, series 6, image 15). Alignment is normal. There is\nmild-to-moderate disc desiccation throughout the lumbar spine.\n\nThe thoracic spine was imaged to the level of T8-9, and from T8-9 through\nT12-L1 there is no spinal canal or neural foraminal narrowing.\n\nAt L1-2, there is minimal diffuse disc bulge in combination with trace L2\nvertebral body retropulsion minimally indenting the canal but not causing\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L2-3, there is diffuse disc bulge in combination with facet degenerative\nchange and ligamentum flavum thickening that minimally narrows the spinal\ncanal and results in mild bilateral neural foraminal narrowing.\n\nAt L3-4, there is diffuse disc bulge, ligamentum flavum thickening and facet\ndegenerative change that minimally narrows the spinal canal. There is mild\nbilateral neural foraminal narrowing.\n\nAt L4-5, there is diffuse disc bulge, ligamentum flavum thickening and facet\ndegenerative change that mildly narrows the spinal canal. The lateral\nrecesses are narrowed bilaterally with contact of the traversing nerve roots. \nThere is mild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is diffuse disc bulge, which is slightly asymmetrically\nprominent on the right and narrows the right lateral recess with probable\ncontact of the traversing nerve root. This also contributes to severe right\nand mild left neural foraminal narrowing.\n\nOTHER: There is a T2 hyperintense right renal cyst.", "output": "1. Likely acute fracture of the L2 vertebral body with minimal retropulsion\ninto the canal that does not compromise the cauda equina nerve roots.\n2. Diffusely heterogeneous bone marrow signal on T1 and T2 may be related to\nosseous demineralization. However, if there is a history of or concern for\nmalignancy, a bone scan could be performed.\n3. Multilevel degenerative changes of the lumbar spine, most severe at L5-S1\nwhere there is severe right 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%\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": "CERVICAL:\nThere is 2 mm retrolisthesis of C5 on C6 and 2 mm anterolisthesis of C7 on T1.\nOtherwise, cervical alignment is anatomic. Vertebral body heights are\npreserved. The marrow signal is diffusely heterogeneous and T1 hypointense,\nsimilar to that of the disc, without focal lesion. This may represent marrow\nreconversion in the setting of chronic systemic process such as anemia or\nhistory of CLL/lymphoma. Clinical correlation is recommended. Degenerative\nloss of disc height is moderate at multiple levels and severe at C5-C6 and\nC6-C7. There is no definitive abnormal enhancement or signal of the\nvisualized posterior fossa or cervical cord.\n\nC2-C3: Remarkable.\n\nC3-C4: A central protrusion does not significantly narrow the spinal canal. \nUncovertebral and facet arthropathy results in moderate left and mild right\nneural foraminal narrowing.\n\nC4-C5: A left central protrusion with thickening of the ligamentum flavum\nresults in mild spinal canal narrowing, mildly effacing the left ventral\naspect of the cord. Uncovertebral and facet arthropathy results in moderate\nto severe left and mild right neural foraminal narrowing.\n\nC5-C6: A central protrusion results in mild spinal canal narrowing, mildly\neffacing the cord. Uncovertebral and facet arthropathy results in severe\nright and moderate left neural foraminal narrowing.\n\nC6-C7: A central protrusion contacts the cord without effacement. There is\nmild spinal canal narrowing. Uncovertebral and facet arthropathy results in\nmoderate bilateral neural foraminal narrowing.\n\nC7-T1: Mild uncovering of the disc secondary to anterolisthesis. There is a\nsmall central protrusion without significant spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. As in\nthe cervical spine, the marrow signal is heterogeneous and T1 hypointense,\nwithout focal lesion. Multilevel hemangiomas are identified. Mild\ndegenerative loss of disc height and signal is diffuse. Small multilevel\ncentral protrusions do not significantly narrow the spinal canal. There is no\nsignificant neural foraminal narrowing. A prominent 7 mm left perineural\nneural foraminal cyst (series 12, image 32) is identified. There is no\ndefinitive cord signal abnormality. No abnormal postcontrast enhancement.\n\nVisualized on sagittal sequences, there are multiple disc protrusions of the\nupper lumbar spine resulting in mild spinal canal narrowing. In conjunction\nwith facet arthropathy, there appears to be mild bilateral neural foraminal\nnarrowing at these levels.\n\nOTHER: Incidental note is made of a large hiatal hernia. An nonenhancing T2\nhyperintense cystic lesion in hepatic segment ___ is compatible with a simple\ncyst, although not completely within the field of view. Bilateral parapelvic\nrenal cysts or diverticulum. There is a small right glenohumeral joint\neffusion on localizer sequences.", "output": "1. No abnormal enhancement or mass lesion in the cervical or thoracic spine.\n2. No definitive cord signal abnormality.\n3. Multilevel degenerative changes are most prominent in the cervical spine\nwith there is mild spinal canal narrowing at C4-C5 through C6-C7 where central\nprotrusions minimally efface the cord without underlying cord signal change. \nAt C4-C5 there is mild to severe left neural foraminal narrowing. At C5-C6\nthere is severe right neural foraminal narrowing.\n4. The marrow signal is diffusely heterogeneous and T1 hypointense without\nfocal lesion. This may represent marrow reconversion in the setting of\nchronic anemia, other systemic process or potentially infiltrative disease. \nClinical correlation is recommended." }, { "input": "Alignment is near anatomic. There are diffuse osseous metastases\ninvolving all the visualized vertebrae from T12 through S3. There is\nposterior element and spinous process involvement as well at multiple levels,\nmost prominent at T12, L1 and L2.\n\nThere is epidural metastasis along the left thecal sac at T12-L1 (8:7, 23:6). \nWhile this may involve some traversing L1 nerve roots, there is no significant\nspinal canal narrowing.\n\nThere is no other evidence of epidural metastases. There are mild underlying\ndegenerative changes with no high-grade spinal canal or foraminal narrowing.\n\nBilateral adrenal masses are suspicious for metastases. Small renal cysts are\nincidentally noted. There is sacral and ilial bony metastases diffusely as\nwell. The diffuse bony metastases are manifested by markedly heterogeneous T1\nand T2 signal within the marrow along with markedly heterogeneous enhancement.\nThere is no evidence of pathologic fracture.", "output": "1. Diffuse osseous metastases with no evidence of pathologic compression\nfracture.\n\n2. Epidural metastasis along the left thecal sac at the T12-L1 level.\n\n3. Bilateral adrenal metastases." }, { "input": "CERVICAL:\nAlignment is normal.Vertebral body height and marrow signal is maintained. \nThere is loss of normal T2 disc signal and height throughout the cervical\nspine.The spinal cord appears normal in caliber and configuration.\n\nAt C1-C2, there is no significant spinal canal narrowing.\n\nAt C2-C3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, a small posterior disc bulge, in combination with facet arthropathy,\nresults in mild spinal canal narrowing. There is moderate to severe right and\nmild left neural foraminal narrowing.\n\nAt C4-C5, a posterior disc bulge results in mild canal narrowing with\ncompression of the anterior thecal sac and mild remodeling of the anterior\ncord. No significant neural foraminal narrowing.\n\nAt C5-C6, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C6-C7, a posterior disc bulge results in mild spinal canal and mild\nbilateral neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of significant spinal canal or neural foraminal\nnarrowing. T2 hyperintense lesions in the neural foraminal at multiple levels\nlikely represent perineural cysts, the largest in the right T11-T12 and T12-L1\nneuroforamen, as well as the left T9-T10 neuroforamen. Again seen is a\ncompression fracture of the superior endplate of the L1 vertebral body with no\nencroachment on the spinal canal.\n\nOTHER: The visualized paravertebral soft tissues are unremarkable.", "output": "1. No evidence of spinal cord infarct.\n2. Multilevel degenerative changes in the cervical spine, worst at C4-C5 where\nthere is mild canal narrowing with compression of the anterior thecal sac and\nmild remodeling of the anterior cord, and C3-C4 where there is moderate to\nsevere right neural foraminal narrowing.\n3. Compression fracture of the L1 vertebral body.\n4. No significant spinal canal or neural foraminal narrowing in the thoracic\nspine." }, { "input": "CERVICAL:\nThere is 3 mm anterolisthesis of C7 on T1. Vertebral body alignment is\notherwise preserved. Multilevel degenerative changes, mild disc osteophyte\ncomplexes. Disc space narrowing C5-C6, C6-C7 levels, similar to prior. \nPosterior element hypertrophic changes. Normal cord. Mild edema C5, C6, C7\nlevels, likely degenerative, no paraspinal edema, no disc signal abnormality.\n\nMild central canal narrowing C5-C6, C6-C7 levels, central canal otherwise\npatent.\n\nMild left C2-C3, mild right and mild-to-moderate left C3-C4, mild bilateral\nC4-C5, moderate bilateral C5-C6 or, moderate right and moderate to severe left\nC6-C7, mild-to-moderate bilateral C7-T1 foraminal narrowing.\n\n\nTHORACIC:\nEndplate edema T1-T2 level, mild paraspinal edema, mild disc space linear T2\nsignal abnormality, linear enhancement, findings may be degenerative, early\ndisc space infection could have similar appearance.\n\nMild right T2-T3 endplate edema, linear T2 signal abnormality of the disc,\nlinear disc enhancement, moderate adjacent right paraspinal soft tissue\nabnormality, bright STIR signal, associated enhancement. Differential\nconsiderations include infection, tumor. It is very unlikely degenerative in\netiology.\n\nMultilevel degenerative changes thoracic, upper lumbar spine, few endplate\nSchmorl's nodes. No cord T2 signal abnormality..\n\nWidely patent central canal at all levels.\n\nModerate bilateral T1-T2, moderate to severe right T2-T3, mild right T3-T4\nforaminal narrowing. Multilevel mild foraminal narrowing at other levels in\nthe thoracic spine.\n\nLinear band of opacity enhancement left upper lung, similar to prior chest CT\n___, may be postsurgical/posttreatment change. Dependent\natelectasis posterior lungs.", "output": "1. Abnormal T1-T2 level, mild paraspinal edema, likely degenerative; early\ndisc space infection could have this appearance.\n2. Abnormal T2-T3 level; right paraspinal moderate abnormality, enhancement,\ndifferential considerations disc space infection, tumor. Findings not\nconsistent with degenerative/reactive change unless there is near by occult\nfracture.\n3. If there are progressive spine symptoms, follow-up MR thoracic spine within\n2 weeks recommended.\n4. Degenerative changes cervical, thoracic, as above.\n\nRECOMMENDATION(S): If there are progressive spine symptoms, follow-up MR\nthoracic spine within 2 weeks recommended.\n\nNOTIFICATION: Findings communicated to Dr. ___ by Dr. ___\n(neuroradiology fellow) via telephone on ___ at 14:17 pm" }, { "input": "Mild anterolisthesis is seen involving C3 on C4. Alignment is otherwise\nnormal. Vertebral body signal intensity appears normal. Diffuse disc\ndesiccation, degenerate radiology is seen throughout the cervical spine. The\nspinal cord appears normal in caliber and configuration.\n\nC2/C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3/C4: Mild anterolisthesis results in uncovering of the intervertebral disc\nas well as a mild central disc bulge. Mild canal narrowing is seen at this\nlevel. Uncovertebral hypertrophy and facet joint arthropathy contributes to\nmoderate left and mild right neural foraminal narrowing.\n\nC4/C5: Central disc bulge is seen resulting in mild canal narrowing. Facet\njoint and uncovertebral hypertrophy results in moderate to severe right and\nmild left neural foraminal narrowing.\n\nC5/C6: Central disc protrusion is seen, resulting in mild canal narrowing. \nUncovertebral and facet joint arthropathy contribute to mild bilateral neural\nforaminal narrowing, left greater than right.\n\nC6/C7: Central disc bulge is seen however there is no significant spinal\ncanal or neural foraminal narrowing at this level.\n\nC7/T1: There is no significant spinal canal narrowing. There is moderate\nright foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. No traumatic injuries identified within the cervical spine. No cord signal\nabnormality seen.\n2. Cervical spondylosis, most pronounced at C4/C5 with moderate to severe\nright and mild left neural foraminal narrowing." }, { "input": "Mild anterolisthesis at C1 on the occipital condyles is better appreciated on\nthe prior cervical spine CT. There is minimal anterolisthesis of C4 on C5 and\nC7 on T1. Vertebral body heights are maintained. Bone marrow signal is\nmildly heterogeneous but does not demonstrate suspicious osseous lesions. \nThis tear hyperintense signal at the T2-3 endplates without signal abnormality\nintervertebral disc or adjacent soft tissues probably represents ___ type 1\ndegenerative change although sequela of mild compression deformity of the\nsuperior T3 endplate is not entirely excluded. There is no gross evidence of\nligamentous disruption within limitations of motion artifact.\n\nThere is no signal abnormality of the cervical or visualized upper thoracic\nspine. T2 hyperintense lesions of the visualized brainstem may represent\nchronic microangiopathy.\n\nAt C2-3, a central disc protrusion indents the anterior spinal cord and there\nis also moderate narrowing of spinal canal. Uncovertebral osteophytes result\nin mild bilateral neural foraminal narrowing.\n\nAt C3-4, a central disc protrusion that is mildly eccentric to the left\nindents the anterior spinal cord and results in at least moderate narrowing of\nthe spinal canal. Uncovertebral osteophytes result in mild bilateral neural\nforaminal narrowing.\n\nAt C4-5, a small broad disc protrusion is eccentric to the right with\nassociated intervertebral osteophytes results in mild narrowing of the spinal\ncanal. Neural foraminal narrowing is mild.\n\nAt C5-6, there is a round central disc protrusion that is eccentric to the\nleft with intervertebral osteophytes indents the left anterior cord, resulting\nin mild narrowing of the spinal canal. Uncovertebral osteophytes result in\nmild bilateral neural foraminal narrowing.\n\nC6-7, there is a broad posterior disc protrusion with intervertebral\nosteophytes that contacts the spinal cord with mild narrowing of the spinal\ncanal. There is no significant neural foraminal narrowing.\n\nC7-T1, there is no appreciable spinal canal or neural foraminal narrowing.\n\nThere is no significant spinal canal or neural foraminal narrowing in the\nvisualized upper thoracic spine.\n\nTrace retropharyngeal fluid is identified, which may be secondary to patient's\nintubated status. No large fluid collection is identified.", "output": "1. No evidence of marrow edema in the cervical spine to suggest occult\ncervical fracture. There is no signal abnormality of the cervical or\nvisualized upper thoracic spine.\n2. There is T2/STIR hyperintense signal of the T2-T3 endplates, most\nprominently along the T3 superior endplate, which may represent ___\ndegenerative change. However in the context of recent trauma, very subtle\ncompression fracture of the T3 superior endplate is not excluded.\n3. Multilevel cervical spondylosis as described is at least moderate narrowing\nof the spinal canal at C2-3 and C3-4 levels." }, { "input": "From T11-12 through L5-S1 levels the intervertebral discs demonstrate normal\nsignal and there is no evidence of significant disc bulge disc herniation or\nspinal stenosis. There is no foraminal narrowing. There is no nerve root\ndisplacement. The vertebral bodies demonstrate normal signal without\ncompression fracture or marrow edema. There is no spondylolysis or listhesis.\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "No significant abnormalities are seen on MRI of the lumbar spine." }, { "input": "From T11-12 through L1-2 levels no abnormalities are seen.\n\nAt L2-3 level, disc bulging and a small right-sided disc protrusion (05:13). \nThere is narrowing of the right subarticular recess (08:18). There is no\ncentral canal stenosis. There is no foraminal narrowing.\n\nAt L3-4 and L4-5 levels mild disc bulging identified without spinal stenosis.\n\nAt L5-S1 level diffuse disc bulge and facet degenerative changes and\nthickening of the ligament seen. There is a left-sided disc protrusion and\nannular tear (09:19) which displaces the left S1 nerve root. There is no\nforaminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Small right-sided disc herniation at L2-3 level narrowing the right\nsubarticular recess.\n2. Left-sided disc herniation at L5-S1 level displacing the left S1 nerve\nroot.\n3. Clinical correlation recommended to determine the significance of this\nfindings." }, { "input": "Numbering is based on the lowest rib-bearing vertebral body. Mild\nretrolisthesis of L1 on L2 and L2 on L3 levels. Mild anterolisthesis of L4 on\nL5. Vertebral body heights are preserved. There is diffuse loss of disc\nheight and signal throughout the lumbar spine, severe at L1-2 and L5-S1 with\nendplate irregularity and type ___ endplate changes. The spinal cord\nappears normal in caliber and configuration terminating normally at L1. The\nsacroiliac joints are preserved bilaterally. There is no abnormal enhancement\nafter contrast administration.\n\n8 mm well-circumscribed T2 hyperintense lesion within the spleen is unchanged,\nlikely benign (series 6, image 4). Note is made of extrarenal pelvis on the\nleft.\n\nAt T11-12 and T12-L1, there is no high-grade spinal canal or neural foraminal\nstenosis.\n\nAt L1-2, grade 1 retrolisthesis with mild broad-based disc bulging, but no\nhigh-grade spinal canal stenosis. However, the disc bulging does cause mild\nbilateral neural foraminal stenosis. Small bilateral facet joint effusions.\n\nAt L2-3, grade 1 retrolisthesis with mild broad-based disc bulging, but no\nhigh-grade spinal canal stenosis. Disc bulging and facet hypertrophy causes\nmild bilateral neural foraminal stenosis, slightly worse on the left.\n\nAt L3-4, mild broad-based disc bulging with thickening of the ligamentum\nflavum causes mild spinal canal narrowing. The disc bulge in combination with\nfacet hypertrophy causes mild left and moderate right neural foraminal\nstenosis.\n\nAt L4-5, grade 1 anterolisthesis with disc uncovering and thickening of the\nligamentum flavum, which in combination causes mild to moderate narrowing of\nthe spinal canal and crowding of the cauda equina nerve roots. Disc bulging\nwith facet hypertrophy causes moderate right and mild to moderate left neural\nforaminal stenosis.\n\nAt L5-S1, no high-grade spinal canal stenosis, however, facet hypertrophy\ncauses moderate right neural foraminal stenosis. No left neural foraminal\nstenosis.", "output": "1. Grade 1 retrolisthesis of L1 on L2, L2 on L3. Grade 1 anterolisthesis of\nL4 on L5.\n2. Severe degenerative disc disease at L1-2 and L5-S1, with endplate\nirregularity and ___ type 2 endplate changes, milder at other levels.\n3. Mild to moderate spinal canal narrowing at L4-5 due to anterolisthesis,\ndisc uncovering, and thickening of the ligamentum flavum. Mild spinal canal\nnarrowing at L3-4.\n4. Multilevel neural foraminal stenosis, moderate at L3-4 on the right, L4-5\nbilaterally, and L5-S1 on the right. Milder neural foraminal stenosis at\nother levels, as described above." }, { "input": "There is minimal anterolisthesis of C2 on C3 and possibly also at C3 and C4. \nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. The spinal cord demonstrates normal signal intensity.\nVisualized posterior fossa and craniocervical junction appear unremarkable.\n\nC2-C3: Broad-based central disc protrusion indents ventral thecal sac without\nspinal cord contact or significant spinal canal narrowing. There is moderate\nto severe right neural foraminal narrowing by uncovertebral and facet\nosteophytes. There is left facet arthropathy without significant left neural\nforaminal narrowing.\n\nC3-C4: Broad-based central disc protrusion indents the ventral thecal sac but\ndoes not contact the spinal cord or significantly narrow the spinal canal. \nThere is mild bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC4-C5: Broad-based central/left paracentral disc protrusion indents the\nventral thecal sac but does not contact the spinal cord. The spinal canal is\nmildly narrowed. There is mild bilateral neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nC5-C6: There is a small broad-based central disc protrusion indenting the\nventral thecal sac and mildly narrowing the spinal canal. The ventral cord is\nmildly remodeled without evidence for signal abnormalities. There is severe\nbilateral neural foraminal narrowing by left greater than right uncovertebral\nosteophytes and facet osteophytes.\n\nC6-C7: Broad-based central disc protrusion indents the ventral thecal sac and\nmildly remodels the ventral spinal cord. In combination with ligamentum\nflavum thickening, this causes mild to moderate spinal canal narrowing. There\nis moderate to severe bilateral neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n\nC7-T1: There is a mild disc bulge indenting the ventral thecal sac but not\ncontacting the spinal cord. There is mild right and moderate left neural\nforaminal narrowing by uncovertebral and facet osteophytes.", "output": "Multilevel cervical spondylosis. The ventral spinal cord is mildly remodeled\nat C3-C4, C5-C6, and C6-C7, without cord signal abnormalities. Advanced\nneural foraminal narrowing at multiple levels, as detailed above." }, { "input": "There is mild prevertebral soft tissue edema from C5 through C7 levels with\nlikely ligamentous injury to the anterior longitudinal ligament (05:10). \nThere is questionable subtle STIR hyperintensity of the anterior C7 vertebral\nbody possibly related to bone marrow contusion. The alignment of the cervical\nspine is maintained. The vertebral body heights are preserved. There is\ndiffuse narrowing of the spinal canal, likely on a combined congenital on\ndegenerative basis, without evidence of abnormal spinal cord signal or edema. \nThere is prominence of the epidural fat with prominent infolding of the\nligamentum flavum, possibly calcified.\n\nC2-C3: There is disc protrusion with facet and uncovertebral joint\narthropathy, resulting in slight progression of moderate to severe left and\nmild right neural foraminal narrowing, with moderate narrowing of the spinal\ncanal spinal canal without cord compression.\n\nC3-C4: There is disc protrusion with bilateral facet and uncovertebral joint\narthropathy, resulting in slight progression of severe left and moderate right\nneural foraminal narrowing and moderate spinal canal stenosis without cord\ncompression.\n\nC4-C5: There is disc protrusion with bilateral facet and uncovertebral joint\narthropathy, resulting in progression of mild bilateral neural foraminal\nnarrowing with mild spinal canal stenosis.\n\nC5-C6: There is disc protrusion with bilateral facet and uncovertebral joint\narthropathy, resulting in stable mild bilateral neural foraminal narrowing\nwithout spinal canal stenosis.\n\nC6-C7: There is disc protrusion with ligamentum flavum thickening and\nbilateral facet and uncovertebral joint arthropathy resulting in stable mild\nneural foraminal narrowing without spinal canal stenosis.", "output": "1. Prevertebral soft tissue edema from C5 through C7 levels, suggestive of\nligamentous injury to the anterior longitudinal ligament, and questionable\nbone marrow contusion of the anterior C7 vertebral body.\n2. No evidence of cord compression, cord edema, or hemorrhage.\n3. Multilevel cervical spondylosis progressed from ___ MRI with\ndiffuse narrowing of the spinal canal with moderate spinal canal stenosis at\nC2-C3 and C3-C4 levels and moderate to severe multilevel neural foraminal\nnarrowing as above.\n\nNOTIFICATION: The findings above not mentioned in the overnight radiology\nresident preliminary report were emailed to ER QA nurse by ___\n___, M.D. on the telephone on ___ at 1:20 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "5 lumbar-type vertebrae are visualized.\n\nThere is normal lumbar alignment. The vertebrae demonstrate normal height and\nmarrow signal. The conus demonstrates normal signal morphology terminating\nappropriately at the L1-L2 level.\n\nAt T9-10, there is a right paracentral disc protrusion without neural\nforaminal stenosis or spinal canal stenosis. This is only visualized on the\nsagittal sequences.\n\nAt T10-T11, there is disc bulge without neural foraminal or spinal canal\nstenosis. This is only visualized on the sagittal sequences.\n\nAt T11-12, there is no neural foramina or spinal canal stenosis.\n\nAt T12-L1, there is no neural foramina or spinal canal stenosis.\n\nAt L1-L2 there is disc bulge without neural foraminal or spinal canal\nstenosis.\n\nAt L2-L3, there is disc bulge and mild facet arthropathy with synovial\neffusions. No significant spinal ___ or neural foraminal stenosis.\n\nAt L3-L4, there is disc bulge and mild facet arthropathy, without significant\nspinal canal or neural foraminal stenosis.\n\nAt L4-L5, there is disc bulge and facet arthropathy with small synovial\neffusions causing, mild left neural foraminal stenosis. There is no spinal\ncanal stenosis. There is mild soft tissue edema along the right L4-L5 facet,\nlikely inflammatory.\n\nAt L5-S1, there is disc bulge and facet arthropathy with small synovial\neffusions. This causes moderate right neural foraminal stenosis which\ncompresses the exiting right L5 nerve root (3:14). There is mild left neural\nforaminal stenosis. The disc bulge contacts the undersurface of the exiting\nleft L5 nerve root (3:5).\n\nThere are subcentimeter circumscribed T2 hyperintense, likely cystic lesions\nthe right kidney.", "output": "At L5-S1, a disc bulge and facet arthropathy cause moderate right neural\nforaminal stenosis with compression of the exiting right L5 nerve root, and\nmild left neural foraminal narrowing with abutment of the exiting left L5\nnerve root by the disc bulge." }, { "input": "The lumbar lordosis is preserved. Mild scoliosis to the right at the jxn of\nsacrum and lumbar,Vertebral body alignment and height are preserved. Bone\nmarrow signal is within normal limits. The conus demonstrates normal signal\nand morphology and terminates at the level of L1. The cauda equina and nerve\nroots demonstrate a normal morphology and distribution within the thecal sac.\n\nThere is no evidence of degenerative disc disease in the lumbar spine through\nthe L4-L5 level. However, at L5-S1, there is facet joint artropathy and disc\ndesiccation with loss of disc height and disc bulge without significant\nimpingement upon the thecal sac but resulting in moderate right neural foramen\nnarrowing with contact between the disc and the exiting right L5 root. The\nleft neural foramen shows only minimal narrowing at this level.", "output": "Degenerative disc disease with disc herniation at L5-S1 resulting in moderate\nright neural foramen narrowing at this level with contact between the bulging\ndisc and the exiting right L5 root." }, { "input": "There is dextro convex curvature of the lumbar spine with apex at L2 and\ncompensatory levoconvex curvature at L4-L5. 3 mm retrolisthesis of L4 on L5\nhas worsened since ___. 4 mm anterolisthesis of L5 on S1 is similar. \nOtherwise, lumbar alignment is grossly anatomic. L3 osseous hemangioma is\nidentified. There is no suspicious marrow signal. Vertebral body heights are\npreserved. Loss of disc height and signal at L3-L4 is mild. Loss of disc\nheight and signal is moderate at L4-L5 and severe at L5-S1. The conus\nmedullaris terminates at the L1 vertebral level, within expected limits. \nThere is no signal abnormality of the visualized cord or conus. There are\nbilateral pars defects at L5-S1.\n\nT11-T12 through L2-L3: There is minimal left neural foraminal narrowing\nsecondary to dextro convex curvature of the lumbar spine. There is no right\nneural foraminal narrowing. There is no significant spinal canal narrowing.\n\nL3-L4: A left eccentric disc bulge, most prominent along the foraminal and\nextra foraminal zone is identified, which results in minimal crowding of the\nsubarticular zones contacting but not posteriorly displacing the traversing\nnerve roots. Facet arthropathy and compensatory levoconvex curvature of the\nlumbar spine results in moderate right and mild left neural foraminal\nnarrowing.\n\nL4-L5: A small disc protrusion with intervertebral osteophytes as well as\nretrolisthesis of L4 on L5 does not result in significant spinal canal\nnarrowing. Facet arthropathy and compensatory levoconvex curvature results in\nmoderate right and mild left neural foraminal narrowing.\n\nL5-S1: There is mild uncovering of the disc secondary to anterolisthesis. \nThere is no significant spinal canal narrowing. Facet arthropathy and loss of\ndisc height results in moderate bilateral neural foraminal narrowing which\nappears to contact the under surfaces of both exiting nerve roots.\n\nThe above degenerative findings are not significantly changed since ___.\n\nMultiple cystic lesions of the left greater than right renal pelvis, likely\nrepresents parapelvic cyst or diverticula, similar in appearance to prior CT\nexamination ___. There also too small to completely characterize parenchymal\nT2 hyperintense cystic lesions measuring up to 5 mm. Prevertebral and\nparaspinal soft tissues are unremarkable.", "output": "1. Bilateral pars defects of L5-S1, similar appearance to prior exam.\n2. Multilevel multifactorial lumbar spondylosis as described above, most\nprominent at L3-L4 through L5-S1, not significantly changed from prior exam. \nAt L5-S1 there is bilateral neural foraminal narrowing which appears to\ncontact the undersurface of both exiting nerve roots.\n3. Left much greater than right parapelvic cysts or diverticula, similar\nappearance to CT examination of ___. To small incompletely characterized T2\nhyperintense cystic lesions in the bilateral kidneys measuring up to 5 mm,\nstatistically most likely representing simple cyst. These could be further\nevaluated with ultrasound as clinically indicated." }, { "input": "Vertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities seen. The cerebellar tonsils are normally\npositioned, and visualized posterior fossa and lower cerebrum appear\nunremarkable. The cervical and included upper thoracic spinal cord to the\nT2-T3 level demonstrates normal morphology and signal intensity.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: Tiny central disc protrusion without spinal canal narrowing. No\nsignificant neural foraminal narrowing. No interval change.\n\nC4-C5: Tiny shallow broad-based disc protrusion without spinal canal\nnarrowing, unchanged. Minimal left neural foraminal narrowing by\nuncovertebral osteophytes, probably also unchanged.\n\nC5-C6: No spinal canal or neural foraminal narrowing. Unchanged left\nperineural cyst. Tiny right perineural cyst (image 6:21) was not seen\npreviously, which could be due to slice selection given its small size.\n\nC6-C7: Tiny left paracentral disc protrusion without significant spinal canal\nnarrowing. Moderate left neural foraminal narrowing by uncovertebral\nosteophytes. Right perineural cyst. No interval change.\n\nC7-T1: No spinal canal or neural foraminal narrowing.", "output": "Mild multilevel cervical degenerative disease without significant change\ncompared to ___." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved. No\nsuspicious bone marrow signal abnormalities are seen. Minimal retrolisthesis\nof L4 on L5 is unchanged. Mild grade 1 anterolisthesis of L5 on S1 with\nbilateral L5 pars interarticularis defects are also unchanged. The distal\nspinal cord demonstrates normal morphology and signal intensity, with the\nconus medullaris terminating near the L1 lower endplate.\n\nT11-T12: Mild disc bulge and mild facet arthropathy without spinal canal or\nsignificant neural foraminal narrowing. No interval change.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: Minimal disc bulge and minimal facet arthropathy without spinal canal\nor neural foraminal narrowing. No interval change.\n\nL2-L3: Minimal disc bulge and minimal facet arthropathy without spinal canal\nor neural foraminal narrowing. No interval change.\n\nL3-L4: Mild disc bulge, thickening of the ligamentum flavum, moderate right\nand mild to moderate left facet arthropathy are present. The subarticular\nzones are narrowed without frank compression of the traversing L4 nerve roots.\nThe thecal sac is minimally narrowed without mass effect on the intrathecal\nnerve roots. There is mild to moderate, right greater than left neural\nforaminal narrowing. There is no significant interval change.\n\nL4-L5: Minimal retrolisthesis and mild facet arthropathy cause moderate right\nand mild left neural foraminal narrowing, unchanged. No significant spinal\ncanal narrowing.\n\nL5-S1: Grade 1 anterolisthesis with an uncovered and slightly bulging disc\nand moderate facet arthropathy causes moderate bilateral neural foraminal\nnarrowing with foreshortening, unchanged. No significant spinal canal\nnarrowing.\n\nA small Tarlov cyst is again seen in the spinal canal at the level of S2.\n\nLeft renal parapelvic cysts are again noted, as seen on the ___\nabdominal/pelvic CT.", "output": "1. Multilevel lumbar degenerative disease demonstrates no significant change\ncompared to ___. This includes up to moderate narrowing of multiple\nneural foramina, but no significant spinal canal narrowing or mass effect on\nthe intrathecal nerve roots.\n2. Minimal L4-L5 retrolisthesis and mild grade 1 L5-S1 anterolisthesis with\nbilateral L5 pars interarticularis defects are again seen." }, { "input": "Thoracic spine alignment is anatomic. Marrow signal is normal. \nThere are no suspicious osseous lesions. Moderate disc desiccation is seen at\nthe mid and upper thoracic spine, most prominent at T8-T9 and T9-T10. There\nare endplate irregularities at these levels as well, all compatible with\ndegenerative disc disease.\n\nThe spinal cord has normal contour and signal. The conus medullaris is at the\nlevel of L1 with normal contour and signal. \n\nA small, broad-based, disc protrusion at T8-T9 mildly effaces the ventral\nspinal cord. There is no foraminal or spinal canal narrowing. This\ndegenerative disc disease at T8-T9 has minimally increased compared to the\nprior examination. \n\nA small focal central disc protrusion is also present at T10-T11 without\nsignificant spinal canal or foraminal narrowing. This is similar to the prior\nexamination. \n\nVisualized paraspinal soft tissues are unremarkable.", "output": "Mild degenerative disc disease, most prominent at T8-T9 and\nT10-T11. This has minimally progressed compared to ___, but there is no\nsignificant spinal canal or foraminal narrowing." }, { "input": "THORACIC SPINE:\nAlignment is normal. Vertebral body heights maintained. There is a small\nintraosseous hemangioma or area of focal fat within T11. Marrow signal is\notherwise unremarkable. The spinal cord is normal in caliber and signal\nintensity intervertebral discs demonstrate mild signal loss compatible\ndegenerative change. There is no spinal canal narrowing in the thoracic\nspine. There is mild bilateral neural foraminal narrowing at T10-11 due to\ndiffuse disc bulge. No other neural foraminal narrowing in the thoracic\nspine.\n\nPrevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR SPINE:\nThere is 3-4 mm of L5-S1 retrolisthesis. There is 2-3 mm of L2-3\nretrolisthesis. Both these are likely degenerative. Alignment is otherwise\nnormal. Vertebral body heights are maintained. There is a probable\nintraosseous hemangioma in the anteroinferior L2 vertebral body. Probable\nadditional intraosseous hemangioma within L1 is noted. Marrow signal in the\nlumbar spine is otherwise unremarkable. The distal spinal cord and conus\nmedullaris is normal and terminates at L1. The cauda equina nerve roots are\nnormal.\n\nMild signal and height loss of lumbar spine intervertebral discs is consistent\nwith degenerative change, worst at L5-S1. There are multilevel mild disc\nbulges, as well as areas of ligamentum flavum thickening and facet osteophytes\nin the lumbar spine causing varying degrees of lumbar spinal canal and neural\nforaminal narrowing. Specifically:\n\n T12-L1: Unremarkable.\nL1-2: Minimal disc bulge. No spinal canal or neural foraminal narrowing.\nL2-3: Minimal disc bulge. No spinal canal or neural foraminal narrowing.\nL3-4: Unremarkable.\nL4-5: Unremarkable.\nL5-S1: Diffuse disc bulge with superimposed central disc protrusion, causing\nmild spinal canal narrowing and narrowing of the subarticular zones, likely\nwith contact of the descending S1 nerve roots bilaterally (13:27). Moderate\nright and moderate to severe left neural foraminal narrowing (series 10 images\n17 and 5, respectively). There is probable extraforaminal disc contact of the\nexiting left L5 nerve root (13:27).\n\nThere is mild intramuscular edema within the anteromedial left psoas at the\nlevel of L2-3, possibly mild muscle strain (12:2, 13:10).\n\nOtherwise, the remaining lumbar prevertebral and paraspinal soft tissues are\nunremarkable.", "output": "1. Within limitation of a noncontrast study, no evidence of thoracic or lumbar\nspine osseous metastasis.\n2. Lower lumbar spine degenerative changes causing L5-S1 subarticular zone\nnarrowing with probable contact or impingement of the descending bilateral S1\nnerve roots. Moderate to severe left and moderate right L5-S1 neural\nforaminal narrowing, likely with extraforaminal disc contact of the exiting\nleft L5 nerve. Correlate clinically with any corresponding radiculopathy.\n3. Minimal thoracic spine degenerative changes, causing mild bilateral T10-11\nneural foraminal. No spinal canal narrowing in the thoracic spine.\n4. Left psoas muscle edema, nonspecific but possibly mild muscle strain." }, { "input": "Limited views of the paranasal sinuses, skull base, cervicomedullary junction,\nparavertebral soft tissues, and lung apices are unremarkable.\n\nThere is normal cervical alignment. The vertebral body heights are preserved.\nThere is T2 hyperintensity and T1 hypointensity at C5-C6 vertebral bodies\nconsistent with type ___ ___ change. There is segmental ossification of the\nposterior longitudinal ligament at the left lateral dorsal aspect of the C7. \nThere is diffuse low signal within the intervertebral disc spaces with loss of\nheight at C5-C6. There are multiple levels of mild cord deformity secondary\nto spinal canal stenosis, as detailed below, without definitive evidence of\ncord edema or myelomalacia.\n\nAt C2-C3 there is uncovertebral and facet arthropathy, left greater than\nright, causing moderate left neural foraminal stenosis. There is narrowing of\nthe spinal canal but no deformity of the spinal cord.\n\nAt C3-C4 there is uncovertebral and facet arthropathy, left greater than\nright, and bulging of the intervertebral disc causing severe left and mild\nright neural foraminal stenosis and moderate canal stenosis deforming\ntraversing spinal cord.\n\nAt C4-C5 there is uncovertebral facet and intervertebral arthropathy causing\nsevere bilateral neural foraminal stenosis and spinal canal stenosis\ncompression of the spinal cord.\n\nAt C5-C6 there is uncovertebral, facet, and intervertebral arthropathy, right\ngreater than left, causing severe right and moderate left neural foraminal\nstenosis and moderate spinal canal stenosis with deformity of the spinal cord.\n\nAt C6-C7 there is uncovertebral an intervertebral arthropathy and ossification\nposterior longitudinal ligament at the left lateral dorsal C7 vertebrae and\ncausing a moderate left and mild right neural foraminal stenosis. There is\nmoderate to severe stenosis of the left spinal canal which deforms the\ntraversing the spinal cord.\n\nAt C7-T1 there is no neural foramina or spinal canal stenosis.", "output": "1. Multilevel degenerative changes of the cervical spine, as described, with\nlevels of severe neural foraminal stenosis from the C3 to the C7 levels.\n2. Multiple levels of spinal canal stenosis which deforms the traversing\nspinal cord without cord edema or myelomalacia. There is focal segmental\nossification of the posterior longitudinal ligament at the left lateral C7\nvertebra causing focal moderate to severe spinal canal stenosis." }, { "input": "From T10-T11 through L3-4 levels disc degenerative changes and mild bulging\nseen. There is no spinal stenosis seen. Mild narrowing of the left foramen\nis seen at L3-4 level.\n\nAt L4-5 level, disc bulging identified with facet degenerative changes. There\nis mild narrowing of the left foramen without compression of exiting nerve\nroots. The right foramen appears normal.\n\nAt L5-S1 level, disc and facet degenerative changes identified. Facet\ndegenerative changes and thickening of the ligaments resulting in moderate\nnarrowing of the medial portion of the left foramen (200:71). There is no\nspinal stenosis seen. There is no right foraminal narrowing identified.\n\nIncidental Tarlov cysts are visualized within the sacral spinal canal.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes without spinal stenosis.\n2. Moderate narrowing of the medial portion of the left neural foramina at\nL5-S1 level." }, { "input": "Very limited study of the cervical spine with only sagittal T2 and STIR\nsequences which are very motion limited. Unable to assess for epidural\ncollection. Multilevel degenerative changes are noted. Note is made of\ncervical prevertebral edema, partially assessed in this examination.", "output": "Nondiagnostic study due to motion and patient inability to cooperate. Patient\ndid not wish to continue with the study, so only sagittal T2 and STIR\nsequences through the cervical spine were obtained. Unable to assess for\nepidural collection. Considering repeat this examination under sedation or\nanesthesia if clinically warranted." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of infection or neoplasm. There are degenerative changes\nin the lower thoracic, lumbar spine. There is narrowing of L2-L3, L3-L4 disc\nspaces. There is multilevel endplate hypertrophic changes, diffuse disc\nbulges, lumbar facet arthritis, thickening of ligamentum flavum. There is\ntethered cord with conus medullaris terminating at L3-L4 disc space, and\nmildly thickened filum terminale. There is no mass. There is no evidence of\nspinal dysraphism.\nThere is probably mild central canal narrowing at T10-T11 level from posterior\nelement degenerative changes.\nAt L1-L2 level there is right paramedian, inferior shallow disc protrusion. \nThere is mild-to-moderate central canal narrowing, with minimal effacement of\nright posterior, dorsal cord from prominent ligamentum flavum. There is mild\nright foraminal narrowing. Left foramen is patent.\nAt L2-L3 level there is moderate central canal narrowing, with incomplete\neffacement of CSF. There is moderate left, and mild-to-moderate right\nforaminal narrowing. There is minimal L2 on L3 retrolisthesis.\nAt L3-L4 level there is small right superior disc extrusion, encroaching on\nthe exiting right L3 nerve. There is moderate central canal narrowing,\nwithout complete effacement of CSF within thecal sac. There is Encroachment\non bilateral traversing L4 nerves in the lateral recesses by facet arthropathy\nand diffuse disc bulge.\nAt L4-5 level there is mild central canal narrowing, and mild encroachment on\nintrathecal segment traversing left L5 nerve. There is tiny left paramedian\ndisc protrusion. There is moderate right, and mild left foraminal narrowing.\nAt L5-S1 level central canal is patent. There is mild narrowing of left\nlateral recess. There is moderate left, and mild right foraminal narrowing.\n\nThere are multiple benign simple renal cysts, better seen compared with prior\nultrasound exam. Bilateral adrenal glands are thickened, without discrete\nnodule.", "output": "1. There are degenerative changes in the lumbar spine.\n2. There is small right paramedian, superior disc extrusion at L3-L4 level,\nencroaching on right L3 nerve.\n3. There is multilevel central canal narrowing, most prominent and moderate at\nL2-L3, L3-L4 levels.\n4. There is multilevel foraminal narrowing.\n5. There is tethered cord." }, { "input": "Alignment is normal. Vertebral body signal intensity appears normal. There\nis mild multilevel disc desiccation with mild loss of intervertebral disc\nheight primarily at C3-C4. The spinal cord appears normal in caliber and\nsignal intensity. The prevertebral and paraspinal soft tissues are normal.\n\nC2-C3: No significant spinal canal or neural foraminal stenosis.\nC3-C4: Mild disc protrusion and ligamentum flavum thickening results in mild\nindentation on the ventral spinal cord and narrowing of the spinal canal,\nslightly progressed since the prior exam without significant neural foraminal\nnarrowing.\nC4-C5: Mild broad-based disc protrusion, ligamentum flavum thickening, tiny\nendplate osteophytes and mild facet joint arthropathy resulting in minimal\nleft neural foraminal narrowing without significant spinal canal stenosis.\nC5-C6: Mild broad-based disc protrusion, ligamentum flavum thickening, tiny\nendplate osteophytes and facet joint arthropathy results in mild left neural\nforaminal narrowing without significant spinal canal stenosis.\nC6-C7: Mild disc protrusion, ligamentum flavum thickening and mild facet joint\narthropathy without significant spinal canal or neural foraminal stenosis.\nC7-T1: No significant spinal canal or neural foraminal stenosis.", "output": "1. No evidence of high-grade spinal canal or neural foraminal stenosis.\n2. Mild multilevel degenerative changes of the cervical spine with slight\nprogression of the posterior disc protrusion at C3-C4 resulting in mild spinal\ncanal stenosis and mild indentation on the ventral spinal cord without cord\nsignal abnormality.\n3. Mild left-sided neural foraminal narrowing at C4-C5 and C5-C6 as detailed\nabove." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal.There is disc space height loss and decreased signal at\nL5-S1. The spinal cord appears normal in caliber and configuration. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nThere is multilevel facet arthropathy.\n\nAt L4-5, there is a disc bulge and facet arthropathy resulting in mild spinal\ncanal stenosis with no significant neural foraminal stenosis.\n\nAt L5-S1, there is a disc bulge, dorsal epidural fat and facet arthropathy\nresulting in mild spinal canal L and mild bilateral neural foraminal stenosis.\nMild left subarticular zone stenosis is also seen.\n\nOTHER: There is significant enlargement of the spleen, measuring up to 18 cm. \nThe liver is nodular and irregular in appearance, consistent with cirrhosis,\nbetter seen on the subsequently performed abdominal CT. There is a small\nright pleural effusion. Partially visualized ascites is seen. In addition,\nthere is partially visualized bowel wall thickening.", "output": "1. No evidence for osteomyelitis, discitis or epidural abscess\n2. Mild degenerative changes in the lumbar spine, as described above.\n3. Partially visualized stigmata of portal hypertension, better seen on the\nsubsequently performed CT of the abdomen/pelvis." }, { "input": "There is a mild levoscoliosis of the upper lumbar spine and dextroscoliosis of\nthe lower lumbar spine. The 7 mm, grade 1 anterolisthesis of L4 on L5 has\nprogressed from the prior examination. The bone marrow is diffusely\nheterogeneous, related to patchy fatty marrow deposition. The chronic burst\nfracture of the L1 vertebral body is unchanged. The loss of height of the\nsuperior endplate of the L5 vertebral body has progressed in comparison the\nprior examinations. The intervertebral discs are diffusely desiccated. The\nconus medullaris terminates at the mid L1 level. The spinal cord is normal in\nsignal. The paraspinal soft tissues are normal.\n\nAt T9-T10, T10-T11, and T11-T12, there is no spinal canal or neural foraminal\nstenosis, unchanged from the prior examination. There is minimal disc bulge\nat T10-T11.\n\nAt T12-L1, retropulsion of the posterior fracture fragments of L1 and disc\nbulge cause mild-to-moderate spinal canal, moderate right neural foraminal,\nand mild left neural foraminal stenosis, unchanged from the prior examination.\n\nAt L2-L3, disc bulge with superimposed left neural foraminal disc protrusion\nand bilateral facet arthropathy cause mild bilateral neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L3-L4, disc bulge and bilateral facet arthropathy cause moderate spinal\ncanal, mild-to-moderate left neural foraminal, and mild right neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L4-L5, grade 1 anterolisthesis of L4 on L5, disc bulge, and bilateral facet\narthropathy cause severe spinal canal and severe bilateral neural foraminal\nstenosis, unchanged from the prior examination\n\nAt L5-S1, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom the prior examination.\n\nThe visualized intrahepatic biliary ducts are dilated, similar to the prior\nexamination.", "output": "1. Multilevel degenerate changes of the lumbar spine, most advanced at L4-L5,\nwhere there is severe spinal canal and severe bilateral neural foraminal\nstenosis, unchanged from the prior examination.\n2. Progressive compression fracture of the superior endplate of L5.\n3. Unchanged burst fracture of L1.\n4. Progressive, grade 1 anterolisthesis of L4 on L5." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. ___\ntype 1 L4-L5 and L5-S1 endplate changes is minimally more prominent when\ncompared to examination of ___. There is no suspicious marrow signal. Mild\nloss of disc height and signal spanning L3 L4 through L5-S1 is similar to\nprior examination. The conus medullaris terminates at the L1 vertebral level,\nwithin expected limits. There is no signal abnormality of the visualized\ncord, conus medullaris or cauda equina.\n\nT11-T12 through L2-L3: There is no significant spinal canal or neural\nforaminal narrowing. At L2-L3, there is a left facet synovial cyst (series 5,\nimage 25) projecting into the paraspinal muscles.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. \nMild facet arthropathy results in left neural foraminal narrowing. There is\nno significant right neural foraminal narrowing.\n\nL4-L5: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with mild facet arthropathy, this results in mild bilateral neural\nforaminal narrowing.\n\nL5-S1: A small disc bulge does not significantly narrow the spinal canal. \nThere is mild to moderate left and mild right neural foraminal narrowing.\n\nThe above findings do not appear significantly changed from examination of\n___.\n\nThe left kidney demonstrates both T2 hyper and hypointense cystic lesions\ncompatible with simple and hemorrhagic cysts, similar appearance to prior\nMRCP.", "output": "1. Mild lumbar spondylosis, most prominent at L5-S1 where there is mild to\nmoderate left neural foraminal narrowing, unchanged from examination of ___." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is a 3 mm anterolisthesis at L1-L2 and a 2 mm anterolisthesis at L2-L3. \nVertebral body heights are preserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nReduced T2 signal within the intervertebral discs represents a manifestation\nof degenerative change.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\n\nAt L1-L2 there is symmetric disc bulging and ligamentum flavum thickening with\nmild right neural foraminal narrowing.\n\nAt L2-L3 there is symmetric disc bulging ligamentum flavum thickening and\nfacet osteophytes with mild spinal canal narrowing and moderate bilateral\nneural foraminal narrowing.\n\nAt L3-L4 there is ligamentum flavum thickening and facet osteophytes with mild\nbilateral neural foraminal narrowing.\n\nAt L4-L5 there is symmetric disc bulging, the flavum thickening and a\nsuperimposed right foraminal disc protrusion with mild-to-moderate spinal\ncanal narrowing, moderate right and mild left neural foraminal narrowing.\n\nAt L5-S1 there is symmetric disc bulging and facet osteophytes with mild\nspinal canal narrowing, and moderate bilateral neural foraminal narrowing.\n\nOther:\nThere is a 1.0 cm cyst at the lower pole of the right kidney (image 14, series\n10, and image 18, series 2).", "output": "1. Degenerative changes of spine most significant at L4-5 where there is\nmild-to-moderate spinal canal narrowing and moderate right neural foraminal\nnarrowing.\n2. Moderate bilateral neural foraminal narrowing at L5-S1." }, { "input": "There is straightening of the normal cervical lordosis. There is loss of\nvertebral body height with increased marrow signal on T1 and T2 sequences,\nconsistent with severe degenerative changes and bone marrow replacement for\nfat from C4 through T1 vertebral bodies. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is loss of signal within all intervertebral discs throughout the\ncervical spine. There is significant loss of height, with suggestion of\ndegenerative fusion of the C4-C5, C5-C6, C6-7, C7-T1 vertebral levels.\n\nWithin 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.\n\n At C2-3 there is minimal uncovertebral hypertrophy, causing mild left-sided\nneural foraminal narrowing.\n\nAt C3-4 level, there is disc desiccation and posterior spondylosis, bilateral\nuncovertebral hypertrophy, more significant on the left resulting in moderate\nto severe left-sided neural foraminal narrowing.\n\nAt C4-5 there is a moderate, diffuse disc bulge and ossification posterior\nlongitudinal ligament causessevere vertebral canal stenosis. There is\nuncovertebral and facet hypertrophy, left greater than right causing moderate\nto severe left neural foraminal stenosis and mild to moderate right neural\nforaminal stenosis.\n\nAt C5-6 there is a moderate, diffuse disc bulge and intervertebral osteophytes\ncause severe vertebral canal stenosis. There is uncovertebral and facet\nhypertrophy bilaterally causing moderate bilateral neural foraminal stenosis..\n\nAt C6-7 there is a moderate, diffuse disc bulge causing moderate to severe\nvertebral canal stenosis. There is uncovertebral and facet hypertrophy\ncausing mild bilateral neural foraminal stenosis, right greater than left..\n\nAt C7-T1 there is a mild, diffuse disc bulge causing moderate vertebral canal\nstenosis. There is uncovertebral and facet hypertrophy bilaterally causing\nmoderate bilateral neural foraminal stenosis.No vertebral canal or neural\nforaminal narrowing.", "output": "1. Moderate to severe cervical spine degenerative changes, most significant at\nC4 through C7, as outlined above. No evidence of acute fracture within\nlimitations of MRI or acute ligamentous injury.\n2. No focal or diffuse lesions are visualized throughout the cervical spinal\ncord." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Mixed ___ 1 and 2 L5-S1 endplate changes are\noverall similar to prior examination. Degenerative loss of disc height and\nsignal is mild at L3-L4 and L4-L5 and moderate to severe at L5-S1, also\nunchanged. The conus medullaris terminates at the L1 vertebral level, within\nexpected limits. There is no signal abnormality of the terminal cord.\n\nThe patient is status post left L4-L5 and L5-S1 laminotomy. Lack of IV\ncontrast severely limits evaluation of granulation tissue. Within this\nconfine:\n\nT11-T12 through L2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: A disc bulge with central annular fissure does not narrow the spinal\ncanal. There is no significant neural foraminal narrowing. These findings\nare overall similar to prior exam.\n\nL4-L5: A left eccentric disc protrusion does not significantly narrow the\nspinal canal. There is crowding of the left subarticular zone, potentially\nimpinging on the traversing left L5 nerve root (series 6, image 9) against the\nleft facets. In combination with loss of disc height and facet arthropathy,\nthere is mild-to-moderate left neural foraminal narrowing and no significant\nright neural foraminal narrowing. These findings are similar to prior exam.\n\nL5-S1: A left central to foraminal zone disc protrusion impinges on the\ntraversing left S1 nerve root (series 6, image 14), without significant spinal\ncanal narrowing. In combination with facet arthropathy and loss of disc\nheight, there is severe left neural foraminal narrowing and moderate to severe\nright neural foraminal narrowing, overall similar to prior examination.\n\nA T2 hyperintense 1.2 cm cystic lesion in the left superior renal pole is\nstatistically most likely simple cysts. Re-identified is apparent tethering\nand stenosis of the sigmoid colon, essentially unchanged from prior CT\nexamination. Allowing for postsurgical findings, the prevertebral paraspinal\nsoft tissues are otherwise unremarkable.", "output": "1. The patient is status post left L4-L5 and L5-S1 hemilaminotomy. Evaluation\nfor granulation tissue cannot be made secondary to lack of IV contrast.\n2. There remains a left central to foraminal zone L5-S1 disc protrusion which\nimpinges on the traversing left S1 nerve root and in combination with facet\narthropathy result in severe left neural foraminal narrowing. This appears\noverall unchanged from prior exam.\n3. A L4-L5 left eccentric disc protrusion potentially impinges the traversing\nleft L5 nerve root against the left-sided facets, also unchanged from prior\nexamination.\n4. Apparent stenosis and tethering of the mid sigmoid colon (series 6, image\n20), better evaluated on prior CT abdomen and pelvis of ___.\n5. Additional findings as described above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere are type ___ ___ endplate degenerative changes at L5-S1 and type ___ ___\nendplate degenerative change at L2-L3. There is focal fat in the L1 vertebral\nbody. There is otherwise no marrow signal abnormality. The visualized portion\nof the spinal cord is preserved in signal and caliber. The conus medullaris\nterminates at the L1-L2 level.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is minimal intervertebral disc height loss\nat L5-S1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-2 there is minimal disc bulging without significant spinal canal or\nneural foraminal narrowing.\n\nAt L2-3 there is disc bulge indenting the ventral thecal sac without\nsignificant spinal canal, neural foraminal narrowing or nerve root contact.\n\nAt L3-4 there is disc bulge encroach upon the traversing right L4 nerve root\nwithout contact. There is no significant spinal canal narrowing. There is\nmild facet degenerative change producing mild left neural foraminal narrowing.\nThe right neural foramen is patent.\n\nAt L4-5 there is disc bulge with tiny central annular fissure (02:10), without\nsignificant spinal canal narrowing or nerve root contact. Facet degenerative\nchange produces minimal bilateral neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge with central protrusion focally contacting but\nnot displacing the traversing left S1 nerve root. There is no significant\nspinal canal narrowing. Facet degenerative change produces minimal right\nneural foraminal narrowing. The left neural foramen is patent.\n\n1.5 cm T2 hyperintense lesion in the right hepatic lobe likely represents a\ncyst or hemangioma. The remainder of the visualized retroperitoneum is\ngrossly unremarkable.", "output": "1. Mild multilevel lumbar spondylosis, as described, without significant\nspinal canal narrowing or high-grade neural foraminal narrowing.\n2. Mild disc bulge with tiny central annular fissure at L4-L5.\n3. No terminal cord signal abnormality.\n4. 1.5 cm T2 hyperintense lesion in the right hepatic lobe likely represents a\ncyst. This can be confirmed with ultrasound, if clinically indicated.\n\nRECOMMENDATION(S): Point 4. There is a 1.5 cm T2 hyperintense lesion in the\nright hepatic lobe likely represents a cyst. This can be confirmed with\nultrasound, if clinically indicated." }, { "input": "From T11-S3 level, there are no focal bony abnormalities suspicious for\nmetastatic disease. There is no intraspinal mass identified. No paraspinal\nmass or abnormal enhancement is seen.\n\nFrom T11-12 through L3-4 levels disc degenerative changes are seen without\nspinal stenosis or foraminal narrowing. At L4-5 disc and facet degenerative\nchanges and mild bulging seen without spinal stenosis.\n\nAt L5-S1 level mild degenerative disc disease is seen without spinal stenosis.", "output": "1. No evidence of bony metastatic disease in the lumbar spine or intraspinal\nmass.\n2. Mild degenerative changes without spinal stenosis or foraminal narrowing." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is dextroscoliosis of the lumbar spine. Vertebral body heights are\ngrossly preserved. T11, L1 and L2 vertebral body probable hemangiomas are\nagain noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nIntervertebral discheightsandsignalare grossly preserved.\n\nThroughout the lumbar spine there is facet joint hypertrophy at multiple\nlevels without definite evidence of moderate or severe vertebral canal or\nneural foraminal narrowing.\n\nOTHER:\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.\n\nLimited imaging of the sacrum again demonstrates bilateral sclerotic lesions\n(see 4, 6, 7: 41 on current study and 303:180 on ___ abdomen and\npelvis CT). The right iliac bone lesion is grossly similar compared to ___\nprior contrast torso CT (see 2:95 on this prior study). The left iliac bone\nlesion is grossly similar to ___ prior exam (see 604:101 and 5:177 on\nthis prior study).\n\nLimited imaging of liver demonstrates patient's known numerous lesions.", "output": "1. Study is moderately degraded by motion.\n2. Right iliac bone sclerotic lesion grossly unchanged compared to ___ prior\nexam, again suggestive of bone island.\n3. Nonspecific left iliac bone sclerotic lesion not definitely seen on ___\nprior exam, grossly unchanged compared to ___ prior abdomen and\npelvis CT, and not definitely identified as active on ___ GA-68\nDotatate Scan. If concern for metastatic lesion, consider correlation with\nGA-68 Dotatate Scan.\n4. Within limits of study, no definite evidence of enhancing lumbar spine mass\nidentified.\n5. Multilevel lumbar spondylosis as described without definite evidence of\nmoderate or severe vertebral canal or neural foraminal narrowing.\n6. Limited imaging of liver demonstrates patient's known multiple hepatic\nlesions, better demonstrated on ___ chest and abdomen CTA." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\nThere are innumerable small T1 and T2 hypointense lesions throughout the\ncervical, thoracic, and lumbar spine compatible with metastatic disease, some\nof which demonstrate hypoenhancement.\n\nCERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThe bone marrow is diffusely heterogeneous.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThere is no evidence of abnormal enhancement.\n\nThere is mild intervertebral disc height loss at C4-C5, C5-C6, and C6-C7.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C2-3 there is novertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is disc osteophyte complex, mildvertebral canal or neural\nforaminal narrowing.\n\nAt C4-5 there is disc osteophyte complex, mildvertebral canal or neural\nforaminal narrowing.\n\nAt C5-6 there is disc osteophyte complex, mildvertebral canal or neural\nforaminal narrowing.\n\nAt C6-7 there is disc osteophyte complex, mildvertebral canal or neural\nforaminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nTHORACIC:\nThe thoracic vertebral body heights and alignment are maintained. There is a\nprobable hemangioma in the T8 vertebral body (minimal fat suggested on\nsagittal T1 precontrast imaging on series 4, image 8), better demonstrated on\n___ torso CT (see 11:150; 14:62 on this prior exam). Otherwise,\nno focal marrow signal abnormalities.\n\nThe thoracic spinal cord is normal in signal intensity without evidence of\nabnormal enhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nThere is minimal dextroscoliosis of the lumbar spine. The lumbar vertebral\nbody heights and sagittal alignment are maintained.\n\nThe terminal spinal cord is preserved in signal and caliber without evidence\nof abnormal enhanced.\n\nFrom T12-L1 through L5-S1, there is multilevel facet arthrosis without\nsignificant spinal canal or neural foraminal narrowing.\n\nNonspecific probable dependent edema is present in the lumbar subcutaneous\nsoft tissues.\n\nOTHER:\nThere are multiple nodular and consolidative opacities in the visualized lungs\ncompatible with metastatic disease, better demonstrated/evaluated on the prior\nCTA chest dated ___.\n\nNodular thickening of the left adrenal gland is grossly similar to prior CT\nabdomen and pelvis dated ___.\n\nPartially visualized multiple hepatic metastases.\n\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues. Question minimal edema at the L2-3 interspinous space versus\nartifact (see 10:7).", "output": "1. Examination is mildly degraded by motion.\n2. Multiple small osseous metastatic lesions throughout the cervical,\nthoracic, and lumbar spine, mildly progressed from prior MRI lumbar spine\ndated ___.\n3. Within limits of study, no definite evidence of spinal cord signal\nabnormalities or abnormal enhancement.\n4. Multilevel cervical spondylosis with mild spinal canal narrowing from C3-C4\nthrough C6-C7.\n5. No definite moderate or severe spinal canal or neural foraminal narrowing\nin the thoracic and lumbar spine.\n6. Question minimal edema at the L2-3 interspinous space versus artifact. If\nnot artifactual, finding may represent degenerative change or ligamentous\ninjury." }, { "input": "Evaluation is suboptimal due to motion artifact.\n\nFor the purposes of numbering, the last fully formed intervertebral disc is\ndesignated at L5-S1.\n\nGrade 1 anterolisthesis of L4 on L5 is seen. The bone marrow signal is within\nnormal limits. Evaluation of the cord is suboptimal due to motion artifact. \nThere is multilevel disc desiccation.\n\nT11-T12: No spinal canal or foraminal narrowing.\n\nT12-L1: No spinal canal or foraminal narrowing.\n\nL1-L2: No spinal canal or foraminal narrowing.\n\nL2-L3: No spinal canal or foraminal narrowing.\n\nL3-L4: A mild disc bulge is seen without spinal canal or foraminal narrowing.\n\nL4-L5: A disc bulge is seen without spinal canal or foraminal narrowing.\n\nL5-S1: A mild disc bulge is seen without spinal canal or foraminal narrowing.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Suboptimal exam due to motion artifact.\n2. Mild degenerative changes of the lumbar spine, as above." }, { "input": "NUMBERING USED IS SHOWN ON SE 2, IM 10.\n\nThe vertebral body height, alignment, and marrow signal within the lumbar\nspine are normal.\n\nAt the L2-L3 level, there is bilateral facet arthropathy. The spinal canal\nneural foramina appear normal.\n\nAt the L3-L4 level, there is bilateral facet arthropathy. Spinal canal and\nneural foramina appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy. Spinal canal and\nneural foramina appear normal.\n\nThe L5-S1 level, disc desiccation, mild disc bulge with shallow central\nprotrusion, extending onto the left central location, abutting the S1 nerves\nseries 5, image 24. Disc abuts the L5 nerves in the foramen far laterally. \nThere is bilateral facet arthropathy. The spinal canal and neural foramina\nappear normal otherwise.\nPossible mild edema around the facet joints at L4-5 and L5-S1 levels.\nLinear focus in the S1 vertebral body, is hypointense on all sequences may\nrelate to sclerotic line.\nNo obvious edema noted within. (se 4, im 10)\n\nThe conus medullaris is normal in position and morphology in terminates at the\nL1-L2 level.\n\nThere is a moderate sized left-sided retroperitoneal and posterior perinephric\narea of altered signal intensity, with indentation on the lateral aspect of\nleft psoas, a component of which may be also be subcapsular and represents a\nhematoma as not seen on prior ultrasound before biopsy. This measures\napproximately atleast 6.5x7.0cm, partly included as not targeted. These\nfindings are compatible with patient's reported history of recent biopsy.", "output": "1. Left-sided subcapsular renal hematoma with associated retroperitoneal\nhematoma/collection, as described, measuring at least 6.5x 7 cm, partly\nincluded and inadequately assessed. A dedicated renal\nultrasound/CT Abdomen could be performed for further evaluation, as clinically\nwarranted.\n2. No significant spinal canal narrowing or evidence of neural impingement.\n3. Mild facet degenerative changes at L4-5 and L5-S1 levels with mild reactive\nedema in and around.\n4. L5-S1: Degenerative disk changes with mild disk bulge and small protrusion\nindenting the thecal sac outline and abutting the L5 and S1 nerves without\nsignificant deformity.\n5. NOTIFICATION:\n The findings were discussed by Dr. ___ with Dr. ___ by telephone on\n___ at 9:52 AM on ___" }, { "input": "Study is mildly degraded by motion.\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. Within limits of study, the visualized\nportion of the spinal cord are grossly preserved in signal and caliber.\n\nIntervertebral disc signal and heights are preserved.\n\nWithin 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.\n\n At C2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is disc bulge and uncovertebral hypertrophy withno vertebral\ncanal or neural foraminal stenosis.\n\nAt C4-5 there is left paracentral disc protrusion and uncovertebral\nhypertrophy withno vertebral canal or neural foraminal stenosis.\n\nAt C5-6 there is a disc bulge and uncovertebral hypertrophy withno vertebral\ncanal or neural foraminal stenosis.\n\nAt C6-7 there is disc bulge with uncovertebral hypertrophy resulting in\nmoderate left neural foraminal stenosis and ___ vertebral canal stenosis.\n\nAt C7-T1 there is disc bulge and uncovertebral hypertrophy with nowno\nvertebral canal or neural foraminal stenosis.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel degenerative changes as described, most pronounced at C6-7,\nwhere there is moderate left neural foraminal stenosis." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is 12 mm anterolisthesis of L5 on S1 (grade 2). There are bilateral L5\npars defects. Multiple Schmorl's nodes are noted throughout the lumbar and\nvisualized portion thoracic spine. Vertebral body heights are preserved.\nThere is no definite marrow signal abnormality. The visualized portion of the\nspinal cord is preserved in signal and caliber. Conus medullaris terminates\nat mid L1 and nerve roots of the cauda equina are within normal limits.\n\nThere is complete loss of disc height and fusion of the vertebral bodies at\nL5-S1. The remaining intervertebral disc heights are relatively preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nFrom T10-11 through L3-4, there is no disc herniation, spinal canal stenosis,\nor neural foraminal narrowing.\n\nAt L4-5, mild diffuse disc bulging in combination with mild bilateral facet\nhypertrophy, results in mild narrowing of the right neural foramen and mild\nspinal canal narrowing.\n\nAt L5-S1, there is 12 mm anterolisthesis of L5 on S1, complete loss of the\ndisc space and fusion of the posterior L5 and anterior S1 vertebral body. The\nlisthesis results in uncovering of the disc anteriorly and posteriorly and\nsevere narrowing of the neural foramina bilaterally and mild narrowing of the\nspinal canal. There are bilateral pars defects and facet arthropathy at this\nlevel.", "output": "1. L5-S1 bilateral spondylolysis, 12 mm anterolisthesis of L5 on S1 and fusion\nof the posterior L5 and anterior S1 vertebral bodies, resulting in mild spinal\ncanal and severe bilateral neural foramina narrowing.\n\n2. L4-5 spondylosis resulting in mild spinal canal and right neural foraminal\nnarrowing." }, { "input": "At C6-7 level there is increased signal within the anterior portion of the\nintervertebral disc which appears slightly widened indicative of extension\ninjury and injury to the intervertebral disc. There is discontinued of the\nanterior longitudinal ligament (3:8) indicative of disruption. The posterior\nlongitudinal ligament and ligamentum flavum appear intact. There is\nprevertebral soft tissue swelling extending from C2-3 to upper thoracic region\nwhich most pronounced changes at C3 and C4 level.\n\nMultilevel degenerative changes are seen with moderate spinal stenosis at C2-3\nC3-4 and see C6-7 levels with disc bulging contacting and minimally deforming\nthe spinal cord without spinal cord compression. There is no abnormal signal\nseen within the spinal cord. Multilevel degenerative changes are seen at\nother levels. At C2-3 C3-4 and C6-7 levels moderate-to-severe bilateral\nforaminal narrowing seen most pronounced at C6-7 level.", "output": "1. Injury to the anterior C6-7 intervertebral disc with disruption of the\nanterior longitudinal ligament and prevertebral soft tissue swelling.\n2. Moderate spinal stenosis at C2-3 C3-4 and C6-7 levels with slight deformity\nof the spinal cord without high-grade spinal cord compression.\n3. Although slightly limited evaluation secondary to motion no evidence of\nobvious increased signal within the spinal cord. No signs of hemorrhage\ncontusion on gradient echo images." }, { "input": "There is mild retrolisthesis of L 2 on L3, new since the prior examination. \nThere is mild anterior subluxation of L4 on L5, unchanged since the prior\nstudy. There are ___ type 1 signal intensity changes at L2-3. There is\nloss of signal of the intervertebral discs on the T2 weighted images, a\nmanifestation of degenerative disc disease.\nThere is bulging of the disc, intervertebral osteophytes, facet osteophytes\nand ligamentum flavum thickening at T12-L1. Together these produce moderate\nspinal canal narrowing. The neural foramina appear normal.\nAt L1-2, there is bulging of the disc and a tiny left-sided disc protrusion\nthat slightly encroaches on the thecal sac contacting the traversing left L2\nnerve roots. The neural foramina appear normal.\nAt L2-3, there is a broad bulge of the intervertebral disc along with\nintervertebral osteophytes and a right-sided disc protrusion that extends\ninferiorly along the posterior margin of the L3 vertebral body. In this\nlocation, and the disc compromises the traversing right L3 nerve root. There\nare bilateral facet osteophytes that produce severe neural foraminal\nnarrowing.\nThe patient is status post a laminectomy from L3 through L5.\nAt L3-4, intervertebral osteophytes and bulging of the disc mildly encroach on\nthe spinal canal. There is a left-sided protrusion of the disc extending into\nthe spinal canal and inferiorly along the posterior margin of the L4 vertebral\nbody. In this location the disc fragment contacts the traversing left L4\nnerve root. There is postoperative scarring surrounding the thecal sac. \nFacet osteophytes produce severe bilateral neural foraminal narrowing.\nAt L4-5, intervertebral osteophytes mildly encroach on the spinal canal. \nThere are pedicle screws at L4 and L5 for posterior fusion. Facet osteophytes\nmildly encroach on the neural foramina.\nAt L5-S1, pedicle screws are identified along with facet osteophytes. The\nosteophytes produce moderate-severe neural foraminal narrowing. There is no\nencroachment on the thecal sac. Vertebral body and intervertebral disc signal\nintensity appear normal.\nThere is enhancing scar in the anterior epidural space at L4 and L5. \nEnhancing scar surrounds the left-sided L3-4 disc fragment.", "output": "1. Degenerative disc disease at multiple levels with progressive subluxation\nat L2-3.\n2. Postoperative changes from L3 through L5 with enhancing epidural scar.\n3. Disc protrusions at L2-3 and L3-4 with compromise of the right L3 and left\nL4 nerve roots.\n4. Severe neural foraminal narrowing bilaterally at L2-3 and L3-4." }, { "input": "T-spine:\nAlignment is normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm.\n\nAt T10-11, left facet joint hypertrophy causes moderate left neural foraminal\nnarrowing. Degenerative changes at other spinal levels are mild, without\nsignificant spinal canal or neural foraminal narrowing.\n\nL-spine:\nPatient is post L3-5 laminectomy and posterior spinal fusion at L4-5. Grade 1\nretrolisthesis of L2 over L3 is similar to before. L4-5 paraspinal muscle\nedema is similar to before. The spinal cord appears normal in caliber and\nconfiguration. There are ___ type 1 signal changes of the endplates at\nT12-L1, L1-2 and L2-3. There are ___ type 2 changes at L3-4 and L4-5.\n\nAt T12-L1, disc bulge and facet joint hypertrophy cause moderate spinal canal\nand mild bilateral neural foraminal narrowing, similar to before.\nAt L1-2, disc bulge and left disc protrusion contacting the traversing left L2\nnerve root are unchanged. Spinal canal narrowing is mild. Bilateral neural\nforaminal narrowing are mild.\nAt L2-3, disc bulge and facet joint hypertrophy cause mild spinal canal\nnarrowing and severe bilateral neural foraminal narrowing, similar to before. \nRight paracentral disc protrusion extending inferiorly contacts the traversing\nright L3 nerve root (13:20), similar to before.\nAt L3-4, disc bulge and facet joint hypertrophy cause mild spinal canal\nnarrowing and severe bilateral neural foraminal narrowing, similar to before. \nLeft paracentral disc protrusion extending inferiorly contacts the traversing\nleft L4 nerve root, similar to before.\nAt L4-5, there is no significant spinal canal narrowing. Bilateral neural\nforaminal narrowing is mild.\nAt L5-S1, there is no significant spinal canal narrowing. Bilateral neural\nforaminal narrowing is moderate to severe.\n\nMultiple cystic lesions are identified in the liver, measuring up to 1.3 cm,\nincompletely characterized.", "output": "1. Multilevel degenerative changes causing moderate spinal canal narrowing at\nT2-12 L1, L1-2, and L2-3 and severe bilateral neural foraminal narrowing at\nL2-3 and L3-4 are similar to ___.\n2. Unchanged disc protrusions at right L2-3 and left L3-4, contacting the\ntraversing right L3 and left L4 nerve roots.\n3. L4-5 paraspinal muscle edema is similar to before.\n4. Multiple cystic lesions are identified in the liver, measuring up to 1.3\ncm, incompletely characterized." }, { "input": "There is mild scoliosis of lumbar spine. From T11-12 through L3-4 disc\ndegenerative changes and mild bulging identified. Mild foraminal narrowing is\nseen L3-4 level. At L3-4 mild spinal stenosis is seen.\n\nL4-5 mild spinal stenosis identified with mild narrowing of foramina.\n\nAt L5-S1 level disc and facet degenerative change is seen. There is severe\nleft-sided and moderate right-sided foraminal narrowing unchanged from the\nprevious MRI examination there is no central canal stenosis\n\nThe distal spinal cord shows normal signal intensities. A right renal cyst is\nagain identified.", "output": "Overall no significant interval change since the previous MRI changes in the\nlumbar region. Mild spinal stenosis the seen at L3-4 and L4-5 levels. Severe\nleft-sided and moderate right-sided foraminal narrowing is seen at L5-S1\nlevel. No significant new abnormalities are seen." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nand intervertebral disc space are preserved. There is no suspicious marrow\nsignal abnormality or abnormal enhancement. The prevertebral soft tissue is\nthe posterior paraspinal soft tissues appear unremarkable. The craniocervical\njunction appears unremarkable. There is no evidence of cord compression or\ncord edema. There is no abnormal enhancement.\n\nC2-C3, C3-C4: There is no spinal canal stenosis or neural foraminal narrowing.\n\nC4-C5: There is a mild disc bulge without spinal canal stenosis. There is no\nneural foraminal narrowing.\n\nC5-C6, C6-C7, C7-T1: There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand intervertebral disc spaces are preserved. There is no suspicious marrow\nreplacing abnormality. There is no abnormal enhancement. There is a short\nsegment questionable spinal cord signal abnormality at T9-T10 level (8:11,\n12:16) without corresponding enhancement are STIR hyperintensity. There is no\nevidence of spinal canal stenosis or neural foraminal narrowing. There is no\nenhancing soft tissue component.\n\nOTHER: Again seen are multiple T2 hyperintense hepatic lesions, likely related\nto known hepatic metastasis. There is partial visualization of periportal\nlymphadenopathy, better assessed on recent CT abdomen pelvis ___.", "output": "1. No evidence of osseous metastasis or enhancing soft tissue component. No\nevidence of cord compression.\n2. Questionable nonenhancing short-segment focal spinal cord signal\nabnormality at T9-T10 level. This is unlikely to represent metastatic\ndisease. Finding is nonspecific, and may represent infectious or inflammatory\nprocess, or artifactual. Attention on short-term follow-up examination is\nrecommended.\n3. Redemonstration of hepatic metastasis and periportal lymphadenopathy,\nbetter assessed on recent CT abdomen and pelvis ___." }, { "input": "Prior thoracic and lumbar spine radiographs demonstrate that there are 11\nrib-bearing vertebrae and 6 lumbar-type vertebrae. The reports for the ___\nMRI and for the prior lumbar spine radiographs referred to the 5 caudal lumbar\ntype vertebrae as L1 through L5. The same nomenclature is used in the present\nreport, as documented on image 8:11.\n\nVertebral body heights are preserved. Grade 1 anterolisthesis of L4 on L5 and\nminimal, grade 1 anterolisthesis of L5 on S1 are both unchanged. No\nconcerning bone marrow signal abnormalities are identified.\n\nThe distal spinal cord appears normal in morphology and signal intensity, with\nthe conus medullaris terminating at L1.\n\nSagittal images through the T10-11 level demonstrate op mild disc bulge,\nslightly larger on the right, and mild facet arthropathy, resulting in mild\nspinal canal narrowing without mass effect on the spinal cord. This is similar\nin appearance to the ___ thoracic spine MRI. There are no axial images\nthrough this level.\n\nSagittal images through the T11-12 level demonstrated a left paracentral disc\nprotrusion without significant spinal canal narrowing or mass effect on the\nspinal cord, similar to the ___ thoracic spine MRI. There are no axial\nimages through this level.\n\nAt T12-L1, there is a mild disc bulge and mild bilateral facet arthropathy\nwithout significant spinal canal or neural foraminal narrowing, unchanged.\n\nAt L1-2, there is a mild disc bulge without spinal canal or neural foraminal\nnarrowing, unchanged.\n\nAt L2-3, there is a mild disc bulge and minimal bilateral facet arthropathy\nwithout spinal canal or neural foraminal narrowing, unchanged.\n\nAt L3-4, there is a mild disc bulge, larger on the left, and minimal facet\narthropathy. There is no significant spinal canal narrowing. The the left\nneural foramen is mildly narrowed without evidence for impingement of the\nexiting nerve root. These findings are unchanged.\n\nAt L4-5, there is a mild anterolisthesis with a disc bulge and a left\nparacentral disc protrusion, as well as severe bilateral facet arthropathy.\nBilateral traversing nerve roots are contacted by facet osteophytes, more on\nthe left than right, and the left traversing nerve root is slightly displaced.\nThe remainder of the spinal canal is not significantly narrowed. There is mild\nbilateral neural foraminal narrowing without evidence for impingement of the\nexiting nerve roots. These findings are unchanged.\n\nAt L5-S1, and there is a mild anterolisthesis with a mild disc bulge and\nsevere facet arthropathy, left worse than right. The left traversing nerve\nroot is abutted in the subarticular zone. The remainder of the spinal canal is\nnot significantly narrowed. There is mild bilateral neural foraminal\nnarrowing. The exiting right nerve root may be contacted by the disc bulge\nwithin the neural foramen. These findings are unchanged.", "output": "1. Transitional anatomy at the thoracolumbar junction, as detailed above.\n2. Unchanged appearance of lumbar degenerative disease compared to ___,\nwith grade 1 anterolisthesis at L4-5 and minimal, grade 1 anterolisthesis at\nL5-S1.\n3. Unchanged appearance of visualized lower thoracic degenerative disease\ncompared to ___." }, { "input": "The study is somewhat degraded by motion artifact. Alignment is normal. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof spinal canal or neural foraminal narrowing. There is no evidence of\ninfection or neoplasm.", "output": "1. Somewhat limited by motion artifact.\n2. Within these limitations, no abnormalities are detected." }, { "input": "CERVICAL:\n\nThere is no evidence of vertebral body height loss. There is millimetric\nanterolisthesis of C4 on C5 and millimetric retrolisthesis of C5 on C6, both\nof which are likely degenerative in nature. The bone marrow signal is normal.\n\nMultilevel degenerative changes are as follows:\n\nC2-C3, C3-C4: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC4-C5: Mild posterior disc bulging and uncovertebral joint hypertrophy result\nin mild left neural foraminal narrowing.\n\nC5-C6: Posterior disc bulging indents the ventral thecal sac with mild canal\nnarrowing. This combines with uncovertebral joint hypertrophy to result in\nmild right and mild to moderate left neural foraminal narrowing.\n\nC6-C7: A posterior disc bulge and thickening of ligamentum flavum result in\nmild canal narrowing at this level, with mild right neural foraminal\nnarrowing.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\n\nTHORACIC:\nThe thoracic vertebral body heights are grossly maintained. Severe\ndextroscoliosis centered in the mid thoracic spine is noted. There is no\nsuspicious bone marrow signal identified.\n\nThere are multilevel, mild spondylotic changes seen throughout the thoracic\nspine, most notable at T10-T11 with a right paracentral disc protrusion which\nindents the thecal sac.\n\nHowever, there is no evidence for canal stenosis. The spinal cord is normal\nin signal intensity throughout. A right-sided perineural cyst is seen at the\nlevel of T7-T8.\n\nSeveral of bilateral T2 hyperintense renal cysts are incidentally noted.", "output": "1. Multilevel spondylosis of the cervical spine, most notable at C5-6 with\nmild canal narrowing, mild right and mild to moderate left neural foraminal\nnarrowing.\n2. Mild multilevel degenerative changes of the thoracic spine, without\nsignificant canal stenosis. Normal cord signal intensity throughout.\n3. Severe dextroscoliosis centered within the thoracic spine." }, { "input": "Lumbar curve convex to the left, centered at L2. Degenerative changes lumbar\nspine. Multilevel disc space narrowing, most prominent at L4-5 level. \nMultilevel endplate hypertrophic changes, diffuse disc bulges. Lumbar facet\narthritis. Normal visualized cord. No worrisome lesions.\n\nAt L1-L2 patent central canal, patent foramina.\n\nAt L2-L3, mild central canal narrowing. Patent left foramen. Mild right\nforaminal narrowing.\n\nAt L3-L4, mild central canal narrowing.. Moderate left, mild right foraminal\nnarrowing.\n\nAt L4-5, mild central canal narrowing. Minimal mass effect on traversing left\nL5 nerve. Moderate to severe left foraminal narrowing. Mild right foraminal\nnarrowing.\n\nAt L5-S1, patent central canal. Patent foramina.\n\nFew benign perineural cysts L5-S2 levels. Few benign simple renal cysts.", "output": "1. Degenerative changes lumbar spine.\n2. Mild central canal narrowing.\n3. Significant left L4-5 foraminal narrowing.." }, { "input": "At the craniocervical junction and C2-3 levels no abnormalities are seen.\n\nAt C3-4 and C4-5 levels mild disc bulging seen without spinal stenosis or\nforaminal narrowing.\n\nAt C5-6 mild disc bulging and mild left foraminal narrowing identified without\nspinal stenosis.\n\nAt C6-7 level, disc bulging and moderate-to-severe right and mild left\nforaminal narrowing. There is no spinal stenosis.\n\nAt C7-T1 mild bilateral foraminal narrowing is seen with mild disc bulging\nwithout spinal stenosis.\n\nFrom T1-2 to T3-4 mild degenerative changes identified.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression. \nNo abnormal enhancement is identified.", "output": "1. Changes of cervical spondylosis with foraminal narrowing most pronounced on\nthe right side at C6-7 level where moderate-to-severe right foraminal\nnarrowing is seen. Mild foraminal narrowing at other levels as described. \nGiven patient's described left-sided symptoms, clinical correlation\nrecommended to determine the significance of the findings.\n2. No evidence of extrinsic spinal cord compression or intrinsic spinal cord\nsignal abnormalities." }, { "input": "MRI L-SPINE: Vertebral body heights and alignment are normal. Bone marrow\nsignal reveals no focal concerning abnormality. The conus medullaris is\nnormal in morphology and signal intensity, ending posterior to T12-L1. An 11\nmm perineural cyst is seen at the S3 level.\n\nThere is no spinal canal or neural foraminal narrowing from T11-T12 through\nL1-L2, only seen on the sagittal images.\n\nAt L2-L3, there is no spinal canal or neural foraminal narrowing.\n\nAt L3-L4, there is no spinal canal or neural foraminal narrowing. There is\nmild facet arthrosis with a tiny synovial cyst at the left facet (7:13).\n\nAt L4-L5, there is no spinal canal or neural foraminal narrowing. There is\nmild facet arthrosis with tiny synovial cysts in the bilateral facets (7:18).\n\nAt L5-S1, there is mild central disc bulge and mild facet arthrosis without\nspinal canal narrowing. The disc bulge contacts the exiting right L5 nerve\nroot.", "output": "Mild degenerative change as above. Disc bulge at L5-S1 contacts the exiting\nright L5 nerve root." }, { "input": "There is grade 1, 4 mm, anterolisthesis of L4 with respect L5, unchanged from\nthe previous examination. Lumbar spine alignment is otherwise preserved.\n\nThere is new loss of height of the head L4 vertebral body with associated STIR\nhyperintensity and a linear fracture line present on the T1 weighted images.\nNo significant retropulsion of the dorsal cortex is present. In addition,\nthere is STIR hyperintensity along the superior aspect of the L3 vertebral\nbody with minimal loss of height in compatible with an additional compression\nfracture. Again, there is no significant retropulsion of the dorsal cortex\ninto the spinal canal. Vertebral body height is otherwise maintained, and bone\nmarrow signal is otherwise normal.\n\nThe conus medullaris is normal in morphology and signal intensity, and\nterminates at the level of L1.\n\nT12-L1: There is a right paracentral disc extrusion migrating along the\nposterior aspect of the L1 vertebral body without significant spinal canal or\nneural foraminal narrowing.\n\nL1-L2: A mild diffuse disc bulge is present and there is facet degenerative\nchanges with thickening of the ligamentum flavum, but no significant spinal\ncanal or neural foraminal narrowing.\n\nL2-L3: A mild diffuse disc bulge, facet degenerative changes and thickening of\nthe ligamentum flavum is present without significant spinal canal or neural\nforaminal narrowing.\n\nL4-L5: There is a diffuse disc bulge, thickening of the ligamentum flavum and\nfacet degenerative changes contributing to mild spinal canal narrowing. The\nhypertrophied facet joints contacts the traversing L4 nerve roots. There is\nmild bilateral neural foraminal narrowing, right greater than left.\n\nL4-L5: There is a diffuse disc bulge, facet hypertrophy and thickening of the\nligamentum flavum causing severe spinal canal narrowing with complete\neffacement of the cerebral spinal fluid surrounding the cauda equina nerve\nroots. The appearance has not substantially changed in the interval. A\nsynovial cyst present at this level on the previous examination is no longer\nseen. There is moderate bilateral neural foraminal narrowing. The disc bulge\nextends into the neural foramina and contacts the exiting L4 nerve roots.\n\nL5-S1: There is a diffuse disc bulge and facet degenerative changes causing\nnarrowing of the subarticular recess these, left greater than right. The\ndescending left L1 nerve root is compressed between the left facet and disc\nbulge. There is mild right and severe left neural foraminal narrowing with\ncompression of the exiting left L5 nerve root.\n\nThere is fluid signal interposed between the spinous processes of L4 and L5\nwhich demonstrate sclerosis on the CT examination, which may be due Baastrup's\ndisease.", "output": "1. Acute L3 and L4 compression fractures with mild loss of height. There is no\nsignificant bony retropulsion into the spinal canal, compression of the conus\nmedullaris or new compression of the cauda equina.\n2. Advanced lumbar spine degenerative changes, similar to the previous\nexamination, worst at L4-L5 where there is severe spinal canal narrowing.\n3. L4-L5 spinous process sclerosis and interposed fluid signal .\n4. 5. NOTIFICATION:" }, { "input": "There is no evidence of vertebral body height loss. The cervical spinal\nalignment is within normal limits. ___ type 2 degenerative endplate changes\nare noted at the superior endplate of T5.\n\nC2-C3: There is no spinal canal stenosis or neural foraminal narrowing.\n\nC3-C4: Posterior disc bulging flattens the ventral thecal sac with mild canal\nnarrowing and minimal bilateral neural foraminal narrowing.\n\nC4-C5: A posterior disc bulge flattens the ventral thecal sac with mild canal\nnarrowing. This combines with uncovertebral joint osteophytes to result in\nmild bilateral neural foraminal narrowing.\n\nC5-C6: There is no spinal canal narrowing. Uncovertebral joint osteophytes\nresult in minimal left and mild-to-moderate right neural foraminal narrowing.\n\nC6-C7: Minimal posterior disc bulging is noted contributing to mild canal\nnarrowing with mild bilateral neural foraminal narrowing.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nMultiple perineural cysts are seen within the lower cervical spine. The\nprevertebral and paraspinal soft tissues are grossly within normal limits.", "output": "1. Mild multilevel degenerative changes of the cervical spine, as detailed\nabove. No moderate or severe canal narrowing. No severe neural foraminal\nnarrowing." }, { "input": "CERVICAL:\nThe posterior fossa appears normal. No hyperintense signal changes involving\nthe cervical cord.\n\nGeneralized spondylotic changes of the cervical spine in the form of disc\ndesiccation, broad-based disc osteophyte complexes and facet joint\narthropathy.\n\nC2-3: No nerve root compromise.\nC3-4: Moderate left neural foraminal narrowing.\nC4-5: Mild to moderate right neural foraminal narrowing.\nC5-6: Broad-based disc osteophyte complex partially effaces the CSF space\nanterior to the cord. No deformation of the cord. Moderate right neural\nforaminal narrowing.\nC6-7: Broad-based disc osteophyte complex effaces the CSF space anterior to\nthe cord and mildly deforms the cord, but there is still CSF present posterior\nto the cord. No cord signal abnormality at this level. Moderate (right more\nthan left) neural foraminal narrowing.\nC7-T1: No nerve root compromise.\n\nTHORACIC:\nArea of short-segment posterior hyperintense changes involving both halves of\ncord at the level T1-T2. There is questionable enhancement on T1 postcontrast\nimaging (series 18, image 7).\n\nThere is a small right paracentral disc protrusion at the T9-T10 level, but no\nobvious cord or nerve root compromise. Small right paracentral disc\nprotrusion also note that the T3 for level, but no obvious cord or nerve root\ncompromise.\n\nOTHER: No incidental findings of note", "output": "1. Short segment of posterior spinal cord signal intensity abnormality at the\nT1-T2 level involving both halves of the cord. This finding is nonspecific\nand most likely represents an area of demyelination in the setting of multiple\nsclerosis, transverse myelitis or ADEM.\n2. Dedicated brain imaging advised to better characterize this lesion.\n3. Moderate cervical spondylosis as described above." }, { "input": "CERVICAL:\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nAt C3-C4, there is disc bulging resulting in slight flattening/remodeling of\nthe left anterolateral aspect of the cord without evidence of abnormal cord\nsignal. Uncovertebral osteophytes result in severe left and moderate right\nneural foraminal narrowing.\n\nAt C4-C5, uncovertebral osteophytes result in moderate right and mild left\nneural foraminal narrowing.\n\nAt C5-C6, uncovertebral osteophytes result in severe right and\nmild-to-moderate left neural foraminal narrowing.\n\nAt C6-C7, there is disc bulging resulting in mild spinal canal narrowing and\nmild flattening/remodeling of the ventral cord without evidence of abnormal\ncord signal. Uncovertebral osteophytes result in moderate bilateral neural\nforaminal narrowing.\n\nThe remaining levels of the cervical spine are without significant spinal\ncanal stenosis or neural foraminal narrowing.\n\nTHORACIC:\nThere has been interval slight decrease in size and signal intensity of a\nshort-segment posterior spinal cord abnormality at the level of T1-T2\ninvolving both halves of the cord. There is no new or enhancing lesion. \nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no abnormal enhancement after contrast administration.\n\nAt T9-T10, there is a right central disc protrusion resulting in mild\nflattening/remodeling of the right anterolateral aspect of the cord without\nevidence of abnormal cord signal.\n\nThe remaining levels of the thoracic spine do not demonstrate significant\nspinal canal stenosis or neural foraminal narrowing.\n\nOTHER: There is a 1.0 cm T2 hyperintensity within the right kidney likely\nrepresenting a cyst. A few punctate T2 hyperintensities within the visualized\nliver also likely represent small cysts there are incompletely characterized.", "output": "1. Slight decrease in size and signal intensity of a short segment posterior\nspinal cord abnormality at the level of T1-T2 involving both halves of the\ncord. Findings are nonspecific but in keeping with a resolving post vaccinal\nADEM.\n2. Degenerative changes of the cervical spine are most significant at C6-C7\nwhere there is mild spinal canal narrowing and mild flattening/remodeling of\nthe ventral cord without evidence of abnormal cord signal.\n3. Mild degenerative changes of the thoracic spine is most prominent at T9-T10\nwhere a right central disc protrusion results in mild flattening/remodeling of\nright anterolateral aspect of the cord without evidence of abnormal cord\nsignal." }, { "input": "CERVICAL:\nAlignment is within normal limits. Low T1 signal within the vertebral body\nmarrow is likely related to the patient's renal failure. The cord is normal\nin signal and morphology.\n\nMultilevel mild broad-based posterior disc bulges result in mild to moderate\nanterior canal narrowing worse at C5-6, C6-7 and C7-T1. Canal narrowing is\nworse at C6-C7 with moderate attenuation of the anterior thecal sac without\ncord signal abnormality. There is no prevertebral edema. Multilevel, mild\nneural foraminal narrowing is worse at C5-6 and C6-7.\n\nTHORACIC:\nAlignment is within normal limits. ___ changes are noted in the inferior\nendplates at T12 and L1.\nA central disc protrusion at T2-3 flattens the anterior surface of the spinal\ncord, greater on the left than right.\nA disc bulge at T ___ flattens the spinal cord slightly.\nA disc bulge and tiny midline protrusion at T4-5 slightly indents the anterior\nsurface of the spinal cord.\nA bulging disc and tiny midline protrusion flatten the anterior surface of the\nspinal cord at T5-6.\nA mild bulge at T6-7 slightly encroaches on the spinal canal but does not\ndeform the spinal cord.\nA midline protrusion at T7-8 slightly indents the anterior surface of the\nspinal cord.\nDisc bulging at T8-9 mildly narrows the spinal canal but does not contact the\nspinal cord.\nDisc bulging at T9-10 along with intervertebral osteophytes mildly narrows the\nspinal canal but does not contact the spinal cord.\nImages from T10 through L1 demonstrate no spinal canal encroachment. \nLigamentum flavum hypertrophy bilaterally at T11-T12 results in mild\nattenuation of the posterior thecal sac (series 13, image 24).\n\nLUMBAR:\n___ endplate changes are noted in the inferior endplates at T12 and L1\nand also at L3-4.\n\nThe cord terminates at L1.\n\nT12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: A mild broad-based posterior disc bulge does not result in significant\nspinal canal or neural foraminal narrowing.\n\nL2-3: A mild to moderate broad-based posterior disc bulge results in mild\nanterior canal narrowing with contact of the traversing L3 nerve roots. \nLigamentum flavum hypertrophy posteriorly, results in mild posterior\nattenuation of the thecal sac and minimal crowding of the nerve roots. \nBilateral neural foraminal narrowing is mild.\n\nL3-4: Ligamentum flavum hypertrophy and a mild to moderate broad-based\nposterior disc bulge results in mild narrowing of the thecal sac and anterior\ncontact of the traversing L4 nerve roots by the broad-based posterior disc\nbulge. Bilateral neural foraminal narrowing is moderate.\n\nL4-5: A moderate broad-based posterior disc bulge results in mild anterior\nattenuation of the thecal sac. Bilateral neural foraminal narrowing is\nmoderate.\n\nL5-S1: There is grade 1 anterolisthesis of L5 on S1. A moderate broad-based\nposterior disc bulge results in mild anterior attenuation of the thecal sac\nwith severe bilateral neural foraminal narrowing.\n\nOTHER: The kidneys are extremely atrophic, bilaterally and contain multiple\nsimple cysts. The urinary bladder is incompletely characterized, but\ndemonstrates diffuse wall thickening, likely due to underdistention.\n\nThe spleen and liver homogeneously low in T2 signal.", "output": "1. Multilevel, overall moderate degenerative change, as detailed above worse\nat L5-S1, where there is severe bilateral neural foraminal narrowing.\n2. Atrophic native kidneys are noted. Homogeneously low splenic and hepatic\nsignal can be seen in the setting of iron deposition secondary to chronic\nhemodialysis. Low T1 marrow signal also be secondary to iron deposition or\nmay represent hematopoietic proliferative changes due renal failure." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nAlignment is normal. Vertebral body height and marrow signal are preserved. \nConus medullaris terminates at L1. Signal intensity within the partially\nvisualized portions of the lower cord is preserved. Intervertebral disc space\nheight is preserved, with disc desiccation at L4-L5. Within the limitations\nof this noncontrast study, there is no evidence of infection or neoplasm. \nThere is nonspecific dependent subcutaneous edema overlying the lumbar spine\n(4:11). Limited images of the abdomen are remarkable. Additional\ndegenerative changes are as follows:\n\nAt T12-L1, and L1-L2, there is no significant spinal canal or neuroforaminal\nstenosis.\n\nAt L2-L3, there is a broad-based disc bulge that results in mild bilateral\nneuroforaminal stenosis. No significant spinal canal narrowing. Facet joint\narthropathy on the right is mild.\n\nAt L3-L4, there is a broad-based disc bulge, ligamentum flavum hypertrophy,\nand bilateral facet joint arthropathy that results in moderate narrowing of\nthe subarticular recess and neural foramen bilaterally. This is similar in\nappearance compared to the prior study in ___.\n\nAt L4-L5, there is a disc bulge with annular fissure, ligamentum flavum\nhypertrophy and facet joint arthropathy that results in mild spinal canal\nnarrowing and moderate bilateral neuroforaminal stenosis, right greater than\nleft. This is stable in the prior study.\n\nAt L5-S1, there is no significant spinal canal or neuroforaminal stenosis.", "output": "1. Study is mildly degraded by motion.\n2. Stable multilevel multifactorial degenerative changes, most pronounced at\nL3-L4 and L4-L5 where there is mild spinal canal and moderate bilateral neural\nforaminal stenosis." }, { "input": "CERVICAL SPINE: The vertebral body heights and alignment are maintained. The\nbone marrow signal is diffusely hypointense suggestive of an infiltrative\nprocess. There is loss of disc height at C6-C7.\n\nThe craniocervical junction is unremarkable. The cervical cord is normal in\nsignal intensity. There is no abnormal enhancement.\n\nAt C2-C3, there is posterior disc osteophyte complex, uncovertebral and facet\nosteophytes resulting in mild spinal canal and mild right neural foraminal\nnarrowing.\n\nAt C3-C4, there is posterior disc osteophyte complex, uncovertebral and facet\nosteophytes resulting in mild spinal canal narrowing with the ventral\nremodeling of the cord, and moderate right and mild left neural foraminal\nnarrowing.\n\nAt C4-C5, there is posterior disc osteophyte complex, uncovertebral and facet\nosteophytes resulting in mild spinal canal narrowing with ventral remodeling\nof the cord, and mild bilateral neural foraminal narrowing.\n\nAt C5-C6, there is posterior disc osteophyte complex, uncovertebral and facet\nosteophytes resulting in moderate spinal canal narrowing with ventral\nremodeling of the cord, moderate right and mild left neural foraminal\nnarrowing.\n\nAt C6-C7, there is posterior disc osteophyte complex, ligamentum flavum\nthickening, uncovertebral and facet osteophytes resulting in mild spinal canal\nnarrowing with ventral remodeling of the cord, severe left and moderate right\nneural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC SPINE: The vertebral body heights and alignment are preserved. There\nis diffuse hypointense bone marrow signal suggestive of infiltrative process.\nWithin the T12 vertebral body there is a T1 and T2 hyperintense lesion likely\nrepresenting a hemangioma.\n\nThe thoracic cord is normal in morphology and signal intensity. There is no\nabnormal enhancement.\n\nAt T8-T9, there is central disc protrusion without significant spinal canal or\nneural foraminal stenosis.\n\nLUMBAR SPINE: The vertebral body heights are preserved. There is loss of\nnormal disc signal and height at the L4-L5 level. There is diffuse\nheterogeneous hypointense bone marrow signal indicative of an infiltrative\nprocess.\n\nThe conus medullaris is normal in appearance and terminates at the mid L2\nlevel. There is no abnormal enhancement.\n\nAt L3-L4, there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in mild right neural foraminal narrowing. There is no\nsignificant spinal canal or left neural foraminal narrowing.\n\nThere are minimal disc bulges, facet arthropathy and ligamentum flavum\nthickening without no significant spinal canal or neural foraminal narrowing\nat the other lumbar spine levels.", "output": "Diffuse hypointense bone marrow signal throughout the spine is suggestive of\nan infiltrative bone marrow process such as leukemia given patient's history.\n\nCervical and lumbar spondylosis as detailed above. There is no spinal cord or\ncauda equina compression." }, { "input": "There is a heterogenous mass with central T1 and T2 hypointensity and\nperipheral T2 hyperintensity and T1 isointensity demonstrating avid\npostcontrast enhancement. The epicenter of this mass is in the subcutaneous\nfatty tissue. This mass has a spiculated appearance with spicules radiating\ninto the superficial subcutaneous fat with a more lobular/mushroom like\nexophytic component. There is disruption of the skin in this area. The\nlesion measures 30 mm (AP) by 60 mm (TV) by 43 mm (cc). There is no\ninvolvement of the deeper paravertebral muscles or spinal canal.\n\nMotion artifact degrades the diagnostic quality of the imaging. The vertebral\nbodies are normal in number. Grade 1 anterolisthesis of L4 on L5 mildly\npronounced lumbar lordosis. Normal vertebral body bone marrow signal\nintensity. Fluid present in the T11-12, T12-L1, L1-2 and L5-S1 discs. Small\nhemangioma is present in the T11 and L1 vertebral bodies.\nThe conus terminates at the L1 level. No conus masses. No myelopathic signal\nchange.\n\n\nThere are multilevel degenerative changes as evidenced by disc desiccation,\nbroad-based disc protrusion, facet joint arthropathy and ligamentum flavum\nhypertrophy. These degenerative changes does not result in obvious compromise\nof the nerve roots in the spinal canal. Grade 1 anterolisthesis of L4 on L5\nresults in moderate narrowing of the lateral recesses bilateral. There is\nmultilevel neural mild-to-moderate neural foraminal narrowing. If the patient\ndoes have radiculopathy then repeat dedicated imaging is advised. Right L3-4\nand L5-S1 facet joint effusions.", "output": "1. Exophytic soft tissue mass in the superficial subcutaneous tissue of the\nlower back with a T1 and T2 hypointense center and more hyperintense mushroom\nshaped exophytic component and demonstrates avid enhancement postcontrast.\n2. This lesion is localized to the superficial tissues and does not involve\nunderlying paraspinal muscles, spine or cord.\n3. This lesion has the radiographic appearance of a dermatofibrosarcoma\nprotuberans. Correlation with histology is advised.\n4. Generalized degenerative changes of the lumbar spine, but evaluation is\ncompromised by motion artifact.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:30 am, 10 minutes after\ndiscovery of the findings." }, { "input": "Study is mildly degraded by motion.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no definite focal marrow signal abnormality. The visualized portion\nof the spinal cord is grossly preserved in signal and caliber.\nThere is mild loss of intervertebral disc height and signal at C5-6.\n\nWithin 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.\n\n At C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is disc bulge withno vertebral canal or neural foraminal\nnarrowing.\n\nAt C4-5 there is central disc protrusion with mildvertebral canal and no\nneural foraminal narrowing.\n\nAt C5-6 there is disc bulge, facet arthropathy and uncovertebral hypertrophy\nwithno vertebral canal or neural foraminal narrowing.\n\nAt C6-7 there is disc bulge withno vertebral canal or neural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.", "output": "1. Study is mildly degraded by motion.\n2. Mild multilevel degenerative changes as described, most pronounced at C4-5,\nwhere there is mild vertebral canal narrowing." }, { "input": "Alignment is normal. There is a Schmorl's node in the inferior endplate of L4\nwith no surrounding edema. There is trace STIR hyperintense signal in the\nright pedicle of L5, series 4, image 4- 5. Otherwise, vertebral body signal\nintensity appears normal. There is decreased signal in the L3-4 and L4-5 disc\nspaces. The spinal cord appears normal in caliber and configuration. There\nis facet arthropathy at L2-L3, L3-4 L4-5 and L5-S1 with a small associated\neffusions seen. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.", "output": "1. No significant spinal canal or neural foraminal stenosis.\n2. Minimal edema in the right L5 pedicle, likely secondary to stress reaction.\n\nNOTIFICATION: A message was left with the QA nurse at 09:50 regarding the\nminor discrepancy." }, { "input": "THORACIC SPINE:\n\nThe thoracic cord is normal in morphology and signal intensity. No syrinx. \nNo epidural collection.\nLast there is epidural lipomatosis in the thoracic spine extending from T2\nthrough the T8 level, contributing to mild central canal narrowing, CSF\nventral and dorsal to the cord is preserved.\n\nThe thoracic vertebral bodies are normal in number and interrelationship. \nDegenerative changes as evidenced by desiccation of the intervertebral discs,\nendplate irregularity/Schmorl nodules as well as mild kyphotic deformity of\nthe mid thoracic spine most notable at the T6 through T9 levels. Mild\nposterior disc protrusion at the T5-6, T6-7, T7-8, T8-9 and T10-11 levels with\nmild effacement of the anterior CSF space,, no definite cord flattening.\nNo acute fracture. No paraspinal collection.\nThere are calcified pleural plaques bilaterally, better seen on CT from ___. There is dark pleural surface signal, which is likely all\ncalcification, pneumothorax should be excluded as it could have similar\nappearance. There were definite calcifications of the posterior pleura on CT\n___ in the area of MRI abnormality. Small the right and trace\nleft pleural effusions. Right basilar consolidations only partially seen.\n\nLUMBAR SPINE:\nThe conus terminates at the L1-2 level. Normal signal intensity.\nMultilevel degenerative changes in the lumbar spine, with disc space\nnarrowing, diffuse disc bulges, advanced lumbar facet arthritis, ligament\nflavum thickening.\n\nL1-2: Mild central canal and bilateral foraminal narrowing.\n\nL2-3: Mild-to-moderate central canal narrowing. Mild bilateral foraminal\nnarrowing.\n\nL3-4: Moderate to severe narrowing of the spinal canal, incompletely face CSF.\n___ effect on the traversing right L4 nerve root in the subarticular zone. \nModerate bilateral foraminal narrowing.\n\nL4-5: Mild central canal narrowing, mild ___ effect on traversing bilateral\nL5 nerves in the subarticular zones. Moderate to severe right, moderate left\nforaminal narrowing.\n\nL5-S1: Patent central canal. Moderate left and mild-to-moderate right\nforaminal narrowing.\n\nExtra-spinal. Trace pleural effusions bilateral. Simple appearing right\nrenal cortical cyst measuring 38 x 46 mm in the axial plane. A saturation\nband partially obscures the distal abdomen aorta, but the distal aorta appears\naneurysmal (although incompletely visualized) with peripheral suspect thrombus\nand dedicated imaging of the abdominal aorta is advised. Infrarenal abdominal\naortic aneurysm measures approximately 5.3 cm.", "output": "1. Moderate to severe spinal canal stenosis at the L3-4 level.\n2. Multilevel significant neural foraminal narrowing as described above.\n3. Mild degenerative change of the thoracic spine.\n4. Normal cord.\n5. Abdominal aortic aneurysm, measuring approximately 5.3 cm.\n6. Right basilar consolidation is only partially seen. Recommend chest PA and\nlateral to evaluate extent of pleural plaques, right lung consolidation, and\nexclude small likelihood of small pneumothorax.\n\nRECOMMENDATION(S): Chest PA and lateral.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:03 am, 10 minutes\nafter discovery of the findings." }, { "input": "Study is mildly degraded by motion.\n\nCERVICAL:\n\nThere is straightening of the cervical lordosis. Redemonstration of patient's\nknown C4-5 ACDF is again noted.\n\nAt C6-7, there is loss of intervertebral disc signal.\n\nPartially empty sella. The imaged posterior fossa and craniocervical junction\nare preserved. Bilateral maxillary and sphenoid sinus mucosal thickening is\npresent.\n\nC2-3: There is no evidence of vertebral canal neural foraminal narrowing.\n\nC3-4: Disc osteophyte complex effaces the CSF anterior to the cord, with mild\nvertebral canal, mild right and moderate left neural foraminal narrowing.\n\nC4-5: Intervertebral body device/disc spacer in situ which results in\nsusceptibility artifact obscuring the T1 axial imaging. There is posterior\nbony ankylosis of the C4 and C5 vertebral bodies. This bony bridging results\nin moderate to severe spinal canal narrowing with cord deformation and\neffacement of the CSF anterior to the cord. There is very minimal CSF still\npresent posterior to the cord at this level. Hyperintense cord signal seen in\nthe right lateral cervical spinal cord. Please note that it is difficult to\ndetermine the timing/chronicity of this signal abnormality. Moderate right\nand moderate to severe left neural foraminal narrowing.\n\nC5-6: Disc osteophyte complex effaces the CSF space anterior to the cord. \nThere is still minimal CSF present posterior to the cord. Moderate severe\nbilateral neural foraminal narrowing.\n\nC6-7: Effacement of the CSF space anterior to the cord. More focal right\nparacentral disc protrusion is also noted. There is still CSF posterior to\nthe cord. No cord signal abnormality. Moderate left and mild right neural\nforaminal narrowing.\n\nAt the level C7-T1: Central and right paracentral disc osteophyte\ncomplex/protrusion effaces the CSF anterior to the cord, but no abnormal cord\nsignal. The neural foramina are patent.\n\nTHORACIC:\nThere is no compromise of the thoracic cord in the spinal canal.\nModerate narrowing of the left T1-T2, mild narrowing of the bilateral T2-3 and\nmoderate narrowing of the right T10 neural foramina.\nThe rest of the thoracic neural foramina are patent\n\nLUMBAR:\nThe cord terminates at the L1-2 level. No conus signal abnormality.\n\nGeneralized degenerative changes of the lumbar spine in the form of disc\ndesiccation, broad-based disc protrusions with associated facet joint\narthropathy and ligamentum flavum hypertrophy most marked at the L3-4, L4-5\nand L5-S1 levels as described below.\n\nL1-2: No compromise of the conus or nerve roots.\n\nL2-3: Mild narrowing of the right neural foramina. No nerve root compromise.\n\nL3-4: Mild narrowing of the subarticular zones bilateral. Moderate neural\nforaminal narrowing bilateral.\n\nL4-5: Degenerative changes with combination of mild epidural lipomatosis\nresults in moderate narrowing of the spinal canal with the thecal sac\nmeasuring 7 mm in AP diameter. There is still minimal CSF outlining the nerve\nroots. There is moderate to severe neural foraminal narrowing bilateral.\n\nL5-S1: No compromise of the nerve roots in the spinal canal. Severe narrowing\nof the neural foramina bilateral.", "output": "1. Study is degraded by motion and spinal fusion hardware artifact.\n2. Postoperative changes related to prior C4-5 ACDF.\n3. Multilevel cervical spondylosis as described, most pronounced at C4-5,\nwhere there is moderate to severe spinal canal narrowing with deformation of\nthecal sac and spinal cord and age indeterminate right cervical hemicord\nlesion, and moderate right and moderate to severe left neural foraminal\nnarrowing.\n4. Moderate narrowing of the spinal canal at the levels C3-4 through C6-7.\n5. Multilevel lumbar spondylosis as described, most pronounced at L4-5, where\nthere is moderate vertebral canal and moderate to severe bilateral neural\nforaminal narrowing.\n6. No evidence of epidural hematoma or collection.\n\nNOTIFICATION: The wet read was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:52 pm, 2 minutes\nafter discovery of the findings." }, { "input": "From T11-S3 level there are no focal abnormalities within the vertebral bodies\nsuspicious for metastatic disease. However, diffuse low signal is identified\nwithin the posterior right iliac bone could suggestive of metastatic disease\nas visualized on the previous PET CT.\n\nThere is no intraspinal mass or abnormal enhancement seen. There is no\nevidence of high-grade thecal sac compression identified.\n\nFrom T11-12 through L3-4 levels mild degenerative change seen. At L4-5 mild\ndisc bulging and facet degenerative changes seen without spinal stenosis or\nforaminal narrowing.\n\nAt L5-S1 level mild degenerative disc disease seen.\n\nThe distal spinal cord is normal in appearance.", "output": "1. Bony infiltrative process indicative of metastatic disease in the posterior\nright iliac bone as on the previous PET-CT.\n2. No bony metastatic disease in the vertebral bodies. No intraspinal \nepidural disease.\n3. Mild degenerative changes without spinal stenosis." }, { "input": "Some of the sequences have been degraded by movement artifact. Allowing for\nthis;\n\nAlignment is normal. There is an expansile lesion involving the posterior\naspect of the left ninth rib, measuring 2.2 cm x 3.9 cm, with adjacent STIR\nhyperintensity and enhancement within the left side of T9 vertebral body,\nextending into the left pedicle and left transverse process, in keeping with\nmalignant spinal involvement. There is no epidural extension and there is no\nspinal canal narrowing at this level. There is also ligamentum flavum\nthickening and bilateral facet joint arthropathy at T8-T9, with mild left\nneural foraminal narrowing. This lesion in the posterior aspect of the left\nninth rib was identified on the PET-CT scan dated ___, however\nimaging is not available for direct comparison.\n\nThe expansile lesion arising from the posterior aspect of the right twelfth\nrib is again noted but is incompletely visualized. This lesion does not\nextend to the adjacent thoracic spine. No additional lesions are identified. \nT1 and T2 hyperintense foci are noted within the vertebral bodies of T8, T9,\nT10, T12 and L1. These are consistent with vertebral hemangiomas. Vertebral\nbody and intervertebral disc signal intensity appear normal.\n\nThe spinal cord appears normal in caliber and configuration. The conus ends\nat L1 level. There is no abnormal leptomeningeal or intrinsic cord\nenhancement. There is no evidence of spinal canal or neural foraminal\nnarrowing at the remaining imaged vertebral levels. There is no evidence of\ninfection.", "output": "1. Involvement of the expansile lesion in the posterior aspect of the left\nninth rib with the adjacent left side of T9 vertebral body, extending into the\nleft pedicle and left transverse process. There is no epidural extension. No\nspinal canal narrowing at this level. In conjunction with facet joint\narthropathy, there is mild left T8-T9 neural foraminal narrowing.\n2. The expansile lesion in the posterior aspect of the right twelfth rib is\nagain noted but is partially imaged. This does not extend to the adjacent\nthoracic spine.\n3. No abnormal leptomeningeal or cord enhancement.\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": "There is new STIR hyperintensity with corresponding T1 hypointensity involving\nthe L1 vertebral body with destruction of the inferior endplate with\nassociated irregular enhancement measuring approximately 2.5 x 2.6 x 1.5 cm\n(5:10 and 7:12). The sagittal alignment is maintained. There is mild disc\ndesiccation and loss of intervertebral disc height at L4-L5 with a posterior\nannular fissure. The spinal cord appears normal in caliber and configuration.\nThere is mild edema in the right psoas muscle with associated enhancement at\nthe level of L1-L2. Extensive subcutaneous edema is noted in the superficial\nposterior paraspinal soft tissues.\n\nT12-L1: There is a disc bulge left paracentral disc extrusion resulting in\nmild effacement of the ventral CSF space, slightly increased without\nsignificant spinal canal or neural foraminal stenosis.\nL1-L2: Mild disc bulge without significant spinal canal or neural foraminal\nstenosis.\nL2-L3: Mild disc bulge without spinal canal or neural foraminal stenosis.\nL3-L4: Mild disc bulge, ligamentum flavum thickening and mild facet\nhypertrophy without significant spinal canal or neural foraminal narrowing.\nL4-L5: Diffuse disc bulge with a posterior annular fissure, ligamentum flavum\nthickening and facet joint arthropathy results in mild narrowing of the\nsubarticular zones with contact of the traversing L5 nerve roots and mild\nbilateral neural foraminal narrowing, slightly progressed.\nL5-S1: Mild disc bulge and facet arthropathy without significant spinal canal\nor neural foraminal stenosis.", "output": "1. New 2.5 x 2.6 x 1.5 cm peripherally enhancing lesion in the L1 vertebral\nbody with associated inferior endplate destruction and marrow edema concerning\nfor metastatic disease given history of malignancy. Although infection may\nalso have this appearance, however there is no abnormal STIR hyperintensity or\nenhancement within the intervertebral disc at L1-L2 to suggest discitis. No\nadditional enhancing lesions.\n2. Mild edema/soft tissue changes in the right paraspinal region at the level\nof L1-L2.\n3. Extensive subcutaneous edema in the posterior paraspinal tissues likely\ndependent edema..\n4. Mild multilevel degenerative changes with slight progression of a left\nparacentral disc protrusion at T12-L1 without significant spinal canal\nstenosis and mild bilateral neural foraminal narrowing at L4-L5.\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 cervical lordosis is exaggerated. A left C6 lamina fracture is better\nseen in prior CT. Increased STIR signal in the posterior paraspinal tissues\nspanning from C3 through C7 is likely post traumatic. No ligamentous injury\nis identified. No bone marrow edema. Minimal retrolisthesis of L3 on L4 is\nunchanged from ___ and likely sue to ligamentous laxity from DDD.\n\nAtlanto-occipital joint: The foramen magnum is within normal limits. The\ncerebral tonsils are above the level of the foramen magnum. There is no pannus\nof the atlanto-occipital ligament or spinal canal narrowing.\n\nC1-C2: The lateral masses are symmetric with respect to the dens. No spinal\ncanal narrowing. No abnormality of the alar ligaments. No evidence of\nbasilar invagination.\n\nC2-C3: There is mild bulging without spinal canal stenosis.\n\nC3-C4: Minimal retrolisthesis of C3 on C4 is unchanged from ___. Associated\nconcentric disc bulge and ligamentum flavum hypertrophy result in mild to\nmoderate spinal canal stenosis with flattening of the anterior aspect of the\ncord. Bilateral facet joint hypertrophy results in moderate bilateral neural\nforaminal narrowing.\n\nC4-C5: Mild DJD without spinal canal stenosis.\n\nC5-C6: Concentric disc bulge and ligamentum flavum hypertrophy resulting in\nmild spinal canal stenosis without cord compression.\n\nC6-C7: There is concentric disc bulge with a focal broad-based protrusion\nextending into the left neural foramen resulting in severe left neural foramen\nnarrowing.\n\nC7 Through T3: There is mild disc desiccation loss of disc height but no disc\nherniation, spinal canal stenosis, or neural foraminal narrowing.", "output": "1. Edema in the posterior paraspinal soft tissues may be secondary to trauma.\nLeft lamina fracture at C6 seen on prior CT is not clearly identified on MR.\n___ is no bone marrow edema or ligamentous injury\n\n2. Severe narrowing of the left neural foramen at C6-C7. Other degenerative\nchanges as above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\n Vertebral body alignment is preserved.\n\nThere is chronic appearing mild to moderate superior endplate compression\ndeformity of the L1 vertebral body with anterior wedging, without associated\nvertebral body edema. Remainder the vertebral body heights are maintained. A\n25 mm T1 and T2 hyperintense lesion with incomplete fat suppression in the L4\nvertebral body is compatible with vertebral body hemangioma. Other scattered\nareas of mild marrow heterogeneity likely represent a combination of\ndegenerative change and fatty marrow conversion. There is no prevertebral\nsoft tissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is minimal intervertebral disc height loss\nat the L4-L5 level. The remainder of the intervertebral disc heights are\nrelatively well preserved.\n\nThe visualized distal spinal cord is preserved in signal and caliber. The\nconus medullaris terminates at the T11-T12 level.\n\nMild multilevel facet joint degenerative changes seen.\n\nSagittal view of T11-T12 demonstrates no significant spinal canal or neural\nforaminal narrowing.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L 2, there is trace disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L2-L3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, there is trace disc bulge without significant spinal canal\nnarrowing. Facet and endplate osteophytes produce mild bilateral neural\nforaminal narrowing.\n\nAt L4-L5, disc bulge mildly narrows the spinal canal, with contact and mild\ndisplacement of the traversing bilateral L5 nerve roots, though without frank\ncompression. Facet and endplate osteophytes produce moderate right and mild\nleft neural foraminal narrowing.\n\nAt L5-S1, there is trace disc bulge without significant spinal canal\nnarrowing. Facet and endplate osteophytes produce moderate bilateral neural\nforaminal narrowing.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Multilevel lumbar spondylosis, as described, with disc bulge mildly\nnarrowing the spinal canal at L4-L5 with contact and displacement of the\ntraversing bilateral L5 nerve roots, and up to moderate neural foraminal\nnarrowing at the right L4-L5 and bilateral L5-S1 levels. No high-grade spinal\ncanal narrowing.\n2. Mild to moderate superior endplate compression deformity of the L1\nvertebral body with anterior wedging appears chronic.\n3. L4 vertebral body hemangioma." }, { "input": "Alignment is normal. Vertebral body heights are normal. Again, there is\nheterogeneity of the bone marrow signal which may again reflect posttreatment\nchanges acute not exclude diffuse lymphomatous involvement. There is mild\nintervertebral disc space narrowing most predominantly at C5-C6 and C6-C7,\nsimilar to prior. There is loss of disc signal suggestive of disc desiccation\nprimarily at C5-C6. The visualized portion of the spinal cord appears normal.\nThere is linear increased signal at the posterior aspect of the spinal cord at\nC5 and C6 level which is unchanged from prior study. It is somewhat unusual\nlocation for prominent central canal. Given its posterior location and the\ninvolvement of 2 vertebral segments it could be sequela of subacute combined\ndegeneration in proper clinical settings. There is no abnormal enhancement\nafter contrast administration.\n\n At C2-C3, there is no spinal canal narrowing or neural foraminal narrowing.\n\nAt C3-C4, there is no spinal canal narrowing or neural foraminal narrowing.\n\nAt C4-C5, minimal diffuse posterior disc bulge, bilateral uncovertebral\nhypertrophy and facet osteophytes are seen without spinal canal narrowing. \nThere is mild bilateral neural foraminal narrowing.\n\nAt C5-C6, endplate osteophytes, diffuse posterior disc bulge, uncovertebral\nhypertrophy, and ligamentum flavum thickening results in moderate spinal canal\nnarrowing with indentation of the anterior spinal cord without spinal cord\nsignal abnormality. There is moderate bilateral neural foraminal narrowing.\n\nAt C6-C7, there is diffuse posterior disc bulge, uncovertebral hypertrophy,\nand facet hypertrophy which is old in mild spinal canal narrowing. There is\nmild bilateral neural foraminal narrowing.\n\nFrom C7-T1 through T3-T4, there is no spinal canal narrowing or neural\nforaminal narrowing.", "output": "1. Heterogeneous bone marrow signal again may reflect post treatment changes\nbut cannot exclude diffuse lymphoma thus involvement. No evidence of acute\nfracture.\n2. Moderate multilevel degenerative changes most prominent at C5-C6 similar to\nprior.\n3. No abnormal enhancement status post contrast administration.\n4. Linear increased signal at the posterior aspect of the spinal cord at C5\nand C6 level could be sequela of subacute combined degeneration in proper\nclinical setting and is unchanged from the previous MRI study of ___ but better visualized on the current study." }, { "input": "Vertebral body height and alignment is preserved. Intervertebral disc space\nheights are maintained. Bone marrow signal intensity is within normal limits.\n\nThe spinal cord is normal in caliber and configuration. The cauda equina\nnerve roots appear unremarkable. The conus terminates normally at the L1-L2\nlevel.\n\nAt L5-S1, there is a central/right paracentral disc protrusion, facet joint\narthropathy with small bilateral facet joint effusions but without spinal\ncanal stenosis or significant neural foraminal narrowing.\n\nThere is no evidence of cord compression, severe spinal canal stenosis,\nepidural collection or significant neural foraminal narrowing along the lumbar\nlevels.\n\nSubcentimeter T2 hyperintense lesion in the left kidney most likely represents\na renal cyst.\nNote is made of a small amount of fluid/edema in the subcutaneous soft\ntissues, predominantly at the L1-L2 level and extending inferiorly to the L4\nlevel (series 3, image 11). There is no abnormal enhancement after contrast\nadministration. This is a nonspecific finding.", "output": "1. No evidence of epidural collection, cord compression, severe spinal canal\nstenosis or significant neural foraminal narrowing along the lumbar levels.\n2. Mild lumbar spondylosis with L5-S1 central/right paracentral disc\nprotrusion but no evidence of spinal canal stenosis or neural foraminal\nnarrowing." }, { "input": "A comminuted burst fracture of the L1 vertebral body is indicated by T2/STIR\nsignal hyperintensity and associated decreased T1 signal intensity spanning\nthe ___ posterior vertebral body. STIR signal intensity is also noted\nextending into the right pedicle at L1 (4:7). There is approximately 50% of\nvertebral body height loss in the mid portion of the L1 (03:10), and\napproximately a 7 mm of posterior retropulsion of fracture fragments (7:13,\n3:12), resulting in moderate spinal canal narrowing. The spinal cord itself\nis normal in caliber and intrinsic signal intensity throughout its course,\nterminating at the L1 level. No diffusion abnormality is detected in the\nlower spinal cord.\n\nPrevertebral soft tissue swelling is noted at the T12 through L1 levels. The\nanterior and posterior longitudinal ligaments appear intact. A broad area of\nincreased signal intensity is identified in the T12 spinous process where a\nfracture was detected on the recently obtained CT torso. The paraspinal\nmusculature ligamentous structures are unremarkable. There is no epidural\nfluid collection or hematoma. A 6 mm T2/T1 hyperintense focus in the central\nportion of the L3 vertebral body (03:10) is compatible with an osseous\nhemangioma.\n\nMild intervertebral disc height loss at the L3-4 and L5 levels is accompanied\nby decrease fluid sensitive signal intensity, compatible with desiccation. \nThere are diffuse disc bulges at the L3-4, L4-5, and L5-S1 levels, causing no\nsignificant spinal canal narrowing and only mild bilateral neural foraminal\nnarrowing at the L3-4 and L4-5 levels.", "output": "1. Acute burst fracture of the L1 vertebral body with approximately 50% height\nloss and 7 mm retropulsion of fracture fragments, resulting in moderate spinal\ncanal narrowing.\n2. Normal signal intensity and morphology of the lower spinal cord.\n3. Multilevel lumbar spondylosis results and mild bilateral neural foraminal\nnarrowing at L3-4 and L4-5, as described above.\n4. L3 vertebral body osseous hemangioma." }, { "input": "Benign vertebral body hemangiomas T11, L1. Minimal retrolisthesis L1-L 2, new\nsince prior. Minimal retrolisthesis L2-L3, similar. Multilevel degenerative\nchanges, disc space narrowing diffuse disc bulges, lumbar facet arthritis. \nNormal cord. Schmorl's node superior T12 endplate.\n\nAt L1-L2 level there is mild central canal narrowing, similar to prior. \nPatent foramina.\n\nAt L2-L3 level there is mild central canal narrowing, similar. Mild bilateral\nforaminal narrowing, similar.\n\nAt L3-L4 level there is mild-to-moderate central canal narrowing, mildly more\nprominent since prior. Preserved CSF. Mild mass effect on traversing both L4\nnerves, greater on the left. Mild bilateral foraminal narrowing, similar.\n\nAt L4-5 level there is moderate central canal narrowing, minimally worsened\nsince prior. Mass effect on traversing both L5 nerves, narrowed both lateral\nrecesses, similar. Mild bilateral foraminal narrowing, similar.\n\nAt L5-S1 level there is minimal central canal narrowing. Mild mass effect on\ntraversing left S1 nerve from diffuse disc bulge and facet arthropathy, more\nprominent. Mild bilateral foraminal narrowing, similar.\n\nAtrophy posterior paraspinal musculature.", "output": "1. Degenerative changes lumbar spine, mildly worsened since prior.\n2. Moderate central canal narrowing L4-5 level.\n3. Multilevel mild foraminal narrowing." }, { "input": "Mild 2 mm retrolisthesis of T12 on L1 is identified, unchanged from plain film\nof ___. Otherwise, thoracic alignment is anatomic. Vertebral body\nheights are preserved. There is no focal suspicious marrow lesion although\nthe marrow is T1 diffusely heterogeneous and slightly hypointense, likely\nrepresenting demineralization and degenerative changes. A T2 vertebral body\nhemangioma is identified. There is severe loss of T12-L1 disc height. The\nremainder the disc height and signal are preserved. No definite cord signal\nabnormality.\n\nA 1.1 x 0.7 x 1.2 cm (TRV, AP, SI) extramedullary likely intradural lesion at\nthe right ventral aspect of the T2 spinal canal is identified, compressing the\ncord with posterior left lateral displacement (series 6, image 7). There is\nno evidence of underlying cord edema. No other mass lesions are identified.\n\nMild degenerative changes throughout the thoracic spine, including small disc\nbulges and mild facet arthropathy results in no significant spinal canal or\nneural foraminal narrowing.\n\nThere is a T2 1.1 cm hypointense cystic lesion in the superior left renal pole\n(series 7, image 32) which could potentially represent a hemorrhagic cyst. \nAdjacent to the spleen and apparently contacting the superior renal pole at\nthe same level may be either a exophytic 1.9 cm lesion arising from the kidney\nor a small splenule (series 7, image 32). 5 mm T2 hyperintense focus of the\nright hepatic lobe (series 7, image 30) may represent a hemangioma versus\ncyst. The remainder of the visualized prevertebral and paraspinal soft\ntissues are unremarkable.\n\nThere is also a 1.6 cm T2 hyperintense cystic lesion of the inferior right\nlobe of the thyroid.", "output": "1. Extramedullary likely intradural 1.2 cm mass along the dorsal right aspect\nof the T2 spinal canal, compressing the cord with posterior left lateral\ndisplacement. There is no definitive cord signal abnormality.\n2. The lesion likely represents a meningioma, potentially a schwannoma. \nMetastatic disease is considered much less likely but not entirely excluded. \nRecommend further evaluation with contrast.\n3. No definitive suspicious osseous lesions.\n4. A T2 1.1 cm hypointense cystic lesion in the superior left renal pole,\npotentially representing a hemorrhagic cyst. However, further evaluation with\nultrasound or MRI is recommended. In addition, there is an rounded 1.9 cm\nlesion abutting the superior left renal pole, potentially representing a\nsplenule versus renal lesion.\n5. A 5 mm T2 hyperintense cystic lesion of the right hepatic lobe, potentially\na hemangioma versus cyst.\n6. 1.6 cm T2 hyperintense nodule in the inferior right lobe of the thyroid.\n\nRECOMMENDATION(S):\n1. Further evaluation with ultrasound or MRI of impression 4 and 5 is\nrecommended.\n2. Further evaluation with thyroid ultrasound is suggested for impression 6 by\ncurrent ACR recommendations for incidentally noted thyroid nodules.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:37 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "THORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is heterogeneous, which may represent degenerative changes\nand/or marrow reconversion without focal suspicious lesion. T2 fatty\nrest/osseous hemangioma is re-identified. Disc heights and signal are\nmaintained.\n\nRe-identified is a extramedullary intradural homogeneously enhancing\nT2-weighted slightly hypointense rounded 1.4 x 0.9 x 1.5 cm (TRV, AP, SI) the\nlesion along the right ventral aspect of the T2 vertebral level spinal canal\nresulting in severe spinal canal narrowing and flattening of the cord. The\nlesion demonstrates suggestion of a dural tail (series 16, image 5 and 6). \nThere is no definitive underlying cord signal change. No other enhancing\nlesions are identified in the spinal canal.\n\nAllowing for mild degenerative disc protrusions at multiple levels, there is\nno significant spinal canal or neural foraminal narrowing.\n\nLUMBAR:\n4 mm anterolisthesis of L4 on L5 is unchanged from prior examination. \nOtherwise, lumbar alignment is anatomic. Vertebral body heights are\npreserved. The marrow signal is heterogeneous without focal lesion,\ncompatible with degenerative changes and potentially marrow reconversion. \nVertebral body heights are preserved. Degenerative loss of disc height and\nsignal spanning L2-L3 through L4-L5 is moderate. The conus medullaris\nterminates at the L1 level, within expected limits. There is no abnormal\nsignal or enhancement of the terminal cord, conus medullaris or cauda equina.\n\nT12-L1 and L1-L2: Small disc bulges do not significantly narrow the spinal\ncanal. There is no neural foraminal narrowing.\n\nL2-L3: A small disc bulge results in mild spinal canal narrowing. In\ncombination with facet arthropathy there is mild bilateral neural foraminal\nnarrowing.\n\nL3-L4: A small disc bulge with mild epidural fat and thickening of the\nligamentum flavum results in mild spinal canal narrowing. Facet arthropathy\nis associated with small right greater than left facet joint effusions. There\nis mild left and no significant right neural foraminal narrowing.\n\nL4-L5: A disc bulge with prominent thickening of the ligamentum flavum\nresults in severe spinal canal narrowing. Loss of disc height and facet\narthropathy results in mild bilateral neural foraminal narrowing. The disc\nmay contact the under surfaces of the right greater than left exiting nerve\nroots. There are multiple posteriorly projecting synovial cysts measuring up\nto 4 mm predominantly on the right.\n\nL5-S1: There is no significant spinal canal narrowing. Facet arthropathy\nresults in mild left-greater-than-right bilateral neural foraminal narrowing.\n\nOTHER: On sagittal T1 weighted localizer images, cervical alignment is grossly\nanatomic. No definitive osseous abnormality or evidence of high-grade spinal\ncanal narrowing is identified.\n\nRe-identified is a 1.6 cm T2 hyperintense cystic lesion of the inferior right\nlobe of the thyroid (series 3, image 3).\n\nThere are multiple T2 hypointense cystic lesions of the left kidney, including\na exophytic 1.9 cm lesion demonstrates layering fluid fluid level without\ndefinitive postcontrast enhancement. The exophytic lesion was previously\ndescribed on the prior examination as a possible splenule versus hemorrhagic\nrenal cyst. 5 mm T2 hyperintense right hepatic lesion (series 7, image 26)\nunchanged, potentially representing a hemangioma versus cyst.\n\nThe remainder the visualized prevertebral and paraspinal soft tissues are\nunremarkable.", "output": "1. Re-identified is a 1.5 cm extramedullary intradural mass in the right\nventral T2 spinal canal, demonstrating homogeneous enhancement and suggestion\nof dural tails, resulting in severe flattening of the cord. There is no\nunderlying cord signal change. The imaging characteristics are most\ncompatible with a meningioma. Nerve sheath tumor is a consideration but\nconsidered less likely. The lack of additional lesions makes metastatic\ndisease also much less likely.\n2. There is severe spinal canal narrowing at L4-L5 secondary to degenerative\nchanges including a large disc bulge and prominent thickening of the\nligamentum flavum and facet arthropathy. Additional thoraco lumbar\nspondylosis as described above.\n3. Re-identified are multiple T2 hypointense cystic lesions of the left kidney\nwhich do not demonstrate definitive enhancement although the evaluation is not\noptimized for such evaluation. These may represent hemorrhagic cysts, however\nfurther evaluation with dedicated renal MRI or ultrasound is recommended for\nfurther evaluation.\n4. As noted on the prior examination, there is a 1.6 cm T2 hyperintense nodule\nof the inferior right lobe of the thyroid. Further evaluation with ultrasound\nis suggested by current ACR recommendations for incidentally noted thyroid\nnodules.\n\nRECOMMENDATION(S):\n1. Dedicated MRI or ultrasound for impression 3 is recommended.\n2. Further evaluation with thyroid ultrasound is recommended for impression 4.\n\nNOTIFICATION: The preliminary findings were discussed with ___,\nD.O. by ___, M.D. on the telephone on ___ at 6:11 ___, 5\nminutes after discovery of the findings. No interval change from\npreliminaries wet read and final dictation." }, { "input": "There are postsurgical changes from T1 through T3 laminectomy and resection of\nan intradural mass at T2. There is no residual nodular enhancement to suggest\nresidual or recurrent mass. There is mild thin epidural enhancement at this\nlevel, which may reflect postsurgical change. Within the laminectomy defect,\nthere is a nonenhancing fluid collection measuring at least 58 x 4 mm (03:11)\nabutting the dura, likely representing postoperative seroma. \nPseudomeningocele is not excluded, though no obvious dural defect is seen. In\nthe superficial soft tissues in this region, there is an additional 45 x 14 mm\nfluid collection, with surrounding mildly enhancing soft tissue, likely\nrepresenting granulation tissue, most likely reflecting postoperative seroma.\n\nVertebral body heights and alignment are preserved. Focal fat is noted in a\nfew vertebral bodies. There is otherwise no focal bone marrow signal\nabnormality.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. Small Schmorl's nodes are seen at multiple levels.\nThe intervertebral disc heights are otherwise relatively well preserved.\n\nThere is subtle punctate focus of T2 hyperintensity within the spinal cord at\nthe level of T2 in level of prior compression (3:9, 6:13). The visualized\nspinal cord is otherwise preserved in signal and caliber.\n\nSmall disc bulges and protrusions are seen at multiple levels without\nsignificant spinal canal narrowing. There is no significant neural foraminal\nnarrowing.\n\nLimited view of the lower cervical spine demonstrates disc bulge and\nligamentum flavum thickening producing mild to moderate spinal canal narrowing\nat C5-C6. At C6-C7 mild disc bulge and ligamentum flavum thickening produce\nmild spinal canal narrowing. Facet and uncovertebral osteophytes produce\nmoderate left and mild right neural foraminal narrowing at C6-C7. At C7-T1,\nthere is no significant spinal canal or neural foraminal narrowing.\n\nThe visualized lungs are grossly clear. A T2 intermediate exophytic lesion\nmeasuring 18 mm off the left upper pole kidney demonstrates no post-contrast\nenhancement, and there is suggestion of a fluid level and likely represents a\nhemorrhagic cyst. Additional T2 and T1 hypointense, nonenhancing lesion in\nthe left upper pole kidney also likely represents a proteinaceous or\nhemorrhagic cyst. The visualized upper retroperitoneum is otherwise grossly\nunremarkable.", "output": "1. Postsurgical changes from T1 through T1 laminectomy and meningioma\nresection without evidence of residual or recurrent disease.\n2. 54 x 4 mm nonenhancing fluid collection within the laminectomy defect\nabutting the dura likely representing postoperative seroma. Pseudomeningocele\nis not excluded given location, though no gross dural defect is seen.\n3. Additional of 45 x 14 mm superficial soft tissue fluid collection at the\nlevel of surgical incision with mild peripheral enhancement with surrounding\ngranulation tissue. This also likely represents postoperative seroma.\n4. Punctate focus of cord signal abnormality at T2 in the level of prior\ncompression, likely representing myelomalacia.\n5. Mild thoracic degenerative disc disease without significant spinal canal or\nneural foraminal narrowing.\n6. Partially visualized degenerative changes of the lower cervical spine with\nup to mild to moderate spinal canal narrowing at C5-C6, and up to moderate\nneural foraminal narrowing at the left C6-C7 level.\n7. Likely left-sided hemorrhagic renal cysts." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is slightly T1 hypointense, but not darker than the disc,\npotentially representing marrow reconversion in the setting of anemia. \nClinical correlation is recommended. Otherwise, there is no focal suspicious\nmarrow lesion. Degenerative loss of disc height and signal is mild at L5-S1. \nThe conus medullaris terminates at the L1 level, within expected limits. \nThere is no signal abnormality of the terminal cord.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: A small disc bulge and minimal facet arthropathy does not narrow the\nspinal canal but results in mild left-greater-than-right neural foraminal\nnarrowing.\n\nL5-S1: A small central protrusion does not contact or displace the traversing\nnerve roots. There is no significant spinal canal or neural foraminal\nnarrowing.\n\nVisualized abdominal, prevertebral paraspinal soft tissues are grossly\nunremarkable.", "output": "1. Minimal degenerative changes at L4-L5 and L5-S1 which do not significantly\nnarrow the spinal canal. There is minimal left greater than right L4-L5\nneural foraminal narrowing which do not appear to impinge on the traversing\nnerve roots.\n2. Mild T1 hypointensity of the bone marrow diffusely, although not darker\nthan the disc. This may represent marrow reconversion in the setting of\nchronic anemia. Clinical correlation is recommended.\n3. Additional findings described above." }, { "input": "From T11-12 through L3-4 levels, no significant disc bulge disc herniation or\nspinal stenosis seen.\n\nAt L4-5 level, disc bulging facet degenerative changes and thickening of the\nligaments results severe spinal stenosis. There is a moderate left foraminal\nnarrowing seen. There is no significant interval change.\n\nAt L5-S1 mild disc bulging is seen. There is no spinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Severe spinal stenosis at L4-5 level which is unchanged from the previous MRI\nexamination." }, { "input": "The patient is status post remote C5 through C7 ACDF, similar appearance to\nprior examination. Cervical alignment is anatomic. Vertebral body heights\nare preserved. There is no focal suspicious marrow lesion. Disc height and\nsignal are maintained. The visualized posterior fossa is unremarkable. \nT2/STIR hyperintense signal of the C6-C7 cord is unchanged from prior\nexamination. There is no new cord signal abnormality. There is no abnormal\npostcontrast enhancement.\n\nThere is borderline spinal canal narrowing at baseline secondary to congenital\nshortening of the pedicles.\n\nC2-C3: A central protrusion and thickening of the ligamentum flavum results\nin mild spinal canal narrowing, similar to prior examination with minimal\neffacement of the ventral aspect of the cord. Uncovertebral and facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nC3-C4: A small central protrusion with thickening of the ligamentum flavum\nresults in mild spinal canal narrowing, remodeling the ventral aspect of the\ncord. There is no significant neural foraminal narrowing.\n\nC4-C5: A left central disc protrusion and thickening of ligamentum flavum\nresults in moderate to severe spinal canal narrowing, effacing the left\nventral aspect of the cord without underlying cord signal change. \nUncovertebral and facet arthropathy results in left mild-to-moderate and mild\nright neural foraminal narrowing. This appears overall similar to prior\nexamination.\n\nC5-C6 and C6-C7: The patient is status post ACDF with mild to moderate spinal\ncanal narrowing. No significant neural foraminal narrowing. There are\nbilateral C6-C7 perineural cysts measuring up to 4 mm.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes, most prominent at C4-C5 where a left\ncentral disc protrusion and thickening of the ligamentum flavum results in\nmoderate to severe spinal canal narrowing with effacement of the left ventral\naspect of the cord, similar to prior examination without underlying cord\nsignal change at this level.\n2. The patient is status post remote C5 through C7 ACDF. Unchanged\nmyelomalacia at the C6-C7 level.\n3. No significant interval change from prior examination." }, { "input": "There is been no significant interval change. No evidence of disc bulge disk\nherniation or spinal stenosis visualized in lumbar region. The bony structures\nare well maintained without focal abnormalities to indicate infiltrative\nprocess. There is no compression fracture seen. There is no intraspinal mass\nor abnormal enhancement identified. The distal spinal cord and paraspinal soft\ntissues are unremarkable.", "output": "No significant abnormalities are identified. No significant change since the\nprevious MRI." }, { "input": "Lumbar spine numbering is established by designating the lowest rib-bearing\nvertebra as T12. 1-2 mm retrolisthesis of T12 on L1, L1 on L2 and 2-3 mm\nanterolisthesis of L5 on S1 is identified. The remainder of the lumbar\nalignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Degenerative loss of disc height is mild spanning\nL1-L2 through L4-L5 and moderate at L5-S1. The conus medullaris terminates at\nthe L1 level, within expected limits. There is no signal abnormality of the\nterminal cord.\n\nT10-T11 and T11-T12: On sagittal sequences, mild disc bulges do not\nsignificantly narrow the spinal canal. There is no significant neural\nforaminal narrowing.\n\nT12-L1: A small disc bulge does not narrow the spinal canal. In conjunction\nwith facet arthropathy there is mild right no significant left neural\nforaminal narrowing.\n\nL1-L2: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is moderate left-greater-than-right\nneural foraminal narrowing.\n\nL2-L3: A small disc bulge does not narrow the spinal canal. In conjunction\nwith facet arthropathy there is mild bilateral neural foraminal narrowing.\n\nL3-L4: There is no significant spinal canal or neural foraminal narrowing.\n\nL4-L5: A small disc bulge does not narrow the spinal canal. Crowding of the\nleft subarticular zone which contacts and potentially minimally posteriorly\ndisplaces the traversing left L5 nerve root (series 8, image 30). Conjunction\nwith facet arthropathy, there is no significant right neural foraminal\nnarrowing. There is mild left neural foraminal narrowing. The disc does\nappear to contact the undersurface of the exiting right L4 nerve root (series\n101, image 4).\n\nL5-S1: A disc bulge does not significantly narrow the spinal canal. Minimal\ncrowding of the subarticular zones does not displace the traversing nerve\nroots. Loss of disc height with facet arthropathy results in moderate to\nsevere left neural foraminal narrowing, likely impinging on the exiting left\nL5 nerve root (series 101, image 3). There is no significant right neural\nforaminal narrowing.\n\nThere is questionable bilateral L5-S1 spondylolysis.\n\nThere are T2 hyperintense cystic lesions in the left kidney measuring up to 9\nmm, statistically most likely simple cysts. Visualized prevertebral paraspinal\nsoft tissues are otherwise unremarkable.", "output": "1. Mild multilevel lumbar spondylosis most prominent at L5-S1 where a disc\nbulge, loss of disc height and facet arthropathy results in moderate to severe\nleft neural foraminal narrowing, likely impinging on the exiting left L5 nerve\nroot. In addition, a disc bulge at L4-L5 crowds the left subarticular zone\nwhich contacts and potentially minimally posteriorly displaces the traversing\nL5 nerve root.\n2. There is no evidence of high-grade spinal canal narrowing. No other\nhigh-grade neural foraminal narrowing in the remainder of the lumbar spine.\n3. Possible bilateral L5-S1 spondylolysis.\n4. Additional findings described above." }, { "input": "There are 5 lumbar type vertebral bodies. Alignment is normal. Vertebral\nbody and intervertebral disc signal intensity appear normal. The distal cord\nis normal in caliber and signal characteristics. The conus terminates at the\nlevel of L1/L2, within normal limits. There is no evidence mass or infection\nwithin the limitations of this non-contrast enhanced study. Lower lumbar\nfacet arthritis. Multilevel mild diffuse disc bulges. Mild congenital\nnarrowing upper lumbar spinal canal. There is mildly inhomogeneous T1 marrow\nsignal, without associated STIR hyperintensity, overall brighter than disc\nsignal, likely red marrow.\n\nNo significant central canal or foraminal narrowing at T12-L1 through L3-L4.\n\nAt L4-L5, there is a broad-based disc bulge without significant spinal canal\nstenosis. There is mild bilateral foraminal narrowing.\n\nAt L5-S1 level central canal is patent. There is moderate bilateral foraminal\nnarrowing, best seen on sagittal images 6, 15.\n\nThere is mildly prominent fluid signal in the ventral and dorsal epidural\nspace at L5, S1 level, may be from prominent epidural venous plexus. There\nare no findings to suggest disc space infection. No posterior element osseous\nedema or inflammatory changes about facet joint to suggest facet joint\ninfection. No prevertebral edema. If there is clinical concern for acute\nsymptoms, post gadolinium images may be helpful in further evaluation.", "output": "Degenerative changes in the lumbar spine with lower lumbar facet arthritis.\nModerate bilateral L5-S1 foraminal narrowing.\nSubtle prominence of the epidural space at L5, S1 level, indeterminate, may\nrepresent prominent epidural venous plexus. No evidence of discitis. No\nnoncontrast evidence of facet joint infection. If there is clinical concern,\npost gadolinium images may be helpful in further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:23 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Preceding radiographs demonstrate 5 lumbar-type vertebrae. The localizer\nsequence again demonstrates a levoconvex curvature centered at L4-5 and an\nincompletely evaluated mild dextroconvex curvature in the lower thoracic or\nlumbar spine. Vertebral body heights are preserved. Alignment is normal.\n\nThere is no evidence for an osseous, epidural, or leptomeningeal malignancy in\nthe lumbar spine. The conus medullaris appears normal, terminating at T12-L1.\n\nAt L3-4, there is loss of disc height with discogenic marrow changes in the\nendplates, a disc bulge, and moderate facet arthropathy. The right neural\nforamen is moderately narrowed with abutment of the exiting right L3 nerve\nroot. There is no significant spinal canal narrowing.\n\nAt L4-5, there is a minimal disc bulge and mild facet arthropathy. The right\nsubarticular zone is slightly narrowed without evidence for nerve root\nimpingement. The remainder of the spinal canal is not significantly narrowed.\nThere is mild bilateral neural foraminal narrowing without nerve root\nimpingement.\n\nAt L5-S1, there is a disc bulge, a tiny central disc protrusion, and facet\narthropathy. The spinal canal is not significantly narrowed. The left neural\nforamen is moderately narrowed by the known large pelvic mass.\n\nThe large expansile pelvic mass is again partially demonstrated, involving the\ncentral and left sacrum, and a small portion of the medial left ilium. The\nmass extends into the sacral spinal canal and into the left posterior\nparavertebral muscles, at as seen on the preceding pelvic MRI.\n\nEnlarged fibroid uterus is again noted.", "output": "1. Large expansile central and left sacral mass, extending into the medial\nleft ilium and moderately narrowing the left L5-S1 neural foramen, is again\npartially visualized.\n2. No evidence for osseous, epidural, or leptomeningeal malignancy in the\nlumbar spine.\n3. Lower lumbar degenerative disease, as detailed above.\n4. Enlarged fibroid uterus." }, { "input": "For the purposes of numbering, the lowest rib-bearing vertebral body was\ndistended the T12 level. There are 5 non-rib-bearing lumbar type vertebrae.\n\nAgain seen are multiple T1 hyperintense foci paralleling the inferior\nendplates of the L4-L5 vertebral bodies, likely representing degenerative\nchanges. As before, there is a S2 hemangioma.\n\nThere is disk desiccation throughout the visualized spine and a moderate\ndegree of disc height loss at L5-S1.\n\nThe spinal cord appears normal in caliber and configuration and the conus\nterminates at L1.\n\nAgain seen is an incidentally noted infrarenal fusiform abdominal aortic\naneurysm, which measures up to 4.7 cm in AP dimension (___), previously 4.4\ncm in ___.\n\nAt T12-L1 through L2-3, there is no vertebral canal or neural foraminal\nstenosis.\n\nAt L3-4 there is a small right foraminal disc protrusion, which causes mild\nright neural foraminal narrowing. There is bilateral facet hypertrophy. No\nsignificant canal or left neural foraminal narrowing.\n\nAt L4-5 there is a small right foraminal disc protrusion, subarticular recess\nnarrowing and ligamentum flavum infolding, causing mild canal narrowing. \nThere is mild bilateral, left greater than right, neural foraminal narrowing. \nAgain seen is a central annular fissure. There is mild facet joint\nhypertrophy.\n\nAt L5-S1 there is mild circumferential disc bulge without significant\nvertebral canal or neural foraminal narrowing.", "output": "1. Compared to ___, no significant change of the multilevel\ndegenerative changes, as described above.\n2. Minimal interval increase in size of an infrarenal fusiform abdominal\naortic aneurysm, measuring up to 4.7 cm, previously 4.4 cm in ___." }, { "input": "At T11-12 through L2-3 levels disc degenerative change and minimal bulging\nseen without spinal stenosis.\n\nAt L3-4 disc bulging is seen without spinal stenosis or foraminal narrowing.\n\nAt L4-5 level, disc and facet degenerative changes noted there is no spinal\nstenosis. Mild narrowing of the foramina seen.\n\nAt L5-S1 level, decreased disc height and disc bulging is seen with facet\ndegenerative changes. No spinal stenosis or foraminal narrowing identified.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. \nPreviously noted focally ectatic abdominal aorta is only partially visualized\non the current study secondary to a saturation band.", "output": "Mild multilevel degenerative changes which are overall stable compared to ___. No evidence of spinal stenosis or high-grade foraminal narrowing\nidentified." }, { "input": "Vertebral body heights are preserved. Alignment is normal. No suspicious\nbone marrow signal abnormalities are seen.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\nunremarkable.\n\nC2-C3: Shallow central disc protrusion plus/minus endplate osteophytes\nminimally indents the ventral thecal sac without significant spinal canal\nnarrowing. Right greater than left facet arthropathy without significant\nneural foraminal narrowing.\n\nC3-C4: Broad-based endplate osteophytes, right larger than left, mildly indent\nthe ventral thecal sac without spinal cord contact. Moderate right and mild\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Broad-based central disc protrusion, right larger than left, indents\nthe ventral thecal sac with spinal cord remodeling and moderate spinal canal\nnarrowing. Severe bilateral neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Broad-based central disc protrusion indents the ventral thecal sac with\nventral cord remodeling and severe spinal canal narrowing. Moderate to severe\nright and severe left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC6-C7: Broad-based endplate osteophytes, left larger than right, severely\nnarrowing the spinal canal with spinal cord remodeling. Moderate to severe\nright and severe left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC7-T1: Broad-based right paracentral disc protrusion mildly to moderately\nnarrows the spinal canal with mild right ventral cord remodeling. Moderate to\nsevere right and mild-to-moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nThere is questionable subtle hyperintensity in the spinal cord from C4-C5\nthrough C6-C7 on STIR images, versus artifact. No cord signal abnormality is\ndefinitively identified on sagittal or axial T2 weighted images.\n\nPartially visualized nasopharyngeal soft tissues appear mildly prominent with\na 5 mm T1 and T2 hyperintense focus on the left, sagittal images 2:10 and\n4:10, which may represent a mucous retention cyst.", "output": "1. Multilevel degenerative disease. Spinal canal narrowing is severe at C5-C6\nand C6-C7, and moderate at C4-C5, with spinal cord remodeling.\n2. Questionable subtle hyperintensity in the spinal cord from C4-C5 through\nC6-C7 on STIR images, which may represent myelomalacia, versus artifact. No\ncord signal abnormality is definitively identified on sagittal or axial T2\nweighted images.\n3. Advanced multilevel neural foraminal narrowing, as detailed above.\n4. Mild prominence of the partially visualized nasopharyngeal soft tissues\nwith a 5 mm probable mucous retention cyst on the left.\n\nRECOMMENDATION(S): Given the patient's age, direct visualization of the\nnasopharyngeal soft tissues by ENT should be considered.\n\nNOTIFICATION: Electronic preliminary report regarding the spinal canal\nstenosis, mass effect on the spinal cord, and cord signal abnormality was\nprovided at 17:54 on ___ by Dr. ___. Impression item 4 and the\nrecommendation above were emailed to the ED QA nurses list by Dr. ___ on ___ at 12:32." }, { "input": "The alignment of the cervical spine is maintained. There is mild mild height\nloss of the C5 vertebral body and minimal height loss of the C4 vertebral\nbody, likely degenerative. Remaining cervical vertebral body heights are\npreserved. There is moderate to severe intervertebral disc height loss at\nC4-C5 and C5-C6. There are mixed ___ type 1 and type 2 endplate changes\nthroughout the cervical spine. Calcified/bone island noted in the posterior\naspect of C5, small hemangioma in the rightward posterosuperior C7 vertebral\nbody.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nAt C2-C3 and C3-C4, there is mild disc bulge resulting in mild spinal canal\nnarrowing. No significant neural foraminal narrowing at these levels.\n\nC4-C5: There is mild disc bulge, ligamentum flavum thickening, and\nuncovertebral joint and facet joint osteophytes. There is effacement of the\nventral CSF space and flattening/remodeling of the ventral spinal cord without\nevidence of edema. Moderate spinal canal narrowing and moderate right and\nmoderate to severe left neural foraminal narrowing.\n\nC5-C6: There is mild disc bulge resulting in flattening/remodeling of the\nventral spinal cord without spinal cord signal abnormalities. \nMild-to-moderate spinal canal narrowing and moderate left greater than right\nneural foraminal narrowing due to osteophytes.\n\nC6-C7: There is minimal disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nThe paraspinal muscles and visualized paravertebral structures are\nunremarkable.", "output": "1. Multilevel multifactorial cervical spondylosis, most pronounced at C4-C5\nand C5-C6 levels, with moderate spinal canal narrowing.\n2. Moderate right and moderate to severe left neural foraminal narrowing at\nC4-C5.\n3. No evidence of spinal cord signal abnormalities to suggest edema or\nmyelomalacia." }, { "input": "There is approximately 5 mm of anterolisthesis of L4 on L5, not substantially\nchanged compared to CT performed ___. This is associated with\nbilateral L5 pars defects (4:60, 117). There is an ill-defined area of T1\nhypointensity involving the anterior inferior endplate of the L2 vertebral\nbody which also demonstrates increased edema signal. Increased edema signal\nis also seen along the anterior superior endplate of the L3 vertebral body and\nL2-L3 intervertebral disc (for example 06:11). There is increased\nprevertebral thickening of the anterior longitudinal ligament at the L2-L3\nlevel which is incompletely evaluated on current exam (05:10). Otherwise, the\nremaining visualized vertebral bodies and intervertebral discs demonstrate\nnormal height and signal intensity. The conus appears to terminate at T12-L1.\nThe spinal cord appears normal in caliber and configuration. Multilevel\ndegenerative changes of the lumbar spine are described as follows:\n\nT12-L1: No significant spinal canal or neural foraminal stenosis.\n\nL1-L2: Ligamentum flavum hypertrophy results in mild spinal canal narrowing\nand no significant neural foraminal stenosis.\n\nL2-L3: There is trace fluid in the bilateral facet joints, which is likely\ndegenerative in nature. Facet joint arthropathy and posterior disc bulge\nresults in mild spinal canal narrowing and moderate right greater than left\nneural foraminal narrowing.\n\nL3-L4: Large central disc bulge, ligamentum flavum hypertrophy, and facet\njoint arthropathy are demonstrated. This results in anterior impression upon\nthe thecal sac resulting in severe spinal canal and bilateral neural foraminal\nnarrowing.\n\nL4-L5: Posterior disc bulge, ligamentum flavum hypertrophy, and facet joint\narthropathy result in moderate to severe spinal canal narrowing and moderate\nbilateral neural foraminal narrowing.\n\nL5-S1: Minimal disc bulge and facet joint arthropathy. No significant spinal\ncanal or neural foraminal narrowing.", "output": "1. Increased edema signal involving the L2-L3 endplates and intervertebral\ndisc space associated with increased prevertebral thickening of the anterior\nlongitudinal ligament is incompletely evaluated on current exam and may\nreflect an underlying inflammatory process, however discitis is not entirely\nexcluded. Recommend repeat MRI lumbar spine with contrast for further\nclarification.\n2. Multilevel degenerative changes of the lumbar spine are worse at L3-L4\nwhere there is severe spinal canal and bilateral neural foraminal narrowing. \nNo cord signal abnormalities are seen.\n3. Anterolisthesis of L4 on L5 is not substantially changed compared to CT\nabdomen pelvis performed ___ and is associated with bilateral L5\npars defects.\n\nRECOMMENDATION(S): Increased edema signal involving the L2-L3 endplates and\nintervertebral disc space associated with increased prevertebral thickening of\nthe anterior longitudinal ligament is incompletely evaluated on current exam\nand may reflect an underlying inflammatory process, however discitis is not\nentirely excluded. Recommend repeat MRI lumbar spine with contrast for further\nclarification.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:26 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Unchanged grade 1 anterolisthesis of L4 on L5 with bilateral L5 pars defects.\n\nAgain identified is the ill-defined T1 hypointensity involving the anterior\ninferior aspect of the L2 endplate and superior aspect of the L3 endplate\nwhich again demonstrate increased bone marrow edema. The increased edema\nwithin the L2-L3 disc space is unchanged. On the postcontrast images, there\nis enhancement of these regions. Unchanged increased prevertebral thickening\nof the anterior longitudinal ligament at L2-L3 which demonstrates partial\nenhancement on the contrast-enhanced images. There is no enhancement of the\ndisc to indicate or suggest discitis.\n\nThe spinal cord is normal in caliber and configuration. The conus terminates\nnormally at the T12-L1 level. The cauda equina nerve roots appear\nunremarkable. There is no abnormal enhancement after contrast administration.\n\nAt T12-L1, no significant spinal canal or neural foraminal stenosis.\n\nAt L1-L2, there is ligamentum flavum hypertrophy which result in mild spinal\ncanal stenosis but no significant neural foraminal narrowing.\n\nAt L2-L3, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions, mild spinal canal stenosis and moderate bilateral\nneural foraminal narrowing, right greater than left.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, severe spinal canal stenosis and severe bilateral neural foraminal\nnarrowing.\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, severe spinal canal stenosis and moderate bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is a disc bulge, facet joint arthropathy but no significant\nspinal canal stenosis or neural foraminal narrowing.", "output": "1. Unchanged increased bone marrow edema involving the L2-L3 endplates and\nintervertebral disc space with enhancement of the L2-L3 endplates but no\nenhancement within the disc space, which is consistent with degenerative\nchanges., There is no evidence of discitis.\n2. Stable prevertebral thickening of the anterior longitudinal ligament at\nL2-L3 each demonstrates partial enhancement after contrast administration.\n3. Unchanged multilevel degenerative changes of the lumbar spine, most\npronounced at L3-L4 where there is severe spinal canal doses and severe\nbilateral neural foraminal narrowing. No cord signal abnormality.\n4. Stable anterolisthesis of L4 on L5 with bilateral L5 pars defects." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is minimal C3 on C4 retrolisthesis, grossly similar to ___\nprior cervical spine CT. Vertebral body heights are grossly preserved. \nProbable type ___ ___ changes at the C3-4 endplates is noted without definite\nassociated epidural collection.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc height and signal throughout cervical\nspine.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, deformation of ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, moderatevertebral canal, moderate\nright and mild leftneural foraminal narrowing.\n\nAt C4-5 there is disc bulge, facet joint hypertrophy, uncovertebral\nhypertrophy, ligamentum flavum hypertrophy, deformation of ventral thecal sac\nand spinal cord definite associated cord signal abnormality, moderate to\nseverevertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, facet joint hypertrophy, uncovertebral\nhypertrophy, mildvertebral canaland severe bilateralneural foraminal\nnarrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, mildvertebral canal, severe right and mild leftneural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. The visualized portion of the cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved. Question partial thrombosis\nof right proximal V3 segment versus artifact (see 6, ___ 3, 4, 05:10). \nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by size criteria. Partially\nvisualized is patient's known multinodular goiter with at least 1 nodule\nmeasuring up to 6 mm (see 1627).", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of cervical spinal cord\nlesion.\n3. C3-4 and C4-5 deformation of ventral thecal sac and spinal cord definite\nassociated cord signal abnormality.\n4. Multilevel cervical spondylosis as described, most pronounced at C4-5,\nwhere there is moderate to severe vertebral canal and moderate bilateral\nneural foraminal narrowing.\n5. C3-4 moderate vertebral canal, moderate right and mild left neural\nforaminal narrowing.\n6. C5-6 severe and C6-7 severe right neural foraminal narrowing.\n7. Question partial thrombosis of right proximal V3 segment versus artifact. \nIf clinically indicated, consider head CTA for further evaluation.\n8. Partially visualized is patient's known multinodular goiter. If clinically\nindicated, consider correlation with thyroid ultrasound.\n9. Nonspecific subcentimeter lymph nodes as described, which may be reactive.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 19:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Vertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are identified. The distal spinal cord\nappears unremarkable, with the conus medullaris terminating near the lower\nendplate of L1.\n\nT12-L1 through L3-4 levels appear unremarkable.\n\nAt L4-5, there is a minimal disc bulge and mild, left greater than right,\nfacet arthropathy. The neural foramina are mildly narrowed, and bilateral\nexiting L4 nerve roots may be contacted.\n\nAt L5-S1, there is no spinal canal or neural foraminal narrowing.", "output": "Mild bilateral L4-5 neural foraminal narrowing, possibly contacting bilateral\nexiting L4 nerve roots." }, { "input": "2 mm retrolisthesis of L3 on L4 is similar to prior examination. Otherwise,\nlumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno focal suspicious marrow lesion. ___ type 1 L3-L4 endplate changes are\nidentified. End of loss of disc height and signal at L2-L3 through L5-S1 is\nmild. The conus medullaris terminates at the L1 level, within expected\nlimits. There is no signal abnormality of the visualized terminal cord or\nconus medullaris.\n\nL1-L2: No significant spinal canal or neural foraminal narrowing.\n\nL2-L3: A disc bulge slightly eccentric to the left does not significantly\nnarrow the spinal canal. There is no significant neural foraminal narrowing.\n\nL3-L4: A disc bulge results in mild spinal canal narrowing, minimally\ncrowding the subarticular zones without posteriorly displacing the traversing\nnerve roots. In conjunction with facet arthropathy, there is moderate right\nand mild left neural foraminal narrowing.\n\nL4-L5: A disc bulge crowds subarticular zones without displacing the\ntraversing nerve roots. There are small bilateral facet joint effusions. In\ncombination with facet arthropathy in the disc bulge results in mild bilateral\nneural foraminal narrowing.\n\nL5-S1: A left eccentric disc bulge does not significantly narrow the spinal\ncanal. In conjunction with facet arthropathy, there is mild right and severe\nleft neural foraminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable. .", "output": "1. Multilevel degenerative changes as described above, most prominent at L3-L4\nwhere there is moderate right neural foraminal narrowing and at L5-S1 where\nthere is severe left neural foraminal narrowing. No high-grade spinal canal\nnarrowing is identified.\n2. Additional findings as described above." }, { "input": "There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nMild, grade 1 retrolisthesis of L3 on L4 is unchanged. The remainder of the\nsagittal spinal alignment is maintained. The conus medullaris terminates at\nthe level of L1-L2. There is no signal abnormality of the terminal cord.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: There is a posterior disc bulge which flattens the ventral thecal sac\nand combines with thickening of the ligamentum flavum without significant\nspinal canal stenosis. There is mild left neural foraminal narrowing.\n\nL3-L4: A posterior disc bulge flattens the ventral thecal sac and combines\nwith facet hypertrophy and thickening of ligamentum flavum to result in mild\nspinal canal stenosis with moderate right and mild left neural foraminal\nnarrowing.\n\nL4-L5: A posterior disc bulge with bilateral extraforaminal annular fissures\ncombines with facet hypertrophy to result in mild canal stenosis with\nmild-to-moderate bilateral neural foraminal narrowing.\n\nL5-S1: A left central to foraminal zone disc protrusion, new from prior exam,\nseverely crowds the left subarticular zone, posteriorly displacing and likely\nimpinging on the traversing left S1 nerve root (series 5, image 34). In\nconjunction with facet arthropathy, this results in severe left neural\nforaminal narrowing, impinging on the exiting left L5 nerve root (series 2,\nimage 5). There is mild right neural foraminal narrowing. The left 5 neural\nforaminal narrowing has progressed from prior exam.\n\nThe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. At L5-S1, a new left central to foraminal zone disc protrusion severely\ncrowds the left subarticular zone posteriorly displacing and presumably\nimpinging on the traversing left S1 nerve root. In conjunction with facet\narthropathy, this also results in severe left neural foraminal narrowing,\nworsened from prior exam, impinging on the exiting left L5 nerve root.\n2. Additional lumbar spondylosis is overall similar to prior examination.\n3. Additional findings as described above." }, { "input": "The patient is status post left L5-S1 hemilaminotomy since prior examination\nof ___. Mild enhancing granulation tissue is noted along the\nsurgical bed extending to the left lateral epidural space. There is a\nrecurrent disc protrusion (series 7, image 8; series 8, image 35) which\nimpinges on the traversing left S1 nerve root. In conjunction with facet\narthropathy, there is mild-to-moderate left-greater-than-right neural\nforaminal narrowing, overall similar to prior exam. No evidence of fluid\ncollection within the surgical bed.\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. Mild\n___ type 1 L5-S1 endplate changes is identified, new from prior examination.\nOtherwise, no suspicious marrow lesion. Degenerative loss of disc height and\nsignal is mild to moderate spanning L2-L3 through L5-S1, overall similar to\nprior examination. The conus medullaris terminates at the L1 level, within\nexpected limits. There is no abnormal signal or enhancement of the terminal\ncord, conus medullaris or cauda equina.\n\nT11-T12 through L2-L3: No significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is mild right greater than left\nneural foraminal narrowing, unchanged from prior exam.\n\nL4-L5: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is mild bilateral neural foraminal\nnarrowing. A 5 mm posterior projecting left facet synovial cyst is unchanged.\n\nL5-S1: See above.\n\nAllowing for postoperative findings, the prevertebral paraspinal soft tissues\nare unremarkable.", "output": "1. The patient is status post interval left L5-S1 hemilaminotomy and\nmicrodiscectomy since examination of ___. There is a recurrent\ndisc protrusion, impinging on the traversing left S1 nerve root.\n2. There remains mild to moderate left-greater-than-right neural foraminal\nnarrowing at L5-S1.\n3. Enhancing postoperative granulation tissue along the surgical tract, ending\nalong the left lateral epidural space at L5-S1, without evidence of fluid\ncollection.\n4. Additional findings described above." }, { "input": "The imaged lumbar vertebral bodies demonstrate normal alignment and preserved\nheight. No concerning focal marrow signal abnormalities. Height and signal\nloss of the L2-3, L3-4, L4-5, and L5-S1 intervertebral discs is consistent\nwith degenerative change. High T2/STIR signal in the mid and posterior\nportion of the L5-S1 intervertebral disc is in keeping with postsurgical\nchanges, seen on prior study (03:11).\n\nThe distal spinal cord and conus medullaris is unremarkable. Cauda equina\nnerve roots within normal limits.\n\nA T12-L1 and L1-2 there is no spinal canal or neural foraminal narrowing.\n\nAt L2-3, there is a mild posterior disc bulge (100:50) which is unchanged. No\nspinal canal or neural foraminal narrowing at this level.\n\nAt L3-4, there is mild spinal canal narrowing due to a combination of\nposterior disc bulge, facet osteophytes, and ligamentum flavum thickening,\nunchanged from prior (100:69). Disc bulge causes mild right neural foraminal\nnarrowing which is unchanged from prior (4:5).\n\nAt L4-5, there is a posterior disc bulge which does not cause significant\nspinal canal narrowing. A combination of disc bulge and facet osteophytes\nresult and minimal/mild bilateral neural foraminal narrowing which is\nunchanged.\n\nAt L5-S1, the patient is status post interval microdiskectomy of the\npreviously demonstrated recurrent left disc protrusion. Compared with prior,\nthere is increased enhancing epidural fibrosis occupying the left aspect of\nthe spinal canal at this level, occupying the lateral recess in the site of\nthe previously demonstrated recurrent disc, and extending into the\nproximal/central left neural foramen (series 5 and 7, image 34). No recurrent\ndisc is identified. The fibrosis surrounds/encases the traversing left S1\nnerve root.\n\nPostsurgical changes including left L5-S1 hemilaminectomy defect and soft\ntissue susceptibility foci from posterior approach are again noted at the\nlevel of L5-S1.", "output": "1. Increased epidural fibrosis at L5-S1 in the left spinal canal now occupying\nthe lateral recess at the site of previously demonstrated recurrent disc\nprotrusion, encasing the traversing left S1 nerve root. No recurrent disc\nidentified status post interval revision microdiscectomy this level.\n2. Stable mild discogenic lumbar spine degenerative changes at L2-3, L3-4, and\nL4-5." }, { "input": "There is scoliosis of lumbar spine convex to the right in the lower lumbar and\nto the left in the upper lumbar region.\n\nFrom T11-12 through L2-3 levels disc degenerative change and mild bulging\nseen.\n\nAt L3-4 level, disc bulging is identified facet degenerative changes resulting\nin moderate right-sided and mild-to-moderate left-sided foraminal narrowing.\n\nAt L4-5 there is disc and all there are degenerative changes seen. There is\nthickening of the ligaments predominantly on the left side. There is severe\nleft subarticular recess and mild to moderate right subarticular recess\nnarrowing with mild-to-moderate spinal stenosis. There is a foraminal disc\nherniation with severe narrowing of the left foramen and compression of the\nexiting left L4 nerve root. Degenerative changes at L4-5 level have\nprogressed since the previous MRI examination.\n\nAt L5-S1 level disc bulging is seen with mild narrowing of the right and\nmoderate to severe narrowing of the left foramen.", "output": "Progression of degenerative changes since the previous MRI of ___. Severe\nleft subarticular recess narrowing at L4-5 level with severe left foraminal\nnarrowing could affect the left L5 and L4 nerve roots. Moderate-to-severe\nleft foraminal narrowing at L5-S1 level and also affect the L5 nerve root" }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Degenerative loss of disc height is mild at L3-L4\nand L4-L5, with associated loss of disc signal. There is transitional anatomy\nof L5. The conus medullaris terminates at the inferior endplate of L1, within\nexpected limits. There is no signal abnormality of the terminal cord.\n\nT10-T11 through L2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. In\ncombination with facet arthropathy there is minimal bilateral neural foraminal\nnarrowing.\n\nAt L4-5, a left central to foraminal zone disc protrusion (series 400, image\n61) contacts and posteriorly displaces the traversing left L5 nerve root. \nThere is no significant spinal canal narrowing. In conjunction with facet\narthropathy, there is minimal left and no significant right neural foraminal\nnarrowing.\n\nAt L5-S1 there is no vertebral canal or neural foraminal stenosis.\n\nVisualized on the localizer images only, there is a 0.6 cm T2 hyperintense\nlesion in the region of the right kidney, likely representing a simple cyst. \nMajor the visualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Moderate degenerative changes at L4-L5 with asymmetric left-sided disc\nprotrusion which likely impinges on the traversing left L5 nerve root.\n2. There is no high-grade spinal canal or neural foraminal narrowing.\n3. Additional findings described above." }, { "input": "Exam is somewhat motion limited, particularly on the sagittal T1 weighted\nimages, and only contains sagittal images. Following observations are noted:\n\nExtensive prevertebral hematoma seen spanning from essentially the skullbase\nto C5. There is disruption of the anterior longitudinal ligament at the C3-C4\nlevel (6:8).\n\nThere is T2/ STIR hyperintensity in the region of the interspinous ligaments\nspanning C2-3 through C5-6 worrisome for ligamentous injury. Swelling seen in\nthe adjacent paraspinal musculature at these levels as well.\n\nThere is fluid within the bilateral C1-C2 joints (06:15 and 2). While this\ncould be degenerative, ligamentous injury at this level cannot be entirely\nexcluded.\n\nBased on sagittal images, there is no cord signal abnormality. Included\nportion of the posterior fossa is unremarkable.\n\nMucosal thickening is noted in the right maxillary sinus. .", "output": "Limited exam due to motion and only sagittal images were acquired as this\npatient could not tolerate completing the exam.\nDisruption of the anterior longitudinal ligament at C4-C5 with prevertebral\nhematoma.\nInterspinous ligamentous injury spanning C2-3 through C5-6.\nFluid within the C1-C2 articulations. While this could be degenerative,\nligamentous injury involving this joint is not entirely excluded." }, { "input": "Numbering assumes 5 lumbar type vertebrae.\n\nVertebral body alignment is unremarkable. There is no evidence of an acute\nfracture or dislocation. There is no marrow signal abnormality to suggest\nosteomyelitis or malignancy. There is no abnormal enhancement.\n\nThe visualized spinal cord is preserved in signal and caliber.\n\nThere is disc desiccation and loss of intervertebral height at L5-S1. \nOtherwise the intervertebral body heights are grossly preserved.\n\nAt the T12-L5 level, there is no significant disc disease, spinal canal or\nneural foraminal narrowing.\n\nAt L5-S1, there is a small disc bulge, and mild bilateral facet arthropathy\nwithout significant spinal canal narrowing. There is mild left and no\nsignificant right neural foraminal narrowing. The disc bulge in the left\nneural foramina remodels the undersurface of the exiting left L5 nerve root\n(series 2, image 10).\n\nThere is no paravertebral or paraspinal soft tissue abnormality. No evidence\nof fluid collection or abscess formation.", "output": "1. No evidence of osteomyelitis or abscess formation in the lumbar spine. No\nsuspicious marrow signal.\n2. Very mild lumbar spondylosis most prominent at L5-S1 where disc bulge\nresults in mild left neural foraminal narrowing. The disc bulge contacts and\nremodels the undersurface of the exiting left L5 nerve root in the neural\nforamina. Clinical correlation with patient symptoms is recommended." }, { "input": "Thoracic alignment is anatomic. Vertebral body heights are preserved. No\nfocal suspicious marrow lesion. Scattered fatty rests and hemangiomas are\nidentified, most prominent noted at the T7, T10 and T11. Disc heights are\npreserved. There is no abnormal cord signal. Minimal scattered degenerative\nchanges characterized by small disc protrusions are identified without spinal\ncanal or neural foraminal narrowing.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable. Limited\nevaluation of the cervical spine on T1 sagittal counting sequences\ndemonstrates no gross abnormality.", "output": "1. Mild thoracic degenerative changes characterized by small disc protrusions\nwithout spinal canal or neural foraminal narrowing.\n2. There is no cord signal abnormality.\n3. Additional findings described above." }, { "input": "Vertebral body heights are preserved. No spondylolisthesis. No evidence for\nsuspicious bone marrow signal abnormalities.\n\nWith regard to the reported \"fusion of C2-C5\", there is no evidence for ACDF. \nDisc heights appear within normal limits. No bulky ossification of the\nanterior longitudinal ligament is seen, though thin marginal ossification of\nthe anterior longitudinal ligament from C2 through C5 cannot be excluded.\n\nNo evidence for signal abnormalities in the cervical or included upper\nthoracic spinal cord. No evidence for pathologic contrast enhancement.\n\nThe cerebellar tonsils are normally positioned. No signal abnormalities are\nseen in the included portions of the posterior fossa.\n\nC2-C3: No spinal canal narrowing. Minimal left neural foraminal narrowing by\nfacet osteophytes.\n\nC3-C4: No significant spinal canal narrowing. Mild-to-moderate bilateral\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Shallow broad-based endplate osteophytes without significant spinal\ncanal narrowing. Mild left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Shallow left paracentral disc protrusion minimally indents the ventral\nthecal sac without spinal cord contact. Mild bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Left paracentral disc herniation extending below the disc space, and\noverlying endplate osteophytes, which approach but do not definitively remodel\nthe ventral spinal cord. Mild-to-moderate spinal canal narrowing. Moderate\nto severe right and severe left neural foraminal narrowing.\n\nC7-T1: There is a shallow left paracentral disc protrusion, as well as\nbroad-based endplate osteophytes which are larger on the left than right. The\nventral thecal sac is minimally indented without spinal cord contact. No\nneural foraminal narrowing.\n\nT1-T2: Sagittal images demonstrate a disc herniation extending superiorly\nwhich mildly indents the ventral thecal sac without spinal cord contact. No\naxial images through this level. No evidence for high-grade neural foraminal\nnarrowing.\n\nBilateral prominent nonenlarged level 5 B lymph nodes are noted, 7 mm on the\nright on image 9:16 and 9 mm on the left on image 9:20.", "output": "1. Multilevel cervical degenerative disease.\n2. At C6-C7, a left paracentral disc herniation with endplate osteophytes\napproach but do not definitively remodel the ventral spinal cord, causing\nmild-to-moderate spinal canal narrowing.\n3. Neural foraminal narrowing appears moderate to severe on the right and\nsevere on the left at C6-C7, and milder at other levels, as detailed above.\n4. No evidence for spinal cord signal abnormalities or pathologic contrast\nenhancement." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere are Schmorl's nodes at the inferior endplates of L1 and L3 as well as\nthe superior endplate of L3. There is otherwise no marrow signal abnormality.\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the proximal L1 level.\n\nThere is loss of T2 signal of the L4-L5 and L5-S1 intervertebral discs, a\nmanifestation of degenerative disc disease. There is mild intervertebral disc\nheight loss at L5-S1, unchanged.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nSagittal view of the T11-T12, T12-L1, and L1-L2 levels demonstrate no\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-4 there is trace disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L4-5 there is mild disc bulge indenting the ventral thecal sac without\nsignificant spinal canal or neural foraminal narrowing. There is mild\neffacement of the subarticular zones, with encroachment upon but without\ndefinite compression of the traversing nerve roots. There are mild bilateral\nfacet joint degenerative changes with small effusions.\n\nAt L5-S1 there is trace central disc protrusion without significant spinal\ncanal or neural foraminal narrowing. There are mild bilateral facet joint\ndegenerative changes with trace effusions.\n\nWith the exception of mildly increased facet joint degenerative changes at\nL4-L5 and L5-S1, the degree of degenerative changes largely similar to the ___ examination.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Mild lumbar spondylosis, as described, largely unchanged compared to ___ with the exception of mildly increased facet degenerative change at L4-L5\nand L5-S1 with trace effusions. There remains encroachment upon the\ntraversing bilateral L5 nerve roots without definite compression.\n2. No significant spinal canal or neural foraminal narrowing.\n3. No terminal cord signal abnormality." }, { "input": "From T11-12 through L3-4 levels no significant abnormalities are seen.\n\nAt L4-5 level, central annular tear and disc bulging and a broad-based central\nprotrusion identified slightly extending to the right side of the midline. \nThere is mild-to-moderate narrowing of the right subarticular recess. The\ndisc protrusion contacts the right L5 nerve root without displacement. There\nis no spinal stenosis. The neural foramina are patent.\n\nAt L5-S1 level, no abnormalities are seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Overall no significant interval change since the previous MRI examination of ___ in small slight sided protrusion at L4-5 level with annular tear\nand narrowing of the right subarticular recess. No spinal stenosis seen. No\nsignificant new abnormalities." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is approximately 4 mm grade 1 retrolisthesis of L5 in relation to S1.\nVertebral body heights are preserved. Multifocal type ___ ___ changes are seen\nthroughout lumbar spine. Mixed type 1 and type ___ ___ changes are seen at\nthe L5-S1 endplates. Schmorl's nodes are seen at multiple levels throughout\nlumbar spine. L5 vertebral body probable hemangioma is noted.\n\nThere is filum terminale lipoma, with maximum AP dimension of approximately 2\nmm (see 3:9), most visible at the L2-L4 levels. The conus is identified at\nthe L1-2 level (see 05:10). Otherwise the visualized portion of the spinal\ncord is grossly preserved in signal and caliber.\n\nThere is multilevel disc desiccation with loss of intervertebral disc height,\nmore pronounced at T12-L1, L2-L3, and L5-S1. Nonspecific facet joint fluid is\nnoted at multiple levels of the lumbar spine.\n\nAt T12-L1 there is facet joint hypertrophy, ligamentum flavum thickening,\npleural fat, with novertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, mildvertebral canal and no neural foraminal\nnarrowing.\n\nAt L2-3 there is disc bulge with question contact of bilateral descending L3\nnerve roots, bilateral facet joint hypertrophy, and ligamentum flavum\nhypertrophy with mild vertebral canal and no neural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mildvertebral canaland mild leftneural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge, ligamentum flavum hypertrophy, bilateral joint\nfacet hypertrophy with question contacts bilateral exiting L4 nerve roots with\nmild vertebral canal and mild bilateral neural foraminal narrowing.\n\nAt L5-S1 there is central disc protrusion, disc bulge, bilateral facet\nhypertrophy, ligamentum flavum hypertrophy resulting in minimal effacement of\nthe ventral thecal sac with mild vertebral canal and moderate bilateral neural\nforaminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel cervical spondylosis epidural fat as described, most pronounced\nat L5-S1, where there is mild vertebral canal and moderate bilateral neural\nforaminal narrowing." }, { "input": "There is anatomic alignment. The signal intensity of the vertebral bodies\nappears normal. Visualized spinal cord is normal in signal, caliber and\nconfiguration. There is crowding of the cauda equina nerve roots at the level\nof L4-L5 secondary to severe spinal canal stenosis as described below. There\nis no evidence of infection or neoplasm. Multilevel degenerative changes,\ndiffuse disc bulges, and advanced lower lumbar facet arthritis most prominent\nat L4-5, L5-S1 levels with facet joint effusions.\n\nPatent canal and neural foramina at T12-L1 and L1-L2.\nL2-L3: Asymmetric left disc bulging results in mild crowding of the left\nsubarticular zone, mild left neural foraminal narrowing and mild spinal canal\nstenosis. Right foramen is patent.\nL3-L4: Left paracentral disc extrusion extending into the left lateral recess\nextends 2.0 cm below endplate, measures 0.6 cm in AP diameter. There is mass\neffect on traversing left L4 nerve. Moderate spinal canal stenosis, with\nincomplete effacement of CSF. Mild-to-moderate bilateral neural foraminal\nnarrowing.\nL4-L5: Severe spinal canal stenosis, near complete effacement of CSF. Mild to\nmoderate right, mild left foraminal narrowing.\nL5-S1: Patent canal canal. Mild right and moderate left foraminal narrowing\nsagittal image 13.\n\nOther: Right kidney is not identified. There is moderate fatty replacement of\nthe left psoas and left iliacus muscles, likely related to chronic left hip\ndisease in hip arthroplasty. Which is partially seen on scout images.", "output": "1. Degenerative changes.\n2. Severe central canal narrowing at L4-5 level.\n3. Large disc extrusion at L3-L4 extends into the left lateral recess and\nexerts mass effect on traversing left L4 nerve.\n\nRECOMMENDATION(S): The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 10:04, 10 minutes\nafter discovery of the findings." }, { "input": "CERVICAL:\nAlignment is normal.There are mild changes of degenerative disc disease with\nloss of height of the intervertebral discs and loss of signal on the T2\nweighted images.\n\nAxial images at C2-3 and C3-4 demonstrate no significant abnormalities.\n\nAt C4-5, intervertebral osteophytes and disc bulging slightly flatten the\nanterior surface of the spinal cord. Uncovertebral osteophytes produce\nmoderate bilateral neural foraminal narrowing.\n\nAt C5-6, intervertebral osteophytes narrow the spinal canal and flatten the\nspinal cord, greater on the right than left. Right-sided uncovertebral\nosteophytes produce severe right neural foraminal narrowing.\n\nAt C6-7, intervertebral osteophytes narrow the spinal canal and uncovertebral\nosteophytes produce mild -moderate bilateral foraminal narrowing spinal cord\nsignal intensity appears normal.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal.There are mild changes of degenerative disc disease with\nloss of signal of the intervertebral discs on the T2 weighted images. \nProminent ligamentum flavum encroaches on the spinal canal at T9-10, T10-11,\nand T11-12. There is no spinal cord compression.", "output": "1. Degenerative disc disease in the cervical and thoracic spines as discussed\nabove." }, { "input": "Postoperative changes are identified at C5-6 level with anterior fusion. Disc\nbulging is identified at the C4-5 level with moderate narrowing of the left\nforamen. There is mild indentation on the thecal sac. At C5-6 no spinal\ncanal narrowing is seen. Mild narrowing of the left foramen seen. At C6-7\nlevel, severe right-sided and moderate to severe left-sided foraminal\nnarrowing is identified with posterior disc bulging slightly indenting the\nthecal sac.\n\nIts C7 C7-T1 and T1-2 mild disc degenerative change seen. At T2-3 level, disc\nbulging seen indenting the thecal sac.\n\nThere is atrophy and increased signal within the spinal cord at C5-6 level\nindicative of myelomalacia. No extrinsic compression of the spinal cord is\nseen. No abnormal enhancement seen.", "output": "1. Postoperative changes are seen in the cervical spine at C5-6 level with\npatent spinal canal but with disc bulging indenting the thecal sac at C4-5\nC6-7 and T2-3 levels. No extrinsic spinal cord compression.\n2. Severe right-sided and moderate to severe left-sided foraminal narrowing at\nC6-7 level.\n3. Cord atrophy and myelomalacia at C5-6 level." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nAlignment is normal. There is a 1.0 cm rounded focus of T2 and water-IDEAL\nhyperintensity within the L1 vertebral body that is predominantly T1\nhypointense but does demonstrate T1 hyperintense striations. Marrow signal is\notherwise unremarkable. The distal thoracic spinal cord is normal in course,\ncaliber, and signal. The conus is normal in appearance and position,\nterminating at L1-2.\n\nIntervertebral discs are normal in height and signal.\n\nT12-L1: There is no disc herniation or spinal canal stenosis. There is facet\narthropathy but no neural foraminal stenosis.\n\nL1-2: There is no disc herniation or spinal canal stenosis. There is facet\narthropathy but no neural foraminal stenosis.\n\nL2-3: There is no disc herniation or spinal canal stenosis. There is facet\narthropathy but no neural foraminal stenosis.\n\nL3-4: There is a mild diffuse disc bulge, asymmetric to the left, it\nligamentum flavum thickening, and facet arthropathy. There is left\nsubarticular zone narrowing and mild left neural foraminal narrowing.\n\nL4-5: There is a mild diffuse disc bulge, asymmetric to the left, and facet\narthropathy. There is bilateral subarticular zone narrowing and mild left\nneural foraminal narrowing.\n\nL5-S1: There is no disc herniation. There is no spinal canal or neural\nforaminal narrowing.\n\nThere is a 7 mm oval, well circumscribed T2 hyperintensity within the right\nlobe of the liver(series 6, image 6).\n\nThere is a 9 mm round, well-defined T2 hyperintensity within the interpolar\nregion of the left kidney (series 6, image 11).", "output": "1. No cord compression or high-grade spinal canal stenosis.\n2. Left L3-4 and bilateral L4-5 subarticular zone narrowing and mild left\nneural foraminal narrowing at L3-4 and L4-5 due to mild diffuse disc bulges\nand facet arthropathy.\n3. 7 mm right hepatic lobe at least partially cystic nonspecific lesion. \nWhile finding may represent a cyst, other etiologies are not excluded on the\nbasis of this examination.\n4. Approximately 9 mm left renal at least partially cystic structure. While\nfinding may represent a cyst, other etiologies are not excluded on the basis\nof this examination.\n5. Approximately 1 cm L1 vertebral body structure, with at least partially\nfatty striations as described. While finding may represent a lipid poor\nhemangioma, other etiologies are not excluded on the basis examination.\n\nRECOMMENDATION(S): RE 3: Recommend clinical correlation. If clinically\nindicated, further evaluation may be obtained via dedicated hepatic imaging..\n\nRE 4: Recommend clinical correlation. If clinically indicated, further\nevaluation may be obtained via dedicated renal ultrasound..\n\nRE 5: Recommend clinical correlation. If clinically indicated, further\nevaluation may be obtained via lumbar spine x-ray.." }, { "input": "Alignment is normal. Vertebral bodies are normal in height and signal. There\nis minimal disc desiccation at the L4-L5 and L5-S1 levels with subtle loss of\nintervertebral disc height. Otherwise, the intervertebral discs are normal in\nheight and signal.\n\nThe visualized distal spinal cord and conus medullaris are normal. The conus\nmedullaris terminates at L1-L2.\n\nThere is no evidence of infection or neoplasm.\n\nFrom T11-T12 through L3-L4, there is no disc bulge, there is no spinal canal\nor neural foraminal stenosis.\n\nAt L4-L5, there is a minimal disc bulge with a subtle posterior annular\nfissure. There is mild narrowing of the spinal canal and subarticular\nrecesses, left more than right. However, there is no compression of the\ntraversing nerve roots. There is minimal bilateral neural foraminal\nnarrowing.\n\nAt L5-S1, there is a minimal disc bulge. There is no significant narrowing of\nthe spinal canal. There is mild left and minimal right neural foraminal\nnarrowing.", "output": "1. Mild degenerative changes in the lower lumbar spine with no evidence of\nnerve root compression." }, { "input": "The examination is moderately degraded by motion.\n\nThere are 6 non-rib-bearing vertebral bodies. The first non rib-bearing\nvertebral body is labeled L1.\n\nPatient is status-post L3-L5 laminectomies and posterior fusion.\n\nThere is unchanged grade 1 anterolisthesis of L3 on L4. There is an unchanged\nvery mild kyphotic curvature of the lumbar spine between L4 and L6. Mild L6\nvertebral body height loss is unchanged. No evidence of fracture. There is\nmild multilevel intervertebral disc height and signal intensity loss, height\nloss worst at L3-L4 and L4-L5. There are ___ type 2 marrow signal changes\nat L5-L6 and L6-S1. There is thickening, clumping, and mild enhancement of\nthe cauda equina nerve roots.\n\n T12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: A central disc protrusion and ligamentum flavum thickening result in\nsevere spinal canal narrowing and cord compression. There may be increased T2\nsignal within the conus. There is mild bilateral neural foraminal narrowing.\n\nL2-L3: A disc bulge, facet arthropathy, and ligamentum flavum thickening\nresult in severe spinal canal narrowing. There is mild right and moderate to\nsevere left neural foraminal narrowing.\n\nL3-L4: There is grade 1 anterolisthesis with minimal spinal canal narrowing.\n\nL4-L5: No significant spinal canal or neural foraminal narrowing.\n\nL5-L6: A disc bulge result in mild spinal canal and mild bilateral neural\nforaminal narrowing.\n\nL6-S1: A disc bulge and ligamentum flavum thickening in minimal spinal canal\nand mild bilateral neural foraminal narrowing.\n\nOTHER: Simple appearing right renal cysts.", "output": "1. The examination is moderately degraded by motion.\n2. A central disc protrusion and ligamentum flavum thickening result in severe\nspinal canal narrowing and compression of the conus medullaris at L1-L2,\npossibly with increased fluid signal within the conus medullaris.\n3. A disc bulge, facet arthropathy, and ligamentum flavum thickening result in\nsevere spinal canal narrowing at L2-L3.\n4. Arachnoiditis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:33 pm, approximately\n15 minutes after discovery of the findings.\n\nThe MRI technologist was advised to offer transfer from ___ to the\nEmergency Department by ambulance. The patient reportedly declined ambulance\ntransport and has arranged for alternative transportation.\n\nThe patient was referred to the emergency department with relevant clinical\ninformation through the ED dashboard \"\"referral system." }, { "input": "Postcontrast sagittal T1 weighted images are severely degraded by motion\nartifact. All of the axial images are mildly to moderately degraded by motion\nartifact. Precontrast sagittal images are mildly limited by motion artifact.\n\nThe localizer sequence demonstrates a mild dextroconvex curvature of the\ncervical spine, not seen on the CT from ___, possibly positional. \nThere is unchanged mild anterolisthesis of C3 on C4.Cervical vertebral body\nheights are preserved. Mild T3 superior endplate deformity is unchanged\ncompared to ___. There is no evidence for suspicious bone marrow\nlesions. Allowing for motion artifact, there is no evidence for epidural or\nleptomeningeal metastatic disease. There is no evidence for spinal cord\nsignal abnormalities.\n\nThe cerebellar tonsils are normally positioned. The craniocervical junction\nappears unremarkable. Concurrent brain MRI is reported separately.\n\nC2-C3: No spinal canal narrowing. Bilateral facet arthropathy. Questionable\nmild left neural foraminal narrowing, not seen on the prior CT, versus\nartifact of dextroconvex cervical curvature.\n\nC3-C4: Mild anterolisthesis with an uncovered disc. Small central disc\nprotrusion and infolding of the ligamentum flavum cause mild narrowing of the\nthecal sac without evidence for spinal cord remodeling. Mild bilateral neural\nforaminal narrowing by uncovertebral and facet osteophytes is suspected on\nmotion limited evaluation.\n\nC4-C5: Shallow central endplate osteophytes indent the ventral thecal sac\nwithout spinal cord remodeling or significant spinal canal narrowing. Mild\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes is\nsuspected on motion limited evaluation.\n\nC5-C6: Small central endplate osteophytes mildly indent the ventral thecal sac\nwithout spinal canal narrowing or cord remodeling. Mild-to-moderate right\nneural foraminal narrowing by uncovertebral and facet osteophytes is suspected\non motion limited evaluation. No significant left neural foraminal narrowing\nseen.\n\nC6-C7: No significant spinal canal narrowing. Moderate right and mild left\nneural foraminal narrowing by uncovertebral and facet osteophytes is suspected\non motion limited evaluation.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing seen.", "output": "1. Motion limited exam.\n2. No evidence for osseous, epidural, or leptomeningeal metastatic disease.\n3. Unchanged mild anterolisthesis at C3-C4, with an uncovered disc, small disc\nprotrusion, and infolding of the ligamentum flavum, causing mild narrowing of\nthe thecal sac without evidence for spinal cord remodeling. No significant\nspinal canal narrowing at other levels.\n4. Multilevel neural foraminal narrowing, suboptimally assessed due to motion\nartifact, which appears moderate at C6-C7 on the right, and mild-to-moderate\nat C5-6 bilaterally." }, { "input": "Prior CT chest demonstrates 12 rib-bearing vertebrae. Prior CT abdomen/pelvis\ndemonstrates 5 lumbar-type vertebrae and a partially lumbarized S1.\n\nVertebral body heights are preserved. There is grade 1 anterolisthesis of L5\non S1 there is a 8 mm trabeculated circumscribed lesion in the left anterior\nvertebral body of the partially sacralized S1, images 3:31, 2:10, 5:10, T2\nhyperintense and T1 isointense, most consistent with a hemangioma. There is\nadditional heterogenous artifact through S1 vertebral body on IDEAL images,\nwithout corresponding signal abnormalities on precontrast T1 weighted,\npostcontrast T1 weighted, or T2 weighted images.\n\nThere is no evidence for epidural leptomeningeal metastatic disease. The\ndistal spinal cord demonstrates normal morphology and signal intensity. The\nconus medullaris terminates at L2.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: Minimal disc bulge and minimal facet arthropathy. No spinal canal or\nneural foraminal narrowing.\n\nL3-L4: Mild disc bulge, left greater than right, and mild facet arthropathy. \nNo spinal canal narrowing or significant neural foraminal narrowing.\n\nL4-L5: Mild disc bulge and moderate facet arthropathy. No narrowing of the\nthecal sac. Traversing left L5 nerve root is contacted in the mildly narrowed\nsubarticular zone. Mild-to-moderate bilateral neural foraminal narrowing with\ncontact of the exiting L4 nerve roots.\n\nL5-S1: Grade 1 anterolisthesis with an uncovered and bulging disc. Severe\nfacet arthropathy with partial fusion of the facet joints. No narrowing of\nthe thecal sac. The neural foramina are mildly foreshortened. Exiting right\nL5 nerve root is contacted in the right neural foramen.\n\nS1-S2: Underdeveloped disc and facet joints. No spinal canal or neural\nforaminal narrowing.", "output": "1. 5 lumbar-type vertebrae and a partially lumbarized S1.\n2. 8 mm trabeculated lesion in the left anterior vertebral body of the\npartially lumbarized S1 is most consistent with a hemangioma. Otherwise, no\nevidence for osseous metastases.\n3. No evidence for epidural or leptomeningeal metastatic disease.\n4. At L4-L5, mild disc bulge and moderate facet arthropathy contact the\ntraversing left L5 nerve root in the subarticular zone, and cause\nmild-to-moderate bilateral neural foraminal narrowing with contact of the\nexiting L4 nerve roots.\n5. At L5-S1, there is grade 1 anterolisthesis, an uncovered and bulging disc,\nand severe facet arthropathy, causing mild foreshortening of the bilateral\nneural foramina with contact of the exiting right L5 nerve root.\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):115___-116___\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": "From T11-12 through L1-2 levels no abnormalities are seen. At L2-3 and L3-4\nlevels mild disc bulging and degenerative changes seen. There is mild\nnarrowing of the foramina at L3-4 level.\n\nAt L4-5 level, there is diffuse disc bulge and facet degenerative changes. \nThere is moderate right and moderate-to-severe left foraminal narrowing. \nEndplate degenerative changes are seen.\n\nAt L5-S1 level, minimal degenerative disc disease seen.\n\nThe conus is at a normal level. The paraspinal soft tissues are unremarkable.", "output": "Degenerative disc and facet disease predominantly at L4-5 level with moderate\nright and moderate-to-severe left foraminal narrowing at this level. No\nspinal stenosis." }, { "input": "Alignment is normal. Vertebral bodies are maintained in height. There are\ndegenerative endplate changes at C6-7. There is no suspicious marrow signal\nabnormality. There is diffuse desiccation of the intervertebral discs with\ndisc space narrowing at C6-7. The spinal cord appears normal in caliber,\nconfiguration, and signal. There is no cord hemorrhage or cord diffusion\nabnormality.\n\nC2-3: There is no disc herniation. There is no spinal canal or neural\nforaminal stenosis.\n\nC3-4: There is no disc herniation or spinal canal stenosis. There are\nuncovertebral and facet osteophytes causing mild left neural foraminal\nstenosis.\n\nC4-5: There is no disc herniation or spinal canal stenosis. There is no\nneural foraminal stenosis.\n\nC5-6: There is a central annular fissure with no disc herniation. There are\nuncovertebral and facet osteophytes causing mild left neural foraminal\nstenosis.\n\nC6-7: There is a broad-based disc protrusion causing mild spinal canal\nstenosis. There are uncovertebral and facet osteophytes causing mild\nbilateral neural foraminal stenosis.\n\nC7-T1: There is no disc herniation. There are uncovertebral and facet\nosteophytes causing moderate right and mild left neural foraminal stenosis.\n\nThere is fluid in the mastoid air cells bilaterally. There are endotracheal\nand endogastric tubes, incompletely imaged. There is fluid in the oropharynx.", "output": "1. No evidence of spinal cord injury, ligamentous injury, or fracture.\n2. C6-7 disc protrusion causes mild spinal canal stenosis.\n3. Small bilateral nonspecific mastoid fluid which may be related to presence\nof orogastric tube. Recommend clinical correlation." }, { "input": "Disc and vertebral body heights are maintained. Alignment is anatomic. No\nsuspicious marrow signal. There is no evidence of cord signal abnormality.\nIncompletely characterized appears to be a increase extra-axial space or fluid\nwith mild mass effect on the inferior cerebellar hemispheres, which may\nrepresent an arachnoid cyst ___ cisterna magna.\n\nC2-3: Normal.\n\nC3-4: Mild bilateral uncovertebral joint arthropathy and small posterior disc\nbulge. No significant spinal canal narrowing. Mild left greater than right\nfacet joint hypertrophy contributes to bilateral neural foraminal narrowing.\n\nC4-5: There is a small posterior disc bulge and associated posterior marginal\nosteophyte more prominent on the right. Bilateral uncovertebral arthropathy\nand facet arthropathy is also noted. The disc osteophyte complex contacts and\nminimally effaces the ventral aspect of the thecal sac without remodeling the\ncord. There is no underlying cord signal abnormality. There is severe right\nneural foraminal narrowing and mild left neural foraminal narrowing.\n\nC5-6: There is a small posterior marginal osteophyte and disc bulge, as well\nas mild bilateral uncovertebral arthropathy. No significant spinal canal\nnarrowing. There is mild right neural foraminal narrowing and no significant\nleft neural foraminal narrowing.\n\nC6-7: There is a posterior central disc protrusion with\nleft-greater-than-right uncovertebral arthropathy. The central disc protrusion\nmildly effaces the ventral aspect of the thecal sac without contacting the\ncord. No cord signal abnormality. There is no significant neural foraminal\nnarrowing.\n\nOn sagittal images, there is no evidence of significant spinal canal or neural\nforaminal narrowing of the C7-T1 through T3-4 levels.\n\nThe thyroid gland is unremarkable. The paraspinal and prevertebral soft\ntissues are also unremarkable.", "output": "1. Multifactorial multilevel degenerative changes described above, most\nprominent at C4-5 where there is severe right neural foraminal narrowing.\nAdditional mild to moderate degenerative changes as described above.No\nsignificant spinal canal narrowing is noted in the cervical spine." }, { "input": "Study is mildly degraded by motion.\n\nThere are extensive postsurgical changes with anterior fusion spanning the C4\nthrough C7 levels. There is evidence of C5 and C6 corpectomy with metallic\nstrut seen extending from the inferior endplate of C4 through the superior\nendplate of C7. Posterior bony prominence is noted at C6-C7 level. There is\nfusion across the C3-C4 intervertebral disc space. Small hemangioma is noted\nat T3, and there is subtle chronic anterior wedging of the T1, T2, and T3\nvertebral bodies.\n\nPlease refer to the separate brain MRI for description of posterior fossa\nfindings including multiple bilateral cerebellar infarcts. There is\nmyelomalacia with T2 prolongation and mild volume loss in the spinal cord at\nthe C5 and C6 levels.\n\nThere is loss of the flow void of the left vertebral artery, with occlusion of\nthe left vertebral artery demonstrated on the preceding CT a of the neck.\n\nPartially imaged markedly enlarged multinodular thyroid gland.\n\nC2-C3: Right greater than left facet arthropathy and uncovertebral joint\nosteophyte formation causing mild bilateral neural foraminal stenosis. There\nis no narrowing of the spinal canal.\n\nC3-C4: Right greater than left facet arthropathy and uncovertebral joint\nspurring. There is moderate left and mild to moderate right neural foraminal\nnarrowing. There is no narrowing of the spinal canal.\n\nC4-C5: Postsurgical changes. There is no spinal canal stenosis. Mild\nposterior osteophyte formation is noted. There is left greater than right\nfacet arthropathy and uncovertebral joint osteophyte formation causing\nmoderate to severe left and no right neural foraminal narrowing. Small\nright-sided perineural cysts are noted.\n\nC5-C6: Postoperative changes. Posterior bony prominence causes mild narrowing\nof the spinal canal. Uncovertebral joint osteophytes cause mild-to-moderate\nleft and minimal right neural foraminal narrowing.\n\nC6-C7: Posterior bony prominence as above causing no significant narrowing of\nthe spinal canal. There is uncovertebral joint osteophyte formation causing\nmoderate left and mild right neural foraminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal stenosis.", "output": "1. Extensive postoperative changes of the cervical spine.\n2. Degenerative changes as described with moderate to severe left neural\nforaminal stenosis at the C4-C5 level.\n3. Myelomalacia may be related to the previous history of cervical spine\ntrauma noted on review of the electronic medical record.\n4. Loss of the left vertebral artery flow void, with left vertebral artery\nocclusion noted on the preceding CTA\n5. Mulitnodular goiter." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare preserved without abnormal bone marrow signal. The intervertebral disc\nheights and signal are within normal limits. The conus medullaris terminates\nat L2.\n\nT12-L1 through L3-L4: There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nL4-L5: There is a left paracentral disc extrusion compressing the traversing\nleft L5 nerve root (05:24) with moderate left thecal sac narrowing. There is\nsuperimposed disc bulge with ligamentum flavum thickening and facet\narthropathy causing mild bilateral neural foraminal narrowing.\n\nL5-S1: There is a left paracentral and foraminal disc extrusion compressing\nthe traversing left S1 nerve root and exiting left L5 nerve root with\ndisplacement. There is mild right neural foraminal narrowing.\n\nThere is a 3.3 x 4.6 cm pelvic cyst, possibly related to ovarian cyst but\nincompletely characterized on this study.", "output": "1. Left L4-L5 paracentral disc extrusion compressing the traversing left L5\nnerve root with moderate left thecal sac narrowing and moderate bilateral\nneural foraminal narrowing.\n2. Left L5-S1 paracentral and foraminal disc extrusion compressing the\ntraversing left S1 nerve root and causing severe narrowing of the left neural\nforamina with compression of the exiting left L5 nerve root." }, { "input": "The examination is slightly motion degraded. Within these confines:\n\nCervical alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is slightly heterogeneous, compatible with degenerative changes\nor marrow reconversion. There are no is focal suspicious lesions. Disc\nheight and signal are preserved. The visualized posterior fossa is\nunremarkable. There is no cord signal abnormality.\n\nC2-C3 through C4-C5: There are mild degenerative changes without significant\nspinal canal or neural foraminal narrowing.\n\nC5-C6: A central disc protrusion and thickening of the ligamentum flavum does\nnot result in significant spinal canal narrowing. Left uncovertebral facet\narthropathy results in mild left neural foraminal narrowing. There is no\nsignificant right neural foraminal narrowing.\n\nC6-C7 through T3-T4: No significant spinal canal or neural foraminal\nnarrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative changes,eee most prominent at C5-C6 where there is very\nminimal left neural foraminal narrowing. Otherwise, there is no significant\nspinal canal or neural foraminal narrowing.\n2. Prevertebral paraspinal soft tissues are unremarkable." }, { "input": "Degenerative changes lumbar spine. Multilevel diffuse disc bulges. Lumbar\nfacet arthritis. Mild edema right posterior elements L4, L5, mild adjacent\nsoft tissue posterior paraspinal edema, most likely reactive/inflammatory, no\nsignificant facet joint effusion or endplate irregularity to suggest\ninfection. Effusions bilateral L5-S1 facet joints. Normal visualized cord. \nNormal alignment.\n\nProbable tiny disc free fragment at the level of mid T11 vertebral body, no\nsignificant central canal narrowing.\n\nAt L1-L2, patent central canal, patent foramina.\n\nAt L2-L3,, mild central canal narrowing. Mild bilateral foraminal narrowing.\n\nAt L3-L4, tiny left paramedian disc protrusion, minimal mass effect on\ntraversing left L4 nerve. Mild central canal narrowing. Mild-to-moderate\nbilateral foraminal narrowing.\n\nAt L4-5, mild central canal narrowing. Annular disc tear. Mild left\nforaminal narrowing. Mild-to-moderate right foraminal narrowing.\n\nAt L5-S1, patent central canal. Moderate left, mild right foraminal\nnarrowing.\n\nTiny benign simple cyst right kidney, no further follow-up is indicated. \nProminent extrarenal pelvis bilaterally, no hydronephrosis.", "output": "1. Degenerative changes lumbar spine.\n2. Edema right L4, L5 posterior elements, likely reactive/inflammatory.\n3. Mild central canal narrowing.\n4. Multilevel foraminal narrowing, as above." }, { "input": "CERVICAL:\nCervical spine vertebral bodies are maintained in height and grossly\nmaintained alignment. No suspicious bone marrow signal is identified. There\nis no prevertebral soft tissue edema. The cervical cord is normal in\nmorphology and signal intensity. No evidence of ligamentous injury.\n\nAt C2-3, a posterior disc bulge indents the ventral thecal sac with mild canal\nnarrowing. Neural foraminal narrowing is mild-to-moderate on the left.\n\nAt C3-C4, posterior disc bulging indents the ventral thecal sac and marginates\nthe ventral cord with mild canal narrowing. Neural foraminal narrowing is\nmild on the right and moderate on the left.\n\nAt C4-5 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6 posterior disc bulging results in mild canal narrowing with severe\nleft and moderate to severe right neural foraminal narrowing.\n\nA posterior disc bulge at C6-7 indents the ventral thecal sac and mildly\ncontacts the ventral cord with mild-to-moderate canal narrowing. Neural\nforaminal narrowing is mild on the right and moderate on the left.\n\nAt C7-T1 there is no moderate or severe canal/neural foraminal narrowing.\n\n\nTHORACIC:\nThere is a moderate, chronic appearing compression deformity of T11 without\nfrank retropulsion into the canal, demonstrating approximately 50% loss of\nheight. Mild chronic appearing compression deformities also affect the T6\nthrough T8 vertebral bodies, as well as T12. No evidence of ligamentous\ninjury.\n\nAllowing for mild focal kyphosis centered at T11, the sagittal alignment of\nthe thoracic vertebral bodies is grossly maintained. The thoracic spinal cord\nis normal in morphology and signal intensity. Areas of mild posterior disc\nbulging are seen throughout the thoracic spine, without moderate/severe spinal\ncanal narrowing.\n\n\nLUMBAR:\nThere is a severe burst fracture deformity of L4 demonstrating areas of STIR\nhyperintensity suggesting a subacute fracture. This results in greater than\n75% loss of height. There is approximately 5 mm bony retropulsion into the\ncanal at this level. The anterior longitudinal ligament at L3-L4 appears\nthinned, likely disrupted. No definite disruption of the posterior\nlongitudinal ligament. The ligamentum flavum interspinous ligaments are\npreserved.\n\nMinimal T2 hyperintense signal is seen anterior to this vertebral body. There\nis no frank paraspinal edema or associated soft tissue mass.\n\nThe remainder of the lumbar vertebral bodies are grossly maintained in height\nand maintained in alignment. No additional site of bone marrow edema is\nidentified. The conus medullaris terminates at L1.\n\nT12-L1: There is no canal or neural foraminal narrowing.\n\nL1-L2: Minimal posterior disc bulging is seen with annular fissure. No\nresultant canal stenosis or neural foraminal narrowing. Trace bilateral facet\njoint effusions are seen.\n\nL2-L3: There is no spinal canal or neural foraminal stenosis.\n\nL3-L4: At the level of the intervertebral disc, there is minimal disc bulging\nwithout appreciable canal stenosis. Neural foraminal narrowing is mild\nbilaterally. At the level of the L4 vertebral body, bony retropulsion into\nthe canal results in mild canal narrowing overall.\n\nL4-L5: Minimal posterior disc bulging is seen with bilateral facet arthropathy\nand trace bilateral facet joint effusions. This results in no appreciable\ncanal narrowing, although there is mild-to-moderate right and mild left neural\nforaminal narrowing.\n\nL5-S1: A posterior disc bulge with annular fissure is noted without definite\ncanal narrowing. Neural foraminal narrowing is mild bilaterally. Bilateral\nfacet joint effusions and synovial cysts are noted.\n\nThere is no abnormal intramedullary, leptomeningeal, or epidural enhancement. \nNo epidural mass or collection. A small subcentimeter T2 hyperintense left\nrenal lesion likely represents a cyst.", "output": "1. Severe subacute burst fracture deformity of L4 with anteroposterior and 5\nmm retropulsion of the fracture fragments. The anterior longitudinal ligament\nis not well visualized at the L3-L4 level, likely obstructed. The posterior\nlongitudinal ligament, ligamentum flavum and interspinous ligaments appear\nintact.\n2. The L4 fracture deformity results in approximately 75% loss of height,\nwithout high-grade spinal canal or neural foraminal narrowing.\n3. Chronic compression deformities of T6 through T8 as well as T11 and T12 as\ndescribed above without evidence of high-grade spinal canal or neural\nforaminal narrowing.\n4. There is no cord signal abnormality or enhancement.\n5. Multilevel degenerative changes of the cervical spine resulting in mild\nspinal canal narrowing. The findings are most prominent at C5-C6 where there\nis severe left and moderate to severe right neural foraminal narrowing.\n6. Additional findings described above." }, { "input": "THORACIC:\n\nAlignment is anatomic. There is mild chronic compression deformities of the\nsuperior endplate of T4 through T8 and T12, similar to prior. There is\nredemonstration of chronic anterior compression deformity of T11 vertebral\nbody with approximately loss of 50% vertebral body height at T11 without frank\nretropulsion. Vertebral body signal intensity appears normal. There is\nmultilevel loss of disc height and degenerative endplate changes, most notably\nat T10-T11. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of high-grade spinal canal or neural foraminal narrowing.\n\nLUMBAR:\n\nAlignment is anatomic. There is chronic burst compression fracture of the L4\nvertebral body with approximately 6 mm bony retropulsion into the spinal canal\nand with greater than 75% loss of height of the central aspect of the\nvertebral body (11; 11).\n\nThere is a new severe burst compression fracture deformity of L2 vertebral\nbody demonstrating areas of STIR hyperintensity suggesting a subacute\nfracture. There is trace prevertebral edema (12; 12). This results in\ngreater than 75% loss of height. There is approximately 5 mm bony retropulsion\ninto the spinal canal. There is concern for disruption of the anterior\nlongitudinal ligament at this level (10; 12). The posterior longitudinal\nligament appears intact. The ligamentum flavum and interspinous ligaments are\npreserved.\n\nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. The conus medullaris\nterminates at T12-L1.\n\nAt T12-L1, there is no spinal canal narrowing. There is no neuroforaminal\nnarrowing.\n\nAt L1-L2, 5 mm retropulsion of the L2 vertebral body, posterior disc bulge\nresults in mild spinal canal narrowing. There is no neuroforaminal narrowing.\nTrace bilateral facet joint effusions are again seen.\n\nAt L2-L3, posterior disc bulge, and facet hypertrophy results in mild spinal\ncanal narrowing. There is no neuroforaminal narrowing. Trace effusion is\nseen in the right facet joint.\n\nAt L3-L4, diffuse posterior disc bulge and 6 mm retropulsion results in mild\nspinal canal stenosis with possible contact with nerve roots at the\nsubcuticular zones bilaterally. There is mild bilateral neuroforaminal\nnarrowing.\n\nAt L4-L5, posterior disc bulge, ligamentum flavum thickening, and facet\nhypertrophy results in mild spinal canal narrowing. There is mild\nneuroforaminal narrowing bilaterally with possible contact with the exiting L4\nnerve roots anteriorly (13; 25).\n\nL5-S1: Posterior disc bulge is again seen without spinal canal narrowing. \nThere is a trace joint effusion in the right facet joint with a synovial cyst\n(13; 32). There is mild bilateral neuroforaminal narrowing.\n\nThe spleen measures 15.6 cm on the scout images suggesting splenomegaly,\nsimilar to prior. The common bile duct measures 10 mm.", "output": "1. New acute to subacute burst compression fracture of the L2 vertebral body\nwith 5 mm retropulsion into the spinal canal without spinal canal or neural\nforaminal stenosis. Mild signal abnormality of the anterior longitudinal\nligament raises concern for disruption at this level. No other ligamentous\ninjury is identified.\n2. Chronic burst compression fracture of the L4 vertebral body with 6 mm\nretropulsion without high-grade spinal canal or neural foraminal stenosis is\nagain demonstrated.\n3. Multilevel degenerative changes results in possible contact with the\nexiting L4 nerve roots bilaterally at L4-L5 neural foramen.\n4. Splenomegaly, similar to prior.\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": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nAlignment is normal. Vertebral body heights are maintained. ___ type 2\nchanges are noted primarily involving L2, L3 and L4. The bone marrow signal\nis otherwise within normal limits. Allowing for difference in technique,\nthere has been interval progression of the degenerative changes noted at the\nL3-4 level endplates, with L2 changes noted to be new relative to ___ prior\nexam.\n\nThe spinal cord appears normal in caliber and configuration with conus at the\nT12-L1. Within limits of this noncontrast examination, there is no evidence\nof infection.\n\nThere is an approximately 8 mm left midpole renal cystic lesion, not clearly\nseen on ___ prior exam. Additionally, there is a 9 x 7 mm cystic structure\nin the right lobe of the liver at (see 5:2). Allowing for difference in\ntechnique, this structure was present on the prior CT exam (see 02:15),\nhowever with smaller appearance, though this difference in size may be related\nto imaging technique.\n\n At T12-L1 there is preservation of disc height and signal.No spinal canal or\nneural foraminal stenosis.\n\nAt L1-2 there is preservation of disc height and signal.No spinal canal or\nneuroforaminal stenosis..\n\nAt L2-3 there is loss of disc height and signal and a disc bulge resulting in\nmild bilateral neural foraminal narrowing and no spinal canal stenosis.\n\nAt L3-4 there is loss of disc height and signal and a disc bulge resulting in\nno spinal canal and mild bilateral neural foraminal stenosis.\n\nAt L4-5 there is loss of disc height and signal with a 2 mm posterior disc\nprotrusion resulting in no spinal canal and moderate bilateral neural\nforaminal stenosis.\n\nAt L5-S1 there is loss of disc height and a disc bulge with no spinal canal or\nneural foraminal stenosis.", "output": "1. Interval progression of multilevel degenerative changes compared to ___\nprior exam, as described, most pronounced at L4-5, where there is moderate\nbilateral neural foraminal stenosis.\n2. Nonspecific 8 mm left probable renal cyst. Recommend clinical correlation.\nIf clinically indicated, a renal ultrasound may be obtained for further\nevaluation.\n3. Nonspecific 9 x 7 mm at least partially cystic hepatic lesion as described,\nwhich may have been present on ___ prior exam, and which may represent a\nhepatic cyst. Recommend clinical correlation. If clinically indicated,\nabdominal ultrasound may be obtained for further evaluation." }, { "input": "The examination is motion degraded. Within these confines:\n\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc desiccation and mild loss of is C5-C6\nand C6-C7 disc height is unchanged from prior exam. There is T2 hyperintense\nsignal of the visualized cerebellum and brainstem, better evaluated on MRI\nhead performed the same day.\n\nEvaluation of the cervical cord is limited secondary to patient motion\nartifact, however, when compared to the prior examination of ___, there is\nincreased conspicuity of nonenhancing STIR hyperintense signal of the central\nand dorsal C3 cord (series 7, image 8; series 10, image 15) on both sagittal\nand axial sequences. There is increased conspicuity of STIR hyperintense\nsignal of the central and right lateral cord is active C5 and C6 levels\n(series 7, image 8) on sagittal images not definitively confirmed on the axial\nimages when compared to the prior exam. STIR hyperintense heterogeneous\nsignal of the visualized upper thoracic spine is similar in configuration from\nprior exam. There is no new enhancement.\n\nC2-C3: There is no significant spinal canal narrowing. Facet and\nuncovertebral arthropathy results in moderate left neural foraminal narrowing\nand no significant right neural foraminal narrowing.\n\nC3-C4: A disc protrusion does not significantly narrow the spinal canal. \nUncovertebral facet arthropathy results in severe right neural foraminal\nnarrowing and no significant left neural foraminal narrowing.\n\nC4-C5: Intervertebral osteophyte and central protrusion results in mild\nspinal canal narrowing. Bilateral uncovertebral facet arthropathy results in\nmild neural foraminal narrowing.\n\nC5-C6: A small to protrusion and intervertebral osteophytes results in mild\nspinal canal narrowing. Left greater than right uncovertebral facet\narthropathy results in moderate to severe left neural foraminal narrowing and\nmoderate right neural foraminal narrowing.\n\nC6-C7: A small disc protrusion and intervertebral osteophyte results in mild\nspinal canal narrowing. Uncovertebral facet arthropathy results in mild\nbilateral neural foraminal narrowing.\n\nC7-T1 through T3-T4: No significant spinal canal or neural foraminal\nnarrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. When compared to examination of ___, there is superimposed increased\nconspicuity of STIR hyperintense signal of the central and dorsal C2 cord\nwithout enhancement to suggest active process.\n2. There is apparent increased conspicuity of STIR hyperintense signal of the\nC5 and C6 cord on sagittal images not confirmed on axial images which may\nrepresent interval superimposed acute on chronic process versus artifact from\ntechnical differences.\n3. STIR hyperintense heterogeneous signal of the thoracic cord is similar in\nappearance.\n4. Multilevel multifactorial cervical spondylosis as described above." }, { "input": "CERVICAL:\nThe examination is significantly limited by motion. The alignment is normal. \nThe height of the vertebral bodies are preserved. The cyst in the posterior\nC2 vertebral body is unchanged. The intervertebral disc spaces of C5-C6 and\nC6-C7 are mildly narrowed. The intervertebral discs are diffusely desiccated.\nThere are multilevel disc protrusions from C3-C4 to C6-C7, causing mild spinal\ncanal stenosis at C4-C5, C5-C6, and C6-C7, unchanged from the prior\nexamination. The T2/STIR hyperintense signal in the dorsal spinal cord at C3\nis grossly unchanged from the prior examination. The previously described\nT2/STIR hyperintense lesions at C5 and C6 are difficult to distinguish in the\nmidst of extensive motion artifact. No definite T2/stir hyperintense lesions\nare identified within the spinal cord.\n\nLUMBAR:\nThe alignment is normal. The bone marrow is normal in signal. The conus\nmedullaris terminates at the mid L2 level. The height of the vertebral bodies\nand intervertebral disc spaces are maintained. The intervertebral discs of\nL5-S1 is desiccated. The spinal cord and nerve roots of the cauda equina are\nnormal in signal.\n\nAt T12-L1, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom the prior examination.\n\nAt L1-L2, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom the prior examination.\n\nAt L2-3, there is diffuse disc bulge a without spinal canal or neural\nforaminal stenosis, unchanged from the prior examination.\n\nAt L3-L4, diffuse does bulge and bilateral facet arthropathy cause mild\nbilateral neural foraminal stenosis, progressed from the prior examination. \nThere is no spinal canal stenosis.\n\nAt L4-L5, diffuse does bulge and bilateral facet arthropathy cause mild\nbilateral neural foraminal stenosis, progressed from the prior examination. \nThere is no spinal canal stenosis.\n\nAt L5-S1, diffuse disc bulge with annular fissure and bilateral facet\narthropathy cause narrowing of the right subarticular zone and moderate\nbilateral neural foraminal stenosis, right greater than left, progressed from\nprior examination. There is no spinal canal stenosis.\n\nOTHER: The paraspinal tissues are normal.", "output": "1. Severely limited examination of the cervical spine due to motion. \nUnchanged T2/STIR hyperintense lesion in the C3 spinal cord with no definite,\nnew lesions in the cervical spinal cord.\n2. Multilevel degenerative changes of the lumbar spine as described above." }, { "input": "CERVICAL:\nA 1 mm anterior subluxation of C3 on C4 is seen.There is mild multilevel loss\nof disc height and signal intensity.The spinal cord appears normal in caliber\nand configuration.\n\nC3-C4: A disc bulge is seen with bilateral facet arthropathy. There is mild\nspinal canal narrowing with moderate right and mild left foraminal narrowing.\nC4-C5: A disc bulge is seen with bilateral facet arthropathy. There is mild\nspinal canal narrowing without foraminal narrowing.\nC5-C6: A disc bulge is seen with bilateral facet arthropathy. There is mild\nspinal canal narrowing without foraminal narrowing.\nC6-C7: A disc bulge is seen with bilateral facet arthropathy. There is mild\nspinal canal narrowing with mild right foraminal narrowing.\n\nTHORACIC:\nThe alignment is normal.Vertebral body and intervertebral disc signal\nintensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing.\n\nLUMBAR:\n\nThere mild levoconvex curvature of the lumbar spine is seen. Grade 1\nanterolisthesis of L4 on L5 is seen.Multilevel disc desiccation is seen.The\nspinal cord appears normal in caliber and configuration.\n\nT12-L1: A mild disc bulge is seen without significant spinal canal or\nforaminal narrowing.\nL1-L2: A mild disc bulge is seen without significant spinal canal or foraminal\nnarrowing.\nL2-L3: A mild disc bulge is seen with bilateral facet arthropathy. There is\nno significant spinal canal narrowing. There is mild bilateral foraminal\nnarrowing.\nL3-L4: A disc bulge is seen, asymmetric to the left with bilateral facet\narthropathy. There is mild spinal canal narrowing with no right and mild left\nforaminal narrowing.\nL4-L5: A disc bulge is seen with a left sided disc protrusion. There is\nbilateral facet arthropathy. There is narrowing of the left lateral recess\nwith likely compression of the exiting left L5 nerve root. The protrusion\nextends into the left neural foramen and compromises the exiting left L4 nerve\nroot.\nL5-S1: There is a symmetric disc bulge and bilateral facet arthropathy. There\nis no significant spinal canal narrowing with mild-to-moderate right and mild\nleft foraminal narrowing.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nOTHER:", "output": "1. Mild cervical spondylosis, worst at C3-4, as above.\n2. Moderate degenerative change of the lumbar spine, worst at L4-5 and L5-S1,\nas above.\n3. Grade 1 anterolisthesis of L4 on L5." }, { "input": "There is minimal retrolisthesis of C5 on C6. There is mild degenerative loss\nof height at C3 C5 and C6. A 7 mm T1/T2 hyperintense lesion in the C5\nvertebral body is likely a hemangioma. Marrow signal is maintained. There is\ndiffuse loss of normal T2 disc signal throughout the cervical spine.\n\nThere is a 3 x 3 x 9 mm (AP x TRV x CC) T1 hyperintense T2 hypointense lesion\nin the left anterior spinal cord at the C1 level which demonstrates low signal\non GRE images (5:7, 8:7, 3:7). This lesion does not appear to have\nsignificant enhancement on postcontrast images. There are no additional\nintramedullary lesions in the spine.\n\nAt C1-C2, there is no significant spinal canal narrowing.\n\nAt C2-C3, a posterior disc osteophyte complex causes mild spinal canal\nnarrowing with effacement of the anterior thecal sac. No cord signal\nabnormality. No significant neural foraminal narrowing.\n\nAt C3-C4, a posterior disc osteophyte complex causes mild spinal canal\nnarrowing with flattening of the anterior thecal sac, without cord signal\nabnormality. Uncovertebral hypertrophy causes mild bilateral neural foraminal\nnarrowing.\n\nAt C4-C5, a posterior disc osteophyte complex causes mild spinal canal\nnarrowing with mild flattening of the anterior spinal cord, without cord\nsignal abnormality. Facet hypertrophy results in mild bilateral neural\nforaminal narrowing.\n\nAt C5-C6, a posterior disc osteophyte complex causes moderate to severe spinal\ncanal narrowing with near complete effacement of the CSF and flattening of the\nspinal cord, without cord signal abnormality. Facet arthropathy and\nuncovertebral hypertrophy results in at moderate to severe bilateral neural\nforaminal narrowing.\n\nAt C6-C7, a predominantly left-sided disc osteophyte complex causes mild to\nmoderate spinal canal narrowing with flattening of the left ventral spinal\ncord, without cord signal abnormality. There is moderate bilateral neural\nforaminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nThe visualized portions of the paraspinal soft tissues are unremarkable.", "output": "1. A 9 mm T1 hyperintense nonenhancing lesion with susceptibility in the left\nanterior cord at C1 is most consistent with a cavernous malformation vs less\nlikely a metastatic lesion.\n2. Multilevel degenerative changes as described above, worst at C5-C6 where\nthere is moderate to severe stenosis without cord signal abnormality, and\nmoderate to severe bilateral neural foraminal narrowing.\n\nRECOMMENDATION(S): Neurosurgical consult as well as a3-month follow up with\ncervical spine MRI with and without contrast is recommended\n\nNOTIFICATION: The findings and recommendations were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 3:22\npm, 10 minutes after discovery of the findings." }, { "input": "The patient is status post recent C2 through C5 laminectomy and remote C4\nthrough C6 anterior fixation of the cervical spine. Susceptibility artifact\nfrom the spinal hardware is present. At the site of laminectomy there is a\nband of T2 hyperintense signal posterior to the ligamentum flavus indicative\nof fluid at the surgical bed. This linear fluid collection does not show rim\nenhancement and there is no significant edema related to it to suggest\ninfection.\n\nAt the site of the prior epidural abscess along the posterior aspect of the\nvertebral body of C3 there is thickening of the epidural space with associated\npachymeningeal enhancement but no discrete fluid collection. This may\nrepresent post-operative changes versus residual phlegmon. Retrolisthesis of\nC3 on C4 along with the previously described thickening of the epidural space\ncontinue to cause impingement upon the spinal cord, which appears swollen,\nwith high T2 signal intensity at this level but no enhancement. Owing to the\nlaminectomy procedure, the anteroposterior diameter of the thecal sac at this\nlevel is significantly increased compared with the preoperative exam, now\nmeasuring 12.4 mm (compared to 3 mm), allowing for the expansion of the cord\nwhich appears deformed and tethered posteriorly.\n\nOtherwise the visualized the structures of the posterior fossa are\nunremarkable. The aerodigestive tract is grossly within normal limits. No\nfluid collection or lymphadenopathy is identified in the neck. There has been\ninterval resolution of the previously seen prevertebral soft tissue swelling.", "output": "1. Status post C2 through C5 laminectomy with decompression of the spinal cord\nwhich appears deformed, expanded and tethered posteriorly, with increased T2\nsignal, likely related to edema due to prior compression.\n\n2. Interval resolution of epidural abscess with residual thickening and\nhyperenhancement of the epidural space along the posterior aspect of the\nvertebral body of C3, which may be related to post-operative changes but\nphlegmonous process cannot be completely excluded with this appearance.\nAttention on follow up is recommended.\n\n3. Thin line of high T2 signal along the laminectomy bed posterior to the\nligamentum flavus without surrounding edema or enhancement likely represents\npostsurgical seroma.\n\n4. Interval resolution of prevertebral soft tissue swelling." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nGrade 1 posterior spondylolisthesis L5 over S1 is identified.\n\n Vertebral body heights are preserved. Schmorl's nodes are seen at multiple\nlevels throughout lumbar spine. Type ___ ___ changes are seen at L5-S1\nendplates.\n\nThere is near complete loss of intervertebral disc height at L5-S1. There is\nloss of intervertebral disc signal at L4-5.\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 no vertebral canal or neural foraminal narrowing.\n\nAt L3-4 there is bilateral facet joint hypertrophy with left-sided synovial\ncyst (see 05:28), novertebral canal and no neural foraminal narrowing.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, nonspecific facet edema,\nligamentum flavum hypertrophy, mildvertebral canal and mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, nonspecific bilateral facet edema, mildvertebral canal and\nbilateral mild-to-moderateneural foraminal narrowing.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \nNonspecific dependent edema is noted.", "output": "1. Study is mildly degraded by motion.\n2. No evidence of spinal cord or cauda equina compression.\n3. Mild multilevel degenerative changes are identified in the lumbar spine,\nmost pronounced at L5-S1, where there is mild vertebral canal and bilateral\nmild-to-moderate neural foraminal narrowing." }, { "input": "The alignment of the cervical spine is normal. T1 hypointense and T2/IDEAL\nhyperintense signal at the endplates of C5-C6 and C6-C7 likely represent\ndegenerative type ___ ___ changes. The height of the vertebral bodies are\nmaintained. The C5-C6 and C6-C7 intervertebral discs are mildly narrowed. \nThe C2-C3, C3-C4, C5-C6, and C7-T1 intervertebral discs are hypo intense on\nthe T2 weighted images, a manifestation of degenerative disc disease. The\nspinal cord is normal in signal. No fluid collections or masses are\nidentified. The prevertebral and paraspinal soft tissues are normal.\n\nAt C2-C3, there is no spinal canal or neural foraminal stenosis.\n\nAt C3-C4, left facet and uncovertebral osteophytes cause mild-to-moderate left\nneural foraminal stenosis. There is no spinal canal stenosis.\n\nAt C4-C5, there are bilateral facet and uncovertebral osteophytes without\nspinal canal or neural foraminal stenosis.\n\nAt C5-C6, intervertebral osteophytes flatten and remodel the spinal cord. \nBilateral uncovertebral and facet osteophytes cause severe right and moderate\nleft neural foraminal stenosis.\n\nAt C6-C7, intervertebral osteophyte, eccentric to the right, bilateral\nuncovertebral and facet osteophytes cause moderate to severe right neural\nforaminal and mild left neural foraminal stenosis. There is no spinal canal\nstenosis.\n\nAt C7-T1, small intervertebral osteophytes, bilateral uncovertebral and facet\nosteophytes cause severe left and moderate right neural foraminal stenosis. \nThere is no spinal canal stenosis.", "output": "Multilevel degenerative changes of the cervical spine, most advanced at C5-C6,\nwhere there is mild-to-moderate spinal canal, severe right neural foraminal,\nand moderate left neural foraminal stenosis." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nPostsurgical changes related to left L4 and L5 level hemi laminectomies are\nagain noted. There is no marrow signal abnormality. There is no evidence of\nfracture.\n\nDisc desiccation is most prominent from L3 through S1, progressed compared to\nprior exam.\n\nThe conus is noted at L1/L2. Note is made of a lipoma of the filum terminale.\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nL3 - L4: Disc extrusion measuring approximately 7 mm (AP) is noted (see\n02:11) with annular fissure, ligamentum flavum hypertrophy and facet joint\narthropathy resulting in mild vertebral canal and no neural foraminal\nstenosis. Overall, findings have progressed compared to prior exam.\n\nL4 - L5: A focal left central disc protrusion and mild disc bulge is seen,\nresulting in severe canal narrowing and crowding of the nerve roots. There is\nmoderate to severe left and mild right neural foraminal narrowing. There is\ncontact with the traversing left L5 nerve roots, and exiting bilateral L4\nnerve roots.\n\nL5 - S1: Disc bulge and facet joint arthropathy resulting in moderate right\nand mild left neural foraminal and mild vertebral canal stenosis.\n\nThere 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.", "output": "1. Study is mildly degraded by motion.\n2. Postsurgical changes related L4 and L5 hemilaminectomies.\n3. Interval progression of L4-5 left paracentral disc protrusion, now\nresulting in severe vertebral canal stenosis.\n4. Interval progression of L3-4 spondylosis, now with 7 mm disc extrusion, and\nmild vertebral canal stenosis.\n5. L5-S1 moderate left and mild right neural foraminal and mild vertebral\ncanal stenosis, unchanged." }, { "input": "The vertebral body heights and alignment throughout the lumbar spine are\nmaintained.\n\nThere is increased T1 and T2 signal within the L4, L5, and S1 vertebral\nbodies, as well as the distal sacrum, which is presumably on the basis of\nprior radiation therapy. Additionally, there are focal areas of T1\nhypointensity/STIR hyperintensity within the sacrum with enhancement which are\nlikely representative of metastatic lesions. There is no associated epidural\nextension or soft tissue mass. The remaining bone marrow signal within the\nlumbar and imaged portions of the lower thoracic spine is decreased in\ndiffusely heterogenous which may be on the basis of reactive marrow in\nrelation to treatment.\n\nThe conus medullaris is normal in signal and morphology and terminates at the\nL1-L2 level.\n\nMultiple metastatic lesions are seen within the incompletely imaged liver.\n\nAt the L2-L3 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge with minimal spinal canal narrowing. The\nneural foramina appear normal.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, a diffuse disc bulge, and superimposed posterior disc protrusion\ncausing minimal spinal canal narrowing. The neural foramina appear normal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge, and intervertebral osteophytes which cause\nmild spinal canal narrowing as well as moderate bilateral neural foraminal\nnarrowing, left greater than right, likely contacting the exiting bilateral L4\nnerve roots.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, diffuse disc bulge,\nand superimposed posterior disc protrusion with annular tear, as well as\nintervertebral osteophytes which cause mild spinal canal narrowing. The disc\nbulge and intervertebral osteophytes may contact the traversing right S1 nerve\nroot within the lateral recess. There is also moderate bilateral neural\nforaminal narrowing.", "output": "1. Osseous metastatic disease within the sacrum as described.\n2. No evidence of cord compression.\n3. Bone marrow signal within the lumbar and imaged portions of the lower\nthoracic spine is decreased and diffusely heterogenous which may be on the\nbasis of reactive marrow in relation to treatment. Recommend clinical\ncorrelation.\n4. Additional partially visualized metastatic lesions seen within the\nincompletely imaged liver. Recommend correlation with dedicated hepatic\nimaging.\n5. Multilevel lumbar spondylosis as described, greatest at the L4-5 and L5-S1\nlevel, where there is mild spinal canal stenosis with moderate bilateral\nneural foraminal stenosis." }, { "input": "At the craniocervical junction and C2-3 level no evidence of spinal stenosis\nseen. At C2-3 level there are right-sided facet joint changes with mild\nnarrowing of the right foramen.\n\nAt C3-4 and C4-5 levels, no significant disc bulge or herniation spinal\nstenosis or foraminal narrowing seen.\n\nAt C5-6 level, right-sided uncovertebral degenerative changes result in\nmoderate right foraminal narrowing without compromise of the left foramina or\nspinal canal.\n\nAt C6-7 level, there is right-sided uncovertebral degenerative change with\nmild-to-moderate right foraminal narrowing seen without compromise of the left\nforamen.\n\nAt C7-T1 and inferiorly to T3-4 levels, no abnormalities are seen.\n\nThe spinal cord shows normal signal intensities. No extrinsic spinal cord\ncompression seen.", "output": "Mild to moderate changes of cervical spondylosis with moderate right-sided\nforaminal narrowing at C5-6 and mild to moderate right-sided foraminal\nnarrowing at C6-7 levels as described above. No evidence of spinal stenosis. \nNo evidence of intrinsic spinal cord signal abnormalities or extrinsic spinal\ncord compression." }, { "input": "Alignment is normal. Mild loss of signal on T2-weighted images in several\nlower lumbar intervertebral discs is compatible with degenerative change. \nOtherwise, vertebral body and intervertebral disc signal intensity appear\nwithin normal limits. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There are no foci\nof abnormal enhancement following the administration contrast.\n\nIncidentally noted is a likely large layering left pleural effusion, partially\nimaged.", "output": "1. Mild lower lumbar spine degenerative change. Otherwise, unremarkable MR\nthoracic and lumbar spine.\n2. Partially imaged likely large layering left pleural effusion." }, { "input": "The study is moderately degraded by patient motion, especially on the STIR\nimages somewhat limiting the evaluation.\n\nCERVICAL:\nThere is a 3 mm retrolisthesis of C6 on C7. The alignment of the cervical\nspine is otherwise maintained. The vertebral body heights are maintained. \nThe marrow signal is unremarkable. The visualized cervical spinal cord\nappears unremarkable without focal cord signal abnormality or cord expansion.\n\nThe prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable. The visualized thyroid gland appears unremarkable. \nThere is a 4 mm enhancing lesion in the pons as seen on image 15:10 concerning\nfor intracranial metastasis.\n\nAt C2-C3, neural foramina and spinal canal are patent.\n\nAt C3-C4, there is central disc osteophyte complex indenting the ventral\nthecal sac. The bilateral neural foramina are patent.\n\nAt C4-C5, there is central disc osteophyte complex indenting the ventral\nthecal sac. Bilateral neural foramen are patent.\n\nAt C5-C6, there is central disc osteophyte complex indenting the ventral\naspect of the cord with moderate to severe spinal canal stenosis on image\n11:23. Also seen is bilateral uncovertebral and facet arthropathy causing\nsevere left neural foraminal narrowing (11:23)and moderate right neural\nforaminal narrowing.\n\nAt C6-C7, there is central disc osteophyte complex indenting the ventral\naspect of the cord causing moderate spinal canal stenosis. Also seen is\nbilateral uncovertebral and facet arthropathy causing mild bilateral neural\nforamen narrowing.\n\nAt C7-T1, bilateral neural foramen and spinal canal are patent.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. There are osseous lesions\ninvolving the T1, T6, T7 and T10 vertebrae which corresponds to lytic lesion\nseen on prior outside CT of chest abdomen and pelvis suggestive of underlying\nosseous metastasis. No pathologic fractures are however seen. The vertebral\nbody heights are maintained. The visualized thoracic spinal cord appears\nunremarkable. No focal cord signal abnormality or cord expansion is seen.\n\nThe visualized paravertebral, paraspinal and mediastinal soft tissues appear\nunremarkable. The visualized lung parenchyma is clear.\n\nThere is mild loss of disc height and signal at T8-T9 and T9-T10 with mild\nbroad-based disc bulge indenting the ventral thecal sac. The spinal canal and\nneural foramen are patent at all levels.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. There is compression\ndeformity along the superior endplate of L4 vertebrae with loss of height by\napproximately 30%. The vertebral body heights are maintained at all other\nlevels. There is diffuse T2/STIRhyperintensity and T1 hypointensity involving\nthe L4 vertebrae and sacrum with enhancement on postcontrast images suggestive\nof underlying osseous metastasis. There is soft tissue component associated\nwith the sacral lesions extending into the spinal canal posteriorly causing\nsevere spinal canal stenosis at the level of S1 and S2 vertebrae. There is\nenhancing soft tissue and osseous component surrounding the exiting right S1\nnerve root and exiting bilateral S2 nerve roots, there is expansion of S2\nvertebral body.\n\nThe conus terminates at L1. The visualized retroperitoneal, paraspinal and\nparavertebral soft tissues appear unremarkable.\n\nAt T12-L1, intervertebral disc height and signal are maintained. Bilateral\nneural foramen and spinal canal are patent.\n\nAt L1-L2, intervertebral disc height and signal are maintained. Bilateral\nneural foramen and spinal canal are patent.\n\nAt L2-L3, there is mild loss of intervertebral disc signal. The disc height\nis maintained. Bilateral neural foramen and spinal canal are patent.\n\nAt L3-L4, there is mild loss of disc height and signal with broad-based disc\nbulge and bilateral facet arthropathy. Bilateral neural foramen and spinal\ncanal are patent.\n\nAt L4-L5, there is mild loss of disc height and signal with broad-based disc\nbulge. Bilateral neural foramen and spinal canal are patent.\n\nAt L5-S1, there is loss of disc height and signal with mild broad-based disc\nbulge and bilateral facet arthropathy. The neural foramen and spinal canal\nare patent. Next", "output": "1. Multiple osseous metastatic lesions involving T1, T6, T7, T10, L3 vertebrae\nand sacrum, with soft tissue component extending into the sacral canal,\ncausing severe spinal canal stenosis and encasing the right exiting S1 and\nbilateral exiting S2 nerve roots as described above.\n2. Associated pathologic fracture involving the L4 vertebrae with loss of\nheight by approximately 30%.\n3. Multilevel multifactorial degenerative disease of the cervical spine, worst\nat C5-C6 with severe spinal canal stenosis and severe left and moderate right\nneural foramen narrowing.\n4. No neural foramina or spinal canal stenosis is seen in the thoracic or\nlumbar spine.\n5. 4 mm enhancing lesion in the pons is concerning for intracranial\nmetastasis." }, { "input": "The vertebral body height and alignment within the cervical spine are normal.\nThere is uniformly decreased T1 bone marrow signal without correlate on STIR\nimaging which is likely representative of red marrow conversion in a female\npatient of this age.\n\nThe spinal cord is normal in signal and morphology. There is no cerebellar\ntonsillar ectopia.\n\nThe diffusion imaging appears normal without evidence of cord infarct.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the C2-C3 level, the spinal canal and neural foramina appear normal.\n\nAt the C3-C4 level, there is a small posterior disc protrusion without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt the C4-C5 level, the spinal canal and neural foramina appear normal.\n\nAt the C5-C6 level, there is a right paracentral disc protrusion which indents\nthe ventral aspect of spinal cord and may contact the exiting right C6 nerve\nroot within the right neural foramen.\n\nAt the C6-C7 level, there is a right paracentral disc protrusion without cord\ndeformity which possibly contacts the exiting right C7 nerve root within the\nright neural foramen.\n\nAt the C7-T1 level, the spinal canal and neural foramina appear normal.", "output": "1. Mild multilevel degenerative disc disease, particularly at the C5-C6 and\nC6-C7 levels, where right paracentral disc protrusions may impinge upon the\nexiting right C6 and C7 nerve roots, respectively.\n2. Uniformly hypointense regional bone marrow signal, without correlate on\nSTIR imaging, likely represents red marrow re-conversion in response to\nanemia, in a female patient of this age." }, { "input": "There is no evidence of bony injury or ligamentous disruption.\n\nThere is basilar invagination with high position of the odontoid process and\nfusion of C1 with the occipital and C2 with C3. From history this finding is\nknown. There is mild narrowing of the foramen magnum but no compression of the\nspinal cord or abnormal signal seen within the spinal cord.\n\nAt C3-4 mild retrolisthesis and mild to moderate bilateral foraminal narrowing\nseen. At C4-5 C5-6 and C6-7 mild disk bulging identified. There is no spinal\nstenosis seen. There is no abnormal signal within the spinal cord in the\ncervical or thoracic region.", "output": "Craniocervical fusion deformity likely congenital in nature without\nsignificant spinal canal narrowing or spinal cord compression. Basilar\ninvagination results in slight deformity of the cervical medullary junction\nbut no abnormal signal seen within the spinal cord. No evidence of\nligamentous disruption or bony trauma. Degenerative changes." }, { "input": "Alignment is anatomic. The spinal cord has normal signal. There\nare no suspicious osseous lesions. Left maxillary sinus mucosal thickening is\npartially visualized. \n\nAt C3-4, a small disc protrusion does not cause significant spinal canal\nnarrowing. There is mild left foraminal narrowing due to uncovertebral joint\nosteophytes. \n\nAt C4-C5, there is a small central disc protrusion without significant\nnarrowing.\n\nAt C5-C6, there are similar findings to the level above.\n\nAt C6-C7, a broad-based disc protrusion mildly narrows the spinal canal with\nmild remodeling of the ventral spinal cord, this process is worse on the\nright. There is no significant foraminal narrowing. This disc protrusion is\ndecreased in size compared to ___.", "output": "Disc protrusion at C6-C7, greater on the right, with mild spinal\ncanal narrowing and remodeling of the ventral cord. This has decreased in\nsize compared to ___." }, { "input": "Severely motion limited exam. In addition, the examination was terminated\nearly with only sagittal T2 and STIR sequences performed secondary to patient\nintolerance of the exam. Within these confines:\n\nThere is geographic T2/STIR hyperintense signal of the cervical cord spanning\nC3 through T1 with apparent expansion of the cord. Multilevel degenerative\nchanges results in at least moderate spinal canal narrowing at C6-C7. \nCervical alignment is grossly anatomic.", "output": "1. Severely motion degraded study. In addition, the examination was\nterminated early with only sagittal T2 and STIR sequences performed.\n2. Incompletely characterized T2/STIR hyperintense signal of the cervical cord\nspanning C3 through T1 with apparent cord expansion. In the context of\nmetastatic disease, this may represent metastatic disease. Differential\nconsiderations include demyelinating process such as transverse myelitis or\ncord contusion." }, { "input": "Study is mildly degraded by motion.\n\nDegenerative changes are partially visualized in the cervical spine,\nincompletely characterized, given no dedicated imaging at this site. There is\na partially visualized disc protrusion is C7-T1 with no significant spinal\ncanal or neural foraminal stenosis.\n\nTHORACIC:\nAlignment is normal.Vertebral body height and signal is normal. There is\nmultilevel disc space height loss and decreased signal. The spinal cord\nappears normal in caliber and configuration.A perineural cyst is noted in the\nright T11-12 level. There are multilevel disc bulges with ligamentum flavum\nthickening and no resulting spinal canal or neural foraminal stenosis. There\nis no evidence of infection or neoplasm. There is no abnormal enhancement\nafter contrast administration.\n\nLUMBAR:\nAlignment is normal.Heterogeneous bone marrow signal is noted throughout the\nlumbar spine with ___ type 2 endplate changes at the inferior endplate of\nL4. No focal marrow replacing lesion is identified. There is disc space\nheight loss and decreased signal at L5-S1. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.\n\nThere is multilevel facet arthropathy and throughout the lumbar spine.\n\nAt L3-4, there is a disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in mild spinal canal stenosis, mild right subarticular,\nmoderate left subarticular zone stenosis and mild bilateral neural foraminal\nstenosis.\n\nAt L4-5 there is facet arthropathy, ligamentum flavum thickening and disc\nbulge resulting in mild spinal canal stenosis, severe right subarticular zone\nstenosis with the disc abutting the transiting right L5 nerve root and mild\nbilateral neural foraminal stenosis.\n\nAt L5-S1 there is a disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in mild spinal canal stenosis and moderate bilateral\nsubarticular zone stenosis with mild to moderate right neural foraminal\nstenosis. The disc abuts the bilateral transiting S1 nerve roots.\n\nOTHER: Multi focal peripheral lung lesions are seen, better seen on the\npreviously performed CT chest. There is redemonstration of the complicated\nright pleural effusion. Grossly stable small left pleural effusion is also\nagain noted. Persistent bibasilar airspace disease is seen, right greater\nthan left. There is a 1.1 cm thyroid nodule, seen best on series 2, image 3,\nwhich requires no further imaging follow-up according to ___ College of\nRadiology guidelines. There are multiple partially visualized T2 hyperintense\nlesions in the kidneys, better seen on the previously performed CT, likely\nrepresenting a simple cysts. A multi lobulated T2 hyperintense lesion is\nnoted in the right hepatic lobe, also seen on the prior CT.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no evidence for discitis, osteomyelitis or epidural\nabscess.\n3. Degenerative changes throughout the thoracic spine with no significant\nspinal canal or neural foraminal stenosis.\n4. Degenerative changes throughout the lumbar spine resulting in severe right\nsubarticular zone stenosis at L4-5 and moderate bilateral subarticular zone\nstenosis at L5-S1, abutting the transiting right L5 and bilateral S1 nerve\nroots, respectively.\n5. Multi focal lung lesions with complex right and small left pleural effusion\nand right posterior hepatic lobe lesion, better visualized on recent chest CT." }, { "input": "There is stable grade 1 anterolisthesis of C3 on C4. The alignment of the\ncervical spine is otherwise maintained. There is STIR signal hyperintensity\ninvolving C7, T1 and T2 vertebral bodies with corresponding low T1 signal\nintensity. There is mild corresponding loss of height of these 3 vertebral\nbodies by approximately 10% anteriorly. Also seen is edema in the paraspinal\nsoft tissues at the level of C2-T1 (4:8) as well as interspinous ligament at\nC5-C6 and C6-C7. No prevertebral soft tissue swelling seen. In the T3\nvertebral body is suggested a hemangioma (see series 3, 4, 5, image 11).\n\nAt the C4-C5 and C5-C6, there is focal T2 signal abnormality, nonspecific cord\nsignal abnormality versus artifact.\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.\n\nAt C2-C3, there is loss of disc signal with central disc osteophyte complex. \nNo neural foramina or spinal canal stenosis.\n\nAt C3-C4, there is loss of disc signal with pseudo disc bulge secondary to\nanterolisthesis of C3 on C4 causing indentation of the ventral thecal sac. No\nspinal canal or neural foraminal narrowing is seen.\n\nAt C4-C5, there is loss of disc height and signal with diffuse disc osteophyte\ncomplex causing indentation of ventral thecal sac and moderate to severe\nspinal canal narrowing with remodeling of the spinal cord. There is\nmild-to-moderate bilateral neural foraminal stenosis at this level.\n\nAt C5-C6, there is loss of disc height and signal with diffuse disc osteophyte\ncomplex causing indentation of ventral thecal sac and mild spinal canal\nnarrowing with remodeling of the spinal cord. No neural foramen narrowing is\nseen.\n\nAt C6-C7, there is loss of disc height and signal with posterior disc\nosteophyte complex. No neural foramina or spinal canal stenosis is seen.\n\nAt C7-T1, there is mild loss of disc signal. No neural foramina or spinal\ncanal narrowing is seen.", "output": "1. Acute mild compression fractures involving C7, T1 and T2 vertebrae with\nloss of height by approximately 10%.\n2. Edema involving the interspinous ligament at C5-C6 and C6-C7 with diffuse\nedema involving the paraspinous soft tissues, likely secondary to recent\ntrauma.\n3. Multilevel degenerative disease of the cervical spine as described above,\nmost pronounced at C4-C5, where there is moderate to severe spinal canal and\nmild-to-moderate bilateral neural foraminal stenosis." }, { "input": "Sagittal IDEAL sequences are motion degraded. Within these confines:\n\nThere is very mild unchanged 2 mm retrolisthesis of C4 on C5. Anterior wedge\ncompression deformities of C7 through T2 is similar in appearance to\nexamination of ___ with near-complete resolution of superior endplate\nwater sensitive hyperintense signal compatible with subacute to chronic\ncompression fractures. Otherwise, cervical alignment is anatomic. There is\nno other suspicious marrow signal. The visualized posterior fossa is\nunremarkable. Incompletely visualized is known right sellar macro adenoma,\nmuch better evaluated on prior MRI pituitary of ___. There is no\ncord signal abnormality.\n\nC2-C3: A disc protrusion minimally narrows the spinal canal. There is no\nsignificant neural foraminal narrowing.\n\nC3-C4: A central protrusion and thickening of the ligamentum flavum results\nin mild to moderate spinal canal narrowing, minimally remodeling the ventral\naspect of the cord. There is no significant neural foraminal narrowing.\n\nC4-C5: A disc protrusion and thickening of the ligamentum flavum results in\nmoderate to severe spinal canal narrowing, remodeling the cord. There is no\nsignificant neural foraminal narrowing.\n\nC5-C6: A central protrusion and thickening of the callosum flavum results in\nmild spinal canal narrowing. Bilateral uncovertebral facet arthropathy\nresults in moderate right neural foraminal narrowing and mild left neural\nforaminal narrowing.\n\nC6-C7: A small central protrusion minimally narrows the spinal canal. There\nis no significant neural foraminal narrowing.\n\nC7-T1 through T3-T4: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nThe above degenerative changes are similar in appearance to prior exam.\n\nSignificantly improved water sensitive hyperintense signal of the interspinous\nligaments and cervical paraspinal muscles when compared to examination of ___.", "output": "1. Expected and improving sequela of previously seen C7 through T2 acute mild\nanterior wedge compression fractures.\n2. Superimposed degenerative changes are unchanged from the prior exam, most\nprominent at C5-C6 where there is moderate right neural foraminal narrowing\nand at C4-C5 where there is a moderate to severe spinal canal narrowing,\nremodeling the cord.\n3. No cord signal change.\n4. Additional findings as described above." }, { "input": "In comparison with the prior examinations, there is minimal anterolisthesis at\nL4 upon L5 level, with no evidence of spondylolysis, the configuration of the\nlumbar vertebral bodies appears maintained, the conus medullaris terminates at\nthe level of T12 and is unremarkable.\n\nFrom T11/T12 through L1/L2 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L2/L3 level, there is disc desiccation and a small posterior annular tear,\nbetter depicted in the axial T2 and sagittal ideal sequence (image 16, series\n6, and image 9, series 3). There is minimal diffuse disc bulge, causing\nminimal bilateral neural foraminal narrowing with no frank evidence of nerve\nroot compression, mild unchanged articular joint facet hypertrophy is present.\n\nAt L3/L4 level, there is disc desiccation and diffuse disc bulging, contacting\nthe traversing nerve roots bilaterally (image 23, series 6), unchanged\nmoderate bilateral articular joint facet hypertrophy and ligamentum flavum\nthickening, causing mild spinal canal stenosis.\n\nAt L4/L5 level, there is disc desiccation and diffuse disc bulge, causing mild\nanterior thecal sac deformity, contacting the traversing nerve roots and\nproducing bilateral neural foraminal narrowing, which appears slightly more\npronounced since the prior study, bilateral articular joint facet hypertrophy\nand ligamentum flavum thickening at this level appear unchanged.\n\nAt L5/S1 level, the intervertebral disc space appears maintained with no\nevidence of neural foraminal narrowing or spinal canal stenosis, mild\narticular joint facet hypertrophy remains unchanged.\n\nThe sacroiliac joints and the visualized aspect of the retroperitoneum are\nunremarkable.", "output": "In comparison with the recent examinations, there is mild degenerative\nanterolisthesis at L4 upon L5 level, with no evidence of spondylolysis. \nSlightly more pronounced disc bulging at L4/L5, otherwise relatively stable\nmultilevel degenerative changes throughout the lumbar spine as described\nabove." }, { "input": "Overall there has been no significant interval change. From T11-12 through\nL2-3 levels, mild disc degenerative changes seen.\n\nAt L3-4 level minimal anterolisthesis of L3 over L4 seen and facet\ndegenerative changes with mild narrowing of foramina without compression of\nexiting nerve roots. There is no spinal stenosis.\n\nAt L4-5 level, facet degenerative changes are seen with minimal\nanterolisthesis of L4 over L5. Mild narrowing of foramina seen without\ncompression of exiting nerve roots.\n\nAt L5-S1 level mild degenerative disease seen.\n\nThe conus is at a normal level. The paraspinal soft tissues are unremarkable.", "output": "Overall no significant change since the MRI of ___ in multilevel\ndegenerative changes with mild anterolisthesis of L3 over L4 and L4 over L5\ndue to facet degenerative changes with mild narrowing of the foramina without\ncompression exiting nerve roots. There is no evidence of spinal stenosis." }, { "input": "1-2 mm anterolisthesis of L4 on L5 is unchanged from prior examination. \nOtherwise, lumbar alignment is anatomic. Vertebral body heights are\npreserved. No focal suspicious marrow lesion. Degenerative loss of disc\nheight is mild spanning L1-L2 through L5-S1, unchanged. The conus medullaris\nterminates at the L1 level, within expected limits. There is no signal\nabnormality of the terminal cord.\n\nT10-T11 through L2-L3: Mild degenerative changes not result in significant\nspinal canal or neural foraminal narrowing, similar to prior exam.\n\nL3-4: A small disc bulge does not narrow the spinal canal. There is bilateral\nfacet arthropathy with small facet joint effusions. The degenerative changes\nincluding facet osteophyte results in mild right neural foraminal narrowing\nand no significant left neural foraminal narrowing.\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. A disc bulge does\nnot significantly narrow the spinal canal. Minimal crowding of the\nsubarticular zones contacting but not posterior displacing the traversing\nnerve roots is noted. In conjunction with facet arthropathy, there is mild\nright and no significant left neural foraminal narrowing. Small facet joint\neffusions noted.\n\nL5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nA 1.4 cm simple left renal cyst is unchanged from prior exams. Otherwise, the\nremainder the visualized prevertebral paraspinal soft tissues are\nunremarkable.", "output": "1. Minimal lumbar spondylosis without evidence of high-grade spinal canal or\nneural foraminal narrowing.\n2. Additional findings described above." }, { "input": "Alignment is anatomic. Vertebral body heights are preserved. The marrow\nsignal is diffusely heterogeneous, likely representing known diffuse osseous\ndemineralization. Loss of disc height is severe spanning C2-C3 through T1-T2.\nThe visualized posterior fossa is unremarkable. There is no definitive cord\nsignal change.\n\nNo definite prevertebral edema noted. The anterior and posterior longitudinal\nligaments appear intact. The ligamentum flavum and interspinous ligaments\nalso appear intact. No epidural collection.\n\nC2-C3: A disc protrusion and thickening of ligamentum flavum results in mild\nspinal canal narrowing. Uncovertebral and facet arthropathy results in at\nleast moderate bilateral neural foraminal narrowing.\n\nC3-C4: A central protrusion with thickening of the ligamentum flavum results\nin moderate to severe spinal canal narrowing, remodeling the cord without\ndefinitive underlying cord signal change. Uncovertebral facet arthropathy\nresults in moderate left and mild right neural foraminal narrowing\n\nC4-C5: A central protrusion with thickening of ligamentum flavum results in\nmoderate spinal canal narrowing, remodeling the cord. Uncovertebral and facet\narthropathy results in moderate left and mild right neural foraminal\nnarrowing.\n\nC5-C6: A central protrusion with thickening of the ligamentum flavum results\nin moderate to severe spinal canal narrowing. Uncovertebral and facet\narthropathy results in moderate to severe bilateral neural foraminal\nnarrowing.\n\nC6-C7: A thickening of the ligamentum flavum and at central protrusion results\nin moderate spinal canal narrowing. Uncovertebral facet arthropathy results\nin moderate right and mild left neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nVisualized prevertebral and paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. Multilevel cervical spondylosis most prominent spanning C3-C4 and C4-C5\nwhere there is moderate to severe spinal canal narrowing, remodeling the cord\nwithout definitive underlying cord signal change. Neural foraminal narrowing\nis most prominent at C5-C6 where there appears to be moderate to severe\nbilateral neural foraminal narrowing.\n2. No definite evidence for ligamentous injury.\n3. No definite prevertebral edema.\n4. No definite marrow signal abnormality to suggest occult fracture." }, { "input": "CERVICAL SPINE: There is reversal of cervical lordosis with kyphotic\ncurvature, the apex of which is at the C5-C6 disc space. There is minimal, 2\nmm, anterolisthesis of C4 on C5. The alignment is unchanged compared to the\nrecent MRI.\n\nIncreased STIR/T2 signal within the cervical spinal cord seen only on the\nsagittal images is likely artifactual. There is no abnormal intradural\nenhancement.\n\nUnderlying degenerative changes include: \n\nAt C3-C4, a small broad-based disc bulge without significant narrowing.\n\nAt C5-C6, minimal anterolisthesis with unroofing of the disc, andmild spinal\ncanal narrowing.\n\nAt C5-C6, kyphotic angulation with a broad-based disc bulge and vertebral body\nosteophytes moderately narrows the spinal canal, with remodeling of the\nventral spinal cord. Uncovertebral joints moderately narrow the foramina\nbilaterally as well.\n\nAt C6-7, a broad-based disc protrusion with mild ligamentum flavum thickening,\nmildly narrows the spinal canal.Uncovertebral joints moderately narrow the\nforamina bilaterally as well.\n\nIncreased T1 signal at the level of the foramen magnum seen only on the axial\npst gadolinium sequence is likely artifactual.\n\nTHORACIC SPINE: Below the level of T7, the spinal canal, posterior paraspinal\nsoft tissues, and vertebrae are obscured by susceptibility artifact from\nextensive hardware. The artifact extends more superiorly than in the ___\nexamination compatible with extension of surgical hardware. \n\nWithin the visualized thoracic spine, there is a central disc protrusion at\nT7-T8, which mildly indents the anterior thecal sac but does not cause high-\ngrade spinal canal narrowing. There is no abnormal intradural enhancement\nwithin the visualized thoracic spine and alignment is preserved. Questionable\nincreased T2 signal within the central mid thoracic spinal cord is likley\nartifactual. There is no abnormal associated enhancement.\n\nLUMBAR SPINE: The lumbar spine is almost totally obscured by susceptibility\nartifact from the patient's spinal hardware. The thecal sac is partially\nvisable at the L5 and S1 levels. At these levels, there is no spinal canal\nnarrowing.", "output": "1. Degenerative changes, most severe at the cervical spine with moderate\nspinal canal narrowing at C5-C6. \n2. Increased T2 signal within the lower thoracic spine is most likely\nartifactual. \n3. The lower thoracic and lumbar spine are obscured by the patient's spinal\nhardware." }, { "input": "CERVICAL SPINE:\nThe alignment of the cervical spine is maintained. There is evidence of prior\nanterior spinal fusion of C5-C6 and C7-T1 with osseous fusion of the vertebral\nbodies at these levels.\n\nThe vertebral body heights are otherwise maintained. The susceptibility\nartifact from the hardware limits the evaluation for marrow signal\nabnormality. The visualized spinal cord appears unremarkable without focal\ncord signal abnormality or cord expansion.\n\nThe visualized posterior fossa structures, prevertebral and paravertebral soft\ntissues appear unremarkable.\n\nAt C2-C3, there is minimal degenerative disease with no encroachment on the\nthecal sac or neural foramina.\n\nAt C3-C4, there is right sided intervertebral osteophyte indenting the ventral\nthecal sac. Uncovertebral and facet arthropathy results in moderate bilateral\nneural foramen narrowing.\n\nAt C4-C5, imaging is severely degraded by artifacts from the fusion hardware. \nThere is little useful information about the diameter of the spinal canal or\nthe neural foramina. .\n\nAt C5-C6, there has been prior anterior spinal fusion. Neural foramen and\nspinal canal are patent.\n\nAt C6-C7, the neural foramen and spinal canal are patent.\n\nAt C7-T1, the neural foramen and spinal canal are patent.\n\nTHORACIC. SPINE:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. There is a focal 1.7 x 1.5 cm T2/T1\nhyperintense lesion in the body of T8 vertebrae, likely a hemangioma. The\nmarrow signal is otherwise unremarkable. The intervertebral disc signal and\nheight is maintained at all levels.\n\nThe visualized thoracic spinal cord appears unremarkable without focal cord\nsignal abnormality or cord expansion.\n\nThe esophagus is slightly patulous with fluid within it. The visualized\nprevertebral, paravertebral and paraspinal soft tissues appear otherwise\nunremarkable.\n\nThe neural foramen and spinal canal are patent at all levels.", "output": "1. Evidence of prior anterior spinal fusion of C5-C6 and C7-T1 vertebrae with\nassociated susceptibility artifact somewhat limiting the evaluation at these\nlevels.\n2. Multilevel multifactorial degenerative disease of the cervical spine,\npoorly characterized due to artifact from fusion hardware.\n3. Unremarkable MRI of the thoracic spine without neural foramina or spinal\ncanal stenosis at any level." }, { "input": "The quality of the study is moderately degraded by magnetic susceptibility\nartifact from spinal hardware. Patient is status post C4 through T1 ACDF and\nC4-5 posterior fixation. Postsurgical alignment now appears anatomic. There\nis a T1 hypointense and T2/STIR hyperintense collection with surrounding\nedema, which measures 1.8 (AP) x 1.6 (TV) x 2.5 (SI) cm (see series 2, image\n7 and series 5, image 13 ). This collection appears to communicate to the\nposterior elements of C6, however the facet joints are poorly visualized due\nto susceptibility artifact. There is not appear to be extension into the\nepidural space.There is also surrounding soft tissue edema that extends from\napproximately C2 to C7. Allowing for susceptibility artifact, vertebral\nbody and intervertebral disc signal intensity appear normal. The spinal cord\nappears normal in caliber and configuration, without evidence of signal\nabnormality. Evaluation of the neural foramina is limited by susceptibility\nartifact.\n\nC2-3: Uncovertebral and facet joint hypertrophy and mild disc bulging without\nspinal canal narrowing or high-grade foraminal narrowing without evidence of\nimpingement on the spinal cord.\n\nC3-4: Right paracentral disc protrusion causes mild narrowing of the\nvertebral canal and foraminal narrowing unchanged from the prior study.\n\nC4-5: Limited by susceptibility artifact, within these limitations there does\nnot appear to be significant spinal canal or neural foraminal narrowing.\n\nC5-6: Limited by susceptibility artifact, within these limitations there is\nnot appear to be any significant vertebral canal or neural foraminal\nnarrowing.\n\nC6-7: Limited by susceptibility artifact, within these limitations there does\nnot appear to be any significant spinal canal or neural foraminal narrowing.", "output": "1. The study is greatly limited by metallic susceptibility artifact.\n2. Within these limitations, a posterior cervical soft tissue fluid collection\nwith surrounding edema, which may represent postsurgical changes including\nseroma formation after posterior fixation. This does not appear to be due to\nabscess. However, any associated infection cannot be excluded from MRI\nappearances alone\n3. Mild to moderate degenerative changes stable from the previous MRI. No new\ndisc herniation is seen.\n4. No intraspinal fluid collection or cord compression." }, { "input": "Evaluation is limited by a metallic hardware artifact, particularly the neural\nforamen.\n\nNumbering of the cervical spine is provided on series 2, image 8.\n\nThere is been prior anterior fusion extending from C5 through T1, and\nposterior fusion at C4-C5. Alignment of the cervical spine is anatomic. No\nmarrow signal abnormalities are identified. Cord signal is within normal\nlimits. There is no critical spinal canal stenosis. Within the limitations\nof this study, evaluation of the neural foramen reveals following:\n\nAt C2-C3, there is no critical neural foraminal stenosis.\n\nAt C3-C4, there is a small right paracentral disc protrusion that indents the\nventral thecal sac. There is also a small left foraminal disc protrusion that\nresults in at least mild neuroforaminal narrowing (6:7).\n\nAt C4-C5, evaluation is substantially limited by artifact.\n\nAt C5-C6, C6-C7 and C7-T1, there is no evidence of critical neuroforaminal\nstenosis.", "output": "1. Study limited by metallic hardware artifact from cervical hardware.\n2. No evidence of cord compression.\n3. Mild left neural foraminal narrowing at C3-C4, unchanged from ___." }, { "input": "CERVICAL:\nPlease note, the study is significantly limited due to patient motion artifact\ndegrading image quality in addition to susceptibility artifact from prior\nsurgery limiting evaluation of the adjacent structures. Within the\nlimitations of the study, findings are as follows:\n\nThe patient is status post anterior cervical spinal fusion extending from C5\nthrough T1 level and posterior spinal fusion at C4-C5 level. There is\napparent cord signal abnormality at C4-C5 level (05:10), which is felt most\nlikely artifactual related to adjacent metallic hardware. Further evaluation\nis limited due to significant patient motion artifact, without definite\nevidence of focal cord signal abnormality or cord compression.\n\nC3-C4: There is a central disc bulge resulting in mild effacement of the\nventral thecal sac. In conjunction with bilateral facet and uncovertebral\njoint hypertrophy, there is mild bilateral neural foraminal narrowing.\n\nWithin the limitations of this study, the remaining cervical spine levels\ndemonstrate mild degenerative changes without significant spinal canal or\nneural foraminal narrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is otherwise well maintained. There is a\nstable hemangioma at T8 level. The cord appears normal in caliber. There is\nno spinal canal stenosis or neural foraminal narrowing.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. There is disc desiccation\nwith loss of T2 signal intensity at L3-L4 and L4-L5 levels. The conus\nterminates at L2 level. There is no abnormal cord signal intensity.\n\nMild central disc bulges are noted at the L3-L4 through L5-S1 levels,\nresulting in mild effacement of the ventral thecal sac. There is no spinal\ncanal stenosis. There is mild neural foraminal narrowing at the right L5-S1\nlevel. There is no other significant neural foraminal narrowing.\n\n5 mm probable hepatic cyst is suggested (see 13:21) the left iliac bone donor\nsite is again noted (see 14:35 on current study and 02:58 on ___\nprior abdomen pelvis CT).", "output": "1. Study is severely limited by metallic artifact and motion degradation.\n2. Within the limitations of the study, no evidence of cord compression.\n3. Suggested cord deformity at C4-C5 level (05:10), may be artifact caused by\nsusceptibility artifact from adjacent metallic hardware.\n4. Probable hepatic cyst. If clinically indicated, abdominal ultrasound may\nbe obtained for further evaluation." }, { "input": "THORACIC:\nAnterior fusion hardware is partially visualized at the C3-T1 levels with\nsusceptibility artifact limiting localized evaluation. Vertebral body\nalignment is preserved.Vertebral body heights are preserved. There is an\nunchanged 16 x 16 mm T1 and T2 hyperintense lesion within the T8 vertebral\nbody which incompletely suppresses on the water IDEAL images compatible with\nhemangioma. There is a tiny Schmorl's node at the superior endplate of T9. \nThere are minimal type ___ ___ endplate degenerative changes at T6-T7 and\nT8-T9. There is no other focus of focal bone marrow signal abnormality.\n\nThere is mild loss of T2 signal of the intervertebral discs, a manifestation\nof degenerative disc disease. The intervertebral disc heights are relatively\nwell preserved.\n\n The spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm.\n\nThere is no spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nVertebral body alignment is preserved.Vertebral body heights are preserved. \nThere is no focal bone marrow signal abnormality.\n\nThere is loss of T2 signal of the intervertebral discs from the levels of\nL2-L3 through L5-S1, a manifestation of degenerative disc disease. The\nintervertebral disc heights are relatively well preserved.\n\n The spinal cord appears normal in caliber and configuration.The conus\nmedullaris terminates at the L1-L2 level. There is no evidence of infection or\nneoplasm.\n\nThere is a trace central disc protrusion at L2-L3 and minimal disc bulges at\nL3-L4 and L4-L5 without spinal canal narrowing.\n\nA small midline and right-sided disc protrusion at L5-S1 focally contacts the\ntraversing right S1 nerve root without displacement and does not produce\nsignificant spinal canal narrowing (13:29, 10:30).\n\nMild facet osteophytes are noted at multiple levels, most prominent in the\nlower lumbar spine producing mild neural foraminal narrowing at the bilateral\nL4-L5 and L5-S1 levels. Otherwise, there is no significant spinal canal or\nhigh-grade neural foraminal narrowing.\n\nThe degree of degenerative changes is similar to the ___\nexamination.\n\nOTHER: The visualized lungs are grossly clear. A 6 mm T2 hyperintense lesion\nwithin the right hepatic lobe is unchanged, likely representing a cyst. The\nvisualized retroperitoneum is otherwise grossly unremarkable. Left iliac bone\ngraft donor site is again noted (13:34).", "output": "1. Mild thoracic and lumbar spondylosis, as described, unchanged since ___, without significant spinal canal narrowing or high-grade neural\nforaminal narrowing.\n2. No cord signal abnormality." }, { "input": "THORACIC:\nThe patient is status post anterior spinal fusion at C3-T1 levels with\nsusceptibility artifact associated with the hardware obscuring visualization\nof the adjacent structures. There is redemonstration of a T1 and T2\nhyperintense lesion within T8 vertebral body, likely representing a\nhemangioma. The vertebral body heights and intervertebral disc space and\nsignal are preserved. The spinal cord is normal in caliber morphology without\nabnormal signal intensity or enhancement. There is no spinal canal or neural\nforaminal stenosis, cord compression, or cord edema.\n\nLUMBAR:\nThere is stable 2 mm retrolisthesis of L3 on L4. The vertebral body heights\nand intervertebral disc spaces are preserved. There is loss of intervertebral\ndisc T2 signal at multiple levels, likely related to degenerative process. \nThe conus medullaris terminates at L2. The prevertebral and paraspinal soft\ntissues appear unremarkable. There is a mild disc bulge at L3-L4 and L4-L5\nwith ligamentum flavum thickening and bilateral facet arthropathy indenting\nthe ventral thecal sac and causing mild bilateral neural foraminal narrowing\nwithout spinal canal stenosis. There is small bilateral facet joint effusion\nat L3-L4 and left L4-L5.\n\nOTHER: There is a stable nonenhancing 6 mm cyst within the right hepatic lobe,\nlikely a simple cyst.", "output": "1. No evidence of high-grade spinal canal stenosis, cord compression or\nabnormal enhancement.\n2. Stable mild degenerative changes of the lumbar spine." }, { "input": "The patient is status post anterior cervical spinal fusion from C3-T1,\nalthough proper delineation of the vertebral bodies is obscured by\nsusceptibility artifact from the hardware. Posterior cervical spinal fusion\nat C3-C4 are again seen. The alignment of the cervical spine is maintained. \nThe visualized vertebral body heights are preserved.\n\nThe spinal cord is normal in caliber morphology without cord edema or cord\ncompression. The craniocervical junction, prevertebral, paraspinal soft\ntissues appear unremarkable. There is small cervical lymph nodes without\nlymphadenopathy per size criteria. There is no abnormal enhancement or fluid\ncollection.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: There is disc protrusion with bilateral facet and uncovertebral joint\narthropathy resulting in moderate left and mild right neural foraminal\nnarrowing.\n\nC4-C5: There is disc protrusion with bilateral facet and uncovertebral joint\narthropathy resulting in severe left and moderate right neural foraminal\nnarrowing.\n\nC5-C6: There is no spinal canal or neural foraminal stenosis.\n\nC6-C7 and C7-T1: There is no spinal canal or neural foraminal stenosis.", "output": "1. Status post cervical spinal fusion, with susceptibility artifact associated\nwith the hardware obscuring visualization of the adjacent structures.\n2. No evidence of cord compression, cord edema, or abnormal enhancement.\n3. Multilevel degenerative changes of the cervical spine with\nmoderate-to-severe neural foraminal narrowing as detailed above, without\nsignificant spinal canal stenosis." }, { "input": "Study limited due to motion artifacts.\n\nCERVICAL SPINE:\n\nThe vertebrae are normal in height and alignment. There is no suspicious\nmarrow signal abnormality.\nDisc dessication noted at multiple levels.\nAt C5/6 and C6/7 levels, mild disc bulge with shallow central protrusion\nindenting the ventral thecal sac outline.\nSmall perineural cyst on the right side at C6-7 level.\n\nThere is no significant spinal canal or foraminal stenosis.\nLimited evaluation of the extent of foraminal narrowing due to motion on axial\nimages.\nThe cord is normal in course and caliber.\nThere is no abnormal enhancement.\n\nTHORACIC SPINE:\n\nThe vertebrae are normal in height and alignment. There is no suspicious\nmarrow signal abnormality.\nAt T11-T12: Disc desiccation, mild diffuse disc bulge, endplate irregularity\nno disc herniation, no canal or significant foraminal narrowing.\nThere is no significant spinal canal or foraminal stenosis.\nThe cord is normal in course and caliber. There is no fluid collection in the\nspinal canal.\nThere is no abnormal enhancement.\n\nLUMBAR SPINE:\n\nLumbar vertebral bodies are grossly normal in height, signal intensity and\nalignment.\nL1-L3: No disc herniation, no canal or significant foraminal narrowing.\nMild facet changes are noted on both sides.\n\nThere is irregularity of the L4-5 endplates with type I and type ___\nchanges and mild vertebral body enhancement posteriorly, unchanged from MRI on\n___. There is enhancement of a small Schmorl's node at the\nsuperior endplate of L5, also unchanged from prior MRI. (Evaluation is\nsomewhat limited due to the absence of pre contrast T1 axial images) mild\nfacet changes are noted on both sides.\nMild foraminal narrowing inferiorly.\nL5-S1: No disc herniation, no canal or significant foraminal narrowing.\nMild facet changes on both sides.\n\nThere is no marrow or disc space signal abnormality suggestive of\ndiscitis-osteomyelitis.\nThe conus is normal in appearance and position, terminating at L1-L2.\nThe nerve roots of the cauda equina are normal in appearance.\nThere is no fluid collection within the spinal canal.\n\nThere is patchy consolidation of the lung bases and a left pleural effusion.", "output": "1. No epidural abscess of the cervical, thoracic, and lumbar spine. F/u as\nneeded for subtle changes\n2. Degenerative disc disease at L4-5, unchanged compared to prior MRI from ___.\n3. Mild degenerative disk changes at C5-6 ; possible multilevel foraminal\nnarrowing\n4. T11-T12: Disc desiccation, mild diffuse bulge, no disc herniation, no\ncanal or foraminal narrowing.\n5. Patchy consolidation of the lungs and a left pleural effusion, better\nassessed on the concurrent CT chest." }, { "input": "Alignment of the lumbar spine is normal. There is no evidence of infection or\nneoplasm. Vertebral body heights are preserved. Marrow signal is\nheterogeneous in appearance, likely due to scattered foci of focal fat. \nAdditional note is made ___ type 2 changes along the inferior endplate of\nT12 (3:10, 4:9). Conus medullaris terminates at L1-L2. No cord signal\nabnormalities are identified within the visualized portions of the cord. \nThere is loss of normal T2 signal in the T11-T12 intervertebral disc,\ncompatible with degenerative disc disease. No significant spinal canal or\nneural foraminal narrowing is seen in the lumbar spine.\n\nA T2 hyperintense lesion that measures at least 1.6 cm is seen arising from\nthe upper pole of the left kidney (6:1), which may represent a cyst.", "output": "1. No epidural collection.\n2. No spinal canal or neuroforaminal stenosis in the lumbar spine. \nDegenerative changes include degenerative disc disease at T11-T12 and ___\ntype 2 changes at T12.\n3. Approximately 1.6 cm T2 hyperintense left upper pole renal lesion,\npossibly representing a cyst." }, { "input": "CERVICAL:\nMillimetric anterolisthesis of C7 on T1 is likely degenerative.The cervical\nvertebral body heights are maintained.No fracture is identified. 9 mm fat\ncontaining rounded lesion in the C6 vertebral body is compatible with\nhemangioma.Bone marrow signal is otherwise normal.There is no epidural\ncollection or hematoma. There is no evidence of discitis or osteomyelitis. \nThere are multilevel moderate to severe degenerative changes with\nintervertebral disc space narrowing most prominent at the C4-C5 level. \nLigamentum flavum hypertrophy causes mild canal stenosis at the C3-C4 level. \nCombination of a large posterior osteophyte, posterior disc bulge and\nligamentum flavum hypertrophy causes moderate canal stenosis at the C5-C6\nlevel ventrally impinging on the spinal cord, though there is no underlying\ncord signal abnormality. Additionally, there is moderate narrowing of the\nneural foramina at the C5-C6 level there is additional moderate narrowing of\nthe left neural foramen at the C3-C4 level. Cord signal and morphology is\nnormal.\n\nTHORACIC:\nThoracic vertebral alignment and vertebral body heights are well-maintained. \nThe vertical lucency in the anterior endplate of the T12 vertebral body is\nbetter seen on the prior CT examination and there is no associated vertebral\nbody edema or height lossthere are overall mild multilevel multifactorial\ndegenerative changes without high-grade spinal canal or neural foraminal\nstenosis. There is moderate narrowing of the intervertebral disc space at\nwith small posterior disc bulges at the C7 through T3 level.Facet hypertrophy\ncauses moderate narrowing of the right T1-T2 and T2-T3 neural foramina.There\nis otherwise no high-grade spinal canal or neural foraminal stenosis.Cord\nsignal and morphology is normal. Bone marrow signal is normal. There is no\nepidural collection or hematoma.\n\nLUMBAR:\nAn oblique fracture line is seen in the anterior and inferior endplate of the\nL4 vertebral body without significant height loss. The fracture line is well\ndemarcated with sclerotic margins on the CT examination and on the MR\nexamination there is only trace surrounding edema.Vertebral body heights are\notherwise well maintained.Terminal spinal cord signal and morphology is\nnormal. The conus medullaris terminates at the L1 level.There are multilevel\nmultifactorial moderate to severe degenerative changes. Intervertebral disc\nspace narrowing is most prominent at the L1-L2 and L4-L5 levels. A small\nposterior disc bulge at the L1-L2 level causes mild canal stenosis. Moderate\nposterior disc bulge with osteophyte and ligamentum flavum hypertrophy causes\nsevere canal stenosis at the L4-L5 level. There is moderate\nleft-greater-than-right neural foraminal narrowing at the L1-L2 level. There\nis mild left neural foraminal narrowing at the L2-L3 level. There is moderate\nleft-greater-than-right neural foraminal narrowing at the L3-L4 level. There\nis severe narrowing of the bilateral neural foramina at the L4-L5 level with\ncompression of the exiting nerve roots. There is moderate narrowing of the\nbilateral neural foramina at the L5-S1 level.Bone marrow signal is otherwise\nnormal. There is no epidural hematoma or collection.\n\nOTHER: There is increased T2 signal within the visualized portion of the\nsacrum which is not completely characterized or visualize. There are moderate\nbilateral pleural effusions. Numerous T2 hyperintense lesions are seen in the\nbilateral kidneys measuring up to 0.5 cm in the left upper pole kidney, likely\nrepresenting cysts.", "output": "1. L4 anterior inferior endplate fracture with only minimal edema and\nwell-circumscribed sclerotic fracture line on CT compatible with chronic\nfracture.\n2. No abnormality or edema corresponding to the horizontal fracture line of\nthe T12 vertebral body as seen on prior CT. This represents either a vascular\nchannel or chronic fracture.\n3. Incompletely characterized increased T2 signal within the visualized\nportion of the sacrum. Fracture cannot be excluded.\n4. Moderate to severe multilevel, multifactorial degenerative changes of the\nspine most prominent at the L4-L5 level, as characterized above.\n5. Moderate bilateral pleural effusions.\n6. Bilateral renal cysts.\n\nRECOMMENDATION(S): Recommend correlation with physical examination to\nevaluate for sacral pain. If there is focal pain in this area, evaluation for\nfracture can be done with MSK protocol MRI of the pelvis." }, { "input": "There is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. There is no concerning focal bone marrow signal\nabnormality. There is loss of signal within the L4-L5 and L5-S1 intervertebral\ndiscs. The conus medullaris terminates at the level of L1-L2. There is no\nspinal cord signal abnormality detected.\n\nOn sagittal imaging, there is no appreciable canal or neural foraminal\nnarrowing at the level of T11-T12. Similarly, no canal or neural foraminal\nnarrowing is noted at the levels of T12-L1 and L1-L2.\n\nL2-L3: A mild posterior disc bulges noted without significant canal or neural\nforaminal narrowing.\n\nL3-L4: Mild ligamentum flavum hypertrophy and posterior disc bulge flattens\nthe thecal sac, causing mild bilateral neural foraminal narrowing and\ncontacting the traversing right L4 nerve root.\n\nL4-L5: A mild posterior disc bulge flattens the thecal sac read ligamentum\nflavum hypertrophy, causes minimal bilateral neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge with superimposed central disc protrusion new\ncauses mild bilateral neural foraminal narrowing\nThere 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.", "output": "1. No evidence for metastatic disease within the spine.\n2. Mild to moderate multilevel degenerative changes of the lumbar spine, as\ndescribed above, most significant at the level of L5-S1." }, { "input": "Thoracic spine:\n\nThere is diffuse low signal in the visualized bony structures likely secondary\nto chronic renal failure. The T5 vertebra demonstrates increased T1 and T2 as\nwell as inversion recovery signal. Slight prominence of left-sided paraspinal\nsoft tissues is seen on the axial T2 weighted images (10:21). There is no\nintraspinal mass identified.\n\nAt T11-12 mild disc bulging identified. There is no spinal cord compression\nor abnormal signal seen within the spinal cord in the thoracic region. No\nevidence of discitis or osteomyelitis.\n\nLumbar spine:\n\nThere is no discitis or osteomyelitis identified in the lumbar region. \nMultilevel disc bulging is seen most pronounced at L4-5 level. There is no\nspinal stenosis or high-grade foraminal narrowing seen.\n\nIn the partially visualized paraspinal region prominence of left psoas muscles\nnoted which was seen on the previous CT of ___ but is not fully\nevaluated.", "output": "1. No evidence of discitis or osteomyelitis in thoracic or lumbar region.\n2. Evidence of cord compression or high-grade thecal sac compression.\n3. Prominent left psoas muscle shown to be due to hematoma on the previous\nabdominal CT is not fully evaluated.\n4. Hemangioma of T5 vertebra with slight prominence of left paraspinal soft\ntissues can be further evaluated with the thoracic spine CT for better\nassessment and to exclude aggressive changes.\n5. Diffuse low signal in the bony structures likely related to chronic renal\nfailure." }, { "input": "There is minimal posterior subluxation of L 2 on L3. Otherwise, alignment is\nnormal. There is mixed ___ type 1 and type 2 signal intensity changes in\nthe inferior endplate of the T12 vertebral body. Intervertebral discs\ndemonstrate loss of signal on the T2 weighted images. There is loss of height\nof the intervertebral discs from T10 through L3. There are small Schmorl's\nnodes in the superior endplates of T11, T12, L1, and L3. The spinal cord\nappears normal in caliber and configuration. The spinal cord ends at T12-L1.\nAxial imaging from T12 through L2 demonstrates no spinal canal or neural\nforaminal narrowing.\nAt L2-3, subluxation and mild bulging of the disc combines with facet\nosteophytes and thickening of the ligamentum flavum to mildly narrow the\nspinal canal. The neural foramina appear normal. There are small bilateral\nfacet joint effusions.\nImaging at L3-4 demonstrates bilateral facet joint effusions but no spinal\ncanal or neural foraminal compromise.\nAt L4-5 there are prominent bilateral facet osteophytes but no narrowing of\nthe spinal canal.\nThere are prominent bilateral facet osteophytes at L5-S1 with no narrowing of\nthe spinal canal.\nThere is no evidence of infection or neoplasm.", "output": "1. Degenerative disc disease with multiple levels of prominent facet\nosteophytes but no spinal canal or neural foraminal narrowing." }, { "input": "The craniocervical junction and C2-3 level no abnormalities are identified.\n\nAt C3-4 level, disc bulging and uncovertebral degenerative changes seen\nwithout spinal stenosis with mild to moderate bilateral foraminal narrowing.\n\nAt C4-5 level, disc bulging indents thecal sac. There is a left-sided disk\nprotrusion seen. There is severe left foraminal narrowing identified with mild\nnarrowing of the right foramen. These findings are new since the previous MRI\nexamination.\n\nAt C5-6 level, the patient has undergone spinal fusion. The spinal canal and\nforamina are patent.\n\nC6-7 level, mild disc bulging seen. Although foraminal evaluation is limited\nby artifacts from the metallic implants, no evidence of high-grade stenosis\nseen.\n\nAt C7-T1 and T1-2 abnormalities are seen.\n\nSpinal cord shows normal intrinsic signal without extrinsic compression.\n\nPreviously seen soft tissue lipoma is no longer visible.", "output": "1. New left-sided disc herniation at C4-5 level which severely narrows the\nleft foramen and may affect left C5 nerve root.\n2. Mild progression of degenerative changes at C3-4 level.\n3. Status post spinal fusion at C5-6 level." }, { "input": "There is 1 mm retrolisthesis of C4 on C5 and 2 mm retrolisthesis of C5 on C6\nas well as 1 mm anterolisthesis of C6 on C7, likely on a degenerative basis. \nVertebral body heights are normal. There is multilevel disc desiccation with\nloss of intervertebral disc height at C4-C5 and C5-C6. The bone marrow signal\nintensity is normal without a suspicious enhancing lesion. The visualized\nportion of the spinal cord appears normal. There is no evidence of infection\nor neoplasm. There is a 7 x 2.5 cm fat intensity deposit in the posterior\nsuboccipital subcutaneous soft tissues, likely a lipoma. The prevertebral and\nparaspinal soft tissues are otherwise normal.\n\nC2-C3: Small posterior disc protrusion without significant spinal canal or\nneural foraminal stenosis.\nC3-C4: Ligamentum flavum thickening and mild facet joint arthropathy without\nsignificant spinal canal or neural foraminal stenosis.\nC4-C5: Minimal retrolisthesis, broad-based disc protrusion and ligamentum\nflavum thickening results in mild narrowing of thecal sac. Uncovertebral\nfacet joint arthropathy contributes to moderate bilateral neural foraminal\nnarrowing.\nC5-C6: Minimal retrolisthesis, broad-based disc protrusion, and ligamentum\nflavum thickening results in mild effacement of the thecal sac with mild\nindentation on the ventral spinal cord. Uncovertebral facet joint osteophytes\ncontribute to moderate right and mild left neural foraminal narrowing.\nC6-C7: Broad-based disc protrusion, ligamentum flavum thickening and facet\njoint arthropathy results in mild left neural foraminal narrowing without\nsignificant spinal canal stenosis.", "output": "1. No evidence of metastatic disease, cord signal abnormality or cord\ncompression in the cervical spine.\n2. Mild multilevel degenerative changes resulting in mild spinal canal\nstenosis at C4-C5 and C5-C6 without significant cord deformity or signal\nabnormality.\n3. Mild multilevel neural foraminal narrowing including moderate bilateral\nneural foraminal narrowing at C4-C5 and moderate right neural foraminal\nnarrowing at C5-C6 as detailed above." }, { "input": "Please note, for counting purposes, the last intervertebral disc space is\nconsidered L5-S1.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nand disc spaces for preserved. There is no suspicious marrow replacing lesion\nor abnormal enhancement. The spinal cord is normal in caliber and morphology.\nThere is a stable small disc protrusion at T7-T8 with indentation of the\nventral thecal sac, stable, without spinal canal or neural foraminal stenosis.\nCentral canal is patent at other levels in the thoracic spine. There is no\nsignificant foraminal narrowing in the thoracic spine.\n\nLUMBAR:\nThe patient is status post L3-S1 posterior spinal fusion with L3-4 pedicle\nscrews and spinal rods with intervertebral disc spacer device at L3-L4 through\nthe L5-S1 and additional laminectomy at L5. The hardware alignment and\nintegrity is better assessed by CT or radiography. There is interval decrease\nin size of a focal fluid collection posterior to L5 laminectomy site, which\ncurrently measures 3.3 x 1.3 cm (10:10), previously 4.2 x 1.9 cm. There is no\ndirect communication with the thecal sac. There is no evidence of new fluid\ncollection. The conus terminates at L1-L2 level. The spinal cord is normal\nin signal intensity and morphology. There is mild clumping of the cauda\nequina nerve roots (14:20), which is similar to the prior study.\n\nT12-L1 and L1-L2: There are mild facet degenerative changes without spinal\ncanal or neural foraminal stenosis.\n\nL2-L3: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet osteophytes, similar to the prior study, with mild residual annular\ntear, and small disc protrusion, stable. . There is narrowing of the\nbilateral subarticular recess with mild spinal canal stenosis, similar to the\nprior study. There is no neural foraminal stenosis.\n\nL3-L4: There is no spinal canal or neural foraminal stenosis.\n\nL4-L5: Endplate osteophytes again seen. Again seen is left paramedian\nfullness extending into the lateral recess, resulting in encroachment on\ntraversing left L5 nerve root, without effacement of the CSF within nerve root\nsleeve, without mass effect on the thecal sac which is similar, and which has\nfairly homogeneous enhancement on axial post gadolinium images, favoring\nepidural fibrosis, with possible small component of disc protrusion series 16,\nimage 28 centrally. . There is no significant central canal narrowing. \nThere is no neural foraminal stenosis.\n\nL5-S1: Again seen is a posterior endplate osteophyte resulting in mild\nindentation of the ventral thecal sac without spinal canal stenosis or neural\nforaminal narrowing.\n\nOther: Common bile duct is dilated measuring 1.1 cm, may be related to prior\ncholecystectomy this has been performed, correlate with LFTs if clinically\nindicated.", "output": "1. No evidence of spinal cord compression or abnormal enhancement.\n2. Status post L3-S1 posterior spinal fusion, with decrease in a\nmultiloculated fluid collection at L5 laminectomy site.\n3. Mild clumping of the cauda equina nerve roots, which may represent\npostsurgical arachnoiditis, similar to the prior study.\n4. Stable multilevel degenerative changes, most prominent at L4-L5, similar.\n5. Dilated common bile duct may be related to prior cholecystectomy if this\nhas been performed, correlate with LFTs if clinically indicated." }, { "input": "Axial images of the present exam do not include the lowest rib-bearing\nvertebra, but the prior MRI and radiographs demonstrate that there are 5\nlumbar-type vertebrae. The numbering is documented on image 2:8.\n\nThere is instrumented anterior fusion at L3-L4, L4-L5, and L5-S1, as seen on\nthe prior MRI. There also laminectomies at L3 through L5, and posterior\nfusion of L3 and L4 with bilateral pedicle screws. The hardware is not\nassessed by MRI. There is bone graft in the posterior elements from L3\nthrough S1, better seen on the ___ lumbar spine radiographs. \nFluid collection posterior to the laminectomy beds from L4-L5 through L5-S1\nlevels is unchanged compared to the ___ MRI, measuring 5.8 x 1.2 x\n3.6 cm on images 5:21 and 2:9 (transverse, AP, craniocaudad). This fluid\ncollection is surrounded by enhancing granulation tissue, as before. It does\nnot exert mass effect on the thecal sac.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating near the upper endplate of L2. Mild\nclumping of the intrathecal nerve roots at L3 on images ___ is unchanged,\ncompatible with sequela of prior arachnoiditis.\n\nThere is no evidence for an epidural collection.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: Minimal retrolisthesis unchanged. There is a mild disc bulge and a\nbroad-based central/right paracentral disc protrusion without spinal canal\nnarrowing, unchanged. No significant neural foraminal narrowing.\n\nL3-L4: No spinal canal or neural foraminal narrowing.\n\nL4-L5: No spinal canal narrowing. Small central posterior bone ridge is again\nnoted. Mild right neural foraminal narrowing by endplate and facet\nosteophytes is unchanged.\n\nL5-S1: No spinal canal narrowing and no significant neural foraminal\nnarrowing.", "output": "1. Status post anterior fusion at L3-L4, L4-L5, and L5-S1. S/p bone graft\nmediated posterior fusion for from L3 through S1 with instrumentation at L3\nand L4. Unchanged minimal retrolisthesis of L 2 on L3.\n2. Small fluid collection posterior to the laminectomy beds from L4 through\nL5, surrounded by enhancing granulation tissue, is unchanged since ___, likely a seroma versus pseudomeningocele. While infection cannot be\nexcluded by imaging, lack of change is reassuring.\n3. No evidence for an epidural collection.\n4. No significant spinal canal narrowing." }, { "input": "Images were degraded by motion artifact.\n\nAt C3-C4 level; there is central disc protrusion effacing the ventral\nsubarachnoid CSF space and indenting ventral cervical cord with no underlying\nintramedullary signal abnormality. There is associated dorsal facet\narthropathy ligamentum flavum thickening resulting in spondylitic moderate\nspinal canal stenosis.\n\nThere is no underlying other significant spinal canal stenosis. There are\nmultilevel uncovertebral arthropathy resulting in multilevel neural foramina\nstenosis more pronounced at right C3-C4 and right C4-C5.\n\nThe spinal cord appears normal in caliber and signal intensity.\n\nThe sagittal alignment is relatively preserved. Vertebral body heights and\nsignal intensity appear grossly unremarkable. There is no definite evidence\nof infection or neoplasm.", "output": "1. Spondylitic moderate spinal canal stenosis at C3-C4 level.\n2. No definite underlying intramedullary signal abnormality.\n3. Spinal cord show normal volume and signal intensity.\n4. Multilevel different degrees neural foraminal stenosis more pronounced at\nright C3-C4 and right C4-C5 foramina." }, { "input": "The lumbar spine alignment is normal. There is diffuse bone marrow T1\nhypointensity. The cord terminates at L1 and is unremarkable. Disc bulges\nand loss of disc height are seen at L4-5 and L5-S1; otherwise there is no\nspinal canal or foraminal narrowing:\n\nFrom T12-L1 through L3-L4 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nL4-L5: There is a diffuse disc bulge causing mild anterior thecal sac\ndeformity, contacting the traversing nerve roots bilaterally towards the\nsubarticular zones (series 7, image 31), the disc bulge is causing mild\nbilateral neural foraminal narrowing, mild bilateral articular joint facet\nhypertrophy with minimal articular joint effusions as well as mild ligamentum\nflavum thickening, there is no evidence of central spinal canal stenosis.\n\nL5-S1: Disc bulge, asymmetric to the left, abutting the descending left cauda\nequina nerve roots, bilateral facet osteophytes, mild spinal canal narrowing,\nno right and mild left foraminal narrowing.\n\nThere is no abnormal enhancement after contrast administration. The\nparaspinal soft tissues are unremarkable. Limited view of the pelvis\ndemonstrates enlarged uterus in anteflexion position and fibroid changes.", "output": "1. Disc degenerative changes identified at L4-5 level, contacting the\ntraversing nerve roots towards the subarticular zones bilaterally, articular\njoint facet hypertrophy and minimal articular joint effusions are seen as\ndescribed detail above.\n2. Disc bulge at L5-S1 is asymmetric to the left, and abuts the descending\nleft cauda equina nerve roots, causing mild spinal canal narrowing, and mild\nleft foraminal narrowing.\n3. Diffuse bone marrow low signal, representing chronic anemia or a marrow\nreplacing process. There is no evidence of abnormal enhancement after\ncontrast administration." }, { "input": "LUMBAR:\nAlignment is normal. The patient is status post L5-S1 discectomy. T2/STIR\nhyperintense signal is noted along the posterior disc margin of the L5 and S1\nvertebral bodies. There is a T1 hypo intense focus along the ventral aspect of\nthe spinal canal spanning from L5-S1 with internal focus of enhancement,\ncompatible with granulation tissue. No definite encroachment of the nerve\nroots at this level. There is persistent deformity of the thecal sac at\nL5-S1, which may represent expected early postsurgical changes, however\nresidual disc material cannot be excluded. T2 hyperintensity in the\nparaspinous soft tissues from L2-L4 likely represents postsurgical edema.\n\nThe spinal cord and cauda equina demonstrate no abnormal signal or\nenhancement. Mild loss of disc space height and T2 signal of the L4-L5\nintervertebral disc, likely secondary to degeneration. Disc protrusion at\nL4-L5 results in mild spinal canal stenosis.\n\nOTHER: The partially visualized bilateral kidneys and psoas muscles are\nunremarkable. No abdominal aortic aneurysm.", "output": "1. No evidence of spinal cord or cauda equina compression.\n2. Status post L5-S1 discectomy with postsurgical changes as described above. \nThere is persistent deformity of thecal sac at this level, which may represent\nexpected early postsurgical change, however, residual disc material cannot be\nexcluded.\n3. Mild degenerative changes as described above including mild spinal canal\nstenosis at L4-L5." }, { "input": "There is mild scoliosis of lumbar spine convex to the right in the lower\nlumbar and to the left in the upper lumbar region. There is hemangioma in the\nL1 vertebral body, otherwise vertebral body signal intensity is normal. There\nis degenerative disc signal, most prominent from the L3 through L5 levels. No\nprevertebral edema.\n\nFrom T11-12 through L3-4 levels disc degenerative changes mild bulging noted\nwithout spinal stenosis or foraminal narrowing. Incidental perineural cysts\nare seen in both foramina from L1-2 to L3-4 levels..\nL4-5: A disc bulge with superimposed central protrusion in combination with\nligamentum flavum thickening and facet osteophytes. There is no spinal\nstenosis. There is mild left neural foraminal narrowing. No appreciable\nright neural foraminal narrowing.\nL5-S1: There is decreased disc height and disc bulging. There is moderate to\nsevere left neural foraminal narrowing with contact of the exiting L5 nerve\nroot by an osteophyte. Mild right neural foraminal narrowing.\n\nOther: Multiple sacral Tarlov cysts are incidentally noted.", "output": "1. Moderate to severe left L5-S1 neural foraminal narrowing with contact of\nthe exiting L5 nerve root by osteophytes.\n2. An annular fissure is noted at L3-4. Possible annular fissure versus\ndegenerative disc signal is also present at L5-S1.\n3. Additional multilevel degenerative changes of the lumbar spine as described\nabove." }, { "input": "Artifacts, which appear to be machine-generated. Degrade the sagittal T1\nweighted pre- and post-gadolinium enhanced images. These artifacts are\npositioned in the prevertebral soft tissues.\n\nAt C4-5, there is a 1 mm, possible degenerative anterior subluxation of C4\nupon C5. Uncovertebral spurring produces moderately prominent right and\nmilder left neural foraminal stenosis.\n\nAt C5-6, there is a shallow left paracentral posterior spondylitic ridge\napproaching the left ventrolateral cord margin. The disc is moderately\nprominently narrowed. Uncovertebral spurring causes prominent left neural\nforaminal stenosis. It is possible that this left neural foraminal stenosis\nmay account what appears to be asymmetric prominent enhancement of the\nepidural soft tissues in this vicinity, perhaps representing congested\nepidural veins, rather than an intrinsic neoplastic or inflammatory\npathological process. Please see image 22, series 10. In that regard, there\nare no other areas of pathological enhancement seen within the cervical spine.\nMoreover, neither you nor the patient indicated that there was any history of\na prior malignancy there would raise the question of an isolated epidural\nmetastatic process. Please confirm this supposition.\n\nAt C6-7, uncovertebral spurring produces mild left neural foraminal stenosis.\n\nThe cervical spinal cord signal pattern, foramen magnum and its contents, as\nwell as limited cervical paraspinal soft tissue imaging does not disclose\nadditional abnormalities. There is partial imaging of what is probably a\nmildly prominent right side of the lingual tonsil, contacting the anterior\naspect of the epiglottis. Please correlate this observation by direct\nvisualization.", "output": "Cervical spondylosis. Please see above report for details." }, { "input": "At T11-12 and T12-L1 is levels no abnormalities are seen. At L1-2 and L2-3\nlevels mild disc bulging and mild narrowing of the foramina seen. Minimal\nnarrowing of the spinal canal is noted.\n\nAt L3-4 level, disc and facet degenerative changes seen. There is\nmild-to-moderate spinal stenosis. There is moderate left foraminal narrowing.\n\nAt L4-5 level, there is diffuse disc bulge and a protrusion extending to both\nsides left greater than right side. There is thickening of the ligaments. \nThere is compression of the thecal sac with high-grade spinal stenosis. In\naddition, protrusions are seen in both foramina with severe narrowing of the\nleft foramen and deformity of the exiting left L4 nerve root and moderate\nnarrowing of the right foramen.\n\nAt L5-S1 level and rudimentary disc is seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Disc protrusion and facet degenerative changes resulting in severe spinal\nstenosis at L4-5 level with severe left foraminal narrowing and compression of\nexiting left L4 nerve root with moderate right foraminal narrowing at this\nlevel.\n2. Multilevel degenerative changes at other levels as described above." }, { "input": "The patient is status post L3-4 laminectomies depression of the spinal canal,\nthere is a fluid collection within the L3-4 laminectomy bed measures 12 x 35\nmm (AP, SI). There is mild edema within the region of the laminectomy bed.\nLumbar vertebral body height and alignment are preserved. The conus\nmedullaris terminates at the T12-L1 level. The conus medullaris and cauda\nequina appear normal in morphology and signal intensity. There is no abnormal\nintradural enhancement\n\nThere are moderate degenerative endplate changes at L3-4 and L4-5 levels, with\nloss of intervertebral disc height.\n\nAt L1-2, there is a disc bulge and facet hypertrophy with mild spinal canal\nand bilateral neural foraminal narrowing.\n\nAt L2-3, there is a disc bulge and facet hypertrophy with mild to moderate\nspinal canal narrowing. There is no definite impingement on the traversing\nright L3 nerve root within the subarticular zone. There is mild bilateral\nneural foraminal narrowing.\n\nAt L3-4, there are L3 laminectomy changes. There is a small fluid collection\nwithin the laminectomy bed at the L3 and L4 levels with mild mass effect on\nthe thecal sac. There is narrowing of the subarticular zones due to residual\ndisc bulge and facet hypertrophy, without definite impingement on traversing\nnerve roots. There is mild right and moderate left neural foraminal\nnarrowing.\n\nAt L4-5, there are L4 laminectomy changes. There is possible impingement on\nthe traversing nerve roots within the subarticular zones due to the residual\ndisc bulge and facet hypertrophy. There is moderate spinal canal and\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is no spinal canal or neural foraminal narrowing.", "output": "1. L3-4 laminectomy changes with decompression of the spinal canal at the L3-4\nlevel. Fluid collection most likely reflects a postoperative seroma, however\nabscess or CSF leak cannot be excluded.\n2. Possible impingement of the traversing bilateral L5 nerve roots within the\nL4-5 subarticular zone due to a residual disc bulge and facet hypertrophy." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T12 and is\nunremarkable. Focal area of high signal intensity is identified at T10\nvertebral body, suggestive of a small non expansile hemangioma.\n\nAt T12/L1 level, from T10/T11 through L2/L3 levels, there is no evidence of\nneural foraminal narrowing or spinal canal stenosis.\n\nAt L3/L4 level, the intervertebral disc space appears maintained, there is\nminimal bilateral articular joint facet hypertrophy with no evidence of neural\nforaminal narrowing or spinal canal stenosis\n\nAt L4/L5 level, there is minimal diffuse disc bulge, contacting the traversing\nnerve roots bilaterally (image 17, series 6), mild articular joint facet\nhypertrophy is present.\n\nAt L5/S1 level, interval progression of the degenerative changes, consistent\nwith disc desiccation and disc bulge, causing mild bilateral neural foraminal\nnarrowing, contacting the traversing nerve roots bilaterally (image 23, series\n6), moderate articular joint facet hypertrophy is present, the sacroiliac\njoints are unremarkable. The visualized paravertebral structures are grossly\nnormal.", "output": "1. Mild degenerative changes in the lower lumbar spine at L3/L4 and L4/L5\nlevels.\n\n2. At L5/S1 level, there is interval progression of the disc degenerative\nchanges, consistent with disc desiccation and disc bulge, causing mild\nbilateral neural foraminal narrowing and contacting the traversing nerve roots\nbilaterally." }, { "input": "The visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.\n\nThere is no evidence of appreciable vertebral body height loss to suggest\ncompression fracture. The cervical spinal alignment is within normal limits.\n\nPresumed ___ type 1 changes are noted at C6-7, with ___ type 2 changes\nseen at C5-6. No focal suspicious bone marrow signal is identified.\n\nThe cervical cord is normal in morphology and signal intensity.\n\nMultilevel degenerative changes are as follows:\n\nC1-C2, C2-C3: There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nC3-C4: There is a posterior disc protrusion indenting the ventral thecal sac\nand nearly contacting the spinal cord, resulting in mild canal stenosis. No\nsignificant neural foraminal narrowing.\n\nC4-C5: A posterior disc protrusion indents the ventral thecal sac and\nminimally contacts the spinal cord without underlying cord signal abnormality.\nThere is mild canal stenosis without neural foraminal narrowing.\n\nC5-C6: A posterior disc protrusion results in mild canal stenosis with minimal\nright and moderate left neural foraminal narrowing.\n\nC6-C7: A posterior disc protrusion results in mild canal stenosis with\nuncovertebral joint hypertrophy contributing to moderate bilateral neural\nforaminal narrowing.\n\nC7-T1: An asymmetric left posterior disc protrusion results in mild to\nmoderate canal stenosis with moderate to severe bilateral neural foraminal\nnarrowing.\n\nThe prevertebral and paraspinal soft tissues are grossly within normal limits.", "output": "1. Multilevel spondylosis of the cervical spine, most prominent at C7-T1 with\nmild to moderate canal stenosis and moderate to severe bilateral neural\nforaminal narrowing.\n2. Additional findings as described above." }, { "input": "Please refer to the concurrent MR brain for full description of the clival and\nsphenoid wing mass.\n\nMild anterolisthesis of C6 on C7 and C7 on T1, likely degenerative. Alignment\nis normal. Vertebral body heights are preserved. There is moderate\ndegenerative disc disease throughout the cervical spine with type ___ ___\nchanges of the adjacent endplates at C5-6 and C6-7. There also type ___ ___\nchanges at the anterior endplates of T4-5, partially imaged. Vertebral body\nhemangiomas are seen at C7 and T4. The spinal cord appears normal in caliber\nand configuration. There is no evidence of infection or aggressive neoplasm. \nMultiple small upper thoracic perineural cysts.\n\nAt C1-C2 through C3-4, there is no spinal canal or neural foraminal narrowing.\n\nAt C4-5, there is a small posterior disc bulge with minimal effacement of the\nthecal sac, but no contact of the ventral cord. Uncovertebral osteophytes\ncause mild bilateral neural foraminal narrowing.\n\nAt C5-6, there posterior intervertebral osteophytes with disc bulging which\ncauses effacement of thecal sac without contact of the ventral cord. \nUncovertebral and facet osteophytes cause severe bilateral neural foraminal\nnarrowing.\n\nAt C6-7, there is a posterior disc bulge with effacement of thecal sac, but no\ncontact of the ventral cord. Uncovertebral osteophytes cause mild right and\nmoderate left neural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.", "output": "1. Moderate degenerative disc disease throughout the cervical spine with\nposterior disc bulging that causes mild narrowing of the spinal canal without\ncontact of the ventral cord.\n2. Multilevel neural foraminal narrowing, severe at C5-6 bilaterally.\n3. Please refer to the concurrent MR brain for full description of the clival\nand sphenoid wing mass." }, { "input": "There is levoconvex curvature of the lumbar ___ at L3.\n\nWhen compared to prior exam of ___, there is increased loss of disc height at\nL3-4 as well as STIR hyperintense ___ type 1 endplate changes. Multilevel\nvacuum disc phenomenon spanning L1-2 through L5-S1 is also noted. There is\nsevere loss of disc height at L2-3. Mild loss of disc height at L4-5 and L5-S1\nis similar to prior exam. Superior T12 endplate Schmorl's node is unchanged\nfrom prior exam. There is a L1 vertebral body hemangioma. The marrow signal is\nslightly heterogeneous, which may be seen in setting of marrow reconversion\nand is unchanged since ___. Otherwise, there is no focal suspicious marrow\nlesion.\n\nT11-12 through T12-L1: There is no significant spinal canal or neural\nforaminal narrowing.\n\nL1-2: There is a disc bulge as well as bilateral facet arthropathy with\nthickening of the ligamentum flavum. These changes results in mild spinal\ncanal narrowing and moderate bilateral neural foraminal narrowing. This is\nsimilar in appearance to prior exam.\n\nL2-3: There is a disc bulge as well as severe bilateral facet arthropathy with\nthickening of the ligamentum flavum. There is mild spinal canal narrowing,\nsevere right neural foraminal narrowing and moderate left neural foraminal\nnarrowing.\n\nL3-4: There is a disc bulge as well as severe bilateral facet arthropathy with\nthickening of the ligamentum flavum. This results in mild to moderate spinal\ncanal narrowing as well as crowding of the bilateral subarticular recesses.\nThere is severe right neural foraminal narrowing and moderate left neural\nforaminal narrowing.\n\nL4-5: There is a broad disc bulge with new left 9 mm inferiorly migrating disc\nextrusion, as well as severe bilateral facet arthropathy and thickening of the\nligamentum flavum, resulting in moderate spinal canal narrowing. There is new\nimpingement of the traversing left L5 nerve root (series 8, image 18). There\nis severe left neural foraminal narrowing and mild right neural foraminal\nnarrowing.\n\nL5-S1: The patient is status post left L5-S1 hemilaminotomy, medial\nfacetectomy and foraminotomy. There is a broad disc bulge. When compared to\nthe prior exam, interval thinning of ventral epidural T1 and T2 isointense\nmaterial previously described as potential epidural fibrosis with residual T1\nand T2 hypointense linear signal along the ventral aspect of the thecal sac.\nThere is mild spinal canal narrowing. The disc and epidural tissue impinges\nthe traversing right S1 nerve root (series 8, image 23). There is mild right\nneural foraminal narrowing and moderate to severe left neural foraminal\nnarrowing, similar appearance to prior exam.\n\nOther: Essentially unchanged appearance of a 4.7 x 1.0 x 4.9 cm (CC, AP, TRV ;\nseries 6, image 6 and series 9, image 5) left paraspinal subcutaneous lipoma.\nBilateral extra renal pelves are noted. There is a left mid renal 8 mm T2\nhyperintense cystic lesion most likely representing a simple cyst, unchanged\nfrom prior exam. Additional much smaller incompletely characterized cystic\nlesions are noted in both kidneys, also presumably representing simple cysts.", "output": "1. Interval progression of lumbar degenerative changes as described above.\n2. Of note, there is new L4-5 left lateral inferiorly migrating disc extrusion\nwhich severely impinges the traversing left L5 nerve root. There is also\nsevere left neural foraminal narrowing at this level.\n3. At L5-S1, the postsurgical findings of hemilaminotomy,facetectomy and\nforaminotomy are similar in appearance. Although the epidural soft tissue\ncollection/ fibrosis is less apparent on today's exam, the residual soft\ntissue and disc impinges on the traversing right S1 nerve root.\n4. Severe right neural foraminal narrowing at L2-3 and L3-4 and severe left\nneural foraminal narrowing at L4-5 and L5-S1 are again noted." }, { "input": "There is severe compression fracture of flattening of the T12 vertebral body\nwith mild retropulsion of the posterior wall into the spinal canal. There is\nT1 hyperintense signal in the T12 vertebral body that is eccentric to the\nright and extends to the pedicle. There is no appreciable prevertebral soft\ntissue edema. There is no STIR hyperintense signal in the T12 spinous process\nor adjacent supraspinous or infraspinous ligaments to suggest injury to the\nposterior ligamentous complex. Ligamentum flavum is intact.\n\nRemaining vertebral bodies are normal in height and alignment. A few T1 and\nT2 hyperintense foci intervertebral bodies largest in the T11 vertebral\nmeasuring 18 mm are probably intraosseous hemangiomas.\n\nDegenerative changes in the thoracic spine are mild and do not result in\nsignificant spinal canal or neural foraminal stenosis.\n\nThe visualized spinal cord is normal in caliber and signal intensity. There\nis no paraspinal or epidural fluid collection.\n\nThere is an 8 mm T2 hyperintense nodule in the left lobe of the thyroid gland,\nfor which no follow-up is indicated as per current ___ College of\nRadiology guidelines.\n\nParenchymal areas of intermediate T2 signal in the lungs are not adequately\nevaluated and correlation with chest radiograph or chest CT is recommended.", "output": "1. Chronic appearing severe compression fracture and flattening of T12\nvertebral body with mild retropulsion as described. There is no evidence of\nprevertebral or paraspinal fluid collection or soft tissue abnormality. No\nappreciable epidural hematoma.\n\n2. Normal morphology and signal intensity of the spinal cord. No cord\ncompression.\n\n3. No ligamentous disruption identified. No signs of acute ligamentous\ninjury." }, { "input": "No significant change in the 6 mm grade 1 anterolisthesis at L4-L5. If if\nminimal grade 1 L3-L4 anterolisthesis is more prominent. No pars defect.\nFew benign hemangiomas.. Additional areas of scattered fatty marrow signal\nare present. Degenerative changes lumbar spine. There is been interval mild\nprogression in disc height loss at L3-L4, L4-L5. The spinal cord appears\nnormal in caliber and configuration. The conus terminates at the level of L1.\nThere is no evidence of infection or neoplasm. Multilevel diffuse disc\nbulges. Advanced lumbar facet arthritis in the lower lumbar spine, most\nprominent at L4-5.\n\nT11-12: Patent central canal, neural foramina.\n\nT12-L1: Patent canal and neural foramina.\n\nL1-L2: Small left central disc protrusion, also present on prior, with mild\ncentral canal narrowing, similar. Patent foramina.\n\nL2-L3: Tiny right paramedian disc protrusion, new since prior.. Mild central\ncanal narrowing, more prominent. Patent foramina.\n\nL3-L4: Mild-to-moderate spinal canal stenosis is similar.. Mild bilateral\nforaminal narrowing, similar on the left, more prominent on the right.\n\nL4-L5: Anterolisthesis, advanced facet arthropathy. Severe central canal\nnarrowing, minimal residual CSF within thecal sac, mildly worsened. \nSubarticular zone narrowing, right greater than left. Crowding of the cauda\nequina nerve roots. There is moderate left and moderate to severe right\nforaminal narrowing, right side has mildly worsened since prior.\n\nL5-S1: Shallow tiny central disc protrusion. Mild mass effect on the\ntraversing left S1 nerve, more prominent since prior. No significant central\ncanal narrowing.. Stable moderate bilateral foraminal narrowing.", "output": "Advanced degenerative changes in the lumbar spine, mildly worsened since\nprior.\n\nSevere central canal narrowing at L4-5 level, mildly worsened since prior.\n\nAnterolisthesis L3-L4, L4-5.\n\nMultilevel significant foraminal narrowing, as above.\n\nNOTIFICATION: The findings were communicated with ___, M.D. via\nemail by ___, M.D. on the telephone on ___ at 8:42 am, \nminutes after discovery of the findings." }, { "input": "There is redemonstration of the patient's previously noted C4-C6 ACDF. \nVertebral body heights and alignment are maintained. Metallic hardware\nartifact limits evaluation of prevertebral and paravertebral soft tissues. \nWithin limits of examination, previously noted prevertebral soft tissue\nswelling has resolved.\n\nVertebral body alignment is preserved. C2, C3, C4 and C7 vertebral body\nheights are maintained.\n\nLimited imaging of the brain stem suggest small focal prominence of the\ncentral canal at approximately the C1 level (see series 2, image 9). Allowing\nfor differences in technique, this finding is grossly similar to the focal\narea of spinal canal prominence on the ___ prior brain MRI study\n(see series 6, image 2).\n\nBetween the C2-3 and C3-4 levels, as well as between the C6-7 and C7-T1 level\nthe spinal cord is preserved in caliber and signal. The spinal cord is not\nwell visualized between the C4-5 and C5-6 levels due to artifact. Sagittal\nimaging suggests some cord signal abnormality between the C4-5 and C5-6 level\n(see series 2, image 8). However, allowing for differences in technique, the\nspinal cord at these levels had a similar appearance on the ___\noutside MRI of cervical spine study (see series 5, image 9).\n\nCervical intervertebral disc heights at C2-3, C3-4, and C6-7 are grossly\npreserved.\n\nAt C2-3, C4-5, and C7-T1 there is no spinal canal or neural foraminal\nstenosis.\n\nAt the C5-6 level there is suggestion of left paracentral disc protrusion\nresulting in moderate bilateral neural foraminal and moderate spinal canal\nstenosis (see series 5, image 35).\n\nAt C6-7 there is a central disc protrusion without spinal canal or neural\nforaminal stenosis.\n\nPost-contrast images demonstrate faint enhancement of the thecal sac (see\nseries 7, image 9). This finding is nonspecific, and may be postoperative in\nnature. Evaluation of the spinal cord is limited by metallic hardware and\nmotion artifact. Within limits of this examination, there is no definite\nepidural or intradural enhancing collections.", "output": "1. Redemonstration of postsurgical changes related to patient's C4 through C6\nACDF.\n2. Evaluation of spinal cord between C4-5 and C5-6 levels is limited due to\nartifact.\n3. Within limits of study, suggestion of some cord signal abnormality were\nbetween the C4-5 and C5-6 levels. However, allowing for differences in\ntechnique, findings are similar to the ___ outside prior MRI. \nRecommend clinical correlation, close followup, and attention on followup\nimaging.\n4. Faint enhancement of thecal sac on postcontrast imaging is nonspecific, and\nmay be postsurgical in nature. Recommend clinical correlation.\n5. Evaluation of spinal cord on postcontrast imaging is limited due to\nmetallic hardware artifact and motion degradation. Within limits of study, no\ndefinite epidural or intradural enhancing collection identified.\n6. Partial visualization of 1mm focal prominence of central canal at\napproximately C1 level, which is similar to finding on ___ at\noutside MRI head study.\n7. C5-6 level left paracentral disc protrusion resulting in moderate bilateral\nneural foraminal stenosis and moderate spinal canal stenosis.\n8. Interval resolution of previously noted prevertebral soft tissue swelling." }, { "input": "Cervical spine: Surgical changes from C4 through C6 ACDF are again noted. The\nvertebral body height and alignment is maintained. There is a normal\ncurvature. The bone marrow has a normal signal intensity.\n\nThere is T2 hyperintensity noted within the cervical spinal cord at C5-C6\nwhich is grossly unchanged.\n\n A broad-based disc protrusion and uncovertebral joint hypertrophy is again\nnoted at C5-C6 with resultant moderate left and mild right neural foraminal\nnarrowing\n\nThe posterior elements and paraspinal soft tissues are normal.\n\nThoracic Spine: The thoracic spine has normal curvature vertebral body height,\nbone marrow signal and alignment. The intervertebral disc have normal height\nand signal intensities. Multilevel disc protrusions the largest of which is\nat T7-T8 and contacts the ventral spinal cord are again noted and unchanged. A\nprominent epididymal canal versus tiny syrinx is again noted within the upper\nthoracic spinal cord. The posterior elements and paraspinal soft tissues are\nnormal.\n\nLumbar spine: The vertebral body height and alignment is maintained. The bone\nmarrow has a normal signal intensity. There is loss of normal intervertebral\ndisc signal at T12-L1, L1-L2, and L5-S1. Intervertebral disc height is\nrelatively preserved.\n\nThere is a right paracentral disc protrusion mildly narrowing the spinal canal\nagain noted at T12-L1 and a central disc protrusion at L5-S1 resulting in mild\nspinal canal narrowing and left greater than right neural foraminal narrowing.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1-L2 level. There noted be a\ntiny region of linear T2 hyperintensity within the conus which may represent a\nmild syrinx versus a prominent ependymal canal.\n\nThe posterior elements and paraspinal soft tissues are normal.", "output": "1. Patient is status C4 through C6 ACDF with stable T2 hyperintensity noted\nin the cervical spinal cord at C5-C6.\n\n2. Multilevel degenerative changes as detailed above unchanged from recent\nprior study.\n\n3. Linear hyperintensity in the central spinal cord in the lower cervical/\nupper thoracic spinal cord and within the conus medullaris. Findings are\nunchanged and represent a tiny syrinx." }, { "input": "CERVICAL:\n\nACDF postsurgical changes from C4 through C6 are stable. A disc protrusion at\nC6/C7 is unchanged. The visualized paravertebral structures are grossly\nunremarkable. There is no evidence of an epidural collection.\n\nTHORACIC:\nThere are posterior disc protrusions slightly indenting the spinal cord at the\nlevels T8/T9, T9/T10, T11/T12 and T12/L1. A small syrinx in the distal lumbar\ncord extends to the conus medullaris. The visualized paravertebral thoracic\nstructures are grossly unremarkable.\n\nLUMBAR:\nThere is facet osteophytosis at L4/L5 without spinal canal encroachment. At\nL5/S1 there is midline disc protrusion with extension slightly posteriorly\nalong S1. The sacroiliac joints are normal.", "output": "1. Several regions of disc protrusion in the thoracic and lumbar spine, some\nof which indent the spinal cord.\n2. Stable postoperative appearance of ACDF from C4 through C6." }, { "input": "Study is moderately degraded by motion an limited by spinal fusion hardware\nartifact, which especially limits evaluation for spinal cord signal\nabnormality. Within these confines:\n\nAgain seen are postsurgical changes related to prior anterior spinal fusion of\nC4 through C6.\n\nThere is stable straightening of the cervical lordosis. The vertebral body\nheights are maintained at all levels.\n\nThe visualized spinal cord appears unremarkable without focal cord signal\nabnormality or cord expansion noting artifact from the hardware somewhat\nlimiting the evaluation.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt C2-C3, there is loss of intervertebral disc signal. The disc height is\nmaintained. No neural foramina or spinal canal stenosis.\n\nAt C3-C4, mild loss of intervertebral disc height and signal with central disc\nprotrusion indenting the ventral thecal sac. Bilateral uncovertebral and\nfacet arthropathy results in mild right neural foramen stenosis. No left\nneural foramen stenosis is seen.\n\nAt C4-C5, there is susceptibility artifact from the hardware limiting the\nevaluation of disc height and signal. There is central disc protrusion\nindenting the ventral thecal sac. No neural foramen stenosis or spinal canal\nstenosis is seen.\n\nAt C5-C6, susceptibility artifact from the hardware limits the evaluation of\ndisc height and signal. There is central disc protrusion indenting the\nventral thecal sac. Bilateral uncovertebral and facet arthropathy results in\nmild right and moderate left neural foramen narrowing.\n\nAt C6-C7, there is mild loss of disc signal. Disc height is maintained. No\nneural foramina or spinal canal stenosis is seen.\n\nAt C7-T1, disc height and signal is maintained no neural foramina or spinal\ncanal stenosis is seen.\n\nThe degenerative changes are unchanged compared to the prior MRI from ___.", "output": "1. Study is moderately degraded by motion and fusion hardware artifact, which\nresult in limiting evaluation of spinal cord signal.\n2. Grossly stable postoperative changes related to anterior spinal fusion of\nC4-C6 with associated susceptibility artifact limiting the evaluation and\nthese levels.\n3. Stable multilevel multifactorial degenerative disease of the cervical\nspine, worst at C5-C6 with moderate left neural foraminal narrowing as\ndescribed above." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body heights appear normal. There are\nmultilevel endplate degenerative changes more pronounced at the level of C6-C7\nwith ___ type 1 changes and to lesser extent at the level C5-C6. There are\nmultilevel disc degenerative disease manifested by disc desiccation, decreased\ndisc heights, disc osteophyte complexes formation, uncovertebral and facet\narthropathy.\n\nthe spinal cord appears normal in caliber and configuration.There is no\nevidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nC2-C3: There is no disc bulge, spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: There is diffuse central disc bulge indenting anterior thecal sac and\ncausing mild spinal canal narrowing. There are bilateral moderate neural\nforaminal narrowing caused by disc osteophytosis and uncovertebral\narthropathy.\n\nC4-C5: There is no disc bulge or significant spinal canal stenosis. There are\nbilateral right moderate to severe and left moderate neural foraminal\nnarrowing caused by disc osteophytosis and uncovertebral arthropathy.\n\nC5-6: There is small diffuse disc bulge with no significant spinal canal\nstenosis. There are bilateral right moderate to severe and left moderate\nneural foraminal narrowing caused by disc osteophytosis and uncovertebral\narthropathy.\n\nC6-C7: There is a medium size diffuse disc bulge indenting and anterior\ncervical cord with no underlying intramedullary signal abnormality. There is\nassociated facet and uncovertebral arthropathy causing moderate spinal canal\nnarrowing. Incidental finding of tiny right perineural cyst.\n\nC7-T1: There is no disc bulge, spinal canal stenosis or neural foraminal\nnarrowing.\n\nTHORACIC:\nAlignment is normal. Vertebral body heights appear normal. There are\nmultilevel endplate irregularities and Schmorl's nodule formation more\npronounced from T6 to T12 with no underlying acute edematous changes.\n\nMultilevel disc degenerative disease manifested by disc desiccation and\ndecrease disc height. There are multiple small central disc protrusion noted\nat the levels of T6-T7 and T7-T8 with no significant spinal canal stenosis or\nneural foraminal narrowing.\n\nThe spinal cord appears normal in caliber and configuration.There is no\nevidence of infection or neoplasm.There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc heights appear\nnormal. There are multilevel small endplates ___ type 2 changes involving\nall lumbar vertebral bodies.\n\nThere are multilevel disc degenerative disease manifested by disc desiccation,\nfacet arthropathy and ligamentum flavum thickening with no severe spinal canal\nstenosis.\n\nThe spinal cord and cauda equina fibers appear normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm.There is no\nabnormal enhancement after contrast administration.\n\nL1-L2: There is diffuse disc bulge associated with ligamentum flavum\nthickening and facet arthropathy with no significant spinal canal stenosis. \nThere are mild bilateral neural foraminal narrowing; more on the right side.\n\nL2-L3: There is diffuse disc bulge associated with ligamentum flavum\nthickening and facet arthropathy with mild spinal canal stenosis. There is\nunderlying impingement of the bilateral subarticular zones and resultant\nindentation of the descending L3 nerve roots. There are mild to moderate\nbilateral neural foraminal narrowing.\n\nL3-L4: There is diffuse disc bulge associated with ligamentum flavum\nthickening and facet arthropathy with mild-to-moderate spinal canal stenosis.\nThere is underlying impingement of the bilateral subarticular zones and\nresultant indentation of the descending L4 nerve roots. There are moderate\nbilateral neural foraminal narrowing.\n\nL4-L5: There is diffuse disc bulge associated with ligamentum flavum\nthickening and facet arthropathy with mild to moderate spinal canal stenosis.\nThere is underlying impingement of the bilateral subarticular zones and\nresultant indentation of the descending L4 nerve roots; more on the left side.\nThere are mild to moderate bilateral neural foraminal narrowing.\n\nL5-S1 the central diffuse disc bulge with no significant spinal canal\nstenosis. There are mild bilateral neural foraminal narrowing.\n\nOTHER:", "output": "1. Multilevel disc degenerative disease as described more pronounced at the\nlevel ofC6-C7 causing moderate spinal canal stenosis with no abnormal\nintramedullary cord signal abnormalities." }, { "input": "Study is mildly degraded by motion.\n\nThere is straightening of cervical lordosis. There is minimal C4 on C5\nanterolisthesis, likely degenerative. Multiple Schmorl's nodes are noted\nthroughout the cervical spine. Right C1 and occipital condyle nonspecific\nedema versus artifact is suggested (see 2, 3, 4:4).\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling.. Nonspecific\nbilateral partial mastoid air cell opacification is noted.\n\n At C2-3 there is disc bulge with facet joint hypertrophy resulting in mild\nbilateral neural foraminal and no vertebral canal narrow.\n\nAt C3-4 there is disc bulge, facet joint and uncovertebral hypertrophy\nresulting in mild vertebral canal and bilateral neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, facet joint hypertrophy and uncovertebral\nhypertrophy resulting in mild vertebral canal, mild left and moderate right\nneural foraminal narrowing.\n\nAt C5-6 there is disc bulge withno vertebral canal or neural foraminal\nnarrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy and facet joint\nhypertrophy with mild vertebral canal and bilateral neural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.", "output": "1. Multilevel cervical spondylosis as described, with nonspecific left\noccipital condyle and C1 edema, and most pronounced at C4-5, where there is\nmoderate right and mild left neural foraminal and mild vertebral canal\nnarrowing.\n2. Nonspecific bilateral mastoid air cell partial opacification.\n3. Please see concurrently obtained contrast brain MRI for description of\ncranial structures." }, { "input": "Again there is a transitional lumbar vertebral body segment, otherwise, the\nvertebral body height and alignment are preserved. Multilevel degenerative\ndisc disease throughout the lower thoracic and lumbar spine, most pronounced\nat L3-L4 and L4-L5. There are multilevel Schmorl's nodes along the lumbar\nspine. There are ___ type 1 endplate changes at L3-L4 and L4-L5.\nThere is no evidence of infection or neoplasm.\n\nThe spinal cord appears normal in caliber and configuration. The conus\nterminates normally at the T12-L1 Level.\nThere is transitional lumbosacral anatomy with lumbarization of the S1\nvertebral body.\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nAt T12-L1, there is facet joint arthropathy with small right facet joint\neffusion and ligamentum flavum thickening, no disc herniation, spinal canal\nstenosis or significant neural foraminal narrowing.\n\nAt L1-L2, there is facet joint arthropathy and ligamentum flavum thickening,\nmild spinal canal stenosis but no significant neural foraminal narrowing.\n\nAt L2-L3, there is a disc bulge, facet joint arthropathy with small right\nfacet joint effusion, ligamentum flavum thickening, moderate spinal canal\nstenosis, moderate bilateral neural foraminal narrowing.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy, ligamentum flavum\nthickening, moderate spinal canal stenosis, severe right and moderate left\nneural foraminal narrowing. There is remodeling of the undersurface of the\nright L3 nerve root within the neural foramina (series 2, image 104).\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, moderate spinal canal stenosis, severe left and mild right neural\nforaminal narrowing.\nThe left L4 nerve root is compressed within the neural foramen due to the disc\nbulge and facet joint hypertrophy (series 2, image 64).\n\nAt L5-S1, there is facet joint arthropathy with small bilateral facet joint\neffusions, ligamentum flavum thickening, no spinal canal stenosis, moderate\nleft and mild right neural foraminal narrowing.", "output": "1. Advanced degenerative changes of the lumbar spine, overall progressed from\n___, and most pronounced at L3-L4 and L4-L5 levels, where there are disc\nbulges which in combination with facet joint arthropathy and ligamentum flavum\nhypertrophy results in moderate spinal canal stenosis, with impingement of the\nright L3, and left L4 nerve roots.\n2. Moderate to severe multilevel neural foraminal narrowing as described." }, { "input": "There is straightening of normal cervical lordosis with grade 1\nanterolisthesis of C4 over C5 without surrounding edema to suggest acute\nalignment abnormality. Vertebral body heights are preserved. No change in\nheight of C7 or T1 vertebral body relative to MRI from ___. Again\nseen at the C7-T1 level is complete loss of vertebral body signal on\nT1-sequence with T2 and STIR hyperintensity as well as postcontrast\nenhancement. There is increased T2 signal hyperintensity at these vertebral\nbody levels relative to ___ with unchanged post-contrast enhancement.\nThe remaining vertebral bodies are normal in signal. Small amount of\nprevertebral enhancement anterior to C7-T1 vertebral bodies without focal\ncollection could represent small area of phlegmon, also grossly similar to the\nprior exam.\n\nThe apparent increased cord signal on sagittal STIR sequences at the C6\nthrough T1 level likely represents artifact. Focal increased signal at C4-5\nis unchanged and likely represents sequela of chronic myelomalacia.\n\nThere is increased signal in the anterior epidural space at the level of C7\nand T1 vertebral bodies with evidence of approximately 2.7 x 0.6 cm of\nhomogeneous postcontrast enhancement concerning for epidural phlegmon without\ndiscrete collection. Further, these findings extend into the right neural\nforamina without significant additional narrowing beyond baseline degenerative\nchanges. The extent of the epidural soft tissue enhancement appears grossly\nsimilar to the prior exam.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine in keeping with degenerative disc disease. At the C7-T1 level, there is\ncomplete loss of disc signal on T1 with T2 and STIR hyperintensity, which is\nincreased compared to prior exam, with some evidence of postcontrast\nenhancement consistent with worsening discitis/possible early intradiscal\nabscess.\n\nIncreased STIR paraspinal soft tissue abnormality at the level of C7/T1, is\nconcerning for soft tissue involvement of the infection.\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is novertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is mild-to-moderate disc protrusion with ligamentum flavum\nhypertrophy, uncovertebral hypertrophy, and facet arthropathy causing moderate\nvertebral canal stenosis and moderate to severe neural foraminal stenosis,\nleft greater than right.\n\nAt C4-5 there is there is moderate disc protrusion with ligamentum flavum\nhypertrophy, uncovertebral hypertrophy, and facet arthropathy causing moderate\nvertebral canal stenosis and moderate to severe bilateral neural foraminal\nstenosis..\n\nAt C5-6 there is mild-to-moderate disc protrusion, uncovertebral hypertrophy,\nand facet arthropathy causing mild to moderate vertebral canal stenosis, mild\nleft neural foraminal narrowing, and mild-to-moderate right neural foraminal\nnarrowing.\n\nAt C6-7 there is mild disc protrusion, uncovertebral hypertrophy, and facet\narthropathy causing mild vertebral canal stenosis and mild bilateral neural\nforaminal stenosis.\n\nAt C7-T1, the epidural phlegmonous changes contributes to at least\nmild-to-moderate spinal canal narrowing in conjunction with a disc bulge at\nthis level. This is grossly similar to the prior exam. No underlying cord\nsignal abnormality is seen.", "output": "1. Worsening osteomyelitis at C7/T1 with stable anterior epidural phlegmonous\nchanges and worsening intradiscal T2 hyperintensity, concerning for worsening\ndiscitis vs early intradiscal abscess. The epidural phlegmon at this level\nextends into the right neural foramina without evidence of a discrete\ncollection.\n2. Multilevel, multifactorial moderate to severe degenerative disease of the\ncervical spine, most notable at C4-5, C5-6." }, { "input": "Thoracic spine:\nImages are mildly to moderately motion degraded. Images through the\nvisualized lower cervical, and very proximal thoracic spine through T3 level\nare moderately degraded by artifact, evaluation of the proximal cord is\nindeterminate on sagittal STIR and axial images. If there is high clinical\nsuspicion of abnormality in this area, exam should be repeated. Mid and lower\nthoracic cord are normal.\n\nAlignment is normal. There is benign hemangioma T3 vertebral body.\nMinimal degenerative changes thoracic spine. No significant central canal or\nforaminal narrowing at any level. No epidural collections or disc protrusion.\nNo worrisome vertebral body abnormalities.\n\nLumbar spine:\nMinimal retrolisthesis L5-S1, degenerative in etiology. Alignment is\notherwise normal. Multilevel mild degenerative changes lumbar spine. \nMultilevel diffuse disc bulges. Lumbar facet arthritis. Effusions bilateral\nL4-5, L5-S1 facet joints.\n\nAt L1-L2 level central canal, foramina are patent.\n\nAt L2-L3 level there is mild central canal narrowing. Patent foramina.\n\nAt L3-L4 level central canal, foramina are patent.\n\nAt L4-5 level there is mild central canal narrowing. Mild narrowing both\nlateral recess from diffuse disc bulge.. Patent foramina.\n\nAt L5-S1 level there is mild-to-moderate central canal narrowing. Broad-based\nshallow central disc bulge, combined with facet arthropathy exerts mass effect\non both traversing S1 nerves, left greater than right. Mild right, moderate\nleft foraminal narrowing.", "output": "1. Images are mildly to moderately motion degraded.\n2. Mild-to-moderate central canal narrowing at L5-S1 level, with mass-effect\non both traversing S1 nerves. Moderate left L5-S1 foraminal narrowing.\n3. Evaluation of the lower cervical cord through thoracic cord at T3 level is\nindeterminate secondary to artifact. If there is high clinical suspicion of\ncord abnormality at this level, repeat exam is recommended.\n4. Degenerative changes lumbar spine elsewhere as above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. In the emergency\ndepartment by ___, M.D. on the telephone on ___ at 8:48 am,\n5 minutes after discovery of the findings." }, { "input": "The most caudal rib-bearing vertebra is not included on the axial images. The\nvertebra above the lowest fully formed disc is labeled L5 for the purposes of\nthis report. The numbering is documented on image 2:8.\n\nVertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are seen.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at L1.\n\nSagittal images through the T11-12, T12-L1, L1-2, and L2-3 levels demonstrate\nno spinal canal or neural foraminal narrowing. There are no axial images\nthrough these levels.\n\nAt L3-4, there is a minimal disc bulge, minimal right and mild left facet\narthropathy. The left neural foramen is mildly narrowed without evidence for\nneural impingement. No right neural foraminal narrowing or spinal canal\nnarrowing is seen.\n\nAt L4-5, there is a mild disc bulge, a very shallow central disc protrusion,\nand mild facet arthropathy, without evidence for spinal canal narrowing or\nsignificant neural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge, a right paracentral disc herniation, and\nmoderate bilateral facet arthropathy. The traversing right S1 nerve root is\ncompressed in the subarticular zone. The remainder of the spinal canal is not\nsignificantly narrowed. There is moderate, right greater than left neural\nforaminal narrowing with abutment of bilateral exiting L5 nerve roots, right\nmore than left.\n\nThere is elevated T2 signal in the midline subcutaneous fat of the upper\nlumbar spine, a nonspecific finding which is frequently seen in patients of\nthis body habitus.", "output": "1. At L5-S1, a disc bulge, a right paracentral disc herniation, and moderate\nbilateral facet arthropathy result in compression of the traversing right S1\nnerve root within the subarticular zone, as well as moderate, right greater\nthan left neural foraminal narrowing with abutment of bilateral exiting L5\nnerve roots, right worse than left.\n2. Mild degenerative changes at L3-4 and L4-5 without spinal canal or neural\nforaminal narrowing." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMild rightward curve lumbar spine is seen along with straightening of lumbar\nlordosis. Probable degenerative endplate edema is noted at L4-L5 endplates. \nMultiple Schmorl's nodes are seen throughout the lumbar spine. Vertebral body\nheights are otherwise relatively well preserved.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nConus medullaris is unremarkable and terminates at L1-2.\n\nAt T12-L1 there is no vertebral canalor neural foraminal narrowing.\n\nAt L1-2 there is diffuse disc bulge with central protrusion and facet\ndegenerative change causing mild central canalnarrowing with mild bilateral\nneural foraminal narrowing.\n\nAt L2-3 there is diffuse disc bulge and facet degenerative change causing mild\ncentral canal and mild bilateral neural foraminal narrowing.\n\nAt L3-4 there is diffuse disc bulge with central protrusion, facet\ndegenerative change with prominence of the ligamentum flavum causing mild\ncentral canal narrowing. Additionally, mild approaching moderate and mild\nleft foraminal narrowing is noted.\n\nAt L4-5 there is right predominant disc bulge with disc encroaching on the\nright neural foramen. Facet degenerative changes, prominence of the\nligamentum flavum and facet hypertrophy are present. There is mild central\nstenosis. Moderate right greater than left foraminal narrowing is present. \nMinimal L4-5 intervertebral disc edema is likely degenerative.\n\nAt L5-S1 there is diffuse disc bulge with central protrusion, facet\narthropathy and ligamentum flavum thickening. Osteophytes encroach on the\ninferior with moderate left greater than right neural foraminal narrowing. No\nsignificant central stenosis is seen.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Mild rightward curve lumbar spine and straightening of the lumbar lordosis.\n2. Multilevel lumbar spondylosis with mild central stenosis and mild to\nmoderate foraminal narrowing as detailed above.\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 vertebral bodies. Lumbar spine alignment is normal. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. The conus medullaris\nterminates at the L1.\n\nT12-L1: No evidence of spinal canal or neural foraminal narrowing.\n\nL1-L2: No evidence of spinal canal or neural foraminal narrowing.\n\nAt L2-L3: No evidence of spinal canal or neural foraminal narrowing.\n\nAt L3-L4: No evidence of spinal canal or neural foraminal narrowing.\n\nAt L4-L5: No spinal canal or neural foraminal narrowing.\n\nAt L5-S1: No spinal canal or neural foraminal narrowing.", "output": "No significant degenerative changes in the lumbar spine. No evidence of\nspinal canal stenosis or neural foraminal stenosis.\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": "CERVICAL:\nVertebral body alignment is preserved.Vertebral body heights are preserved. \nThere is a Schmorl's node at the inferior endplate of C7. There are type 2\n___ endplate degenerative changes at the levels of C5-C6 and C6-C7. The\nspinal cord appears normal in caliber and configuration.\n\nAt C2-C3, there is ossification of the posterior longitudinal ligament that\nencroaches on the right anterior aspect of the spinal cord. Uncovertebral and\nfacet osteophytes produce severe left neural foraminal narrowing. The right\nneural foramen is patent.\n\nAt C3-C4, there is extensive ossification of the posterior longitudinal\nligament that along with intervertebral osteophytes and ligamentum flavum\nthickening producing compress the spinal cord, greater on the right than left.\nUncovertebral and facet osteophytes produce severe bilateral neural foraminal\nnarrowing.\n\nAt C4-C5, thickening and likely ossification of the posterior longitudinal\nligament along with intervertebral osteophytes compress the spinal cord. \nFacet and uncovertebral osteophytes produce moderate right greater than left\nneural foraminal narrowing.\n\nAt C5-C6, thickening and likely ossification of the posterior longitudinal\nligament narrow the spinal canal and flatten the anterior surface of the\nspinal cord. Facet and uncovertebral osteophytes produce mild right greater\nthan left neural foraminal narrowing.\n\nAt C6-C7, thickening and likely ossification of the posterior longitudinal\nligament along with intervertebral osteophytes narrow the spinal canal and\nslightly indent the anterior surface of the spinal cord. . Facet and\nuncovertebral osteophytes minimally narrow the bilateral neural foramina.\n\nAt C7-T1, central disc protrusion and ligamentum flavum thickening mildly\nnarrow the spinal canal slightly indenting the anterior surface of the spinal\ncord. Facet and uncovertebral osteophytes produce severe right greater than\nleft neural foraminal narrowing.\n\n There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nTHORACIC:\nVertebral body alignment is preserved.Vertebral body heights are preserved. \nThere is loss of T2 signal of multiple intervertebral discs, a manifestation\nof degenerative disc disease. Numerous T2 hyperintense, enhancing bone marrow\nreplacing lesions are noted throughout the thoracic spine, at T1, T2, T3,\nsuperior endplate of T6, T8, T9 and superior endplate of T12. The largest\nmeasuring up to 21 x 14 mm in the left aspect of the T2 vertebral body (4:9). \nThere is no evidence of associated pathologic fracture. There is no definite\nextra cortical soft tissue extension.\n\n The spinal cord appears normal in caliber and configuration.\n\nThere is no evidence of significant spinal canal or neural foraminal\nnarrowing.\n\nLUMBAR:\nVertebral body alignment is preserved.Vertebral body heights are preserved. \nThere is loss of T2 signal of multiple intervertebral discs, a manifestation\nof degenerative disc disease. There are multiple STIR hyperintense, marrow\nreplacing enhancing lesions throughout the lumbar spine affecting all of the\nlumbar vertebral bodies with the largest measuring 16 x 13 mm in the L1\nvertebral body (9:9). There is no evidence of pathologic compression fracture\nor extra cortical soft tissue extension.\n\nThe terminal spinal cord appears normal in caliber and configuration. The\nconus medullaris terminates at the L1-L2 level.\n\nThere is no significant spinal canal or neural foraminal narrowing at the\nlevels of L1-L2, L2-L3, L3-L4 or L5-S1.\n\nAt L4-L5, disc bulge and ligamentum flavum thickening produces moderate to\nsevere spinal canal narrowing with crowding of the traversing nerve roots as\nwell as effacement of the bilateral subarticular recesses. Facet osteophytes\nproduce severe left and moderate right neural foraminal narrowing.\n\nOTHER: There is prominent right-sided pleural thickening and enhancement, with\nsmall right lower lobe loculated effusion, appearing progressed compared to\nthe prior examination. There is partial visualization of a large right upper\nlobe mass measuring at least 3.6 cm, better characterized on the prior CT\nexamination (08:18). An additional rounded 1.6 cm right upper lobe mass is\nnoted, which appears increased compared the prior CT examination where it\nmeasured 1 cm in greatest dimension. There is additional irregular subpleural\nopacification in the right lung base, which may represent additional sites of\ninvolvement. There is also asymmetric right-sided bronchial wall thickening\nand enhancement which could potentially represent lymphangitic tumor\ninvolvement. Mediastinal lymphadenopathy is partially visualize, better\ncharacterized on the prior dedicated chest CT examination.\n\nThere is heterogeneous enhancing marrow placement throughout the sacrum and\nvisualized bilateral iliac bones compatible with metastatic involvement.\n\nThere is bilateral thickening of the adrenal glands without frank nodularity. \nThe visualized retroperitoneum is otherwise grossly unremarkable.", "output": "1. Diffuse thoracic, lumbar, sacral and iliac osseous metastases, as\ndescribed. No evidence of pathologic fracture or extra cortical soft tissue\nextension.\n2. Multilevel cervical, thoracic and lumbar spondylosis, as described, most\nnotable for spinal cord impingement at the C3-C4 and C4-C5 levels, without\nunderlying signal abnormality.\n3. No cord signal abnormality or evidence of intrathecal metastasis.\n4. Progressive right-sided pleural thickening and enhancement along with\nextensive asymmetric bronchial wall thickening and enhancement is suspicious\nfor progressive lymphangitic spread of known right-sided lung cancer,\nparticularly given interval increase in size of a 1.6 cm right upper lobe mass\nas well as partial visualization of another large right upper lobe mass. \nInflammatory etiology is a possibility. This can be further characterized\nwith dedicated chest CT, if indicated.\n5. Small loculated right-sided pleural effusion.\n6. Bilateral adrenal gland thickening without discrete nodularity, may\nrepresent either metastatic involvement or hyperplasia." }, { "input": "The craniocervical junction appears unremarkable.\n\nThere is mild retrolisthesis at C4 upon C5, and C5 upon C6 levels, likely\ndegenerative in nature. There is no evidence of acute cervical vertebral body\nfractures. Marked cervical spondylosis in the form of disc desiccation, disc\nosteophyte complexes, facet joint osteophytosis and ligamentum flavum\nhypertrophy as described below:\n\nC2-3: No cord compromise. Mild neural foraminal narrowing bilateral.\n\nC3-4: No cord compromise. Moderate severe right and mild left neural\nforaminal narrowing.\n\nC4-5: Grade 1 retrolisthesis of C4 on C5. There is a large central disc\nosteophyte complex which deforms the cord, and effaces the CSF space\nsurrounding the cord. There is no increased cord signal intensity. Moderate\nsevere right and moderate left neural foraminal narrowing.\n\nC5-6: Grade 1 retrolisthesis of C5 on C6. Broad-based disc osteophyte complex\neffaces the CSF space surrounding the cord, causing mild cord deformation,\nthere is no abnormal cord signal intensity. Moderate severe right and\nmoderate left neural foraminal narrowing.\n\nC6-7: Broad-based disc osteophyte complex with a superimposed central\ncomponent effaces the CSF space anterior to the cord, but there is still CSF\npresent posterior to the cord at this level. No abnormal cord signal\nintensity. Severe right and moderate left neural foraminal narrowing.\n\nC7-T1: No cord compromise. Moderate right neural foraminal narrowing. The\nleft neural foramina is patent.\n\nExtra-spinal: 14 mm left lobe of thyroid nodule is incompletely imaged and if\nclinically indicated dedicated thyroid ultrasound may be performed.", "output": "1. Moderate to severe spinal canal stenosis at the C4-5 and C5-6 levels, and\nmoderate spinal canal stenosis at the C6-7 level as described above. This\ntype of cervical canal stenosis/narrowing is associated with increase risk for\nspinal cord injury due to minor trauma.\n\n2. At the C4-5 and C5-6 levels there is deformation of the cord with\neffacement of the CSF surrounding the cord, but no increased cord signal\nintensity to suggest compromise.\n\nMultilevel neural foraminal narrowing as described above.\n\nRECOMMENDATION(S): Extra-spinal: 14 mm left lobe of thyroid nodule is\nincompletely imaged and if clinically indicated dedicated thyroid ultrasound\nmay be performed.\n\nNOTIFICATION: The primary team was aware of these findings at the time of\nthis interpretation." }, { "input": "The patient is status post anterior fusion of C5, C6 and C7. Fusion hardware\nartifact limits examination. There is 2 mm retrolisthesis of C4 on C5, not\nsignificantly increased from the prior MR in ___. There is mild\nanterolisthesis of C7 on T1, also not significantly increased.\n\nFusion of the C2 and C3 vertebral bodies is again seen. There is no marrow\nsignal abnormality. There is no abnormal enhancement on postcontrast imaging.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nAs before, there is seen medial, retropharyngeal course of the internal\ncarotid artery at C2-C3. Bilateral sphenoid sinus mucosal thickening is\npresent.\n\nAt C2-3 there is a segmentation anomaly and congenital fusion with a small\nresidual rudimentary disc between these vertebrae with fusion of the facets,\nunchanged from prior examinations.No spinal canal or neural foraminal\nstenosis.\n\nAt C3-4 there is there is stable disc protrusion resulting in mild to moderate\nspinal canal stenosis (see 08:11, 5:9). There is no neural foraminal stenosis\nat this level.\n\nAt C4-5 there is mild retrolisthesis as well as a disc osteophyte complex\nwhich mildly narrows the spinal canal. The disc osteophyte complex abuts and\nslightly deforms the thecal sac however there is no abnormal spinal cord\nsignal.There is mild right-sided neural foraminal narrowing.\n\nAt C5-7, the patient is status post anterior fusion with no spinal canal or\nneural foraminal narrowing.\n\nAt C7-T1 there is mild anterolisthesis as well as a mild small disc osteophyte\ncomplex which minimally narrows the spinal canal. The disc osteophyte complex\nagain mildly remodels the ventral spinal cord.No significant neural foraminal\nstenosis is identified at this level.", "output": "1. Fusion hardware artifact limits examination.\n2. Stable postoperative changes related to C5-C7 ACDF.\n3. Multilevel degenerative changes as described, again most pronounced at\nC3-4, where there is mild to moderate spinal canal stenosis. Within limits of\nstudy, findings are grossly stable compared to ___ prior cervical\nspine MRI study.\n4. Stable fusion of C2 and C3 vertebral bodies.\n5. Paranasal sinus disease as described." }, { "input": "Cervical spine: As seen on prior CT cervical spine ___, there is 4\nmm subluxation of C5 on C6 with evidence of left-sided perched facet at this\nlevel. There is a large amount of fluid extending through the intervertebral\ndisc space at C5-C6, with interruption of the anterior and posterior\nlongitudinal ligaments at this level, as well as ligamentum flavum tear. Soft\ntissue edema is also seen in the interspinous and supraspinous ligaments\nextending from C2 through C7. The spinal cord demonstrates increased T2 and\nSTIR signal from C5 through the superior aspect of C7, with evidence of cord\nexpansion which is particularly marked at the level of C5 through C6. At the\nlevel of C5-C6, there is complete effacement of the surrounding CSF spaces\nsecondary to the subluxation and cord edema within expansion of cord caliber,\nresulting in moderate to severe spinal canal narrowing. There is a moderate\namount of fluid is seen in the prevertebral soft tissues extending inferior to\nthe C5-C6 through the level of T6. The diffusion-weighted images demonstrate a\nfocal segmental region of DWI hyperintensity with corresponding ADC\nhypointensity at the level of C6 and corresponding to the region of T2/STIR\nhyperintensity on the other sequences, which is most concerning for spinal\ncord contusion at this level. There is no evidence of hemorrhage within the\ncord at this level, based on GRE sequence.\n\nVertebral body height and alignment are otherwise preserved. There is\ngeneralized intervertebral disc desiccation. Bone marrow signal demonstrates\nsubtle increased STIR signal hyperintensity involving the vertebral bodies of\nC5 and C6, sequela of current traumatic process. The visualized posterior\ncranial fossa and craniocervical junction are unremarkable.\n\nC2-C3: There are bilateral uncovertebral osteophytes and ligamentum flavum\nthickening without spinal canal or neural foraminal narrowing.\n\nC3-C4: There is moderate diffuse disc bulge, uncovertebral osteophytes, facet\narthropathy and ligamentum flavum thickening, resulting in near complete\neffacement of the surrounding CSF spaces and moderate spinal canal narrowing. \nThe spinal cord shows no definite cord signal abnormality at this level. \nThere is bilateral severe neural foraminal narrowing.\n\nC4-C5: There is mild diffuse disc bulge, uncovertebral osteophytes, facet\narthropathy and ligamentum flavum thickening, resulting in moderate spinal\ncanal narrowing with partially effacement of the surrounding CSF spaces and\nspinal cord flattening. There is subtle T2 signal hyperintensity within the\ncord at this level. There is bilateral moderate neural foraminal narrowing.\n\nC5-C6: There are traumatic changes at this level, as described above, with\ndisc material coming in contact with the ventral cord, as well as 4 mm\nanterior subluxation of C5 on C6, uncovertebral osteophytes, facet arthropathy\nand ligamentum flavum thickening, as well as anterior and posterior\nlongitudinal ligament tears. The spinal cord demonstrates increased signal and\ncaliber, as described above. Findings result in moderate to severe spinal\ncanal narrowing with compression and deformity of the cord. There is evidence\nfor cord contusion at this site along the C6 vertebral body level.\n\nC6-C7: There is minimal diffuse disc bulge, uncovertebral osteophytes and\nfacet arthropathy. Without spinal canal narrowing. Increased T2 signal\nabnormality within the cord is visualized at this level, as described above. \nThere is moderate to severe left and moderate right neural foraminal\nnarrowing.\n\nC7-T1: There is mild diffuse disc bulge, uncovertebral osteophytes, facet\narthropathy a, without spinal canal narrowing. The cord demonstrates normal\nsignal at this level. There is no significant neural foraminal narrowing.\n\nThoracic spine: There is abnormal T2 signal abnormality extending obliquely\nalong the inferior corner of the anterior T8 vertebral body, and extending\ninto the anterior longitudinal ligament at this level, most consistent with at\ninferior anterior corner fracture with anterior longitudinal ligament tear.\nThere is no significant displacement of the fractured fragment. The T8\nvertebral body bone marrow signal is diffusely increased, particularly along\nthe fracture line.\n\nA second focus of anterior longitudinal ligament tear is seen at the level of\nT1-T2 (18; 11), with T2 signal hyperintensity extending along the disc space.\nBone marrow signal within the T1 vertebral body anteriorly is also increased.\nNo other evidence of acute fracture, bone marrow signal abnormality or\nligamentous injury identified within the thoracic spine.\n\nVertebral body alignment and height are preserved. There is intervertebral\ndisc desiccation at multiple levels with disc bulges at T2-3, T4-T5 and T8-T9.\nThoracic cord demonstrates normal signal and morphology. There is no evidence\nof slow diffusion within the thoracic cord.\n\nT2-T3: There is a diffuse disc bulge which partially effaces the ventral\nthecal sac but results in no significant cord deformity or signal abnormality.\nThere is mild spinal canal narrowing at this level. The bilateral neural\nforamina are mildly decreased in caliber.\n\nT4-T5: There is moderate diffuse disc bulge which partially effaces the\nventral thecal sac and results in mild spinal canal narrowing. No cord signal\nabnormality is identified. The neural foramina are adequately patent at this\nlevel.\n\nT7-T8: There is a small central disc bulge which minimally effaces the ventral\nthecal sac, but without spinal canal or neural foraminal narrowing\n\nThere is mild posterior dependent atelectasis. The prevertebral tissues\ndemonstrate large amount of fluid extending to the level of T6, as described\nabove. No evidence of soft tissue edema in the posterior paraspinal ligaments\nare soft tissues.", "output": "1. Cervical spine demonstrates a 3 column injury at C5-C6 with cord signal\nabnormality, caliber expansion and focal segmental slow diffusion, which is\nconsistent with spinal cord contusion at this level. There is complete tear of\nthe anterior and posterior longitudinal ligaments, as well as ligamentum\nflavum and edema in the interspinous and supraspinous ligaments. Cord\nexpansion and C5 on C6 anterior subluxation contribute to moderate to severe\nspinal canal narrowing at this level.\n\n2. Significant prevertebral soft tissue swelling and fluid extending from C5\nthrough T6 vertebral levels.\n\n3. Thoracic spine demonstrates 2 focal areas of the anterior longitudinal\nligament tear at the the T1-T2 and T8 levels, with an ___\nnondisplaced corner fracture of the T8 vertebral body. Bone marrow edema is\nseen at T1 and T8 vertebral bodies, consistent with contusion. The posterior\nlongitudinal ligament and ligamentum flavum are preserved throughout the\nthoracic spine and this is consistent with an anterior signal column injury.\nCord signal and caliber are within normal limits.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ (anesthesia) on the telephone on ___ at 11:44 AM, 15\nminutes after discovery of the findings." }, { "input": "Numbering used is shown on se 2, im 10.\n\nAlignment is normal. There is loss of normal disc height and signal at L4-L5\nand L5-S1. There are ___ type 1 changes of the vertebral endplates at L5-S1.\n\nThe lower spinal cord appears normal in size and signal intensity.\nThe conus medullaris is normal and terminates at L1.\n\nAt T11-T12, disc dessication, mild diffuse disc bulge with a central\ncomponent. There is no significant central canal stenosis or neural foraminal\nnarrowing.\n\nAt T12- L1, there is mild diffuse disc bulge and mild bilateral neural\nforaminal narrowing.\n\nAt L1-L2 there is no focal disk herniation, no central canal stenosis or\nneural foraminal stenosis.\n\nAt L2-L3, there is no focal disc herniation, central canal stenosis or neural\nforaminal narrowing. There is mild bilateral facet changes.\n\nAt L3-L4, there is minimal disc bulge. There is no significant central canal\nstenosis or neural foraminal narrowing. There is mild bilateral facet changes.\n\nAt L4 L5, there is mild diffuse disc bulge with a central component,\nthickening of the ligamentum flavum, and moderate bilateral right greater than\nleft facet hypertrophy resulting in mild right greater than left neural\nforaminal narrowing.\n\nAt L5-S1, there is mild diffuse disc bulge with a moderate superimposed\ncentral disc extrusion which is contacting but not deforming the bilateral\nexiting S1 nerve roots. There is no significant central canal stenosis. There\nis mild bilateral facet change which is resulting in moderate left and minimal\nto mild right neural foraminal narrowing.\n\nParaspinal soft tissues are unremarkable.", "output": "L5-S1: Central disc extrusion which is contacting but not deforming the\nbilateral exiting S1 nerve roots; moderate left and minimal to mild right\nneural foraminal narrowing.\nMultilevel disc and facet degenerative changes as detailed above which are\nmost prominent at L4-L5 and L5-S1." }, { "input": "Grade 1 retrolisthesis of L5 on S1 is slightly increased compared with the\nprior study (03:11). Endplate edema involving the inferior endplate of L5 and\nsuperior endplate of S1 is new from the prior study. Vertebral body marrow\nsignal is otherwise normal. There is loss of intervertebral disc height and\ndisc desiccation at L4-5 and L5-S1. Intervertebral disc height and signal\nintensity are otherwise preserved. The spinal cord appears normal in caliber\nand configuration.\n\nAt T11-T12, there appears to be concentric disc bulge with a superimposed left\nparacentral disc bulge causing mild to moderate left neural foraminal stenosis\nand mild spinal canal stenosis, although this level is only partially\nevaluated.\n\nAt T12-L1, a concentric disc bulge and facet arthropathy causes mild left\ngreater than right bilateral neural foraminal stenosis and minimal spinal\ncanal stenosis.\n\nAt L1-L2, facet arthropathy causes mild neural foraminal stenosis bilaterally.\nThere is no spinal canal stenosis.\n\nAt L2-L3, facet arthropathy causes mild neural foraminal stenosis bilaterally.\nThere is no spinal canal stenosis.\n\nAt L3-L4, facet arthropathy causes mild neural foraminal stenosis bilaterally.\nThere is no spinal canal stenosis.\n\nAt L4-L5, right greater than left facet arthropathy with a concentric disc\nbulge causes moderate bilateral neural foraminal stenosis and moderate spinal\ncanal stenosis. The concentric disc bulge contacts and displaces the\ntransiting nerve roots (7:7)..\n\nAt L5-S1, near complete loss of the intervertebral disc space within a\nconcentric disc bulge and superimposed left paracentral disc bulging causes\nmoderate spinal canal stenosis and severe subarticular recess stenosis\ncontacting bilateral transiting S1 nerve roots and displacing the left S1\nnerve root (07:14). There is moderate left neural foraminal stenosis and mild\nright neural foraminal stenosis.", "output": "Multilevel multifactorial degenerative changes have worsened compared with the\nprior study including increased grade 1 retrolisthesis of L5 on S1 and\nincreased L5-S1 disc protrusion which displaces the transiting left S1 nerve\nroot." }, { "input": "Motion artifact mildly limits evaluation. Cervical vertebral body heights are\npreserved. There is mild anterior wedging of T2 vertebral body without marrow\nedema. Alignment is normal. Within the C5 vertebral body, there is a 6 mm\ncircumscribed lesion with small amount of central fat (as evidenced by fat\nsensitive IDEAL images and T1 weighted images) surrounded by low T1 signal and\nhigh signal on fluid sensitive IDEAL images. This may represent a fat poor\nhemangioma.\n\nThere is minimal ectopia of the right cerebellar tonsil without effacement of\nCSF at the cervicomedullary junction. No signal abnormalities are seen in the\nvisualized posterior fossa on limited evaluation.\n\nNo evidence for signal abnormalities in the cervical or included upper\nthoracic spinal cord allowing for mild motion artifact.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: No spinal canal narrowing. Mild bilateral uncovertebral arthropathy\nwithout evidence for significant neural foraminal narrowing.\n\nC4-C5: No spinal canal narrowing. No significant neural foraminal narrowing.\n\nC5-C6: Tiny central disc protrusion without spinal canal narrowing. Small\nbilateral uncovertebral osteophytes scratch without significant neural\nforaminal narrowing.\n\nC6-C7: Shallow broad-based left paracentral disc protrusion with endplate\nosteophytes, without significant spinal canal narrowing. Left greater than\nright uncovertebral osteophytes with mild right and mild-to-moderate left\nneural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.", "output": "1. Mild uncovertebral arthropathy at multiple cervical levels. Mild to\nmoderate left C6-C7 neural foraminal narrowing. No significant spinal canal\nnarrowing.\n2. Circumscribed 6 mm lesion within the C5 vertebral body contains a small\namount of central fat and may represent a fat poor hemangioma.\n3. Minimal ectopia of the right cerebellar tonsil without effacement of CSF at\nthe cervicomedullary junction or other morphologic abnormalities, likely a\nnormal variant.\n\nRECOMMENDATION(S): Consider follow-up cervical spine MRI with and without\ncontrast for reassessment of the C5 vertebral body lesion in 6 months, to\nconfirm expected stability. However, if the patient has a known primary\nmalignancy, or if there is a laboratory data abnormality concerning for a\nprimary marrow lesion, then the C5 vertebral body lesion may be better\ncharacterized by a nuclear medicine bone scan at this time, on a non urgent\nbasis, or reassessed by cervical spine MRI with and without contrast in ___\nmonths.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 10:03 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is grade 1 L5 on S1 anterolisthesis. There is transitional anatomy with\npartial lumbarization of S1. Bilateral L5 pars defects are noted (see 2, 3,\n04:13, 5). Vertebral body heights are preserved. Schmorl's nodes are noted\nat the T11-12, T12-L1, and L1-2 levels. There is no definite focal marrow\nsignal abnormality. The visualized portion of the spinal cord is preserved in\nsignal and caliber.\n\nL5-S1 intervertebral disc demonstrates loss of signal. Intervertebral disc\nheights are preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is no vertebral canal or neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge which contacts bilateral exiting L5 nerve roots\nand facet joint arthropathy, resulting in moderate to severe bilateral neural\nforaminal stenosisand no vertebral canal stenosis.", "output": "1. Bilateral L5 age indeterminate pars defects, with grade 1 L5 on S1\nanterolisthesis.\n2. Multilevel degenerative changes as described, most pronounced at L5-S1,\nwhere disc bulge contacts bilateral exiting L5 nerve roots, and facet joint\narthropathy, resulting in moderate to severe bilateral neural foraminal\nstenosis." }, { "input": "Patient is status post right hemilaminectomy and discectomy at L4-L5. \nAlignment is normal. Vertebral body height and marrow signal is maintained. \nThere is loss of normal T2 disc signal and height from L3-L4 through L5-S1\nwith associated ___ type 2 endplate changes at those levels. There is a\nsmall Schmorl's node along the inferior endplate of L5. The spinal cord\nappears normal in caliber and configuration. The conus terminates at the L1\nlevel.\n\nAt T11-T12, there is no significant spinal canal or neural foraminal narrowing\non the sagittal images.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2, facet arthropathy results in mild spinal canal narrowing without\nsignificant neural foraminal narrowing.\n\nAt L2-L3, there are facet osteophytes resulting in mild spinal canal narrowing\nand mild left and moderate right neural foraminal narrowing, not significantly\nchanged.\n\nAt L3-L4, a posterior disc bulge and facet osteophytes result in moderate\nspinal canal narrowing, stable to minimally increased from prior. There is\nmoderate right and mild-to-moderate left neural foraminal narrowing, not\nsignificantly changed.\n\nAt L4-L5, there is a right hemilaminectomy defect status post diskectomy,\nincompletely evaluated without IV contrast. A posterior disc bulge or\ngranulation tissue and facet osteophytes cause mild spinal canal narrowing. \nThe posterior disc material or granulation tissue may contact the descending\nright L5 nerve root, unchanged. No evidence of recurrent disc herniation. \nThere is moderate right and moderate to severe left neural foraminal\nnarrowing, not significantly changed.\n\nAt L5-S1, a posterior disc bulge and facet osteophytes result in mild spinal\ncanal narrowing and severe bilateral neural foraminal narrowing, not\nsignificantly changed. The posterior disc material may contact the bilateral\ndescending S1 nerve roots, unchanged.\n\nThe visualized paravertebral soft tissues are unremarkable.", "output": "1. Overall no significant change in multilevel degenerative changes in the\nlumbar spine.\n2. Stable postsurgical changes status post right hemilaminectomy at L4-L5. No\nevidence of recurrent disc herniation." }, { "input": "Preliminary inspection of the sagittal images discloses a mild, congenital\nnarrowing of the AP diameter extending from the C3-4 through C6-7 levels. This\ncongenital stenosis contributes to the neural compressive changes noted below:\n\nAt C2-3, infolding of the ligamentum flavum contacts the dorsal cord surface.\n\nAt C3-4, since the prior MR study, there has been interval performance of an\nanterior cervical fusion, consisting of an anterior metal plate and twp pairs\nof screws spanning the interspace. Artifacts arising from these metallic\ndevices obscure adjacent bony and soft tissue detail. Please refer to the CT\nreport which discusses the question of radiolucency on that study relating to\nthe C3 screws. Once again, uncovertebral spurring causes prominent bilateral\nneural foraminal stenosis.\n\nAt C4-5, there is prominent disc space narrowing.. There is a small anterior\nbridging osteophyte. A small posterior spondylitic ridge contacts the ventral\ncord margin. Uncovertebral spurring contributes to causing prominent right\nand moderate left neural foraminal stenosis.\n\nAt C5-6, a shallow posterior spondylitic ridge contacts the ventral cord\nmargin. Uncovertebral spurring, as well as mild disc space narrowing together\ncontribute to cause prominent right and moderate left neural foraminal\nstenosis.\n\nAt C6-7, there is a small anterior bridging osteophyte. Uncovertebral\nspurring causes prominent left neural foraminal stenosis.\n\nThere is no definite signal abnormality seen within the cervical spinal cord. \nThe foramen magnum and its contents, as well as limited cervical paraspinal\nsoft tissue imaging does not appear to reveal additional abnormalities.", "output": "Postsurgical study at C3-4. Extensive multilevel cervical spondylosis and\ncongenital spinal stenosis. Please see above report for details, as well as\nrefer to the accompanying CT scan for additional observations." }, { "input": "Vertebral body heights are preserved. Minimal retrolisthesis of C4 on C5 is\nunchanged. There are discogenic bone marrow changes in the endplates at\nmultiple levels. No concerning bone marrow signal abnormalities are\nidentified.\n\nThe cerebellar tonsils are normally positioned, and the craniocervical\njunction appears unremarkable.\n\nAt C2-3, there is a minimal disc bulge without spinal canal or neural\nforaminal narrowing.\n\nAt C3-4, there is a large central/ right paracentral disc herniation extending\nabove and below the disk space, larger than on ___, which\nseverely narrows the spinal canal and compresses the spinal cord. There is\nnew high T2 signal within the cord at this level, compatible with edema or\nmyelomalacia. There is severe bilateral neural foraminal narrowing by\nuncovertebral osteophytes, not significantly changed on the right, but\nslightly progressed on the left.\n\nAt C4-5, there is a broad-based disc osteophyte complex moderately narrowing\nthe spinal canal and flattening the ventral spinal cord. Cord signal remains\nnormal. There is also severe bilateral neural foraminal narrowing by\nuncovertebral osteophytes. These findings are unchanged.\n\nAt C5-6, there is a broad-based disc osteophyte complex, larger on the right,\nwhich moderately narrows the spinal canal and flattens the ventral spinal\ncord. Cord signal remains normal. There is also severe right and mild to\nmoderate left neural foraminal narrowing by uncovertebral osteophytes. These\nfindings are unchanged.\n\nAt C6-7, there is a broad-based disc osteophyte complex with mild spinal canal\nnarrowing, which does not contact the ventral spinal cord. There is minimal\nright and severe left neural foraminal narrowing by uncovertebral osteophytes.\nThese findings are unchanged.\n\nC7-T1 level is unremarkable in appearance.", "output": "1. Interim enlargement of the central/right paracentral disc herniation at\nC3-4, which severely narrows the spinal canal and compresses the spinal cord.\nNew high T2 signal within the spinal cord at this level is compatible with\nedema or myelomalacia. Recommend neurosurgical consultation.\n2. Unchanged moderate spinal canal stenosis at C4-5 and C5-6 with flattening\nof the ventral spinal cord, but no evidence for cord signal abnormality.\n3. Unchanged severe neural foraminal narrowing at multiple levels.\n\nNOTIFICATION: Item 1 of the impression above was entered into the critical\nresults dashboard by Dr. ___ communication to the referring physician." }, { "input": "Prior radiographs demonstrate 5 lumbar-type vertebrae. Vertebral body heights\nare preserved. Alignment is normal. No concerning bone marrow signal\nabnormalities are identified. Discogenic bone marrow changes are again seen,\nmost prominent from L3-4 through L5-S1.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at L1.\n\nSagittal images through the T11-12, T12-L1, and L1-2 levels demonstrate no\nspinal canal or neural foraminal narrowing. Per there are no axial images\nthrough these levels.\n\nAt L2-3, there is right greater than left facet arthropathy, as before.\nProminent posterior epidural fat appear slightly increased compared to the\n___ MRI. The spinal canal is minimally narrowed without mass effect on the\nintrathecal nerve roots. There is no significant neural foraminal narrowing.\n\nAt L3-4, there is a disc bulge, facet arthropathy, and prominent posterior\nepidural fat, with worsening of the disc bulge and the epidural fat compared\nto the ___ MRI. Bilateral traversing L4 nerve roots are abutted in the\nsubarticular zones, unchanged. Intrathecal nerve roots are not compressed.\nThere is mild to moderate right neural foraminal narrowing with abutment of\nthe exiting right L3 nerve root, unchanged. There is minimal left neural\nforaminal narrowing without nerve root impingement, also unchanged.\n\nAt L4-5, there is a right laminectomy. There is a disc bulge and bilateral\nfacet arthropathy, as before. Small right anterior epidural signal\nabnormality, unchanged compared to the ___ MRI, is compatible with\npostsurgical change prior microdiscectomy, but is not fully assessed in the\nabsence of intravenous contrast. Bilateral traversing L5 nerve roots are\nabutted in the subarticular zones, as before. There is no mass effect on the\nintrathecal nerve roots. There is mild right and moderate to severe left\nneural foraminal narrowing with impingement of the exiting left L4 nerve root,\nunchanged.\n\nAt L5-S1, there is a disc bulge and right greater than left facet arthropathy.\nThe ligamentum flavum is mildly thickened. Bilateral traversing S1 nerve roots\nare abutted in the subarticular zones, more on the right than left, unchanged.\nThere is no mass effect on the intrathecal nerve roots. There is moderate\nbilateral neural foraminal narrowing with abutment and likely impingement of\nthe exiting L5 nerve roots, unchanged.", "output": "1. Compared to ___, there is progression of a disc bulge and posterior\nepidural lipomatosis at L3-4, with slightly increased mild spinal canal\nnarrowing. However, intrathecal nerve roots are not compressed, and abutment\nof bilateral traversing L4 nerve roots in the subarticular zones has not\nsignificantly changed. Mild to moderate right neural foraminal narrowing with\nabutment of the exiting right L3 nerve root is also unchanged.\n2. Mild progression of posterior epidural lipomatosis at L2-3 with minimal\nspinal canal narrowing, but no mass effect on the intrathecal nerve roots.\n3. Postsurgical and degenerative changes at L4-5 are similar to ___,\nas detailed above. Degenerative disease at L5-S1 also appears unchanged." }, { "input": "Acute T6 wedge compression fracture with approximately 40% loss of vertebral\nbody height is identified. Although there is postcontrast enhancement and\nedema of the T6 vertebral body, no cortical expansion or nodular underlying\nenhancing mass lesion is identified allowing for minimal increased thoracic\nkyphosis centered at the compression fracture, the remainder of the thoracic\nalignment is anatomic. The remainder of the vertebral body heights are\npreserved. ___ type 2 L2-L3 endplate changes are identified. No other\nsuspicious marrow lesion is noted. There is no abnormal enhancement or signal\nof the cord. STIR hyperintense signal of the T6-T7 interspinous ligament\nlikely represents mild injury without frank disruption. No other ligamentous\ninjury identified.\n\nT1-T2 through T4-T5: Mild degenerative changes do not significantly narrow the\nspinal canal or neural foramina.\n\nT5-T6: A small disc bulge does not significantly narrow the spinal canal. \nThere is no significant neural foraminal narrowing.\n\nT6-T7: There is minimal enhancement of the anterior epidural space, felt\nlikely to be reactive in nature. A disc bulge does not significantly narrow\nthe spinal canal. There is mild neural foraminal narrowing secondary to\nminimal retropulsion of the posterior cortex.\n\nT7-T8 through T9-T10: No significant spinal canal or neural foraminal\nnarrowing.\n\nT11-T12 through T12-L1: Mild disc bulges do not significantly narrow the\nspinal canal or neural foramina.\n\nL1-L2 and L2-L3: On sagittal sequences, there are small disc bulges resulting\nin mild spinal canal narrowing. In combination with facet arthropathy there\nis no significant neural foraminal narrowing.\n\nThere is a small right pleural effusion. Diffuse thickening of the mid to\ndistal esophagus with enhancement is identified, compatible with patient's\nknown esophageal carcinoma. A 4 mm T2 hypointense nodule other is noted in\nthe posterior edge of the spleen (series 8, image 16) without evidence of\nenhancement. This could represent a small calcification or hemorrhagic cyst. \nMild nodularity of the left adrenal gland is noted without evidence of focal\nlesion. The remainder the visualized prevertebral paraspinal soft tissues are\ngrossly unremarkable. Please refer to recent ___ PET-CT of ___ for\nadditional details.", "output": "1. Acute T6 wedge compression fracture with approximately 40% loss of\nvertebral body height, demonstrating uniform postcontrast enhancement. \nMinimal epidural enhancement posterior to T6 vertebral body is identified,\nlikely reactive. There is no associated nodular enhancement or cortical\nexpansion to suggest underlying mass lesion. However, follow-up examination\nwith contrast is recommended to document resolution of enhancement.\n2. There is mild STIR hyperintense signal of the T6-T7 interspinous ligament,\nlikely representing mild injury without frank disruption. No other\nligamentous injury identified.\n3. No retropulsion of fracture fragments is identified. No high-grade spinal\ncanal or neural foraminal narrowing.\n4. Additional findings as described above including diffuse thickening and\nenhancement of the mid to lower esophagus compatible with known esophageal\ncarcinoma.\n5. T2 hypointense 4 mm lesion of the spleen which does not demonstrate\ndefinitive postcontrast enhancement. This could represent a hemorrhagic cyst,\nhowever attention on followup examinations is recommended.\n6. Please refer ___ PET-CT performed on ___ for additional details." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body signal intensity appear normal. The spinal\ncord appears normal in caliber and configuration. There is no evidence of\nneural foraminal narrowing. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration. Disc bulge\ncauses spinal canal narrowing at C5-6 and C6-7.\n\nTHORACIC:\nAlignment is normal. Vertebral body signal intensity appear normal. The spinal\ncord appears normal in caliber and configuration. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nLevoscoliosis of the lumbar spine is noted. Transitional anatomy with\nsacralization of L5 vertebral body is noted. Vertebral body signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of neural foraminal narrowing. There is no evidence of\ninfection or neoplasm.\n\nAt L2-3 level there is disc desiccation and diffuse disc bulge, causing mild\nanterior thecal sac deformity, apparently contacting the traversing nerve\nroots bilaterally with no evidence of spinal canal narrowing, there is mild\nbilateral articular joint facet hypertrophy.\n\nAt L3-4, disc bulge causes mild bilateral neural foraminal narrowing, right\nworse than left, and mild spinal canal narrowing. There is mild bilateral\narticular joint facet hypertrophy.\n\nAt L4-5 level, there is transitional anatomy as described above, mild disc\ndesiccation, mild to moderate bilateral articular joint facet hypertrophy,\nthere is no evidence of neural foraminal narrowing or spinal canal stenosis.\n\nSTIR hyperintensity and mild enhancement is identified in the paraspinal\nmuscles at level L1-5, right worse than left.", "output": "1. No evidence of epidural abscess.\n2. Edema and mild enhancement of the lumbar paraspinal muscles, right greater\nthan left, likely reflect paraspinal muscle strain.\n3. Transitional lumbar spine anatomy with sacralization of L5 vertebral body\nis present. Levoscoliosis of the lumbar spine.\n4. L3-4 disc bulge causes mild bilateral neural foraminal narrowing." }, { "input": "There is no evidence of vertebral body height loss. The cervical spinal\nalignment is within normal limits. The bone marrow signal is normal.\n\nMild multilevel spondylosis is seen throughout the cervical spine without\nmoderate/severe spinal canal or neural foraminal narrowing. The spinal cord\nis grossly normal in morphology and signal intensity.\n\nThere is no convincing evidence for abnormal intramedullary, leptomeningeal,\nor epidural enhancement. The prevertebral and paraspinal soft tissues are\ngrossly within normal limits.", "output": "1. Minimal multilevel degenerative changes of the cervical spine without\nsignificant canal or neural foraminal narrowing.\n2. No evidence for abnormal cord signal or enhancement." }, { "input": "The examination is moderately degraded by patient motion. Within this\nconfine:\n\nTHORACIC:\nThe thoracic vertebral body heights are grossly maintained. Sagittal spinal\nalignment is maintained.\n\nThere are multiple areas of focal fat seen throughout the thoracic vertebral\nbodies. A probable vertebral body hemangioma is seen in the T3 vertebral\nbody. No focal suspicious lesion is identified on these noncontrast\nsequences.\n\nMild multilevel spondylosis is noted without appreciable canal stenosis or\nneural foraminal narrowing within the thoracic spine.\n\n\nLUMBAR:\n\nThere is increased STIR/T2 signal within the subcutaneous tissues overlying\nthe lumbar spine, most notable at the level of L3-L4, likely relating to the\npatient's recent lumbar drain placement and subsequent removal.\n\nThere is a small, heterogeneous, T2/STIR hypointense and slightly T1\nhyperintense collection seen in the dorsal epidural space extending from the\nlevel of T12 through L2. Evaluation of the total extent of this collection is\nlimited secondary to extensive patient motion.\n\nThis collection results in mass effect on the dorsal thecal sac, combining\nwith underlying spondylosis to cause moderate to severe canal stenosis which\nis most notable at L1-L2.\n\nVertebral body heights are maintained. There is grade 1 anterolisthesis of L4\non L5, and grade 1 retrolisthesis of L5 on S1. The terminus of the conus\nmedullaris is suboptimally visualized, but is potentially visualized at the\nlevel of T12.\n\nThere is loss of intervertebral disc height and signal seen at multiple\nlevels, compatible with desiccation. There are multilevel degenerative\nchanges as follows:\n\nT12-L1: Unremarkable.\n\nL1-L2: A posterior disc bulge combines with the previously described dorsal\nepidural hematoma to result in moderate canal stenosis with bilateral\nsubarticular recess narrowing, mild right and moderate left neural foraminal\nnarrowing.\n\nL2-L3: A posterior disc bulge flattens the ventral thecal sac and combines\nwith prominent dorsal epidural fat and probable trace epidural hematoma to\nresult in moderate canal stenosis with bilateral subarticular recess\nnarrowing, moderate left and moderate to severe right neural foraminal\nnarrowing.\n\nL3-L4: A posterior disc bulge with an equivocal right disc protrusion\nindenting the ventral thecal sac with moderate canal stenosis, bilateral\nsubarticular recess narrowing, moderate to severe right and severe left neural\nforaminal narrowing.\n\nL4-L5: There is a posterior disc bulge which combines with facet arthropathy,\nsmall bilateral facet joint effusions, thickening of ligamentum flavum to\nresult in severe canal stenosis with moderate bilateral neural foraminal\nnarrowing.\n\nL5-S1: A posterior disc bulge flattens the ventral thecal sac resulting in\nmild-to-moderate canal stenosis with severe bilateral neural foraminal\nnarrowing. There is compression of the bilateral exiting L5 nerve roots at\nthis level.\n\nNumerous bilateral T2 hyperintense renal cysts are noted.", "output": "1. Moderately motion degraded examination.\n2. Heterogeneous, predominantly T2/STIR hypointense dorsal epidural fluid\ncollection extending from approximately T12-L2. The collection appears\nrelatively small in volume, although this assessment is notably limited by\npatient motion.\n3. Multilevel spondylosis of the lumbar spine, as detailed above. Findings are\nmost significant at the level of L4-L5 with severe canal stenosis and moderate\nbilateral neural foraminal narrowing.\n4. Increased T2/STIR signal within the lower thoracic and lumbar spinal cord\nis likely secondary to compressive myelopathy in the setting of cord\ncompression, due to background spondylosis and the previously described\nepidural collection.\n\nNOTIFICATION: The initial findings were communicated in person by Dr. ___\nto Dr. ___ at 03:30 on ___, 2 minutes after\ndiscovery. Findings were confirmed with the neuroradiology fellow Dr. ___\nat 04:10 and Dr. ___ was again updated.\n\nFurther updated findings were conveyed by Dr. ___ to Dr. ___ text\n___ at 15:30 on ___, 2 minutes after discovery." }, { "input": "This examination includes only postcontrast T1 images through the thoracic and\nlumbar spine, used in comparison to the patient's noncontrast T1/T2 sequences\nacquired earlier on the same day.\n\nThe examination is severely limited by patient motion. Within these confines:\n\nIn the vicinity of the patient's known, small epidural fluid collection, there\nis no evidence of contrast enhancement to suggest infection. Subtle, diffuse\nleptomeningeal enhancement is seen throughout the thoracic and lumbar spine,\nwhich may relate to the patient's recent lumbar puncture and traumatic spinal\ndrain removal. There is no focal, masslike, or nodular areas of associated\nenhancement.\n\nMultilevel spondylosis within the lumbar spine is better detailed on the\npatient's recent, full MRI examination. Scout images again demonstrate\nnumerous bilateral T2 hyperintense renal cysts and a large infra renal aortic\naneurysm status post grafting.", "output": "1. Postcontrast imaging sequences which are severely limited by patient\nmotion.\n2. No evidence of enhancement within the location of patient's known epidural\nfluid collection. This suggests that the collection is likely hemorrhage.\n3. Mild diffuse leptomeningeal enhancement throughout the thoracic and lumbar\nspine without focal nodular or masslike component. Findings are likely\nreactive in the setting of recent lumbar puncture and drain placement with\nsubsequent removal.\n4. For description of the lumbar spondylosis, please see the dedicated\nnoncontrast portion of this examination performed earlier on the same day." }, { "input": "Vertebral body alignment and height are preserved. Bone marrow signal\ndemonstrates alternating bands of signal intensity, which may be seen in the\nsetting of chronic renal disease (which is mentioned on OMR). There are no\nsuspicious osseous lesions. The conus demonstrates normal signal and\nmorphology and terminates at the level of L1-L2. The cauda equina and nerve\nroots demonstrate a normal morphology and distribution within the thecal sac.\nThe prevertebral paraspinal soft tissues are unremarkable.\n\nThere is generalized intervertebral disc desiccation with mild intervertebral\ndisc height loss at T11-T12 and L5-S1.\n\nT11-T12: There is mild diffuse disc bulge with focal kyphotic deformity, but\nno spinal canal or neural foraminal narrowing.\n\nT12-L1: There is a minimal diffuse disc bulge, without spinal canal or neural\nforaminal narrowing.\n\nL1-L2, L2-L3: No evidence of significant disc herniation, spinal canal or\nneural foraminal narrowing.\n\nL3-L4, L4-L5: There is minimal diffuse disc bulge and mild ligamentum flavum\nthickening and facet arthropathy with small amount of fluid in the facet\njoints, but no spinal canal or neural foraminal narrowing.\n\nL5-S1: There is minimal diffuse disc bulge and mild facet arthropathy with\nsmall amount of fluid in the facet joints, but no evidence of spinal canal or\nneural foraminal narrowing.", "output": "1. Minimal degenerative disc disease, particularly at L5-S1, without spinal\ncanal or neural foraminal narrowing.\n2. Vertebral bone marrow signal abnormality with a stiated pattern, similar to\nthe \"___ spine on radiography, which may be seen in the setting of\nchronic renal disease." }, { "input": "Vertebral body heights are preserved. There is no subluxation. Straightening\nof cervical lordosis and slight smooth kyphotic curvature at C3-4 are again\nseen. The localizer sequence again demonstrates a mild dextroconvex curvature\nof the cervical spine and a partially visualized levoconvex curvature of the\nthoracic spine.\n\nThere is no evidence for bone marrow edema or ligamentous edema. There is no\nprevertebral or posterior paravertebral edema.\n\nThe cerebellar tonsils are normally positioned. Spinal cord signal is normal.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing. Facet\narthropathy is present.\n\nAt C3-4, there is a left paracentral disc protrusion which abuts but does not\ndeform the ventral spinal cord. However, the spinal canal is not significantly\nnarrowed, and the spinal cord is surrounded by plentiful cerebrospinal fluid\nlaterally and posteriorly. There is moderate right neural foraminal narrowing\nby uncovertebral and facet osteophytes.\n\nAt C4-5, there is mild right and moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes. There is no spinal canal narrowing.\n\nAt C5-6, there is a a broad-based disc osteophyte complex flattening the\nventral spinal cord. Cord signal remains normal. There is moderate right and\nmoderate to severe left neural foraminal narrowing, primarily by uncovertebral\nosteophytes.\n\nAt C6-7, there is a small central disc protrusion which indents the ventral\nthecal sac but does not contact the spinal cord. There is moderate right and\nmild left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.", "output": "1. No evidence for bone marrow edema, ligamentous edema, prevertebral edema,\nor posterior paravertebral edema.\n2. Mild to moderate multilevel degenerative disease, as detailed above. At\nC5-6, a broad-based disc osteophyte complex flattens the ventral spinal cord,\nbut cord signal remains normal." }, { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is dextroscoliosis of the lumbar spine. Multiple Schmorl's nodes are\nseen throughout the lumbar spine. Vertebral body heights are preserved. L5-S1\ntype ___ ___ changes are present.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal at L3-4, L4-5, L5-S1. \nThere is loss of intervertebral disc height at L2-3.\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 ligamentum flavum hypertrophy, novertebral canal and no\nneural foraminal narrowing. Nonspecific bilateral facet joint fluid is noted.\n\nAt L3-4 there is ligamentum flavum hypertrophy, novertebral canal and no\nneural foraminal narrowing. Nonspecific bilateral facet joint fluid is noted.\n\nAt L4-5 there is disc bulge, prominent epidural fat, ligamentum flavum\nhypertrophy, facet joint hypertrophy, mildvertebral canal or neural foraminal\nnarrowing. Nonspecific bilateral facet joint fluid is noted.\n\nAt L5-S1 there is disc bulge, central disc protrusion, facet joint\nhypertrophy, mildvertebral canal and mild bilateral neural foraminal\nnarrowing. Nonspecific bilateral facet joint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Multiple bilateral probable renal cysts are\npresent.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel lumbar spondylosis as described, with no definite moderate or\nsevere vertebral canal or neural foraminal narrowing.\n3. Limited imaging of kidneys suggest bilateralrenal probable cysts. If\nclinically indicated, consider dedicated renal ultrasound for further\nevaluation." }, { "input": "Study is mildly degraded by motion.\n\nThere is no evidence of vertebral body height loss. No focal suspicious bone\nmarrow lesion is identified.\n\nThere is stable reversal of cervical lordosis. Millimetric anterolisthesis of\nC3 on C4 with millimetric retrolisthesis of C4 on C5 is noted. Additionally,\nthere is millimetric anterolisthesis of T1 on T2 and T 2 on T3. These\nfindings are grossly unchanged from ___ and likely degenerative.\n\n Vertebral body heights are preserved. Schmorl's nodes are seen throughout\nthe cervical spine. Focal right C1-2 facet increased T2 and STIR signal and\nT1 hypointensity is grossly unchanged (see 2, 4, 05:11 on current study and 3,\n4, 8 on prior exam).\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is grossly stable loss of intervertebral disc height and signal\nthroughout the cervical spine.\n\nC2-C3: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: Mild posterior disc bulging is seen with mild canal narrowing, mild\nright and moderate severe left neural foraminal narrowing.\n\nC4-C5: A posterior disc bulge indents the ventral thecal sac and marginates\nthe ventral cord with mild-to-moderate canal narrowing. Neural foraminal\nnarrowing is moderate bilaterally.\n\nC5-C6: Posterior disc bulging with rightward asymmetry indents the ventral\nthecal sac and marginates the cord with moderate canal narrowing overall. \nNeural foraminal narrowing is mild-to-moderate on the left and severe on the\nright.\n\nC6-C7: Posterior disc bulging with possible superimposed central disc\nprotrusion indents the ventral thecal sac and marginates the ventral cord with\nmild canal narrowing overall. Neural foraminal narrowing is mild-to-moderate\nbilaterally. Last\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nOTHER:\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Scattered subcentimeter nonspecific lymph nodes\nare noted throughout the neck bilaterally, without definite enlargement by\nsize criteria.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel spondylosis of the cervical spine, as detailed above, overall\nminimally changed compared to ___ prior examination.\n3. Findings are again most notable at C5-6, where there is moderate canal,\nmild-to-moderate left and severe right neural foraminal narrowing.\n4. Grossly stable nonspecific probable edema of right C1-2 facet.\n5. Within limits of study, no definite evidence of cervical spinal cord\nlesion.\n6. Nonspecific subcentimeter cervical lymph nodes as described, which may be\nreactive." }, { "input": "Alignment is normal. Degenerative disc disease has increased since prior exam\nin ___.\n\nAt the C3-4 level, there is a mild disc bulge that does not touch the cord. \nThere is bilateral moderate to severe neural foraminal narrowing, left greater\nthan right.\n\nAt the C4-5 level, there is a small midline protrusion that flattens the cord.\nThere is bilateral moderate to severe neural foraminal narrowing, left greater\nthan right.\n\nAt C5-6 level, there is a broad disc bulge that flattens the cord. There is\nbilateral neural foraminal narrowing, left greater than right.\n\nAt the C6-7 level there is a little protrusion that encroaches on the canal\nbut does not touch the cord. There is bilateral severe neural foraminal\nnarrowing, left greater than right.\n\nThere is no evidence of infection or neoplasm.", "output": "Degenerative disc disease with neural foraminal narrowing and multilevel disc\nbulges and protrusions, increased in severity since prior exam in ___." }, { "input": "Patient status post L3, L4, and L5 laminectomies and left L4-L5 discectomy. \nThere is grade 1 anterolisthesis L2 on L3, slightly increased from ___. Mild\ngrade 1 retrolisthesis of L5 on S1, similar to prior. There is no suspicious\nmarrow signal and vertebral body heights are preserved. The terminal cord\ndemonstrates no cord signal abnormality.\n\nMultilevel degenerative changes are noted throughout the lumbar spine with\nloss of disc height, endplate osteophyte formation, facet hypertrophy, and\nligamentum flavum thickening.\n\nT10-T11: Prominent bilateral facet osteophytes results in mild bilateral\nforaminal narrowing. There is no significant neural foraminal narrowing.\n\nT11-T12: Mild posterior disc bulge results in mild spinal canal narrowing and\nno significant neural foraminal narrowing. The posterior disc bulges slightly\nincreased from ___.\n\nT12-L1: Left foraminal and paracentral disc bulge and bilateral facet\nhypertrophy results in mild spinal canal narrowing with moderate left and mild\nright neural foraminal narrowing, both increased from prior.\n\nL1-L2: Posterior disc bulge and bilateral facet hypertrophy result in moderate\nspinal canal narrowing with contact compression of the cauda equina nerve\nroots. There is moderate bilateral neural foraminal narrowing. These\nfindings are new since ___.\n\nL2-L3: There is mild anterolisthesis of L 2 on L3. Posterior disc bulge and\nbilateral facet hypertrophy results in moderate to severe spinal canal\nnarrowing and possible contact with the cauda equina nerve roots, new since\n___. There is no significant neural foraminal narrowing.\n\nL3-L4: Bilateral foraminal posterior disc bulge and bilateral facet\nhypertrophy results in mild to moderate spinal canal narrowing and mild\nbilateral neural foraminal narrowing.\n\nL4-L5: Left paracentral posterior disc bulge and right foraminal disc bulge is\nsimilar to prior. No significant spinal canal stenosis. Moderate right and\nmild left neural foraminal narrowing similar to prior.\n\nL5-S1: Posterior diffuse disc bulge is noted. There is mild spinal canal\nnarrowing, slightly increased from ___. Moderate to severe bilateral neural\nforaminal narrowing is slightly increased compared to prior.\n\nA small Tarlov cyst noted at S2-S3 level is similar to prior.\n\nMultiple T2 hyperintense cystic lesions in the left kidney measuring up to 4\nmm are statistically likely simple cysts. Otherwise, the visualized\nprevertebral and paraspinal soft tissues are unremarkable allowing for\npostsurgical findings.", "output": "1. Slightly increased grade 1 anterolisthesis of L2 on L3. Stable grade 1\nanterolisthesis of L5 on S1, likely degenerative.\n2. Moderate spinal canal narrowing at L1-L2 and moderate to severe spinal\ncanal narrowing at L2-L3 are new since ___.\n3. Moderate to severe bilateral L5-S1 neural foraminal narrowing has slightly\nincreased compared to ___.\n4. The patient is status post L3 through L4 laminectomies. Evaluation for\ngranulation tissue is suboptimal without IV contrast." }, { "input": "Cervical spine: There is mild kyphosis in the upper cervical region with loss\nof lordosis. There are laminectomies C3 to the C7 levels. The craniocervical\njunction and C2-3 mild degenerative change disk bulging and mild to moderate\nbilateral foraminal narrowing identified. At C4-5 mild bilateral foraminal\nnarrowing seen. At C5-6 C6-7 mild bilateral foraminal narrowing is identified.\nAt C7-T1 moderate to severe left-sided and mild right-sided foraminal\nnarrowing.\n\nFrom T1-2 through T3-4 mild degenerative change seen.\n\nThe spinal cord at C4-5 level demonstrates focal area of myelomalacia and cord\natrophy. No extrinsic spinal cord compression seen. No abnormal intraspinal\nenhancement is seen.\n\nLumbar spine:\n\nAt T12-L1 and L1-2 mild degenerative disc disease seen. At L2-3 disc bulging\nidentified without spinal stenosis.\n\nAt L3-4 disk bulging and mild to moderate narrowing of bilateral foramina\nseen. There is no spinal stenosis but there is mild to moderate bilateral\nsubarticular recess narrowing.\n\nAt L4-5 there is disc bulging and moderate right-sided and mild to moderate\nleft foraminal narrowing. Mild to moderate bilateral subarticular recess\nnarrowing seen.\n\nAt L5- Level there is disc bulging identified with moderate to severe right\nforaminal and moderate left foraminal narrowing.\n\nThe distal spinal paraspinal soft tissues are unremarkable. No abnormal\npostcontrast enhancement is seen.", "output": "1. Postoperative changes are seen in the cervical spine without spinal\nstenosis. Foraminal changes most pronounced. Other findings as described\nabove. Myelomalacia at the C4-5 level with mild cord atrophy.\n2. Mild scoliosis of the lumbar spine with multilevel degenerative changes as\ndescribed above. There is moderate-to-severe right-sided and moderate\nleft-sided foraminal narrowing at L5-S1 level." }, { "input": "2-3 mm retrolisthesis of L3 on L4 and L4-L5 is unchanged from prior\nexamination. Otherwise, lumbar alignment is anatomic. Vertebral body heights\nare preserved. ___ type 1 L3-L4 through L5-S1 endplate changes are slightly\nmore prominent when compared to prior examination of ___ as is anterior\nsuperior L2 endplate degenerative changes. T12 inferior endplate Schmorl's\nnode is identified. Otherwise, there is no suspicious marrow lesion. The\nconus medullaris terminates at the L2 level, within expected limits. There is\nno abnormal signal or enhancement of the terminal cord, conus medullaris or\ncauda equina.\n\nT11-T12 and T12-L1: Mild degenerative changes do not result in significant\nspinal canal or neural foraminal narrowing.\n\nL1-L2: A small disc bulge does not significantly narrow the spinal canal. \nThere is minimal left and no significant right neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In combination with facet arthropathy, there is mild\nbilateral neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. A small left facet joint is identified. There is\ncrowding of the bilateral subarticular zones which contacts but does not\nposteriorly displace the traversing nerve roots. In combination with facet\narthropathy, there is moderate to severe right and mild-to-moderate left\nneural foraminal narrowing, overall unchanged from prior exam.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In combination with facet arthropathy, there is\nmoderate to severe bilateral neural foraminal narrowing greater on the left,\noverall unchanged from prior exam.\n\nL5-S1: A disc bulge with thickening of the ligamentum flavum does not\nsignificantly narrow the spinal canal. In conjunction with facet arthropathy,\nthere is moderate severe bilateral neural foraminal narrowing greater on the\nright which appears similar to slightly progressed from prior exam.\n\n There are small nonenhancing T2 hyperintense cystic lesions in both kidneys\nmeasuring up to 3 mm, statistically most compatible with simple cysts. The\nvisualized prevertebral and paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. Multilevel lumbar spondylosis, most prominent spanning L3-L4 through L5-S1.\nAt L3-L4, there is severe right neural foraminal narrowing, at L4-L5 there is\nmoderate to severe left-greater-than-right bilateral neural foraminal\nnarrowing and at L5-S1 there is right greater than left moderate to severe\nneural foraminal narrowing. The findings at the right L5-S1 neural foramina\nappear to have slightly progressed from prior exam.\n2. No evidence of abnormal enhancement or signal of the terminal cord, conus\nmedullaris or cauda equina.\n3. No suspicious marrow lesions.\n4. Additional findings described above." }, { "input": "Alignment is normal. There is anterior T12 vertebral body height loss with\nirregularity of its superior and inferior endplates, essentially unchanged\nsince ___. There is a large T1 and T2 hyperintense lesion in the L1\nvertebral body that demonstrates fat suppression consistent with focal fat.\nThere is a T1 and T2 hypointense lesion in the anterior left L4 vertebral\nbody, likely degenerative in nature. There is diffuse disc T2 signal loss and\nheight loss. The spinal cord appears normal in caliber and configuration. \nThe conus terminates at L2.\n\nT12-L1: There is disc signal and height loss and a superior endplate Schmorl\nnode, but no significant spinal canal or neural foraminal narrowing.\n\nL1-L2: There is no significant spinal canal or neural foraminal narrowing.\n\nL2-L3: There is no significant spinal canal or neural foraminal narrowing.\n\nL3-L4: There is an inferior endplate Schmorl node, but no significant spinal\ncanal or neural foraminal narrowing.\n\nL4-L5: There is an inferior endplate Schmorl node, a left foraminal zone disc\nprotrusion, and bilateral facet osteophytes resulting in in moderate bilateral\nneural foraminal narrowing, but no significant spinal canal stenosis.\n\nL5-S1: There are bilateral facet osteophytes without significant spinal canal\nor neural foraminal narrowing.", "output": "1. A T1 and T2 hypointense lesion in the anterior left L4 vertebral body is\nprobably sclerosis related to degeneration, not identified on CT\nabdomen/pelvis obtained ___. If clinically indicated, dedicated CT could\nbe considered further evaluation.\n2. Multilevel degenerative changes, most severe at L4-L5 with a disc\nprotrusion and bilateral facet osteophytes resulting in moderate bilateral\nneural foraminal narrowing.\n\nRECOMMENDATION(S): Consider spine CT if further evaluation of the L4 lesion\nis indicated." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is moderate lumbar levoscoliosis, centered at the L2-L3 level. \nVertebral body heights are preserved. The signal intensity in the bone marrow\nis heterogeneous, consistent with bone marrow replacement for fat, and ___\ntype 2 endplate changes at all visualized levels. The visualized portion of\nthe spinal cord is preserved in signal and caliber. Conus medullaris\nterminates at the L1-L2 level.\n\nThere is loss of T2 signal of all the visualized intervertebral discs. There\nis severe intervertebral disc height loss from the levels of L1-L2 through\nL5-S1. There is moderate intervertebral disc height loss at T12-L1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nSagittal view of T11-T12 demonstrates no significant spinal canal or neural\nforaminal narrowing.\n\nAt T12-L1 there is a posterior disc protrusion indenting the ventral thecal\nsac without significant spinal canal narrowing. Facet arthropathy produces\nmild left neural foraminal narrowing..\n\nAt L1-2 there is minimal posterior disc protrusion and osteophyte formation\nwhich in conjunction with ligamentum flavum thickening produces a mild spinal\ncanal narrowing. Facet arthropathy produces moderate left neural foraminal\nnarrowing. The right neural foramina is patent..\n\nAt L2-3 there is a large right paracentral osteophyte which focally contacts\nthe traversing right L3 nerve root and effaces the subarticular recess. There\nis mild spinal canal narrowing. In conjunction with facet arthropathy, there\nis production of severe right neural foraminal narrowing. The left neural\nforamen is patent..\n\nAt L3-4 there is posterior osteophyte formation and ligamentum flavum\nthickening produce mild spinal canal narrowing and right greater than left\neffacement of the subarticular recesses. With facet arthropathy, there is\nproduction of mild right neural foramen narrowing. The left neural foramen is\npatent.\n\nAt L4-5 there is mild posterior disc bulge and osteophyte formation which in\nconjunction with ligamentum flavum thickening produces moderate to severe\nspinal canal narrowing and bilateral subarticular recess effacement. With\nfacet arthropathy, there is production of moderate right and severe left\nneural foraminal narrowing.\n\nAt L5-S1 there is minimal posterior disc bulge without significant spinal\ncanal narrowing. Facet arthropathy produces severe left and moderate right\nneural foraminal narrowing.\n\nSmall perineural cysts are visualized in the sacrum. The visualized\nretroperitoneum is grossly unremarkable.", "output": "1. Severe lumbar spondylosis, as described, most notable for severe\ndegenerative disc disease, moderate to severe spinal canal narrowing at L4-L5,\nand severe neural foraminal narrowing and subarticular recess effacement at\nmultiple levels.\n2. Moderate lumbar levoscoliosis." }, { "input": "Postoperative changes lumbar spine with posterior L3-S1 fusion, hardware in\nplace, partial L2 and L3-L5 laminectomies. There is minimal L1-L2\nanterolisthesis, new since prior. There is grade 1 L3-L4, L4-5\nanterolisthesis, probably similar, images are partially compromised from metal\nartifact. Disc space narrowing at L1-L 2, L2-L3, L3-L4, L4-5 levels. Disc\nspace narrowing at L2-L3 level has worsened. Multilevel diffuse disc bulges. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. Degenerative changes\nin the lower thoracic spine contribute to mild central canal narrowing at\nT10-T11, T11-T12 levels.\n\nAt L1-L2 level there is diffuse disc bulge with small central superior disc\nprotrusion. Moderate central canal narrowing, incomplete effacement of CSF,\nmildly worsened since prior. Subarticular zone narrowing on both sides. \nSevere right foraminal narrowing, worsened since prior. Moderate left\nforaminal narrowing, worsened since prior. There are fusions of bilateral\nfacet joints, mild adjacent reactive edema.\n\nAt L2-L3 level there is moderate central canal narrowing, similar to prior,\nincomplete effacement of CSF appear prominent osteophyte from the left facet\njoint. Subarticular zone narrowing on both sides, similar is moderate to\nsevere right, severe left foraminal narrowing, similar to prior\n\nAt L3-L4 level central canal is decompressed mild to moderate right, mild left\nforaminal narrowing, similar to prior.\n\nAt L4-5 level central canal is decompressed. No significant foraminal\nnarrowing.\n\nAt L5-S1 level central canal is decompressed. Patent foramina.", "output": "1. Postoperative changes.\n2. Advanced degenerative changes lumbar spine, mildly worsened since prior.\n3. Moderate central canal narrowing L1-L 2, L2-L3 levels.\n4. Multilevel foraminal narrowing, as above." }, { "input": "Study is mildly degraded by motion.\n\nCERVICAL:\nAlignment is normal.There is mild loss of vertebral body height. There is a\nstable C6 hemangioma. There is stable C5 superior endplate ___ type 2\ndegenerative change.\n\nThe spinal cord is remodeled and C4-C5 through C6-C7, without abnormal signal\nintensity. There is loss of intervertebral disc space at multiple levels with\ndiminished T2 signal, on the basis of degenerative process.\n\nThe prevertebral and paraspinal soft tissues appear unremarkable without\nevidence of a mass, abnormal enhancement, or infection.\n\nC2-3: There is no spinal canal or neural foraminal stenosis.\n\nC3-C4: There is a disc bulge indenting the ventral thecal sac with mild\nspinal canal stenosis, without cord deformity or abnormal signal intensity. \nThere is mild left neural foraminal narrowing from uncovertebral joint and\nfacet osteophytes.\n\nC4-C5: There is a disc bulge with moderate spinal canal stenosis with\nremodeling of the spinal cord, without cord signal abnormality. There is\nmoderate right and mild left neural foraminal narrowing from facet and\nuncovertebral joint osteophytes.\n\nC5-6: There is a disc bulge with asymmetric superimposed left paracentral\nneural foraminal disc protrusion, with moderate spinal canal stenosis, with\ncord remodeling without cord signal abnormality. There is severe left and\nmild right neural foraminal narrowing.\n\nC6-C7: There is a disc bulge with asymmetric left neural foraminal component,\nwith moderate spinal canal stenosis with cord remodeling without cord signal\nabnormality. There is severe left and mild right neural foraminal narrowing.\n\nC7-T1: There is a disc bulge indenting the ventral thecal sac without spinal\ncanal stenosis. There is no neural foraminal narrowing.\n\nTHORACIC:\nDextroscoliosis of the low thoracic spine is noted. Again seen is right T12\nvertebral body marrow signal abnormality extending into the posterior elements\nwith hyperintense STIR signal and hypointense T1 signal, with diffuse\nenhancement after contrast administration. The overall signal abnormality\nwhen compared with the prior study has decreased. A T5 and T11 hemangiomas\nare again seen. There is mild loss of vertebral body height, with flowing\nanterior osteophytes from T8 through T10, suggestive of DISH.\n\nThe spinal cord is normal in caliber and signal intensity. There is minimal\nloss of intervertebral disc height and T2 signal on the basis of degenerative\nprocess.\n\nThere is posterior right T12 through L2 paraspinal muscle edema with diffuse\nhomogeneous enhancement, which is decreased from the prior study. There is\nresolution of previously seen right posterior L3 paraspinal intramuscular\nabscess. There is no evidence of an abscess on the current examination. \nThere are multilevel disc bulge and disc protrusions indenting the ventral\nthecal sac, without spinal canal stenosis or neural foraminal narrowing.\n\nLUMBAR:\nAlignment is normal.There are multiple scattered hemangiomas. The spinal cord\nappears normal in caliber and configuration. The conus terminates at L1.There\nis loss of intervertebral disc height at multiple levels with reduced T2\nsignal on the basis of degenerative process. The prevertebral and paraspinal\nsoft tissues appear unremarkable without a mass, abnormal enhancement, or\ninfection.\n\nT12-L1: There is no spinal canal or neural foraminal narrowing. There is a\ncentral disc protrusion indenting the ventral thecal sac.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: There is a disc bulge with annular fissure, with moderate spinal canal\nstenosis and narrowing of bilateral subarticular zone. There is no neural\nforaminal narrowing. There are bilateral facet osteophytes and ligamentum\nflavum thickening.\n\nL3-L4: There is a disc bulge indenting the ventral thecal sac. There is no\nspinal canal stenosis. There is mild left and no right neural foraminal\nnarrowing.\n\nL4-5: There is an asymmetric left extraforaminal and foraminal disc bulge\nwith mild spinal canal stenosis, with buckling of the cauda equina nerve roots\nwith preserved CSF space. There are bilateral facet osteophytes with joint\neffusions with ligamentum flavum thickening. There is severe left neural\nforaminal narrowing compressing the exiting L5 nerve root.\n\nL5-S1: There is a disc bulge with mild spinal canal stenosis. There is mild\nbilateral neural foraminal narrowing. New right probable synovial cysts cysts\nare noted (see 14, 20:34; 8, 9, 10, 16:6).\n\nOTHER: There are multiple nonenhancing left renal cysts. Limited imaging of\nthe lungs suggests small bilateral pleural effusions.", "output": "1. Study is mildly degraded by motion. +\n2. Again seen is right T12 marrow signal abnormality likely related to\ninfectious or inflammatory process, similar to the prior study.\n3. Right T12 through L2 posterior paraspinal edema. With diffuse enhancement\nsuggestive of phlegmon, decreased from the prior study, with resolution of\npreviously seen intramuscular abscess.\n4. Multilevel degenerative changes as described, including moderate spinal\ncanal stenosis at C4-5 through C6-7 and L2-3, and multilevel neural foraminal\nnarrowing, severe at left L4-L5 compressing the exiting L5 nerve root.\n5. Small bilateral pleural effusions. If clinically indicated, consider\ndedicated chest imaging for further evaluation." }, { "input": "Motion artifact limits evaluation, particularly on the sagittal IDEAL images,\neven though the IDEAL images were repeated.\n\nVertebral body heights are preserved. Alignment is normal. No suspicious\nbone marrow signal abnormalities are seen. Discogenic bone marrow changes are\nnoted at multiple levels. No evidence for spinal cord signal abnormalities on\nslightly motion limited evaluation.\n\nThe cerebellar tonsils are normally positioned. Visualized portions of the\nposterior fossa and lower cerebrum appear unremarkable.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: Small central disc protrusion indents the ventral thecal sac without\nspinal cord contact. There is moderate right neural foraminal narrowing by\nprimarily uncovertebral osteophytes, though minimal facet arthropathy is also\npresent.\n\nC4-C5: Broad-based central disc protrusion, right greater than left,\nmoderately narrows the spinal canal with mild right ventral cord remodeling. \nThere is severe right neural foraminal narrowing, primarily by uncovertebral\nosteophytes, though mild facet arthropathy is also present.\n\nC5-C6: Broad-based central and right paracentral disc protrusion with endplate\nosteophytes cause moderate spinal canal narrowing and mild right ventral cord\nremodeling. There is severe right and moderate to severe left neural\nforaminal narrowing, primarily by uncovertebral osteophytes, though mild facet\narthropathy is also present.\n\nC6-C7: Shallow posterior endplate osteophytes mildly indent the ventral thecal\nsac without spinal cord contact. There is severe right and moderate to severe\nleft neural foraminal narrowing, primarily by uncovertebral osteophytes.\n\nC7-T1: Tiny central disc protrusion is noted without spinal canal narrowing. \nThere is mild, left greater than right facet arthropathy without significant\nneural foraminal narrowing.", "output": "1. Mildly motion limited exam.\n2. At C4-C5 and C5-C6, broad-based disc protrusions, larger on the right than\nleft, cause moderate spinal canal narrowing with mild right ventral cord\nremodeling. No evidence for cord signal abnormalities on mildly motion\nlimited evaluation.\n3. Neural foraminal narrowing, primarily by uncovertebral osteophytes though\nmild facet arthropathy is also present, is moderate on the right at C3-C4,\nsevere on the right at C4-C5, severe on the right and moderate to severe on\nthe left at C5-C6 and C6-C7." }, { "input": "Cervical spine: There is straightening of the normal cervical lordosis.\nVertebral body height and alignment are preserved. Bone marrow signal is\nunremarkable, except for endplate degenerative changes and some heterogeneity\nof signal which can be due to osteopenia. The cord demonstrates normal\nmorphology and signal intensity. The visualized posterior cranial fossa and\ncraniocervical junction are unremarkable. The prevertebral and paraspinal soft\ntissues are unremarkable.\n\nThere are degenerative changes with disc bulges at extending from C3-C4\nthrough C6-C7 which minimally indents the ventral thecal sac but results in no\nspinal canal remodeling or signal abnormality. There are multilevel\nuncovertebral osteophytes and facet arthropathy without evidence of high-grade\nneural foraminal narrowing. There is a focus of high T2 signal within the\nposterior aspect of the disc at C6-C7 ___ and ___ which may represent a\nsmall annular tear.\n\nThoracic spine: The vertebral body alignment and height are preserved. Bone\nmarrow signal is unremarkable without evidence of bone marrow edema or\nsuspicious osseous lesions. There is a focus of T1, T2 and STIR hyperintensity\nwithin the T9 and T10 vertebral bodies, most consistent with a vertebral\nhemangioma. The cord demonstrates normal signal intensity and morphology.\nThere is minimal degenerative disc disease with disc desiccation and minimal\ndisk bulges. There is no spinal canal or neural foraminal stenosis.\n\nThere is a moderately sized left pleural effusion.\n\nLumbar spine: There is a partially collapsed L1 vertebral body, without\nevidence of high signal on stair sequence and stable compared to prior studies\ndating back to at least ___. There is minimal retropulsion of the\nposterior aspect of the L1 vertebral body into the spinal canal, which along\nwith a T12-L1 posterior disc bulge results in partial effacement of the\nventral thecal sac but no direct contact with the conus. There is facet\narthropathy and ligamentum flavum at this level which mildly narrows the right\naspect of the thecal sac at this level. The remainder of the thecal sac is\nadequately patent secondary to the an underlying capacious spinal canal. There\nis mild narrowing of the subarticular zones but no neural foraminal narrowing.\n\nVertebral body alignment and height are otherwise preserved. The conus\nmedullaris demonstrates normal signal and morphology and terminates at the\nlevel of L1. Bone marrow signal is unremarkable, except for endplate\ndegenerative changes but no suspicious osseous lesions or bone marrow edema\nidentified.\n\nThere is generalized intervertebral disk desiccation with intervertebral disc\nheight loss, particularly at L4-L5 and L5-S1.\n\nThere are multiple T2 hyperintense foci throughout the kidneys, with a large 1\nat the left kidney. These are most likely renal cyst.\n\nThere is increased epidural fat surrounding the thecal sac extending from the\nlevel of L5 through the sacral segments, resulting in narrowing of the spinal\ncanal.\n\nL1-L2: Mild diffuse disc bulge and mild facet arthropathy with small amount of\nfluid in the facet joints and mild ligamentum flavum thickening, without\nsignificant spinal canal or neural foraminal narrowing.\n\nL2-L3: No significant disc herniation, spinal canal or neural foraminal\nnarrowing. There is mild facet arthropathy with small amount of fluid in the\nfacet joints and mild ligamentum flavum thickening\n\nL3-L4: There is mild facet arthropathy with small amount of fluid in the facet\njoints and mild ligamentum flavum thickening, without significant spinal canal\nor neural foraminal narrowing.\n\nL4-L5: There is a moderate facet arthropathy and mild ligamentum flavum\nthickening, without significant disc herniation, spinal canal or neural\nforaminal narrowing.\n\nL5-S1: There is increased epidural fat at this level, without significant disc\nherniation or neural foraminal narrowing.", "output": "1. Cervical spine demonstrates mild to moderate multilevel degenerative\nchanges without significant spinal canal or neural foraminal narrowing. Bone\nmarrow signal shows no definite evidence of suspicious osseous lesions or bone\nmarrow edema. Probable small annular tear at intervertebral disc of C6-C7.\n\n2. Thoracic spine demonstrates a focus of T2, T1 and STIR hyperintensity\nwithin the T9 and T10 vertebral bodies, most likely representing a vertebral\nhemangioma. No suspicious osseous lesions identified.\n\n3. Lumbar spine demonstrates tip. A chronic compression fracture of the L1\nvertebral body with minimal retropulsion into the spinal canal but no\nsignificant spinal canal narrowing. There are multilevel mild disc bulges,\nmost prominent at T12-L1. Which results in no significant spinal canal or\nneural foraminal narrowing. No cord signal abnormality or bone marrow edema is\nidentified." }, { "input": "CERVICAL SPINE: The vertebral body heights and alignment are maintained. The\nbone marrow is slightly heterogeneous, but without evidence of a discreet\nsuspicious lesion.\n\nThe cervical cord is normal in morphology and signal intensity. There is no\nabnormal enhancement.\n\nMild cervical spondylosis as previously described is unchanged.\n\nTHORACIC SPINE: The vertebral body height and alignment are preserved. There\nare T1, T2 and STIR hyperintense lesions within the T9 and T10 vertebral\nbodies likely representing low flow venous malformations (ie. hemangiomas).\n\nThe thoracic cord is a normal morphology and signal intensity. There is no\nabnormal in enhancement.\n\nThere is unchanged mild thoracic spondylosis without evidence of significant\nspinal canal or neural foraminal narrowing.\n\nThere is a moderate left pleural effusion.\n\nLUMBAR SPINE: There is stable L1 compression fracture with minimal bony\nretropulsion. The vertebral body heights are otherwise maintained. The bone\nmarrow is mildly heterogeneous, but without evidence of a discreet suspicious\nlesion.\n\nThe conus medullaris is normal in appearance and terminates at the L1. There\nis no abnormal enhancement.\n\nPreviously described multi level lumbar spondylosis is unchanged.\n\nAgain noted are multiple T2 hyperintense nonenhancing renal lesions likely\nrepresenting cysts.", "output": "No evidence of metastatic disease within the cervical, thoracic or lumbar\nspine. There is no abnormal enhancement.\n\nStable L1 compression fracture with a minimal bony retropulsion.\n\nThere is a moderate left pleural effusion.\n\nMultiple nonenhancing T2 hyperintense renal lesions likely representing cysts.\n\nSpinal spondylosis unchanged from recent MRI." }, { "input": "CERVICAL:\nVertebral body heights and alignment are preserved. There is no focal bone\nmarrow signal abnormality. There is no prevertebral soft tissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is mild intervertebral disc height loss at\nC4-C5, C5-C6, and C6-C7.\n\nCurvilinear areas of low T2 signal within the spinal cord at the C4-C5 level\nare likely artifactual, as no correlate is seen on any other sequence. The\nspinal cord is otherwise preserved in signal and caliber. The visualized\nposterior fossa and cervicomedullary junction is preserved. There is no\nepidural collection or abnormal focus of post contrast enhancement.\n\nTiny disc protrusions are seen at multiple levels indenting the ventral thecal\nsac without significant spinal canal narrowing, with minimal flattening of the\nventral spinal cord at the C3-C4 and C5-C6 levels, without underlying cord\nsignal abnormality.\n\nFacet and uncovertebral osteophytes produce mild right and severe neural\nforaminal narrowing at the C3-C4 level, mild bilateral neural foraminal\nnarrowing at the C4-C5 level, moderate bilateral neural foraminal narrowing at\nthe C5-C6 level, and moderate narrowing at the bilateral C6-C7 level. The\nremainder of the neural foramina are widely patent.\n\nTHORACIC:\nVertebral body heights and alignment are preserved. 11 mm T1 and T2\nhyperintense lesion with enhancement in the left superior aspect of the T2\nvertebral body and another smaller similar appearing lesion in the T2\nvertebral body are compatible with hemangioma. There is otherwise no\nsuspicious focal bone marrow signal abnormality. There is no prevertebral\nsoft tissue edema.\n\nThere is mild loss of T2 signal of the intervertebral discs, a manifestation\nof degenerative disc disease. Intervertebral disc heights are otherwise\nrelatively well preserved.\n\nThe spinal cord is preserved in signal and caliber. There is no epidural\ncollection or other abnormal focus of post contrast enhancement.\n\nTrace disc protrusions are seen at several levels without significant spinal\ncanal narrowing. There is no significant neural foraminal narrowing.\n\nLUMBAR:\nThere is frank fluid signal within the mid to posterior aspect of the L1-L2\nintervertebral disc space, with asymmetric intervertebral disc space narrowing\nat this level. There is adjacent endplate irregularity of the L1 and L2\nvertebral bodies surrounding edema and associated enhancement. There is an\napparent rim of enhancement around the intervertebral disc fluid. There is\nalso minimal enhancement of the adjacent dura, though without frank fluid\ncollection or phlegmonous change. No drainable fluid collection is seen.\n\nVertebral body heights are otherwise preserved. Alignment is preserved. A\n2-3 mm T1 and T2 hyperintense lesion in the L4 vertebral body is compatible\nwith hemangioma. Small Schmorl's node is seen at the superior endplate of L4\nas well as the superior endplate of L5. No other areas of focal bone marrow\nsignal abnormality are seen.\n\nThere is mild loss of T2 signal of the intervertebral disc, a manifestation of\ndegenerative disc disease. There is mild intervertebral disc height loss at\nL4-L5. The remainder of the intervertebral disc heights are relatively well\npreserved.\n\nThe distal spinal cord is preserved in signal and caliber. The conus\nmedullaris terminates at the T12-L1 level. There is no epidural collection. \nThere is no abnormal enhancement of the terminal cord, conus medullaris or\ncauda equina.\n\nAt L1-L2, there is mild disc bulge and ligamentum flavum thickening without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L2-L3, there is mild disc bulge and endplate osteophyte formation without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, there is mild disc bulge and superimposed central protrusion without\nsignificant spinal canal narrowing. There is effacement of the left\nsubarticular zone without traversing nerve root impingement. Facet and\nendplate osteophytes produce minimal bilateral neural foraminal narrowing.\n\nAt L4-L5, disc bulge with superimposed left central protrusion and endplate\nosteophytes indent the ventral thecal sac without significant spinal canal\nnarrowing. Facet and endplate osteophytes produce mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is mild left eccentric disc bulge without significant spinal\ncanal narrowing. Facet and endplate osteophytes produce mild to moderate left\nand mild right neural foraminal narrowing.\n\nOTHER: The visualized lungs are grossly clear. The visualized retroperitoneum\nis grossly unremarkable.", "output": "1. Findings raise concern for early L1-L2 discitis-osteomyelitis given\nhistory, although inflammatory Schmorl's node formation can demonstrate a\nsimilar appearance. No drainable fluid collection or frank epidural abscess\nformation. Clinical correlation is advised with low threshold for repeat\nimaging if symptoms progress.\n2. No cord signal abnormality.\n3. Degenerative changes at other levels, as described above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:46 pm, 3 minutes after\ndiscovery of the findings." }, { "input": "The patient is status post kyphoplasty of the L1 vertebral body, with mild\nanterior wedging which appears unchanged dating back to ___. Otherwise,\nvertebral body heights are grossly unremarkable and unchanged. Vertebral body\nalignment is within normal limits, without evidence for subluxation.\n\n___ type 2 degenerative endplate changes are most prominent at L4-L5. No\nfocal suspicious bone marrow lesion is identified. The conus medullaris\nterminates at the level of L1-L2.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nT12-L1: Minimal disc bulging is noted indenting the ventral thecal sac without\nsignificant canal or neural foraminal narrowing.\n\nL1-L2: There is mild bilateral articular joint facet hypertrophy with no\nevidence of spinal canal or neural foraminal stenosis.\n\nL2-L3: A posterior disc bulge flattens the ventral thecal sac, combining with\nprominent dorsal epidural fat and thickening of ligamentum flavum to result in\nmild canal narrowing with bilateral subarticular recess narrowing. There is\nmild left and mild-to-moderate right neural foraminal narrowing. These\nfindings are overall minimally changed from previous examination.\n\nL3-L4: There is a posterior disc bulge with superimposed central disc\nprotrusion and annular fissure combining with facet arthropathy and thickening\nof ligamentum flavum to result in mild-to-moderate canal narrowing. \nAdditionally, there is bilateral subarticular recess narrowing with mild\nbilateral neural foraminal narrowing. These findings of modestly progressed\nfrom the previous examination.\n\nL4-L5: The patient is status post remote left hemilaminectomy at L4 with\nassociated postoperative change. Again seen is a posterior disc bulge with\nsuperimposed left disc protrusion which extends into the subarticular and\nforaminal zones. Overall this is minimally changed from previous examination,\nresulting in mild-to-moderate canal narrowing with severe left subarticular\nrecess and neural foraminal narrowing. The disc bulge/protrusion at this\nlevel compresses the exiting left L4 nerve root and displaces the descending\nleft L5 nerve root. There is no evidence of abnormal enhancement after\ncontrast administration.\n\nL5-S1: Mild posterior disc bulge is noted without significant canal stenosis,\nbut contributing to severe bilateral neural foraminal narrowing with\ncompression of the bilateral exiting L5 nerve roots, overall similar to the\nprevious examination.\n\nThere is no evidence for abnormal intramedullary, leptomeningeal, or epidural\nenhancement. The visualized portions of the paraspinal soft tissues are\ngrossly within normal limits.", "output": "1. Multilevel spondylosis of the lumbar spine, as detailed above.\n2. Findings are most significant at L4-L5 with mild-to-moderate canal\nnarrowing, severe left subarticular recess and neural foraminal narrowing. \nFor L4-L5 disc bulge contributes to compression of the exiting left L4 nerve\nroot and displacement of the descending left L5 nerve root, overall minimally\nchanged from the previous examination.\n3. Unchanged appearance following remote L1 kyphoplasty and left L4\nhemilaminectomy, there is no evidence of abnormal enhancement after contrast\nadministration." }, { "input": "THORACIC:\nThere is rightward curvature of the thoracolumbar spine with the apex at T12. \nThe alignment is normal. The bone marrow signal is within normal limits. \nThere is no abnormal enhancement. The intervertebral discs are normal in\nsignal intensity. There is no spinal canal or foraminal narrowing.\n\nA central focus of T2 hyperintensity seen in the posterior portion of the\nspinal cord at T6-T7 ___, 5:7). There is no enhancement. The spinal cord\nsignal otherwise appears normal. This is compatible with the clinical history\nof multiple sclerosis.\n\n\nLUMBAR:\nThere is S-shaped curvature of the lumbar spine. Grade 1 anterolisthesis of\nL4-5 is seen. The bone marrow signal is within normal limits. There is no\nabnormal enhancement. The cord terminates at L1 and is unremarkable. Mild\nmultilevel disc desiccation loss of disc height are seen with disc bulges at\nT12-L1, L1-L 2, L2-L3, L3-L4 and L4-L5. A central annular fissure is seen at\nL4-5. There is no spinal canal narrowing. There is mild bilateral foraminal\nnarrowing at L3-4 and L4-5.\n\n\nOTHER:\nModerate-sized bilateral pleural effusions are seen. A consolidation is seen\nin the left lower lobe.", "output": "1. Central focus of abnormal high signal signal on T2 weighted images in the\nposterior spinal cord at T6-T7 without enhancement. This is compatible with\nthe clinical history of multiple sclerosis.\n2. Mild degenerative changes of the lumbar spine.\n3. Left lower lobe consolidation. Moderate-sized bilateral pleural effusions.\n\nRECOMMENDATION(S): CT chest with contrast is recommended." }, { "input": "Lumbar curve convex to the left. Multilevel advanced degenerative changes\nlumbar spine, with disc space narrowing, diffuse disc bulges, endplate\nhypertrophic changes. Lumbar facet arthritis, most prominent at L4-5, L5-S1\nlevels. Unilateral left L5 pars interarticularis defect, similar to prior. \nNormal L5-S1 alignment. Normal visualized cord. Small benign simple cyst\nleft kidney, similar.\nMild central canal narrowing lower thoracic spine from degenerative changes.\n\nAt L1-L2 level there is mild central canal narrowing. Moderate right, mild\nleft foraminal narrowing, similar previously seen shallow disc protrusion has\nimproved.\n\nAt L2-L3 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing, stable.\n\nAt L3-L4 level there is mild central canal narrowing. Moderate right, mild\nleft foraminal narrowing, stable.\n\nAt L4-5 level there is mild central canal narrowing. Moderate left, mild\nright foraminal narrowing, stable.\n\nAt L5-S1 level central canal is patent. Moderate left foraminal narrowing,\nstable. Patent right foramen.", "output": "1. Degenerative changes lumbar spine, similar.\n2. Mild central canal narrowing.\n3. Multilevel moderate foraminal narrowing." }, { "input": "There is no evidence of vertebral body height loss. There is millimetric\nretrolisthesis of C5 on C6 C6 on C7, likely degenerative in nature. ___\ntype 1 degenerative endplate changes are most prominent at C6-C7.\n\nC2-C3: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: Mild posterior disc bulging slightly flattens the ventral thecal sac\nwithout appreciable canal stenosis. Mild right neural foraminal narrowing is\nseen.\n\nC4-C5: Posterior disc bulging indents the ventral thecal sac with mild canal\nnarrowing. Neural foraminal narrowing is mild bilaterally.\n\nC5-C6: Posterior disc bulging indents the ventral thecal sac and nearly\nmarginates the ventral cord with mild-to-moderate canal narrowing. Neural\nforaminal narrowing is moderate to severe bilaterally.\n\nC6-C7: A dominant posterior disc bulge indents the ventral thecal sac,\ncontacting the ventral cord with moderate canal stenosis overall. Neural\nforaminal narrowing is moderate bilaterally.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nThe prevertebral and paraspinal soft tissues are grossly within normal limits.", "output": "1. Multilevel spondylosis of the cervical spine, as detailed above. \nNo evidence for severe canal stenosis or cord signal abnormality.\n2. Findings are most notable at C5-C6, C6-C7 levels as described detail above." }, { "input": "CERVICAL:\n4 mm anterolisthesis of C3 on C4, 2-3 mm retrolisthesis of C5 on C6 and 4 mm\nretrolisthesis of C6 on C7 is overall similar to examination of ___. \nVertebral body heights are preserved there is no suspicious marrow signal. \nSevere degenerative loss of disc height at C3-C4 and the ankylosis of the left\nC2-C3 facet and C3-C4 posterior bodies are unchanged. Moderate loss of disc\nheight at C4-C5 and severe loss of disc height at C5-C6 and C6-C7 has\nminimally progressed. Chronic lacunar infarct of the right cerebellar\nhemisphere, otherwise the visualized posterior fossa is unremarkable. There\nis no definitive cord signal abnormality.\n\nC2-C3: Uncovertebral facet arthropathy results in mild-to-moderate left and\nmild right neural foraminal narrowing. There is no significant spinal canal\nnarrowing.\n\nC3-C4: Uncovertebral and facet arthropathy results in mild to moderate\nbilateral neural foraminal narrowing. Intervertebral osteophyte results in\nmoderate spinal canal narrowing, remodeling the cord without underlying cord\nsignal change.\n\nC4-C5: A small disc protrusion does not significantly narrow the spinal canal.\nUncovertebral facet arthropathy results in moderate to severe bilateral neural\nforaminal narrowing.\n\nC5-C6: Intervertebral osteophyte and disc protrusion results in\nmild-to-moderate spinal canal narrowing. Uncovertebral facet arthropathy\nresults in severe bilateral neural foraminal narrowing.\n\nC6-C7: Intervertebral osteophyte and central protrusion with thickening of the\nligamentum flavum results in severe spinal canal narrowing, remodeling the\ncord without underlying cord signal change. Uncovertebral facet arthropathy\nresults in moderate to severe bilateral neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing.\n\nOverall the degree of spinal canal or neural foraminal narrowing is not\nsignificantly changed from examination of ___.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. No\nfocal suspicious marrow lesion. No cord signal abnormality.\n\nT1-T2 through T7-T8: No significant spinal canal or neural foraminal\nnarrowing.\n\nT8-T9 and T9-T10: Small disc bulges results in mild spinal canal narrowing. \nIn conjunction with facet arthropathy there appears to be moderate to severe\nleft T8-T9 neural foraminal narrowing.\n\nT10-T11: A disc bulge with prominent right-sided facet arthropathy results in\nmoderate spinal canal narrowing, remodeling the cord (series 13, image 18). \nNo cord signal abnormality. There is mild bilateral neural foraminal\nnarrowing.\n\nT11-T12: A disc bulge with thickening of ligamentum flavum results in moderate\nspinal canal narrowing. Degenerative changes results in at least moderate\nbilateral neural foraminal narrowing.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: On sagittal images a disc bulge results in mild spinal canal narrowing.\nThere is mild-to-moderate right and mild left neural foraminal narrowing.\n\n\nOTHER: Re-identified is a 1.7 cm left lobe of the thyroid nodule, previously\nevaluated on ultrasound. There is no cervical lymphadenopathy by size\ncriteria. There appears to be atelectasis of the bilateral lung bases. A\nknown cavitary right lower lung superior segment lesion is not well\ndemonstrated on MRI exam. Please refer to CT chest of ___ for additional\ndetails. Bilateral cystic lesions of the kidneys measuring up to 2 cm are\nstatistically most likely simple cysts.", "output": "1. Multilevel cervical spondylosis, most prominent at C3-C4 where there is\nmoderate spinal canal narrowing and remodeling the cord and at C5-C6 where\nthere is severe bilateral neural foraminal narrowing is overall unchanged from\nMRI examination of ___.\n2. Multilevel thoracic spondylosis most prominent at T10-T11 where there is at\nleast moderate spinal canal narrowing remodeling the cord and at T11-T12 where\nthere is moderate bilateral neural foraminal narrowing.\n3. No definitive cord signal abnormality. There is no compression of the\ncervical or thoracic cord.\n4. Re-identified is a 1.7 cm left thyroid lobe nodule previously evaluated on\nultrasound.\n5. Additional findings described above." }, { "input": "The vertebral body heights and alignment within the lumbar spine are\nmaintained. There are multilevel degenerative Schmorl's nodes with\ndegenerative bone marrow endplate changes. The bone marrow signal within the\nlumbar spine is otherwise unremarkable.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe T12-L1 level.\n\nThere is a large, partially imaged right renal cystic lesion which likely\nrepresents a large renal cyst and was present on prior CT. The remaining\nparaspinal and prevertebral soft tissues are unremarkable.\n\nAt the T12-L1 level, there is bilateral facet arthropathy and ligamentum\nflavum thickening without significant spinal canal or neural foraminal\nnarrowing.\n\nAt the L1-L2 level, there is a diffuse disc bulge with superimposed disk\nprotrusion, as well as bilateral facet arthropathy ligamentum flavum\nthickening which cause mild spinal canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nAt the L2-L3 level, there is a diffuse disc bulge with superimposed disk\nprotrusion, as well as bilateral facet arthropathy and ligamentum flavum\nthickening, which cause moderate spinal canal narrowing with compression of\nthe traversing L3 nerve roots between disc bulge and superior facet\nosteophytes, as well as mild right and severe left neural foraminal narrowing\nwith contact of the exiting L2 nerve root.\n\nAt the L3-L4 level, there is a diffuse disc bulge, bilateral facet\narthropathy, and ligamentum flavum thickening, which cause moderate to severe\nspinal canal narrowing with compression of the traversing L4 nerve roots\nbetween disc bulge and superior facet osteophytes, as well as severe left and\nmoderate to severe right neural foraminal narrowing within compression of the\nexiting L3 nerve roots, left greater than right.\n\nAt the L4-L5 level, there is a diffuse disc bulge,, bilateral facet\narthropathy, and ligamentum flavum thickening which cause mild spinal canal\nnarrowing with compression of the traversing L5 nerve roots between and disc\nbulge and superior facet osteophytes, as well as severe bilateral neural\nforaminal narrowing with compression of the exiting L4 nerve roots.\n\nAt the L5-S1 level, there is a diffuse disc bulge, bilateral facet\narthropathy, and ligamentum flavum thickening which cause mild spinal canal\nnarrowing and contact of the traversing right S1 nerve root, as well as severe\nbilateral neural foraminal narrowing with compression of the exiting bilateral\nL5 nerve roots.\n\nWhen compared to prior exam, the disc bulges and neural foraminal stenoses\nhave increased.", "output": "1. Progressive lumbar spondylosis most notably including multilevel severe\nneural foraminal stenoses affecting multiple associated nerve roots, as\ndescribed." }, { "input": "4 mm anterolisthesis of C3 on C4 appears unchanged compared to the radiograph\nfrom ___, increased since prior MR from ___. 3 mm\nretrolisthesis of C6 on C7 is also slightly progressed, previously 2 mm. \nAlignment is otherwise preserved. Vertebral body heights are preserved. \nAreas of mixed type 1 and type ___ ___ endplate degenerative change are noted\nat C3-C4, C5-C6 and C6-C7. No other focal bone marrow signal abnormalities\nare seen. There is no prevertebral soft tissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is up to moderate to severe intervertebral\ndisc space narrowing at the C3-C4 level, progressed compared the prior\nexamination, as is moderate intervertebral disc space narrowing at C6-C7.\n\nSpinal cord signal intensity is normal. The visualized posterior fossa and\ncervicomedullary junction appear normal.\n\nAt C2-C3, there is right-sided uncovertebral osteophyte formation indenting\nthe ventral thecal sac without significant spinal canal narrowing. Facet and\nuncovertebral osteophytes produce mild bilateral neural foraminal narrowing.\n\nAt C3-C4, a combination of anterolisthesis, disc bulge, endplate osteophytes\nand ligamentum flavum thickening produce severe spinal canal narrowing with\neffacement of CSF and cord impingement, without definite underlying cord\nsignal abnormality. Facet and uncovertebral osteophytes produce severe\nbilateral neural foraminal narrowing.\n\nAt C4-C5, tiny disc bulge and ligamentum flavum thickening mildly narrow the\nspinal canal without cord contact. Facet and uncovertebral osteophytes\nproduce moderate to severe bilateral neural foraminal narrowing.\n\nAt C5-C6, a midline disc protrusion along with intervertebral osteophytes\nencroach on the spinal canal and indent the anterior surface of the spinal\ncord without underlying signal abnormality. Facet and uncovertebral\nosteophytes produce severe right greater than left neural foraminal narrowing.\n\nAt C6-C7, a combination of midline disc protrusion, retrolisthesis, disc\nbulge, osteophytes and ligamentum flavum thickening produce severe spinal\ncanal narrowing with effacement of the surrounding CSF and deformity of the\nspinal cord without underlying signal abnormality. Facet and uncovertebral\nosteophytes produce severe right greater than left neural foraminal narrowing.\n\nAt C7-T1, mainly facet osteophytes produce mild spinal canal narrowing without\ncord deformation. Facet osteophytes produce moderate bilateral neural\nforaminal narrowing.\n\nLimited sagittal view of T1-T2 and T2-T3 demonstrate tiny disc bulge at T1-T2\nwithout significant spinal canal narrowing. Facet and endplate osteophytes\nproduce at least mild to moderate right and mild left neural foraminal\nnarrowing at these levels.\n\nDegenerative changes appear progressed since ___.\n\nA cystic structure measuring at least 13 mm is seen anterior and to the left\nof the C7 vertebral body, likely within the left lobe of the thyroid gland,\ncorresponding to nodule seen on chest CT from ___..", "output": "1. Multilevel cervical spondylosis, as described, progressed since ___, with most notable findings including severe spinal canal narrowing at\nthe C3-C4 and C6-C7 levels with underlying cord impingement without associated\ncord signal abnormality, and up to severe neural foraminal narrowing at the\nbilateral C3-C4, bilateral C5-C6, and bilateral C6-C7 levels.\n2. 4 mm anterolisthesis of C3 on C4 and 3 mm retrolisthesis of C6 on C7 has\nprogressed since ___, with worsening degenerative disc disease at\nthese levels.\n3. No cord signal abnormality.\n4. Partial visualization of a probable left lobe thyroid nodule measuring at\nleast 13 mm, as seen recently on chest CT. These have been previously\ninterrogated by ultrasound, with record of multiple biopsies performed." }, { "input": "Vertebral body heights are preserved. Alignment is normal. There is no\nevidence of bone marrow edema. Anterior and posterior longitudinal ligaments,\nas well as ligamentum flavum, appear intact without evidence for edema. There\nis mild interspinous edema from C2-3 through C5-6. There is no epidural\ncollection. The cervical and imaged upper thoracic spinal cord maintains\nnormal morphology and signal intensity. The cerebellar tonsils are normally\npositioned, and the imaged portion of the posterior fossa appears\nunremarkable.\n\nThere is a hemangioma in the T2 vertebral body. There are mild discogenic bone\nmarrow changes in the endplates at C4-5.\n\nAt C2-3 and C3-4, there is no spinal canal or neural foraminal narrowing.\n\nAt C4-5, there is moderate-to-severe right and moderate left neural foraminal\nnarrowing by uncovertebral osteophytes.\n\nAt C5-6, there is severe bilateral neural foraminal narrowing by uncovertebral\nosteophytes.\n\nAt C6-7, there is moderate to severe bilateral neural foraminal narrowing by\nuncovertebral osteophytes.\n\nC7-T1 level is unremarkable.\n\nOpacification of the right sphenoid sinus, as well as mucosal thickening in\nthe left sphenoid sinus, and fluid and mucosal thickening and bilateral\nmaxillary sinuses, are partially visualized but are better assessed on the\nconcurrent CT of the head.", "output": "1. Mild interspinous ligament edema from C2-3 through C5-6. Anterior\nlongitudinal ligament, posterior longitudinal ligament, and ligamentum flavum\nappear unremarkable. No evidence for other traumatic injuries.\n2. Moderate to severe bilateral neural foraminal narrowing from C4-5 and C6-7." }, { "input": "The vertebral body height, alignment, and marrow signal within the lumbar\nspine are normal.\n\nThe conus is normal in position and morphology and terminates at the L1-L2\nlevel.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the L3-L4 level, there is mild bilateral facet arthropathy and minimal\nligamentum flavum thickening. The spinal canal and neural foramina appear\nnormal.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and mild diffuse disc bulge with superimposed posterior disc\nprotrusion, slightly eccentric to the right, with annular fissure which causes\nmild spinal canal narrowing and approaches the descending right L5 nerve root.\nThe neural foramina appear normal. The appearance of this is unchanged when\ncompared to prior exam.\n\nAt the L5-S1 level, there is minimal facet arthropathy. The spinal canal and\nneural foramina appear normal.", "output": "1. Unchanged L4-L5 disc protrusion without significant spinal canal narrowing\nor evidence of neural impingement." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow lesion. Mixed ___ 1 and 2 endplate changes at L5-S1 is\nnoted. There is severe loss of disc height with endplate sclerosis at L5-S1,\nnew since examination of ___, but overall similar allowing for technical\ndifferences from CT examination of ___. The conus medullaris\nterminates at the L1-L2 level, within expected limits. There is no signal\nabnormality of the terminal cord.\n\nT10-T11 and T11-T12: Small disc bulges do not significantly narrow the spinal\ncanal. In conjunction with facet arthropathy, there is moderate right neural\nforaminal narrowing at T11-T12 and mild neural foraminal narrowing elsewhere.\n\nT12-L1 through L4-L5: Mild degenerative changes including disc bulges do not\nresult in significant spinal canal or neural foraminal narrowing. Bilateral\nfacet arthropathy at L4-L5 is greater on the left where there are small\nposteriorly projecting synovial cysts.\n\nL5-S1: A central protrusion does not significantly narrow the spinal canal. \nMinimal crowding of the subarticular zones without displacement of the\ntraversing nerve roots. Loss of disc height with facet arthropathy results in\nmoderate bilateral neural foraminal narrowing where facet osteophytes and the\ndisc remodels the exiting nerve roots greater on the left.\n\nThere are is a 1.9 T2 hyperintense cystic lesion in the right kidney,\nstatistically most compatible with a simple cyst. Remainder the prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes are most prominent at L5-S1 where loss of\ndisc height and facet arthropathy results in moderate bilateral neural\nforaminal narrowing with remodeling of the exiting nerve roots, greater on the\nleft.\n2. There is no severe spinal canal or neural foraminal narrowing. There is no\nabnormal signal of the terminal cord.\n3. Interval progression of loss of L5-S1 disc height and endplate changes.\n4. Additional 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": "There is stable grade 1 anterolisthesis of C3 on 4. Vertebral body heights\nare preserved. Heterogeneous bone marrow signal is identified with no focal\nmarrow replacing lesion seen. The visualized portion of the spinal cord is\npreserved in signal and caliber. There is loss of intervertebral disc height\nand signal at multiple levels. Within the limits of this noncontrast study\nthere is no evidence of infection or neoplasm. There is no prevertebral soft\ntissue swelling.. The visualized portion of the posterior fossa,\ncervicomedullary junction, paranasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is facet arthropathy with no spinal canal or neural foraminal\nstenosis.\n\nAt C3-4 there is uncovering of the disc and facet arthropathy resulting in\nmild spinal canal stenosis and mild left neural foraminal stenosis.\n\nAt C4-5 there is disc protrusion and posterior osteophytes with facet\narthropathy and uncovertebral hypertrophy resulting in mild-to-moderate spinal\ncanal stenosis and moderate left neural foraminal stenosis. In addition,\nthere is ventral indentation of the thecal sac this level.\n\nAt C5-6 there is disc protrusion and posterior osteophytes with facet\narthropathy and uncovertebral hypertrophy resulting in mild spinal canal\nstenosis and mild left neural foraminal stenosis.\n\nAt C6-7 there is a disc protrusion and facet arthropathy resulting in mild\nspinal canal stenosis and no significant neural foraminal stenosis.\n\nAt C7-T1 there is disc protrusion withno spinal canal or neural foraminal\nstenosis.\n\nDegenerative changes are also noted in the upper thoracic spine with disc\nprotrusion at T1-2 and T2-3 with no significant associated spinal canal\nstenosis", "output": "1. Multilevel degenerative changes throughout the cervical spine, worst at\nC4-5 resulting in mild-to-moderate spinal canal stenosis and moderate left\nneural foraminal stenosis, as described above." }, { "input": "There is scoliosis of lumbar spine convex to the right in the lower lumbar and\nto the left in the upper lumbar region.\n\nFrom T10-T11 through L1-2 levels disc degenerative changes seen without\nsignificant bulging. There is no spinal stenosis.\n\nAt L2-3 level, disc bulging and endplate degenerative changes seen. There is\nmild right foraminal narrowing. There is no spinal stenosis.\n\nAt L3-4 level, disc and facet degenerative changes are seen with moderate\nright and mild left foraminal narrowing without spinal stenosis.\n\nAt L4-5 level, disc and facet degenerative changes seen. There is moderate\nleft subarticular recess and mild spinal stenosis seen. There is mild right\nand moderate left foraminal narrowing.\n\nAt L5-S1 level, disc bulging and facet degenerative changes are seen. There\nis moderate right and moderate-to-severe left foraminal narrowing seen. There\nis moderate left subarticular recess narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild scoliosis of lumbar spine.\n2. Multilevel degenerative changes with mild spinal stenosis at L4-5 and\nmoderate left subarticular recess narrowing at L5-S1 level.\n3. Moderate-to-severe left foraminal narrowing at L5-S1 level.\n4. Moderate right foraminal narrowing at L3-4 and moderate left foraminal\nnarrowing at L4-5 level." }, { "input": "For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nMild increased kyphosis of the thoracic spine is seen, centered at T6-7. \nThere is a hemangioma in the T11 vertebral body. Vertebral body heights are\npreserved.\n The visualized portion of the spinal cord is preserved in signal and caliber.\nIntervertebral disc heights and signal are preserved.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. There are trace bilateral pleural effusions.\n\n At C7-T1 there is no vertebral canal or neural foraminal stenosis.\n\nAt T1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt T2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt T3-4 there is ligamentum flavum thickening and facet arthropathy with mild\nleft neural foraminal stenosis and no vertebral canal stenosis.\n\nAt T4-5 there is ligamentum flavum thickening and facet arthropathy with mild\nright neural foraminal stenosis and no vertebral canal stenosis\n\nAt T5-6 there is ligamentum flavum thickening and facet arthropathy with mild\nbilateral neural foraminal stenosis and no vertebral canal stenosis\n\nAt T6-7 there is ligamentum flavum thickening and facet arthropathy with mild\nbilateral neural foraminal stenosis and no vertebral canal stenosis\n\nAt T7-8 there is ligamentum flavum thickening and facet arthropathy with mild\nMRI neural foraminal stenosis and no vertebral canal stenosis\n\nAt T8-9 there is ligamentum flavum thickening and facet arthropathy with mild\nright neural foraminal stenosis and no vertebral canal stenosis\n\nAt T9-10 there is ligamentum flavum thickening and facet arthropathy with mild\nleft neural foraminal stenosis and no vertebral canal stenosis\n\nAt T10-11 there is no vertebral canal or neural foraminal stenosis.\n\nLigamentum flavum thickening at right T11-12 results in mild mass effect on\nthe right lateral spinal cord with no significant spinal canal stenosis.\n\nAt T12-L1 there is disc bulge and facet arthropathy with ligamentum flavum\nthickening withno vertebral canal or neural foraminal stenosis.", "output": "1. Multilevel degenerative changes throughout the thoracic spine with no\nsignificant spinal canal stenosis and multi level mild neural foraminal\nstenosis as described.\n2. Focal right asymmetric ligamentum flavum thickening and facet arthropathy\nat T11-12, which abuts but does not displace the spinal cord with no\nsignificant spinal canal stenosis.\n3. Trace bilateral pleural effusions. If clinically indicated, consider\ndedicated chest imaging for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 23:11 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "There is normal lumbar alignment. The vertebral body heights are preserved. \nNew there are mild type ___ ___ changes at the L5-S1 endplate articulations\ninsert mildly increased in comparison to prior study. There are focal areas\nof fat within the vertebral marrow, otherwise the marrow signal is\nunremarkable. There is heterogeneous signal within the L5-S1 vertebral body\nwhich demonstrates mild loss of height, which is relatively unchanged. The\nconus demonstrates normal signal morphology, terminating appropriately at the\nL1-L2 level.\n\nAt T12-L1 there is no significant neural foramina or spinal canal stenosis.\n\nAt L1-L2 there is no significant neural foramina or spinal canal stenosis.\n\nAt L2-L3 there is no significant neural foramina or spinal canal stenosis.\n\nAt L3-L4 there is disc bulge and facet osteophytes causing mild spinal canal\nnarrowing without significant neural foraminal stenosis.\n\nAt L4-L5 there is disc bulge and facet osteophytes which, which is unchanged\n(05:33). There is no significant neural foraminal stenosis.\n\nAt L5-S1 there is right hemilaminectomy anatomy and with associated enhancing\ngranulation/scar tissue marginating the traversing right S1 nerve root within\nthe subarticular zones (06:39; 08:29). There are facet osteophytes and disc\nbulge with a superimposed right subarticular zone protrusion which\ndemonstrates heterogeneous enhancement which may represent granulation/scar\ntissue and marginates the traversing right S1 nerve root. The size of the\ndisc protrusion is significantly improved from preoperative examination.\n\nThe paravertebral soft tissues are unremarkable.", "output": "1. Post-laminectomy and microdiscectomy changes at L5-S1 with a right\nsubarticular zone disc protrusion which has decreased in size as compared to\nprior study and minimally contacts the traversing right S1 nerve root. There\nis associated enhancement of the disc protrusion consistent with postsurgical\ngranulation/scar tissue.\n2. Enhancing granulation/scar tissue marginating the traversing right S1 nerve\nroot in the subarticular zone.\n3. Mild L5-S1 ___ type 1 degenerative changes which has mildly increased in\ncomparison to prior study." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. The lumbar\nvertebral body heights and alignment are maintained. There are multilevel\n___ type 2 endplate changes. There is mild intervertebral disc height loss\nat L4-L5. Otherwise, the intervertebral disc spaces are maintained.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of T12.\n\nAt T12-L1, L1-L 2, L2-L3, and L3-L4 there is posterior disc bulge without\nsignificant spinal canal or neural foraminal narrowing.\n\nL4-L5: Posterior disc protrusion, facet hypertrophy, and ligamentum flavum\nthickening without significant spinal canal narrowing. In combination with\nfacet arthropathy, there is mild bilateral neural foraminal narrowing.\n\nL5-S1: Posterior disc protrusion, facet hypertrophy, and ligamentum flavum\nthickening result in mild bilateral neural foraminal narrowing. No\nsignificant spinal canal narrowing.\n\nOther: Visualized prevertebral and paraspinal soft tissues are unremarkable,\nnoting mild inflammatory degenerative changes of the right L3-L4 paraspinal\nmuscles..", "output": "1. Mild multilevel degenerative changes, most pronounced at L4-L5 and L5-S1\nwith mild bilateral neural foraminal narrowing. No high-grade spinal canal\nnarrowing.\n2. Additional findings described above." }, { "input": "There is grossly unchanged reversal of the cervical lordosis, and mild\nanterolisthesis at C3 upon C4, and C4 upon C5 levels, the spinal cord appears\nnormal in caliber and configuration. There is no evidence of infection or\nneoplasm, the visualized paravertebral structures are grossly unremarkable.\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, there is mild posterior central disc bulge causing mild anterior\nthecal sac deformity, without significant spinal canal or neural foraminal\nnarrowing, and apparently grossly unchanged when compared with the prior CT of\nthe cervical spine dated ___.\n\nAt C6-7, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.", "output": "1. Mild posterior disc bulge is identified at C5-6 with mild reversal of\nnormal cervical lordosis, grossly unchanged mild anterolisthesis at C3 upon\nC4, C4 upon C5 levels.\n2. No focal or diffuse lesions are visualized throughout the cervical spinal\ncord, there is no evidence of cervical spinal canal stenosis." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nL2 vertebral body hemangioma is noted. L1 and L2 vertebral body superior\nendplate Schmorl's nodes are noted. The visualized portion of the spinal cord\nis preserved in signal and caliber.\n\nThere is loss of intervertebral disc signal at all levels. There is loss of\nintervertebral disc height at L1-2, L2-3 and L3-4.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. The visualized portion of the sacroiliac joints\nare preserved. An approximately 5 x 7 mm hepatic cystic structures noted\n(6:1) root.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is disc bulge with right paracentral disc extrusion (see 2:8),\nligamentum flavum hypertrophy and facet arthropathy withno vertebral canal or\nneural foraminal stenosis.\n\nAt L2-3 there is left paracentral disc protrusion with disc bulge which\ncontacts bilateral L3 nerve roots within bilateral subarticular zones,\nresulting in mild vertebral canal and no neural foraminal stenosis.\n\nAt L3-4 there is disc bulge contacts bilateral L4 nerve roots within bilateral\nsubarticular zones, with mild bilateral neural foraminal stenosis and no\nvertebral canal stenosis.\n\nAt L4-5 there is disc bulge which contacts bilateral L4 nerve roots within\nbilateral subarticular zones, ligamentum flavum hypertrophy and facet\narthropathy resulting in severe bilateral neural foraminal and mild vertebral\ncanal stenosis.\n\nAt L5-S1 there is disc bulge, ligamentum flavum hypertrophy and facet\narthropathy resulting in severe left and moderate rightand no vertebral canal\nstenosis.", "output": "1. Multilevel degenerative changes as described, most pronounced at L4-5\ncouple where disc bulge contacts bilateral L4 nerve roots, and there is severe\nbilateral neural foraminal stenosis with mild vertebral canal stenosis.\n2. L5-S1 severe left and moderate right neural foraminal stenosis.\n3. L1-2 level disc extrusion without data vertebral canal or neural foraminal\nstenosis.\n4. Partially visualized probable hepatic cyst. If clinically indicated,\nfurther evaluation may be obtained via abdominal ultrasound." }, { "input": "Minimal L3-L4, L4-5 anterolisthesis, stable. Degenerative changes lumbar\nspine. Narrowed L1-L2, L2-L3, L3-L4, L4-5 disc spaces. Multilevel diffuse\ndisc bulges. Advanced lumbar facet arthritis, most prominent at L4-5 level,\nwhere there is mild angle reactive edema. Vertebral body and intervertebral\ndisc signal intensity appear normal. The spinal cord appears normal in caliber\nand configuration. There is no evidence of infection or neoplasm. Benign L2\nhemangioma.\nL1-L2 level: Previously seen disc extrusion has nearly completely resolved. \nMild central canal narrowing, improved. Mild bilateral foraminal narrowing.\nL2-L3 level: Mild central canal narrowing, similar. Mild bilateral foraminal\nnarrowing, similar.\nL3-L4 level: Mild central canal narrowing, similar. Moderate left foraminal\nnarrowing, more prominent. Mild right foraminal narrowing, similar.\nL4-5 level: More prominent diffuse disc bulge. Small synovial cyst projects\nmedially from the right facet joint, measures 0.6 cm x 0.3 cm. Mild to\nmoderate central canal narrowing, well preserved CSF within central canal,\nmore prominent. Encroachment on traversing bilateral intrathecal L5 nerves,\nmore prominent. Severe right foraminal narrowing, more prominent. Moderate\nleft foraminal narrowing, more prominent.\nL5-S1 level: Patent central canal. Left far lateral, extra foraminal\nbroad-based disc bulge, endplate hypertrophic change contacts exited left L5\nnerve, more apparent. Mild to moderate left foraminal narrowing, similar. \nPatent right foramen.\nBenign simple hepatic cysts, stable.", "output": "1. Degenerative changes lumbar spine.\n2. Mild-to-moderate central canal narrowing L4-5 level, small contribution\nfrom right synovial cyst, more prominent.\n3. Multilevel significant foraminal narrowing, most prominent at L4-5 level." }, { "input": "The patient is status post anterior fusion of C4 and C5.\n\nAt C3-C4, posterior disc osteophyte complex and ligamentous thickening mildly\nnarrows the spinal canal with remodeling of the ventral spinal cord. At\nC4-C5, the patient is status post anterior fusion. There is small posterior\nosteophyte at this level with mild spinal canal narrowing and mild remodeling\nof the ventral spinal cord.\n\nAt C5-C6, there is a small disc protrusion with underlying osteophytes and\nmild ligamentous thickening. This mildly narrows the spinal canal with\nremodeling of the ventral and dorsal spinal cord.\n\nAt C6-C7 and C7-T1, there is no significant narrowing. At C3-C4, there is\nmild right foraminal narrowing as well secondary to uncovertebral greater than\nfacet osteophytes. The spinal cord has normal signal. There is no abnormal\nintradural enhancement.\n\nTHORACIC SPINE: Alignment is anatomic. The spinal cord has normal signal. \nThere is no abnormal intradural enhancement. The conus medullaris terminates\nat the level of the L1 inferior endplate with normal contour and signal. \nThere are no suspicious osseous lesions. There is mild disc desiccation with\na small disc osteophyte complex at T8-T9 that does not cause significant\nspinal canal narrowing. There is no evidence of significant spinal canal or\nforaminal narrowing in the thoracic spine.", "output": "1. Status post anterior fusion of C4 and C5.\n2. Underlying degenerative changes most prominent at C3-C4 where there is\nmoderate spinal canal narrowing." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Degenerative loss of disc height and\nsignal is mild at C5-C6. The visualized posterior fossa is unremarkable. \nThere is no abnormal signal or enhancement of the cord.\n\nThere is baseline spinal canal narrowing secondary to congenital shortening of\nthe pedicles.\n\nC2-C3: A small central protrusion does not significantly narrow the spinal\ncanal. Uncovertebral facet arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nC3-C4: A small central protrusion results in mild spinal canal narrowing. \nUncovertebral and facet arthropathy results in mild bilateral neural foraminal\nnarrowing.\n\nC4-C5: A small central protrusion results in mild-to-moderate spinal canal\nnarrowing. Uncovertebral and facet arthropathy results in mild right greater\nthan left neural foraminal narrowing.\n\nC5-C6: A central protrusion results in moderate spinal canal narrowing,\nremodeling the ventral aspect of the cord without underlying cord signal\nchange. Uncovertebral and facet arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nC6-C7: A small central protrusion results in mild spinal canal narrowing. \nUncovertebral and facet arthropathy results in mild to moderate left and mild\nright neural foraminal narrowing.\n\nC7-T1: There is a very small central protrusion. No significant spinal canal\nor neural foraminal narrowing.\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. No abnormal enhancement or signal of the cord to suggest sarcoidosis or\nother process.\n2. Mild multilevel cervical spondylosis, most prominent at C5-C6 where\ndegenerative changes and congenital shortening of the pedicles results in\nmoderate spinal canal narrowing, remodeling the ventral aspect of the cord. \nThere is also bilateral mild neural foraminal narrowing secondary to\nuncovertebral and facet arthropathy.\n3. Mild to moderate left C6-C7 neural foraminal narrowing is also visualized.\n4. Additional findings as described above." }, { "input": "The vertebral body height and alignment is maintained. There is a round\nsclerotic focus in the sacrum, as seen on CT from ___. There is\nno suspicious marrow signal abnormality. The intervertebral discs have normal\nheight and signal intensities.\n\nT11-T12: There is a small disc bulge. There is no significant spinal canal or\nforaminal stenosis.\n\nT12-L1: There is no disc herniation. There is no significant spinal canal or\nforaminal stenosis.\n\nL1-L2: There is no disc herniation. There is no significant spinal canal or\nforaminal stenosis.\n\nL2-L3: There is no disc herniation. There is no significant spinal canal or\nforaminal stenosis.\n\nL3-L4: There is no disc herniation. There is no significant spinal canal or\nforaminal stenosis.\n\nL4-L5: There is osteophytosis and a disc bulge slightly narrowing the left\nneural foramen. There is no deformation of the left L4 nerve root to suggest\nnerve impingement. There is no significant spinal canal or right foraminal\nstenosis.\n\nL5-S1: There is a mild disc bulge contacting, but not deforming, the\nbilateral L5 nerve roots. There is no significant spinal canal stenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1 level.\n\nThe posterior elements and paraspinal soft tissues are normal.", "output": "L5-S1 disc bulge contacting, but not deforming, the exiting L5 nerve roots,\nbilaterally." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\n\nThere is a right paracentral disc protrusion at T7-8 effacing the ventral\nthecal sac and contacting the spinal cord.\n\nThere is a left paracentral disc protrusion at T8-9 effacing the thecal sac\nand just contacting the anterior surface of the spinal cord. There is no\nevidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is facet arthropathy at L1-2, L2-3, L3-4, L4-5 and L5-S1. There is no\nevidence of spinal canal or neural foraminal narrowing. There is no evidence\nof infection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nOTHER: There is a 2.2 cm left ovarian cyst.", "output": "1. No evidence for an epidural abscess or hematoma in the cervical, thoracic\nor lumbar spine.\n2. Mild degenerative changes in the thoracic and lumbar spine, as described\nabove." }, { "input": "Alignment is normal. Vertebral body heights are normal. Vertebral body and\nintervertebral disk signal intensity appear normal. The spinal cord appears\nnormal. There is no evidence of abnormal enhancement.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. The prevertebral and paraspinal soft\ntissues are normal.", "output": "1. Normal appearance of the spinal cord.\n2. No evidence of spinal canal stenosis or neural foraminal narrowing in the\ncervical spine." }, { "input": "From T11-12 through L4-5 level, mild degenerative changes seen. There is no\nspinal stenosis foraminal narrowing or focal disc herniation.\n\nAt L5-S1 level, the patient has undergone left-sided hemilaminectomy. Soft\ntissue changes are seen within the left subarticular recess and left side of\nthe spinal canal surrounding the left S1 nerve root which extend to the\nlaminectomy defect. Following gadolinium there is enhancement seen within the\nsoft tissues indicative of epidural scarring. There is minimal deformity of\nthe left side of the thecal sac. There is posterior displacement of the left\nS1 nerve root which appears to be adherent to the thecal sac. This could be\nrelated to epidural scarring but a small associated disc herniation could not\nbe completely excluded.\n\nDistal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Left hemilaminectomy at L5-S1 level with epidural scarring. There is\ndeformity of the left S1 nerve root seen which appears adherent to the thecal\nsac. This could be related to epidural scarring but an associated small disc\nherniation could not be excluded." }, { "input": "The sagittal postcontrast images are limited by motion artifact. Alignment is\nnormal. Vertebral body heights are preserved. Vertebral body and\nintervertebral disk signal intensity appear normal. The visualized portion of\nthe spinal cord demonstrates normal signal intensity. There is no evidence of\ninfection or neoplasm.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\nC3-C4: There is focal central disc protrusion indenting the ventral thecal\nsac. There is mild uncovertebral joint hypertrophy. No neural foraminal\nnarrowing.\nC4-C5: There is focal right subarticular zone disc protrusion. No spinal\ncanal or foraminal narrowing narrowing.\nC5-C6: Disc bulge and small protrusion causes mild spinal canal narrowing with\nminimal indentation on the anterior aspect of the spinal cord.. It also\ncauses moderate right and mild-to-moderate left neural foraminal narrowing.\nC6-C7: Mild disc bulge that is asymmetric to the left mildly indents the\nventral thecal sac. Mild right neural foraminal narrowing.\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nThe paravertebral soft tissues unremarkable.", "output": "1. No abnormal signal within the spinal cord. Minimal anterior indentation on\nthe spinal cord is seen at C5-6 level.\n2. Large disc bulge at C5-C6 causes mild spinal canal narrowing and moderate\nright and mild-to-moderate left neural foraminal narrowing.\n3. Multiple other levels with disc protrusions and disc bulge as above." }, { "input": "Vertebral body heights are preserved. There is minimal retrolisthesis of C6\non C7. No concerning bone marrow signal abnormalities are seen.\n\nCerebellar tonsils are normally positioned. No signal abnormalities are seen\nwithin the cervical or visualized upper thoracic spinal cord. Specifically,\nthere is no syrinx. There is no evidence for abnormal vascular flow voids\nalong the surface of the cord.\n\nAt C2-3, there is no spinal canal narrowing. The left neural foramen is mildly\nnarrowed by facet osteophytes.\n\nAt C3-4, there is a tiny central disc protrusion without spinal canal\nnarrowing. There is mild right and moderate left neural foraminal narrowing\nby uncovertebral and facet osteophytes.\n\nAt C4-5, there is a small central disc protrusion which mildly narrows the\nspinal canal. While it does not contact the spinal cord, the ventral surface\nof the cord is minimally indented. There is mild bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nAt C5-6, there is a a small left paracentral disc herniation which flattens\nthe left ventral surface of the spinal cord. There is mild spinal canal\nnarrowing. There is mild right and moderate left neural foraminal narrowing by\nuncovertebral osteophytes.\n\nAt C6-7, there is a mild retrolisthesis and a central/ right paracentral disc\nextrusion extending both above and below the disk space, which indents the\nventral spinal cord and causes moderate spinal canal narrowing. There is mild\nright neural foraminal narrowing by uncovertebral osteophytes.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nSagittal images through the T1-2 level demonstrate a minimal anterolisthesis\nwithout spinal canal narrowing.", "output": "1. Multilevel degenerative disease. At C6-7, a central/right paracentral disc\nextrusion indents the ventral spinal cord and causes moderate spinal canal\nnarrowing.\n2. Cervical and visualized upper thoracic spinal cord signal is normal without\nevidence for a syrinx.\n3. No evidence for abnormal vascular flow voids. Evaluation for an\narteriovenous malformation or fistula is otherwise limited in the absence of\nintravenous contrast, though it would be unlikely in the absence of abnormal\nflow voids or abnormal cord signal." }, { "input": "Prior radiographs confirmed that there are 5 lumbar-type vertebrae. Vertebral\nbody heights are preserved. There are bilateral L4 laminectomies and\ninstrumented posterior fusion of L4 and L5. The hardware is not assessed by\nMRI. Mild anterolisthesis of L4 on L5 is unchanged. Allowing for hardware\nrelated artifacts, no concerning bone marrow signal abnormalities are\nidentified. The distal spinal cord appears unremarkable in morphology and\nsignal intensity, with the conus medullaris terminating at L1-2.\n\nT12-L1, L1-2 and L2-3 levels appear unremarkable on sagittal images. They are\nnot included on axial images.\n\nAt L3-4, there is a mild disc bulge, a small left paracentral disc protrusion,\nthickening of the ligamentum flavum, and moderate facet arthropathy with fluid\nin the facet joints. The disk protrusion is new compared to the ___ MRI. There is moderate spinal canal narrowing, increased since the prior\nMRI, with crowding of the nerve roots in the thecal sac, as well as new\ncompression of the traversing left L4 nerve root in the subarticular zone.\nModerate bilateral neural foraminal narrowing with impingement of bilateral\ntraversing L3 nerve roots is unchanged.\n\nAt L4-5, the spinal canal is well decompressed by laminectomies. There is a\nminimal disc bulge with moderate facet arthropathy, as before. There is a tiny\nleft foraminal disc protrusion, new since the prior exam (image 6:11), but\nmild left foraminal narrowing is not significantly changed. The right neural\nforamen is also mildly narrowed, as before.\n\nAt L5-S1, there is moderate right and severe left facet arthropathy. There is\nunchanged mild bilateral neural foraminal narrowing. There is no spinal canal\nnarrowing.", "output": "1. Progression of degenerative disease at L3-4 with persistent moderate facet\narthropathy with fluid in the facet joints and a new small left paracentral\ndisc protrusion, resulting in increased, now moderate spinal canal narrowing\nwith crowding of the nerve roots within the thecal sac, as well as new\ncompression of the traversing left L4 nerve root in the subarticular zone.\nModerate bilateral neural foraminal narrowing with impingement of bilateral\ntraversing L3 nerve roots is unchanged.\n2. At L4-5, there is a new tiny left foraminal disc protrusion, but mild\nbilateral neural foraminal narrowing is not significantly changed.\n3. Unchanged appearance of instrumented posterior fusion of L4-5 and mild\nanterolisthesis of L4 on L5." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. There is minimal\nspondylosis at the anterior aspect of C7 level, otherwise the vertebral body\nheights and intervertebral disc space and signal are preserved. The spinal\ncord is normal in caliber without cord compression or cord edema. There is no\nabnormal spinal cord signal intensity or enhancement. The prevertebral and\nparaspinal soft tissues appear unremarkable. There is no spinal canal\nstenosis or neural foraminal narrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. There is a small Schmorl's\nnode at the superior endplate of T9, otherwise, the vertebral body heights and\nintervertebral disc space and signal are preserved. The spinal cord is normal\nin caliber morphology without cord edema. There is no abnormal spinal cord\nsignal intensity or enhancement. The prevertebral and paraspinal soft tissues\nappear unremarkable. There is no spinal canal stenosis or neural foraminal\nnarrowing. The conus medullaris terminates at L1.", "output": "1. No evidence of abnormal spinal cord signal intensity or enhancement. No\nevidence of cord compression or cord edema. Minimal degenerative changes are\nnoted in the anterior aspect of C7 vertebral body.\n2. No spinal canal stenosis or neural foraminal narrowing.\n3. Small Schmorl's node identified at superior endplate of T9." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. No\nevidence of focal suspicious marrow lesion. Disc heights are maintained. The\nconus medullaris terminates at the L1 level, within expected limits. \nEvaluation of postcontrast sagittal sequences is suboptimal secondary to\nartifact which obscures the cauda equina. Within this confine: No definite\nabnormal signal or enhancement of the terminal cord, conus medullaris or cauda\nequina.\n\nL1-L2: Unremarkable\n\nL2-L3: Unremarkable.\n\nL3-L4: There is circumferential disc bulge in to moderate spinal canal and\nmild narrowing of the left neural stenosis. Bilateral facet joint effusions\nnoted.\n\nL4-L5: There is circumferential disc bulge and thickening of the ligamentum\nflavum. There is resulting mild spinal canal, moderate right neural\nforaminal, and mild left neural foraminal stenosis. There is narrowing of the\nbilateral subarticular recesses, asymmetric to the right with likely\nimpingement of the traversing L5 nerve roots. Bilateral facet joint effusions\nare identified.\n\nL5-S1: There is a broad-based posterior disc bulge, bilateral facet\narthropathy, and thickening of the ligamentum flavum. There is moderate\nspinal canal, moderate left neural foraminal, and severe right neural\nforaminal stenosis. There is narrowing of the bilateral subarticular recesses\nwith abutment of the traversing S1 nerve roots. Bilateral facet joint\neffusions noted.\n\nVisualized prevertebral and paraspinal soft tissues are grossly unremarkable.", "output": "1. L4-L5 disc bulge causes mild spinal canal and moderate right neural\nforaminal stenosis. There is narrowing of the bilateral subarticular recesses\nwith possible impingement of the traversing L5 nerve roots.\n2. L5-S1 disc bulge causes severe right neural foraminal stenosis and\nnarrowing of the bilateral subarticular recesses with abutment of the\ntraversing S1 nerve roots.\n3. Examination is degraded by artifact, particularly the sagittal T1 sequences\nwhich obscures evaluation of the cauda equina. No definite abnormal\nenhancement or signal of the terminal cord, conus medullaris or cauda equina\nwithin these confines. If there remains high clinical concern for\nleptomeningeal disease, recommend repeat examination.\n4. In addition, the clinical indication questions inflammation or metastatic\ndisease of lumbosacral plexus. Recommend further evaluation with dedicated\nsacral plexus MRI.\n5. Additional findings 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.\n\nRECOMMENDATION(S):\n-If there remains high clinical concern for leptomeningeal disease, recommend\nrepeat examination.\n-In addition, the clinical indication questions inflammation or metastatic\ndisease of lumbosacral plexus. Recommend further evaluation with dedicated\nsacral plexus MRI." }, { "input": "Grade 1 anterolisthesis of L4 on L5 is unchanged to minimally increased. The\nlumbar spine is otherwise well aligned. Vertebral body signal intensities are\nnormal, excepting mild inferior endplate degenerative changes at L3 and L4. \nVertebral body heights are preserved. The spinal cord appears normal in\ncaliber and configuration. Edema within the subcutaneous tissues overlying\nthe lumbar spine is nonspecific.\n\nL1-L2: Moderate intervertebral disc desiccation. Intervertebral disc height\nis preserved. A small posterior disc bulge results in trace vertebral canal\nnarrowing. No significant neural foraminal narrowing.\n\nL2-L3: Moderate intervertebral disc desiccation. Mild intervertebral disc\nheight loss. Trace inferior endplate Schmorl node. A posterior disc bulge\nresults in mild spinal canal narrowing. No significant neural foraminal\nnarrowing.\n\nL3-L4: Moderate intervertebral disc desiccation. Mild intervertebral disc\nheight loss. A posterior disc bulge and ligamentum flavum thickening results\nin mild to moderate spinal canal narrowing and moderate bilateral neural\nforaminal narrowing. Mild facet hypertrophy with a trace right facet\neffusion.\n\nL4-L5: Grade 1 anterolisthesis. Moderate intervertebral disc desiccation. \nIntervertebral disc height is preserved. A combination of anterolisthesis and\nposterior disc bulge results in moderate spinal canal narrowing and bilateral\nneural foraminal narrowing. Moderate facet hypertrophy with a small left\nfacet effusion.\n\nL5-S1: Moderate intervertebral disc desiccation. Intervertebral disc height\nis preserved. A left lateralizing posterior disc bulge results in mild spinal\ncanal narrowing and neural foraminal narrowing posteriorly displacing the S1\nnerve root. Moderate facet hypertrophy with trace facet effusions.", "output": "Mild-to-moderate multilevel lumbar spondylosis includes grade 1\nanterolisthesis and moderate spinal canal and neural foraminal narrowing at\nL4-L5 in addition to a lateralizing posterior disc bulge at L5-S1 which\nposteriorly displaces the left S1 nerve root. Additional degenerative changes\nas described in the findings." }, { "input": "THORACIC SPINE: Thoracic alignment is anatomic. Minimal anterior wedge\ndeformity of T12 is unchanged from prior CT examination of ___ with\nsuperior endplate Schmorl's node. There is no associated edema pattern. Disc\nheights are maintained. There is no abnormal cord signal.\n\nMild multilevel degenerative changes including small disc bulges do not result\nin significant spinal canal or neural foraminal narrowing.\n\nThe visualize prevertebral paraspinal soft tissues are unremarkable.\n\nLUMBAR SPINE: Lumbar alignment is anatomic. Vertebral body heights are\npreserved. ___ type 2 L4-L5 and L5-S1 endplate changes are identified. \nLoss of disc height and signal at L4-L5 and L5-S1 is moderate. Vacuum disc\nphenomenon at both these levels are identified. The conus medullaris\nterminates at the L1 vertebral level, within expected limits. There is no\nsignal abnormality of the visualized cord or conus.\n\nL1-L2 and L2-L3: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: A disc bulge results in mild spinal canal narrowing. Prominent\nbilateral facet arthropathy is identified. In conjunction with the disc\nbulge, this results in mild to moderate bilateral neural foraminal narrowing.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in\nsevere spinal canal narrowing, crowding the cauda equina. Prominent bilateral\nfacet arthropathy is identified, resulting in moderate to severe bilateral\nneural foraminal narrowing.\n\nL5-S1: A disc bulge crowds the bilateral subarticular zones contacting the\ntraversing nerve roots without significantly narrow the spinal canal. In\nconjunction with facet arthropathy there is moderate bilateral neural\nforaminal narrowing.\n\nThe visualize prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. At L4-L5, a large disc bulge and thickening of the ligamentum flavum\nresults in severe spinal canal narrowing, crowding the cauda equina. In\nconjunction with facet arthropathy there is moderate bilateral neural\nforaminal narrowing at this level.\n2. At L5-S1, a disc bulge crowds the bilateral subarticular zones contacting\nthe traversing nerve roots. In conjunction with facet arthropathy there is\nmoderate bilateral neural foraminal narrowing.\n3. No significant spinal canal or neural foraminal narrowing of the thoracic\nspine.\n4. Chronic anterior wedge deformity of T12 with associated superior endplate\nSchmorl's node, unchanged from examination of ___." }, { "input": "THORACIC:\nThere is diffuse decrease in thoracic bone marrow signal intensity in keeping\nwith history of AML and marrow infiltration. There is no compromise of the\nthoracic cord in the spinal canal. No abnormal cord signal intensity.\n\nFacet joint osteophyte result in moderate left T1-2 and mild left T2-3 neural\nforaminal stenosis.\n\nChronic wedge type compression deformity of the T12 vertebral body appear\nsimilar compared to prior CT chest done ___. Bony fragment\nprotrudes into the spinal canal by 5 mm, partially effacing the CSF space\nanterior to the cord, but there is no cord deformation or cord compromise.\n\nNo high-grade thoracic neural foraminal stenosis at any other level.\n\nLUMBAR:\nThere is diffuse decrease in lumbar bone marrow signal intensity in keeping\nwith history of AML and marrow infiltration.\n\nThe conus terminates at the L1 level.\n\nThere is mild moderate multilevel degenerative changes of lumbar spine in the\nform of disc desiccation, broad-based disc protrusion/bulge, facet joint\nosteophytosis and ligamentum flavum hypertrophy as described below:\n\nL1-2: Small central disc protrusion with superior migration, but no nerve root\ncompromise. Moderate right neural foraminal narrowing. The left neural\nforamina is patent.\n\nL2-3: There is bilateral articular joint facet hypertrophy, more significant\non the right with a sclerotic changes, causing moderate right-sided neural\nforaminal narrowing..\n\nL3-4: Mild diffuse disc bulge, bilateral articular joint facet hypertrophy\ncauses mild bilateral neural foraminal narrowing with no significant spinal\ncanal stenosis.\n\nL4-5: Diffuse disc bulge causes anterior thecal sac deformity, contacting the\ntraversing nerve roots bilaterally, moderate articular joint facet hypertrophy\nligamentum flavum thickening are present resulting in moderate spinal canal\nstenosis (image 16, series 17).\n\nL5-S1: There is diffuse disc bulge, causing minimal bilateral neural foraminal\nnarrowing, slightly more pronounced on the left, moderate articular joint\nfacet hypertrophy is present. There is mild narrowing of the sacroiliac joint\nspace suggesting a sclerotic and degenerative changes.", "output": "1. Diffuse decrease in bone marrow signal intensity in keeping with history of\nAML and marrow infiltration.\n2. No evidence of epidural or paraspinal collections.\n3. Chronic wedge type compression deformity of T12 appear similar compared to\nprior imaging.\n4. There is no evidence of thoracic spinal cord signal abnormality.\n5. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, more significant from L3-L4 through L5-S1 levels." }, { "input": "Alignment is normal. Vertebral body heights are preserved. The conus\nterminates at L1 vertebral body level. Multilevel degenerative disc disease\nas evidenced by T2 hypointense signal with height loss involving L3-L4, L4-L5\nand L5-S1 intervertebral disc is observed. Associated degenerative endplate\nmarrow signal changes and endplate osteophytes, including ___ type 1 signal\nchanges on the right at L5-S1.\n\nL1-L2: Unremarkable. No spinal canal or neural foraminal narrowing.\n\nL2-L3: Unremarkable. No spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild posterior disc bulge without significant spinal canal narrowing. \nThere is minimal narrowing of the subarticular recess bilaterally, more so on\nthe left than the right. No neural foraminal narrowing.\n\nL4-L5: Mild posterior disc bulge without central canal narrowing. There is\nminimal narrowing of the subarticular recess bilaterally resulting in crowding\nof the traversing L5 nerve root without contact. There is mild left and no\nright neural foraminal narrowing.\n\nL5-S1: Degenerative disc height loss as well as posterior disc protrusion\nwithout significant spinal canal narrowing. There is mild-to-moderate right\nand no significant left neural foraminal narrowing.. Disc protrusion narrows\nthe right subarticular recess without contacting the exiting or traversing\nnerve roots.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Multilevel degenerative disc disease mostly involving L3-L4, L4-L5 and\nL5-S1. Findings are most pronounced at L4-L5 and L5-S1, with mild left and\nmild-to-moderate right neural foraminal narrowing at these levels\nrespectively.\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": "Severe loss of vertebral body height of T8, consistent with known chronic T8\ncompression fracture, causing kyphotic spinal curvature. Additionally, there\nis mild vertebral body height loss at T5. Height loss involving the inferior\nendplate of L1 secondary to Schmorl's node (05:11) which has mild associated\nedema, likely related to the Schmorl's node. There is background of diffuse\nloss of in the intervertebral discs T2 signal, consistent with disc\ndesiccation (06:11). There is no evidence of bone marrow edema. No evidence\nof infection or neoplasm.\n\nThere is mild spinal canal narrowing between T8 and T9 from the compression\nfracture. Otherwise, the spinal cord appears normal in caliber and\nconfiguration. Mild diffuse disc protrusion noted between T6-T7. Right\nparacentral disc bulge between T10-T11 and minimal disc bulge seen between\nT11-T12 (8:6). At T12-L1, there is a minimal disc bulge with degenerative\nchanges of the facet joints and thickening of the ligamentum flavum causing\nmild canal narrowing.\n\nThe conus medullaris terminates at L1. Multilevel, partially imaged facet\narthropathy of the lumbar spine is noted.\n\nSmall bilateral pleural effusions with areas of consolidation. Partially\nvisualized enteric tube noted in the esophagus. There is a abdominal aortic\naneurysm that is re-identified. Otherwise the paravertebral muscles and\npartially visualized abdominal organs are unremarkable.", "output": "1. No evidence of cord compression or osteomyelitis.\n2. Severe compression fracture re-identified at T8. Mild vertebral body\nheight loss at T5 and L1..\n3. Chronic degenerative changes as described above.\n4. Re-identified abdominal aortic aneurysm and small bilateral pleural\neffusions with airspace consolidation, atelectasis or pneumonia." }, { "input": "There is straightening of the lumbar lordosis. There is mild posterior\nepidural lipomatosis. Vertebral body height and alignment is otherwise\npreserved. There is mild multilevel degenerative disc disease with mild disc\nspace height loss. There are ___ type 2 degenerative endplate changes at\nL5-S1. Bone marrow signal intensity is otherwise within normal limits. There\nis no evidence of osseous metastatic lesions.\n\nThe spinal cord is normal in caliber and configuration. The conus terminates\nnormally at the L1-L2 level. The cauda equina nerve roots appear\nunremarkable. There is no abnormal enhancement after contrast administration.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions and mild ligamentum flavum thickening, mild spinal canal\nnarrowing, mild bilateral neural foraminal narrowing, left greater than right.\nThe left L3 nerve root is mildly compressed within the neuroforamen (series\n200, image 54 and series 201, image 18).\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions and moderate ligamentum flavum thickening, mild to\nmoderate spinal canal narrowing, moderate left and mild right neural foraminal\nnarrowing. There is remodeling of the undersurface of the left L4 nerve root\nin the neuroforamen (series 201, image 19).\n\nAt L5-S1, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions, mild ligamentum flavum thickening, no spinal canal\nstenosis or neural foraminal narrowing.", "output": "1. No evidence of osseous metastatic disease in the lumbar spine.\n2. Degenerative changes of the lumbar spine resulting in mild spinal canal\nnarrowing at L3-L4 and mild to moderate spinal canal narrowing at L4-L5.\n3. The mild and moderate neural foraminal narrowing at L3-L4 and L4-L5 results\nin mild compression of the left L3 nerve root in the neuroforamen is well as\nremodeling of the undersurface of the left L4 nerve root in the neuroforamen.\n4. Re-demonstrated is extensive retroperitoneal lymphadenopathy concerning for\nneoplastic involvement as seen on the prior CT from ___." }, { "input": "CERVICAL:\nAlignment is anatomic. A T1 and T2 hyperintense lesion within the posterior\nT7 vertebral body is likely a hemangioma. The marrow signal is diffusely T1\nisointense to the disc, which may represent marrow reconversion in the setting\nof chronic anemia. Vertebral body heights are preserved. No focal suspicious\nmarrow lesion. Disc heights are maintained.The spinal cord appears normal in\ncaliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing. Probable perineural cyst of the left traversing nerve\nroot of T1 (08:29). There is no evidence of infection or neoplasm. There is\nno abnormal enhancement after contrast administration.\n\nTHORACIC:\nAlignment is anatomic.The marrow signal is diffusely T1 isointense to the\ndisc, which may represent marrow reconversion in the setting of chronic\nanemia. Vertebral body heights are preserved. No focal suspicious marrow\nlesion. Disc heights are maintained.the spinal cord appears normal in caliber\nand configuration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is anatomic.The marrow signal is diffusely T1 isointense to the\ndisc, which may represent marrow reconversion in the setting of chronic\nanemia. Vertebral body heights are preserved. No focal suspicious marrow\nlesion. Disc heights are maintained.There is no signal abnormality or\nenhancement of the terminal cord, conus medullaris or cauda equina. Conus\nterminates at the L1-L2 level, within expected limits.There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.\n\nOTHER:\nThe cervical lymph nodes are mildly prominent, measuring up to 1.7 cm in long\naxis at the right level 2A. This is nonspecific and likely reactive in\nnature.\n\nAn approximately 1.8 cm cystic appearing lesion at the level of the sacrum\n(11:8, 14:41) is likely a perineural cyst. The imaged paravertebral\nstructures appear unremarkable. The bilateral sacroiliac joints appear\nunremarkable.", "output": "1. No evidence of discitis osteomyelitis. No epidural collection. No\nprevertebral edema. No paraspinal soft tissue abnormality.\n2. No spinal canal or neural foraminal narrowing. There is no signal\nabnormality or enhancement of the spinal cord or cauda equina.\n3. Prominent cervical lymph nodes measuring up to 1.7 cm in long axis at the\nright level 2A. Nonspecific and likely reactive in nature. Clinical\ncorrelation is recommended.\n4. The marrow signal is T1 isointense to the disc, without focal suspicious\nlesion. This likely represents marrow reconversion in setting chronic anemia.\nCorrelation with CBC value is recommended.\n\nRECOMMENDATION(S): Correlation for chronic anemia is recommended for\nimpression 4." }, { "input": "Alignment is normal. Vertebral body heights are normal. Vertebral body and\nintervertebral disk signal intensity appear normal. No abnormal signal within\nthe cord. No cord compression, spinal canal narrowing or neural foraminal\nnarrowing. No epidural collections. Subcentimeter T1/T2 hyperintense focus\nin C4 vertebral body could represent a small hemangioma.", "output": "No acute findings. No cord compression, signal cord abnormality or epidural\ncollections." }, { "input": "Alignment is normal. Vertebral body heights are normal. Vertebral body and\nintervertebral disk signal intensity appear normal. The visualized portion of\nthe spinal cord appears normal. There is no abnormal enhancement. A\nnonspecific STIR hyperintense focus in the C4 vertebral body may reflect a\nhemangioma, unchanged.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There are no enhancing lesions.", "output": "1. Essentially normal cervical spine MRI. No evidence of demyelination." }, { "input": "Alignment is maintained however there is focal kyphotic angulation centered at\nC5-6. Discrete subcentimeter T1 and T2 hypointense lesions in the C3 and T2\nvertebral bodies corresponding to densely sclerotic foci on CT without\nsurrounding marrow edema likely represent bone islands (4:8). The\ncervicomedullary junction is within normal limits. The visualized spinal cord\ndemonstrates normal caliber and signal intensity. Multiple degenerative\nchanges rows follows:\nC2-3: There is no spinal canal or neural foraminal narrowing.\n\nC3-4: There is a small central disc protrusion. No spinal canal or neural\nforaminal narrowing.\n\nC4-5: There is mild disc bulging. No spinal canal or neural foraminal\nnarrowing. C5-6: A disc bulge effaces the anterior CSF space and contacts\nthe cord. There is mild spinal canal narrowing. There is no neural foraminal\nnarrowing.\n\nC6-7: There is no spinal canal or foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nThere is no prevertebral, paraspinal, or epidural fluid collection.", "output": "1. Multilevel degenerative changes as described above, most severe at the C\n___ level where a disc bulge flattens the anterior thecal sac.\n2. Normal appearance of the spinal cord without evidence of compression.\n3. No evidence of traumatic injury." }, { "input": "CERVICAL:\nAlignment is normal.There is a hemangioma in the dens. Otherwise, vertebral\nbody and intervertebral disc signal intensity appear normal. Small effusions\nare seen in the C1-2 lateral mass articulations bilaterally. Perineural cysts\nare seen at left C7-T1. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nThere is stable crowding of the cerebellar tonsils in the posterior fossa with\nsuboccipital craniotomy and C1 laminectomy changes seen.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Perineural cysts are seen at right T1-T2, right T2-T3, right\nT7-T8, left T1-T2, left T7-T8, left T8-T9 and left T9-T10. There is no\nevidence of spinal canal or neural foraminal narrowing. There is no evidence\nof infection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nOf note, no axial imaging through the thoracic spine was acquired due to\npatient intolerance.", "output": "1. Multilevel perineural cysts, predominantly throughout the thoracic spine,\nwith no definitive evidence for CSF leak, however severely limited in\nevaluation given lack of axial imaging through the thoracic spine and no\nheavily weighted T2 sequences performed. A repeat MRI with these sequences\ncan be performed if clinically indicated.\n\n2. Partially visualized crowding in the posterior fossa with postsurgical\nchanges seen, better visualized on the prior dedicated MRI of the brain." }, { "input": "Alignment is normal. There is a T2/STIR hyperintense lesion in the T7\nvertebral body which demonstrates contrast enhancement, likely representing an\natypical hemangioma. Otherwise, vertebral body and intervertebral disc signal\nintensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.\n\nPerineural cysts are seen at the right T1-2, right T2-3, right T6-7, right\nT7-8, left T1-2, left T6-7, left T7-8, left T8-9, left T9-10. No definitive\nevidence for a CSF leak is seen.", "output": "1. Perineural cysts throughout the thoracic spine with no definite evidence\nfor a CSF leak." }, { "input": "The study is partially degraded due to motion artifact.\n\nAlignment is normal. The vertebral body heights are preserved. There is no\nbone marrow signal abnormality. Reduced T2 signal and height loss of the\nL4-L5 and L5-S1 intervertebral discs is consistent with degenerative change. \nThe spinal cord appears normal in caliber and configuration. The conus\nmedullaris terminates at the level of L1-L2. There is no evidence of\ninfection or neoplasm.\n\nT12-L1 through L3-L4: Patent canal and neural foramina.\nL4-L5: A right central disc protrusion and endplate osteophytes result in\nnarrowing of the right subarticular zone and slight posterior displacement of\nthe traversing right L5 nerve root.\n\nMild-to-moderate right and mild left neural foraminal narrowing.\nL5-S1: Diffuse disc bulging with a superimposed central disc protrusion\nresults in mild effacement of the ventral thecal sac. There is mild bilateral\nneural foraminal narrowing.", "output": "Degenerative changes of the lumbar spine most significant at L4-L5 where\nright-sided disc protrusion results in slight posterior displacement of the\ntraversing right L5 nerve root." }, { "input": "Study is severely degraded by motion. Within these confines:\n\n Levels were established by counting down from the C2 level using series 4.\n\nS shaped thoracolumbar scoliosis is noted.\n\nTHORACIC:\n\nThere is evidence of acute to subacute T8 and T9 vertebral body compression\ndeformities with associated marrow edema and postcontrast enhancement. There\nis approximately 50% loss of vertebral body height of the T8 vertebral body\nand up to 25% loss of vertebral body height anteriorly of the T9 vertebral\nbody. Minimal retropulsion of the T8 vertebral body inferior endplate results\nin effacement of the thecal sac but no evidence of cord compression, with mild\nvertebral canal narrowing. Minimal nonspecific enhancement of soft tissue at\nT8-9 posterior disc spaces noted (see 5, 6, 7, 18:12). Additional multilevel\nmild neural foraminal narrowing is noted at multiple levels throughout the\nthoracic spine.\n\nThere are mild T6 and severe T11 and T12 compression deformities. Allowing\nfor difference in technique, these fractures are grossly unchanged compared to\n___ chest x-ray. T6 superior endplate Schmorl's node is present.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal throughout the thoracic\nspine.\n\nLUMBAR:\nGrossly stable severe chronic lumbar compression deformities involving all\nlevels of the lumbar spine, with minimal L1 and L2 posterior vertebral body\nincreased STIR signal are again noted. Numerous Schmorl's nodes are again\nnoted throughout the lumbar spine. There is diffuse signal heterogeneity of\nthe vertebral bodies, likely degenerative.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nT12-L1: Symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes with mild spinal canal narrowing and at least moderate bilateral\nneural foraminal narrowing.\n\nL1-L2: Symmetric disc bulging and facet osteophytes with no significant spinal\ncanal narrowing and at least moderate bilateral neural foraminal narrowing.\n\nL2-L3: Symmetric disc bulging ligamentum flavum thickening and facet\nosteophytes with mild spinal canal narrowing and moderate bilateral neural\nforaminal narrowing.\n\nL3-L4: Mild symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes with mild spinal canal narrowing and moderate bilateral neural\nforaminal narrowing.\n\nL4-L5: Symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes with moderate to severe spinal canal narrowing and crowding of the\ncauda equina nerve roots. There is moderate bilateral neural foraminal\nnarrowing (left greater than right).\n\nL5-S1: Facet osteophytes without significant spinal canal narrowing, severe\nright and moderate left neural foraminal narrowing.", "output": "1. Study is severely degraded by motion.\n2. Acute to subacute compression deformities of the T8 (moderate) and T9\n(mild) vertebral bodies as described, including area of enhancing tissue at\nanterior T8-9 epidural space with mild mass effect on thecal sac. While\nfindings may be posttraumatic, osteomyelitis is not excluded on the basis\nexamination. If clinically indicated, consider correlation with inflammatory\nmarkers.\n3. Multiple additional moderate to severe chronic compression deformities of\nthe thoracolumbar spine as described.\n4. Grossly stable multilevel degenerative changes of the lumbar spine most\nsignificant at L4-L5 where there is moderate to severe spinal canal narrowing." }, { "input": "There is minimal retrolisthesis at L5 upon S1 level, with no evidence of\nspondylolysis. There is loss of disc space and signal intensity at L5-S1. \nThe lower aspect of the thoracic spinal cord is normal in signal intensity. \nThe conus medullaris terminates at L2 and is unremarkable. There is no\nevidence of abnormal enhancement after contrast administration.\n\nFrom L1-L2 through L4-5 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nL5-S1: There is a prominent central disc protrusion, slightly more pronounced\ntowards the left, that compresses the traversing in left S1 nerve root (7:5). \nThis also contacts but not compress the traversing right S1 nerve root (7:5). \nNo neural foraminal narrowing., There is mild bilateral articular joint facet\nhypertrophy and mild ligamentum flavum thickening at this level.\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable.", "output": "Large L5-S1 posterior disc protrusion, slightly more pronounced towards the\nleft, compressing the traversing left S1 nerve root as described detail above.\n\nThere is no evidence of abnormal enhancement after contrast administration." }, { "input": "There is 3 mm of C3-4 anterolisthesis, more pronounced than on radiograph from\n___, at that time measuring 1 mm with the neck in a greater degree\nof extension than on the current study, and not seen on the prior MRI of the\ncervical spine dated ___.\n\nSimilarly, there is minimal, 1 mm of C4-5 retrolisthesis, which appears less\npronounced compared with radiographs from ___ (at that time\nmeasuring up to 3 mm). These findings suggest some degree of dynamic\ninstability of the cervical spine at C3-4, C4-5 levels.\n\nRemainder of the cervical spine demonstrates essentially normal, anatomic\nalignment. Vertebral body heights are maintained. There are ___ type 1\ndegenerative endplate changes seen at C4-5. Marrow signal is otherwise\nunremarkable. The cervical spinal cord is normal in caliber and signal\nintensity.\n\nSignal and height loss of cervical spine intervertebral discs is consistent\nwith degenerative change. There are multilevel posterior disc bulges and\nendplate osteophytes, ligamentum flavum thickening, as well as uncovertebral\nand facet osteophytes, combining to cause varying degrees of multilevel spinal\ncanal and neural foraminal narrowing. Specifically:\n\nC2-3: Is unremarkable.\nC3-4: Mild spinal canal narrowing, slight flattening of the ventral spinal\ncord. Mild bilateral neural foraminal narrowing.\nC4-5: Mild spinal canal narrowing, slight flattening of the ventral spinal\ncord. Moderate bilateral neural foraminal.\nC5-6: Mild spinal canal narrowing, slight flattening of the left ventral\naspect of the spinal cord due to disc bulge contact (06:27). Moderate right,\nand moderate to severe left neural foraminal narrowing (06:26).\nC6-7: No spinal canal narrowing. Mild left and moderate right neural\nforaminal narrowing.\nC7-T1: Unremarkable.\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. 3 mm C3-4 anterolisthesis is more pronounced, and 1 mm C4-5 retrolisthesis\nis less pronounced, compared with recent prior radiographs from ___, at that time measuring 1 mm and 3 mm, respectively. This suggests some\ndegree of dynamic instability within the cervical spine at C3-4 and C4-5. \nConsider spine surgery (e.g. orthopedic/neurosurgical) evaluation. If there\nhas been recent trauma, CT is recommended to assess for any fracture.\n2. Remaining vertebral bodies are normally aligned.\n3. Moderate cervical spine degenerative changes. Spinal canal is worst (mild)\nat C3-4, C4-5, C5-6. No cord compression or cord signal abnormality.\n4. Neural foraminal narrowing is worst (moderate) bilaterally at C4-5 and\nC5-6, and on the right at C6-7.\n\nRECOMMENDATION(S):\n1. Consider spine surgery (e.g. orthopedic/neurosurgical) evaluation for\nfurther assessment of apparent dynamic instability at C3-4, C4-5.\n2. If there has been recent trauma, CT cervical spine is recommended to assess\nfor the presence of fracture." }, { "input": "There is mild retrolisthesis of L5 on S1. Otherwise, alignment is normal. \nVertebral body signal intensity appears normal. There is loss of signal of\nthe intervertebral discs on the T2 weighted images, a manifestation of\ndegenerative disc disease.\nThe spinal cord appears normal in caliber and configuration.\n\nSagittal imaging from T10 to L to demonstrates minimal bulging of the\nintervertebral discs with no evidence of significant canal or foraminal\nencroachment.\nAt L2-3, bulging of the intervertebral disc along with facet osteophytes and\nthickening of the ligamentum flavum produces moderate spinal canal narrowing. \nThe neural foramina appear normal.\n\nBulging of the intervertebral disc, facet osteophyte formation and ligamentum\nflavum thickening produce moderate -severe spinal canal narrowing. The neural\nforamina are mildly narrowed but there is no evidence of nerve root\ncompression within the foramina.\n\nAt L4-5 intervertebral disc bulging, facet osteophytes and thickening of the\nligamentum flavum produce severe spinal canal stenosis and set severe\ncompression of the cauda equina. There is narrowing of the neural foramina\nbilaterally without evidence of nerve root compression in the foramina.\nAt L5-S1, bulging of the disc, facet osteophytes, thickening of the ligamentum\nflavum and the slight retrolisthesis of L5 on S1 produce moderate spinal canal\nstenosis. There is bilateral stenosis of the lateral recesses due to facet\nosteophytes. There is moderate -severe bilateral neural foraminal narrowing. \nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Degenerative disc disease at multiple levels with spinal stenosis most\nsevere at L4-5." }, { "input": "The patient is status post bilateral L5 laminectomy. There is paraspinal soft\ntissue scarring at L4-5 and L5-S1. A T2 hyperintense and T1 isointense fluid\ncollection in the midline subcutaneous fat spanning from L3-L4 to L5-S1, and\nmeasuring 2.2 x 2.1 x 5.4 cm does not have an enhancing or thick wall and\nlikely represents a postoperative seroma or fluid. A posterior fluid \nmeasures 0.5 x 1.0 by 4.1 cm and spans from the mid L4 level to L5-S1 and\ndemonstrates no enhancement. This is homogeneously T1 and T2 isointense to\nCSF indicating widening of the thecal sac due to laminectomy. . The 2 mm,\ngrade 1 anterolisthesis of L2 on L3 is unchanged. The bone marrow is\nheterogeneous, related to patchy, fatty marrow deposition and degenerative\nendplate changes. The height of the vertebral bodies are maintained. There\nare multiple Schmorl's nodes throughout the lumbar spine. The intervertebral\ndiscs of L2-S1 are desiccated. The conus medullaris terminates at L1-L2. The\nspinal cord and nerve roots of the cauda equina are normal in signal without\nenhancement.\n\nAt T11-T12 and T12-L1, there is disc bulge without spinal canal or neural\nforaminal stenosis, unchanged from the prior examination.\n\nAt L1-L2, there is disc bulge and bilateral facet arthropathy without spinal\ncanal or neural foraminal stenosis.\n\nAt L2-L3, disc bulge, ligamentum flavum thickening, bilateral facet\narthropathy, and prominent dorsal epidural fat cause mild-to-moderate spinal\ncanal stenosis, unchanged from the prior examination. There is no neural\nforaminal stenosis.\n\nAt L3-L4, disc bulge, ligamentum flavum thickening, bilateral facet\narthropathy, and prominent dorsal epidural fat cause mild-to-moderate spinal\ncanal stenosis, unchanged from the prior examination. There is no neural\nforaminal stenosis.\n\nAt L4-L5, disc bulge and bilateral facet arthropathy cause moderate to severe\nbilateral neural foraminal stenosis, left greater than right, unchanged from\nthe prior examination. There is no spinal canal stenosis, improved from the\nprior examination.\n\nAt L5-S1, the reduced disc bulge and bilateral facet arthropathy cause severe\nbilateral neural foraminal stenosis, unchanged from prior examination. There\nis no spinal canal stenosis, improved from the prior examination.\n\nThe multiple round, T2 hyperintense lesions in both kidneys likely represent\ncysts, unchanged from the prior examination.", "output": "1. Postsurgical changes with fluid at the laminectomy site Which appears\npostoperative.\n2. Multilevel degenerative changes of the lumbar spine with interval\ndecompression of the severe spinal canal stenosis at L4-L5 and L5-S1." }, { "input": "From T11-12 through L1-2 levels mild degenerative disc disease seen. At L2-3\nminimal anterolisthesis of L3-L2 over L3 identified with facet degenerative\nchange. There is no spinal stenosis or high-grade foraminal narrowing.\n\nAt L3-4 level, disc bulging is identified with thickening ligaments resulting\nin mild spinal canal narrowing without change from previous study.\n\nAt L4-5 and L5-S1 levels the patient has undergone spinal fusion. Widening of\nthe thecal sac is seen secondary to decompression. Mild increased signal in\nthe posterior soft tissues has improved. No abnormal enhancement is seen. \nDisc bulging is identified at L4-5 and L5-S1 levels. At L4-5 moderate\nbilateral foraminal narrowing is seen and at L5-S1 level moderate-to-severe\nbilateral foraminal narrowing identified right greater than left which is\nunchanged from the prior study.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. \nPreviously seen fluid within the subcutaneous fat has resolved. .", "output": "Laminectomies at L4-5 and L5-S1 levels with the compressed spinal canal. \nNarrowing of neural foramina at L4-5 and L5-S1 levels is unchanged compared to\nthe prior study. Previously seen fluid within the subcutaneous fat likely\npostoperative has resolved." }, { "input": "Postoperative changes related to laminectomies at L4-L5 and L5-S1. There is a\nminimal anterolisthesis of L2 on L3 and slight 3 mm anterolisthesis of L4 on\nL5. Redemonstrated are degenerative endplate signal changes at L4-L5. \nReduced T2 signal within the L2-L3 through L5-S1 intervertebral discs is\nlikely on a degenerative basis. The spinal cord appears normal in caliber and\nconfiguration. The conus medullaris terminates at the level of L1-L2. There\nis no evidence of infection or neoplasm.\n\nT12-L1: Patent canal and neural foramina.\n\nL1-L2: Ligamentum flavum thickening and facet osteophytes with patent canal\nand neural foramina.\n\nL2-L3: Symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes with mild spinal canal narrowing and mild right neural foraminal\nnarrowing. There are bilateral facet joint effusions.\n\nL3-L4: Symmetric disc bulging, ligamentum flavum thickening and facet\nosteophytes with moderate spinal canal narrowing, narrowing of the bilateral\nlateral recesses and mild bilateral neural foraminal narrowing. There is a\nleft facet joint effusion.\n\nL4-L5: Symmetric disc bulging and facet osteophytes with a decompressed spinal\ncanal, moderate right and severe left neural foraminal narrowing.\n\nL5-S1: Symmetric disc bulging, prominent anterior epidural fat and facet\nosteophytes result in mild-to-moderate spinal canal narrowing and severe\nbilateral neural foraminal narrowing. There are bilateral facet joint\neffusions.\n\nOverall, findings appear unchanged since on ___.\n\nOther: There has been interval decrease in subcutaneous edema as well as edema\nof the lower posterior paraspinal soft tissues, likely postoperative. A\ncouple small T2 hyperintense lesions within the kidneys measuring up to 1.1 cm\nare compatible with cysts.", "output": "1. Postoperative changes related to laminectomies at L4-L5 and L5-S1.\n2. Stable degenerative changes of the lumbar spine most significant at L3-L4\nwhere there is moderate spinal canal narrowing." }, { "input": "The examination is mildly to moderately motion degraded on multiple sequences.\nWithin this confine:\n\nMild retrolisthesis of C5 over 6 likely degenerative. The remainder of the\ncervical alignment is anatomic. Vertebral body and intervertebral disc signal\nintensity appear normal. There is no definitive cord signal abnormality.\n\nThere is congenital shortening of the pedicles resulting in mild spinal canal\nnarrowing at baseline. Superimposed multilevel degenerative changes are as\nfollows:\n\nAt C2-3, posterior disc protrusion causes mild spinal canal narrowing. There\nis no significant neural foraminal narrowing.\nAt C3-4, posterior disc protrusion causes mild spinal canal narrowing. \nUncovertebral facet arthropathy results in mild right no significant left\nneural foraminal narrowing.\nAt C4-5, posterior disc bulge causes moderate spinal canal narrowing,\ncontacting the ventral surface of the spinal cord. Uncovertebral facet\narthropathy results in mild bilateral neural foraminal narrowing.\nAt C5-6, posterior disc bulge causes moderate to severe spinal canal\nnarrowing, contacting the ventral suface of the spinal cord. Uncovertebral\njoint hypertrophy causes moderate right and moderate to severe left neural\nforaminal narrowing.\nAt C6-7, posterior disc bulge causes moderate to severe spinal canal\nnarrowing, contacting the ventral surface of the spinal cord. Uncovertebral\njoint hypertrophy causes moderate left neural foraminal narrowing.\nAt C7-T1: No spinal canal or neural foraminal narrowing.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Motion degraded study. Congenital shortening of the pedicles results in\nbaseline mild spinal canal narrowing. Multilevel degenerative changes are\nmost notable for moderate spinal canal narrowing at C4-5, moderate to severe\nspinal canal narrowing at C5-6, and C6-7 levels. There is no definitive cord\nsignal change, allowing for the degree of motion artifact.\n2. There is also moderate right and moderate to severe left C5-C6 neural\nforaminal narrowing.\n3. Additional findings as described above." }, { "input": "Interval increase in spread of STIR signal hyperintensity, T1 hypointensity,\nand contrast enhancement in the L2 and L3 vertebral bodies. Associated L2-L3\nendplate destruction is minimally changed. Enhancement of the L2-L3\nintervertebral disc appears minimally changed, though intervertebral disc\nmaterial appears decreased. There is a slight increase in the dear\nosteophytes at L2-3 with surrounding enhancement mildly encroaching on the\nspinal canal. No epidural fluid collection or cord or spinal nerve root\nenhancement. Paraspinal inflammation adjacent to the L2-L3 level appears\nsimilar to the prior examination. A right psoas abscess measuring 7 x 5 mm is\ndecreased in size since the prior examination, perhaps related to the biopsy..\nNo additional levels of vertebral body or intervertebral disc enhancement to\nsuggest spread of infection beyond L2-L3.\n\nThere is grade 1 anterolisthesis of L4 on L5. There is multilevel\nintervertebral disc desiccation and height loss. There is a superior endplate\nSchmorl's node at L1. Small posterior disc protrusions at L1-L2, L4-L5, and\nL5-S1 resulted mild vertebral canal narrowing. There is no significant neural\nforaminal narrowing vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.", "output": "Increased L2-L3 vertebral body signal changes compatible with infection. \nThere is slight interval decrease in L2-L3 intervertebral disc material. No\nevidence of epidural abscess formation or nerve root enhancement. A right\npsoas abscess is decreased in size. No evidence of infection spread to L1-L2\nor L3-L4 levels." }, { "input": "There are 6 non-rib-bearing vertebrae. No imaging of the entire spine is\navailable to establish accurate numbering. The numbering used in the present\nreport is congruent with the numbering in the prior reports, with the vertebra\nabove the most caudal fully formed disc labeled L5, and the uppermost\nnon-rib-bearing vertebra labeled T12.\n\nThere is severe irregularity of L2-L3 endplates, L2 vertebral body loss of\nheight which is severe anteriorly and moderate posteriorly, and mild L3\nvertebral body loss of height, similar in appearance to the ___ CT. \nLoss of height at L2 has progressed since the ___ MRI. Marrow edema at\nL2 and L3 has substantially decreased since the ___ MRI, and no\ndefinite residual edema is seen in the markedly deformed L2-L3 disc. Anterior\nepidural contrast enhancement at L2-L3 has decreased. There is no epidural\ncollection at this time. Prevertebral edema and contrast enhancement L2-L3\nhave also decreased. Disc bulge and facet arthropathy at L2-L3 causes mild\nspinal canal narrowing, decreased from prior. While the intrathecal nerve\nroots is slightly crowded posteriorly at this level, this may be secondary to\ngravity rather than mass effect there is moderate bilateral neural foraminal\nnarrowing with abutment of the exiting L2 nerve roots, similar to prior. \nSmall left facet joint effusion persists.\n\nNo new sites of discitis or osteomyelitis are identified. T10 superior\nendplate deformity and mild loss of height, without marrow edema, are\nunchanged. Grade 1 anterolisthesis of L4 on L5 is unchanged.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at T12. No abnormal intrathecal\ncontrast enhancement is seen.\n\nT12-L1: Minimal disc bulge and facet arthropathy. No significant spinal canal\nor neural foraminal narrowing.\n\nL1-L2: Mild disc bulge and facet arthropathy. Mildly prominent posterior\nepidural fat. Mild narrowing of the thecal sac without mass effect on the\nintrathecal nerve roots. Mild narrowing of the right subarticular zone\nwithout traversing L2 nerve root compression. Mild to moderate right and mild\nleft neural foraminal narrowing. No interval change.\n\nL2-L3: As above.\n\nL3-L4: Mild disc bulge. Moderate facet arthropathy with bilateral facet joint\neffusions. Thickening of the ligamentum flavum. Left subarticular zone is\nnarrowing with abutment, but no evidence for compression of the traversing\nleft L4 nerve root. Mild right and moderate left neural foraminal narrowing\nwith abutment of the exiting left L3 nerve root. No significant interval\nchange.\n\nL4-L5: Grade 1 anterolisthesis, disc bulge, central annular tear, thickening\nof the ligamentum flavum, and severe facet arthropathy with left facet joint\neffusion. Moderate spinal canal narrowing with mild crowding of the\nintrathecal nerve roots. Abutment of bilateral traversing L5 nerve roots,\nworse on the left with likely impingement of the left L5 nerve root. Moderate\nright and moderate to severe left neural foraminal narrowing with abutment of\nthe exiting left L4 nerve root. No significant interval change.\n\nL5-S1: Mild disc bulge and facet arthropathy. No significant spinal canal or\nneural foraminal narrowing.\n\nProminent perineural cyst/dural ectasia is again seen on the left from S1-S2\nthrough S2-S3 levels. Sacroiliac joint degenerative changes are partially\nvisualized.", "output": "1. Apparent improvement in infection at L2-L3 with resolution of disc edema,\nsubstantially decreased marrow edema, resolution of anterior epidural\nenhancement, and decreased prevertebral enhancement. Severe anterior and\nmoderate posterior L2 vertebral body loss of height is similar to ___\nbut progressed since ___. Mild L3 vertebral body loss of height is\nunchanged.\n2. No new sites of infection seen.\n3. Mild spinal canal narrowing at L2-L3, improved since ___.\n4. Multilevel degenerative disease at other lumbar levels is unchanged, as\ndetailed above." }, { "input": "The examination is moderately degraded secondary to patient motion, allowing\nfor this confine:\n\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation. There is no concerning focal\nbone marrow signal abnormality. The conus medullaris terminates at the level\nof L1-L2.\n\nAt T12-L1 through L4-L5, there is no appreciable canal stenosis or neural\nforaminal narrowing.\nL5-S1, minimal posterior disc bulging is noted without canal stenosis, and\nwith mild left-sided neural foraminal narrowing.\n\nThere is no convincing evidence for abnormal intramedullary, leptomeningeal,\nor epidural enhancement. No epidural fluid collection.\n\nNonspecific T2/STIR hyperintensity seen within the subcutaneous tissues\noverlying the lumbar spine, which may represent dependent edema. Otherwise,\nthe remainder of the visualized portions of the paraspinal soft tissues are\ngrossly within normal limits.", "output": "1. No evidence for abnormal epidural enhancement or fluid collection.\n2. Minimal degenerative changes." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Mild diffuse disc bulge at C5-C6 does not contact the spinal\ncord. Otherwise there is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is ___ type 1 signal intensity changes at L5-S1. At\nL5-S1, there is a left sided disc protrusion extending into the left neural\nforamina, causing moderate to severe compression at left L5 exiting nerve\nroot.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nOTHER:", "output": "1. No spinal cord signal abnormality. No abnormal enhancement in the spine.\n2. At L5-S1, there is a left sided disc protrusion extending into the neural\nforamen, causing moderate to severe compression at left L5 exiting nerve root\n.\n3. Mild degenerative changes at C5-C6 causing mild spinal canal narrowing with\nno contact on the spinal cord.\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. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no spinal canal or neural foraminal stenosis. There is no evidence\nof infection or neoplasm. Again noted are multiple thyroid nodules measuring\nup to 2.4 cm in size (301:9).", "output": "1. No significant spinal canal or neural foraminal stenosis.\n2. Multiple thyroid nodules up to 2.4 cm, as seen on prior thyroid\nultrasounds." }, { "input": "There is rotatory levoconvex scoliosis of the lumbar spine with apex at L3. \nThe remainder of the lumbar alignment is anatomic. Anterior chronic wedge\nfracture deformity of T12 is unchanged from prior examination. The remainder\nthe vertebral body heights are preserved. Degenerative loss of disc height is\nmoderate to severe diffusely spanning L1-L2 through L4-L5 with associated\nendplate sclerosis and subcortical cystic change. No suspicious marrow\nsignal.\n\nThe conus medullaris terminates at the L2 level, within expected limits. \nThere is no signal abnormality of the terminal cord.\n\nThe patient is status post laminectomies spanning L3 through L5. No\nsignificant enhancing scar tissue is identified encroaching on the spinal\ncanal or neural foramina, unchanged from prior exam.\n\nT10-T11: A disc bulge results in mild spinal canal narrowing. Scoliosis and\nfacet arthropathy results in moderate bilateral neural foraminal narrowing.\n\nT11-T12: A left central disc bulge results in mild spinal canal narrowing. \nScoliosis and facet arthropathy results in moderate to severe left and\nmild-to-moderate right neural foraminal narrowing.\n\nT12-L1: A disc bulge and epidural fat results in moderate spinal canal\nnarrowing. In conjunction with facet arthropathy and scoliosis, there is\nsevere left and mild right neural foraminal narrowing.\n\nL1-L2: A disc bulge with thickening ligamentum flavum results in moderate to\nsevere spinal canal narrowing, similar to prior examination. Scoliosis and\nfacet arthropathy results in moderate bilateral neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum and epidural fat\nresults in severe spinal canal narrowing, similar to prior examination. In\nconjunction with facet arthropathy, there is mild-to-moderate left and severe\nright neural foraminal narrowing, similar to prior exam.\n\nL3-L4: Patient is decompressed. Scoliosis and facet arthropathy results in\nmoderate right and no significant left neural foraminal narrowing.\n\nL4-L5: Patient is decompressed. Scoliosis and facet arthropathy results in\nmoderate to severe right and mild left neural foraminal narrowing, slightly\nprogressed from prior examination.\n\nL5-S1: A left central disc protrusion is more prominent when compared to prior\nexamination without significant spinal canal narrowing. This does not appear\nto impinge on traversing nerve roots. Scoliosis and facet arthropathy results\nin severe left and no significant right neural foraminal narrowing, slightly\nprogressed on the left from prior examination.\n\nAllowing for postsurgical findings, remainder the visualized prevertebral\nparaspinal soft tissues are unremarkable. There are simple subcentimeter\nrenal cysts bilaterally.", "output": "1. Multilevel lumbar spondylosis as described above, most prominent at L2-L3\nwhere a disc bulge, thickening of the ligamentum flavum and epidural fat\nresults in severe spinal canal narrowing, overall similar to examination of\n___. There is severe right neural foraminal narrowing at this level, also\nsimilar.\n2. There is moderate to severe left T11-T12, severe left T12-L1, moderate to\nsevere L4-L5 and severe left L5-S1 neural foraminal narrowing. Neural\nforaminal narrowing at L4-L5 and L5-S1 appears slightly progressed from prior\nexam.\n3. There is moderate T12-L1 and moderate to severe L1-L2 neural foraminal\nnarrowing, overall similar to prior exam.\n4. There is no cord signal abnormality.\n5. Additional findings described above." }, { "input": "CERVICAL:\nThere is postsurgical changes of anterior spinal fusion at C5-C6 with\nlaminectomies from C3-C6. Alignment is unremarkable. There is fusion of\nC5-C6 vertebral bodies. Postsurgical changes from posterior fusion also\ndemonstrated from C3 through C7. Otherwise the remainder of the vertebral\nbody height is unremarkable. There is no prevertebral soft tissue swelling. \nThe spinal cord is normal in caliber and configuration.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nAt C2-C3, there is no evidence of spinal canal stenosis. There is right\nuncovertebral joint osteophytes and facet joint arthropathy resulting in\nsevere right neural foraminal narrowing. No left neural foraminal narrowing.\n\nAt C3-C4, there is no evidence of spinal canal stenosis. There are\nuncovertebral and facet joint osteophytes resulting in mild bilateral neural\nforaminal narrowing.\n\nAt C4-C5, there is no evidence of spinal canal stenosis. There are\nuncovertebral and facet joint osteophyte resulting in moderate bilateral\nneural foraminal narrowing.\n\nAt C5-C6, there is fusion of C5-C6 vertebral body. There is no evidence of\nspinal canal stenosis. There is mild to moderate bilateral neural foraminal\nnarrowing, due to uncovertebral and facet joint osteophytes.\n\nAt C6-C7 and C7-T1, there is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nTHORACIC:\nAlignment is normal.There are multiple Schmorl's node at T3 through T7\nvertebral bodies without exaggerated kyphosis. Otherwise the vertebral body\nheight are unremarkable. There is mild multilevel disc desiccation and loss\nof intervertebral disc height. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nA T1-T2, there is mild disc bulge, resulting in mild effacement of the ventral\nthecal sac, without contacting the spinal cord. There is associated mild\nbilateral neural foraminal narrowing.\n\nAt T2-T3, there is diffuse disc bulge, indenting on the ventral thecal sac,\nand resulting in mild spinal canal stenosis. There is associated moderate\nbilateral neural foraminal narrowing.\n\nAt T3-T4, there is diffuse disc bulge with mild spinal canal stenosis. There\nis ligamentum flavum thickening with superimposed disc bulge resulting in\nmoderate left and mild right neural foraminal narrowing.\n\nAt T4-T5 and T5-T6, there is diffuse disc bulge with mild spinal canal\nstenosis. There is ligamentum flavum thickening with superimposed disc bulge\nresulting in severe left and mild right neural foraminal narrowing.\n\nAt T6-T7 through T9-T10, there is no significant disc disease, spinal canal\nstenosis, neural foraminal narrowing. A small central disc protrusion is\nnoted at the T8-T9 level.\n\nAt T10-T11 and T11-T12, there is diffuse disc bulge with mild spinal canal\nstenosis. There is ligamentum flavum thickening with superimposed disc bulge\nresulting in moderate bilateral neural foraminal narrowing, right greater than\nleft.\n\nLUMBAR:\nNumbering for this exam is determined by counting from the C2 level. This\nresults in termination of transitional lumbosacral anatomy with lumbarization\nof S1. The numbering used on this exam differs from that utilized previously.\n\nStable postsurgical changes of laminectomy again demonstrated.\nThere is levoconvex scoliosis of the lumbar ___ at L3. There is\nunchanged anterior chronic compression deformity of L1 (previously designated\nT12). There is multilevel disc desiccation with loss of intervertebral disc\nheight at all lumbar level, unchanged compared to prior. The spinal cord\nappears normal in caliber and configuration.\n\n\nAt T12-L1, there is disc bulge with superimposed epidural fat resulting in\nmoderate spinal canal stenosis. There is bilateral facet arthropathy,\nligamentum flavum thickening, in conjunction with disc bulge resulting in\nunchanged bilateral neural foraminal narrowing.\n\nAt L1-L2, there is asymmetric disc bulge due to scoliosis and ligamentum\nflavum thickening resulting in moderate spinal canal stenosis. There is\nbilateral facet arthropathy with superimposed ligamentum flavum thickening and\ndisc bulge resulting in severe left and moderate right neural foraminal\nnarrowing. This is unchanged compared to prior exam\n\nAt L2-L3, there is disc bulge, small epidural fat, resulting in moderate\nspinal canal stenosis. There is bilateral facet arthropathy with superimposed\ndisc bulge and ligamentum flavum thickening resulting in moderate bilateral\nneural foraminal narrowing. This is unchanged compared to prior exam\n\nAt L3-L4, there is fluid signal in intervertebral disc space, without\nassociated enhancement in the intervertebral disc or adjoining vertebral\nbodies. There is facet arthropathy, a disc bulge, and ligamentum flavum\nthickening resulting in severe left and moderate right neural foraminal\nnarrowing. There is moderate to severe spinal canal stenosis. This is\nunchanged compared to prior exam\n\nAt L4-5, there is bilateral facet arthropathy resulting in moderate to severe\nright neural foraminal narrowing, unchanged compared to prior exam. There is\nno significant left neural foraminal narrowing. The spinal canal is\ndecompressed from previous laminectomy.\n\nAt L5-S1, there is bilateral facet arthropathy resulting in mild bilateral\nneural foraminal narrowing. No significant spinal canal stenosis. This is\nunchanged compared to prior. There is decompression of previous laminectomy.\n\nAt the transitional S1-S2 level, there is facet arthropathy and disc bulge\nwith endplate osteophyte formation causing severe left and no right neural\nforaminal narrowing. There is no narrowing of spinal canal.\n\n\nOTHER: There is a large hiatal hernia. The stomach appears mostly\nintrathoracic. The organo-axial configuration is better assessed on CT\nabdomen pelvis done earlier on same date.", "output": "1. No evidence of osteomyelitis discitis, soft tissue or epidural abscess.\n2. Multilevel cervical and thoracic spondylosis, as described above, without\nevidence of severe spinal canal stenosis or cord compression.\n3. Please note that the vertebral numbering utilized in the lumbar spine for\nthis exam differs from that utilized previously. Numbering for this exam was\ndetermined by counting from the C2 level and results in transitional\nlumbosacral anatomy with lumbarization of S1. The previously designated\nchronic T12 compression fracture is designated at L1 on this examination as a\nresult. The degenerative changes of the lumbar spine are similar to the\nprevious examination.\n4. Grossly unchanged multilevel cervical spondylosis, as described above, with\nvarying degree of 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%\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 study is degraded by motion artifact.\n\nCERVICAL:\nThe craniocervical junction appears normal. The cervical cord is normal in\nmorphology and signal intensity. No abnormal enhancing lesions.\n\nNo evidence of fracture. Multilevel disc signal loss on the T2 weighted\nimages due to degenerative disease.\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: Small central disc bulge, but no cord compromise. Disc bulge with\nassociated facet joint osteophytosis results in moderate right and mild left\nneural foraminal narrowing.\n\nC4-5: Small central disc bulge, but no cord compromise. Disc bulge with\nassociated facet joint osteophytosis results in moderate right and mild left\nneural foraminal narrowing.\n\nC5-6: Broad-based disc bulge partially effaces the CSF space anterior to the\ncord, but there is no cord compromise. Disc bulge with associated facet joint\nosteophytosis results in severe right and moderate left neural foraminal\nnarrowing.\n\nC6-7: No compromise of the cord in the spinal canal. Disc bulge with\nassociated facet joint osteophytosis results in mild right neural foraminal\nnarrowing. The left neural foramina is patent.\n\nC7-T1: No cord or nerve root compromise. Small fatty lesion in the left\nanterior inferior aspect of the C7 vertebral body completely suppresses on\nSTIR imaging and should be considered benign.\n\nTHORACIC:\nThere is increase in T1 vertebral body bone marrow signal in the lower\nthoracic and lumbar spine which may suggest that the patient had prior spine\nradiation. Please correlate clinically\n\nT1, T2 and STIR hypointense metastatic lesion in the right T11 pedicle does\nnot demonstrate enhancement postcontrast and may represent a blastic lesion.\n\nT1 and T2 hypointense T12 vertebral body metastatic lesion with minimal STIR\nhyperintensity does not demonstrate marked enhancement postcontrast.\n\nThere is no compromise of the thoracic cord in the spinal canal. The neural\nforamina are patent.\n\nLUMBAR:\nThere is T1 hypointense, T2 heterogenous and STIR hyperintense expansile\nmetastatic disease involving the L1, L2 and L3 vertebral bodies as well as the\nposterior elements of L2 and to a lesser degree L3. These vertebral bodies\ndemonstrate enhancement postcontrast.\n\nL1-2: Expansile metastatic involvement of the L1 vertebral body. Irregularity\nof the inferior endplate may represent a pathological fracture, but there is\nno marked loss in vertebral body height. There is no compromise of the cord\nor the nerve roots at this level.\n\nL2-3: There is circumferential expansile metastatic disease involving the\nvertebral body and posterior elements of the L2 vertebral body which\nencroaches upon the thecal sac resulting in moderate spinal canal narrowing\nwith the thecal sac measuring 10 mm in AP diameter, but there is still CSF\npresent anterior to the nerve roots. The vertebral body and articular process\nexpansion with associated facet joint osteophytosis results in moderate\nnarrowing of the neural foramina bilateral.\n\nL3-4: The expansile L3 vertebral body disease also partially encroaches upon\nthe anterior aspect of the thecal sac resulting in mild narrowing of the\nspinal canal. The expansile vertebral body disease with associated facet\njoint osteophytosis results in moderate severe right and moderate left neural\nforaminal narrowing.\n\nL4-5: Small T1 and T 2 hypointense and STIR hyperintense metastatic lesion in\nthe left lateral aspect of the L4 vertebral body. It demonstrates equivocal\nmild enhancement. There is no compromise of the nerve roots in the spinal\ncanal. Disc protrusion and facet joint osteophytosis results in moderate\nnarrowing of the right L4-5 neural foramina.\n\nL5-S1: T1 and T2 hypointense, STIR hyperintense enhancing lesion in the right\nposterior aspect of the L5 vertebral body. There is no compromise of the\nnerve roots in the spinal canal. Disc osteophyte complex and facet joint\nosteophytosis results in moderate neural foraminal narrowing bilateral.\n\nT1 and T2 hyperintense, STIR hyperintense enhance metastatic lesion in the\nleft sacral ala (S1).\n\nOTHER: Multiple pulmonary nodules are highly suggestive of metastatic disease.", "output": "Extensive bony metastatic disease as described above. Metastatic disease is\nmost marked at the L1, L2 and L3 levels with there is expansile involvement of\nthe vertebral bodies and posterior elements most marked at the L2 level which\nresults in moderate spinal canal narrowing. There is no obvious nerve root\ncompromise at this level.\n\nMultiple pulmonary nodules are concerning for pulmonary metastatic disease.\n\nMultilevel degenerative changes of the cervical and lumbar spine as described\nabove.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 5:09 pm, 10 minutes after discovery\nof the findings." }, { "input": "Comminuted L2 fracture is again demonstrated with distraction of multiple\nvertebral body fragments and cleft through the ___ the vertebral body. \nMild associated kyphosis. There is again retropulsion of fragments, measuring\nup to 5 mm posterior to the margin of the vertebral body. There is edema in\nthe fracture cleft, but otherwise, there is little marrow edema on the current\nexamination. Probable involvement of the spinous process better seen on\nprevious CT. There is mild edema in the spinous process and in the region of\nthe interspinous ligaments between L3 and L4. Some fluid is seen along the\nligamentum flavum on the STIR images, for example image 12 series 5. Anterior\nligamentous structures appear intact. There is possibly some disruption of\nthe posterior longitudinal ligament on image number 13 of series 5.\n\nThe remaining lumbar vertebral bodies are normal in height, and sagittal\nalignment is otherwise maintained. There is loss of intervertebral disc\nheight and T2 signal most prominently at the L4-L5 level, and there are\nmultilevel degenerative endplate marrow signal changes and bulky anterior\nendplate osteophyte formation.\n\nThe visualized distal spinal cord is normal. The conus medullaris terminates\nat L1.\n\nThe spinal canal appears congenitally narrow due to short pedicles at the\nL2-L3 levels, there is also prominent epidural fat at these levels.\n\nThere is moderate to severe spinal canal narrowing at the L2 level mostly due\nto the retropulsed fracture fragment superimposed on the congenitally narrowed\nspinal canal in combination with prominent epidural fat. There is effacement\nof the CSF spaces surrounding the cauda equina nerve roots at this level, with\nredundancy of the cauda equina nerve roots above this level. There also\ndegenerative changes of the slow vol with disc bulge as well as ligamentum\nflavum infolding and facet arthropathy seen at L2-L3 and at L1-L2, with\ndegenerative findings causing mild spinal canal narrowing. There is moderate\nbilateral neural foraminal narrowing at L2-L3.\n\nAt L3-L4, there is a disc bulge with ligamentum flavum infolding and facet\narthropathy as well as prominent epidural fat causing subtotal effacement of\nthe CSF spaces surrounding the cauda equina nerve roots. There is moderate\nbilateral neural foraminal narrowing.\n\nAt L4-L5, there is a disc bulge facet arthropathy as well as prominent\nepidural fat causing mild narrowing of the spinal canal and mild-to-moderate\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is a diffuse disc bulge facet arthropathy causing no\nsignificant narrowing of the spinal canal resulting in severe right and\nmoderate left neural foraminal narrowing.", "output": "1. L2 Chance fracture appears chronic, with some edema seen within distracted\nfracture cleft through the mid vertebral body, but otherwise little marrow\nedema demonstrated. There is continued retropulsion which combined with\nepidural lipomatosis and superimposed on a congenitally narrowed spinal canal\ncauses moderate to severe spinal canal narrowing with redundancy of the cauda\nequina nerve roots above this level.\n2. There is evidence for associated ligamentous injury with edema seen in the\ninterspinous region, fluid along the ligamentum flavum, and potential injury\nof the posterior longitudinal ligament.\n3. Multilevel degenerative changes with severe right neural foraminal stenosis\nat L5-S1.\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": "Thoracic:\nAlignment is normal. There are ___ type 2 endplate changes at multiple\nlevels, most prominent at T8-9. Otherwise, vertebral body signal intensity is\nnormal. There is loss of signal of the intervertebral discs on the T2\nweighted images, manifestation of degenerative disease. The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing.\nLumbar:\nThere is slight anterior subluxation of L4 on L5. There are multiple levels\n___ type 2 signal change. There is loss of signal of the intervertebral\ndiscs on the T2 weighted images. Imaging from T11 through L4 reveals\nbilateral facet osteophytes but no spinal canal or neural foraminal narrowing.\nAt L4-5, there is moderate-severe spinal canal narrowing due to subluxation,\ndisc bulge, facet osteophytes and ligamentum flavum thickening.\nAt L5-S1 there is a midline disc protrusion with the fragment extending\nsuperiorly along the posterior margin of the L5 vertebral body. This slightly\ncompresses the thecal sac but does not contact the nerve roots. The neural\nforamina are mildly narrowed.", "output": "1. Degenerative disc disease.\n2. Moderate to severe spinal canal narrowing at L4-5.\n3. Midline disc protrusion at L5-S1.\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": "Lumbar spine lumbar rings established by designating the lowest rib-bearing\nvertebra as T12.\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Degenerative loss of disc height is mild at L3-L4\nthrough L5-S1. The conus medullaris terminates at the L1-L2 level, within\nexpected limits. There is no signal abnormality of the terminal cord.\n\nT11-T12 through L2-L3: There is no spinal canal or neural foraminal narrowing.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy, there is minimal bilateral neural\nforaminal narrowing.\n\nL4-L5: A small disc bulge with annular fissure does not significantly narrow\nthe spinal canal. Minimal crowding of the subarticular zones does not\nposteriorly displace the traversing nerve roots. In conjunction with facet\narthropathy, there is mild bilateral neural foraminal narrowing.\n\nL5-S1: There is no spinal canal or neural foraminal narrowing.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Minimal lumbar spondylosis most prominent at L3-L4 and L4-L5 where there\nare small disc bulges without significant spinal canal narrowing. No evidence\nof high-grade neural foraminal narrowing or impingement of the nerve roots.\n2. Additional findings as described above" }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord terminates at the L1-L2 level and is preserved in signal and caliber.\n\nThere is stable mild desiccation and mild loss of disc height of the L3-L4 and\nL4-L5 discs, similar to prior. Remaining disc heights and intradiscal signal\nis within normal limits.\n\nThere is a stable sized 6 mm perineural cyst at the L5-S1 level abutting the\nleft S1 nerve, just prior to its exiting (7:34) and a stable 5 mm perineural\ncyst at the S1 level abutting the traversing right S2 and S3 nerves (7:36).\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.. The visualized portion of the sacroiliac joints\nare preserved.\n\nAt T12-L1 through L2-L3, there is no vertebral canal or neural foraminal\nnarrowing.\n\nAt L3-4 there is a left centric disc bulge, slightly increased in size along\nthe left central region, resulting in minimal spinal canal stenosis. The disc\nbulge crowds the left subarticular zone contacting the traversing nerve root\nwithout posterior displacement. There is no significant neural foraminal\nnarrowing.\n\nAt L4-5 there is similar size small central disc protrusion with annular\nfissure with minimal effacement of the spinal canal. The disc bulge, along\nwith facet arthropathy, causes similar degree of mild bilateral neural\nforaminal stenosis.\n\nAt L5-S1 there is no vertebral canal or neural foraminal narrowing. There is\na stable 6 mm perineural cyst abutting the left S1 nerve, just prior to its\nexiting (7:34).", "output": "1. Similar mild lumbar spondylosis most prominent at L3-L4 and L4-L5 where\nthere are small disc bulges causing minimal spinal canal narrowing and mild\nbilateral neural foraminal stenosis. No evidence of high-grade spinal canal\nor neural foraminal narrowing.\n2. Additional 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": "CERVICAL:\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nand intervertebral disc space and signal are preserved.\n\nPlease note, no contrast images of the cervical spine were obtained. The\ncraniocervical junction, prevertebral, paraspinal soft tissues appear\nunremarkable. The spinal cord is normal in caliber and morphology without\nabnormal signal intensity.\n\nC2-C3 through C5-C6 levels and C7-T1: There is no spinal canal stenosis or\nneural foraminal narrowing.\n\nC6-C7: There is bilateral facet and uncovertebral joint arthropathy resulting\nin mild bilateral neural foraminal narrowing without spinal canal stenosis.\n\nTHORACIC:\n\nThe lung vertebral there are T2 hyperintense foci within T3, T5 and T6\nvertebral bodies, which are difficult to correlate on the motion degraded\nsagittal T1 images, possibly representing hemangiomas. The visualized\nportions of the spinal cord demonstrates normal caliber morphology without\nabnormal signal intensity.\n\nThere are mild multilevel degenerative changes without evidence of spinal\ncanal stenosis or neural foraminal narrowing. There is a left perineural cyst\nat T10-T11 measuring 0.7 cm.\n\nLUMBAR:\n\nThere is 6 lumbar type vertebral bodies with lumbarization of S1. For\ncounting purposes, the last complete intervertebral disc space is designated\nas S1-S2, as annotated on PACS series 7, image 9. Based on this anatomic\nlabeling, the patient is status post posterior spinal fusion of L5 through S2\nlevel with intervertebral disc space device. Susceptibility artifact\nassociated with the hardware obscures visualization of the adjacent\nstructures.\n\nThe alignment of the lumbar spine is maintained. There is mild loss of L5 and\nS1 vertebral body heights with endplate degenerative changes. There is slight\nloss of intervertebral disc T2 signal at L3-L4 and L4-L5 on the basis of\ndegenerative process. There are T2 hyperintense foci within L2 and L4\nvertebral bodies, with corresponding T1 hyperintensity better seen on prior\nstudy, likely representing hemangiomas.\n\nThe conus medullaris terminates at L2. The prevertebral soft tissues appear\nunremarkable. There are postsurgical changes within the posterior paraspinal\nsoft tissues related to prior surgery without a discrete fluid collection or\nabnormal enhancement.\n\nT12-L1 through L2-L3: There is no spinal canal or neural foraminal stenosis.\n\nL3-L4: There is an asymmetric right disc bulge with ligamentum flavum\nthickening and bilateral facet arthropathy with mild narrowing of the right\nsubarticular zone with mild right neural foraminal narrowing without spinal\ncanal stenosis or left neural foraminal narrowing.\n\nL4-L5: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet arthropathy resulting in mild bilateral neural foraminal narrowing\nwithout spinal canal stenosis.\n\nL5-S1: Postsurgical changes are seen related to posterior spinal fusion, with\nsusceptibility artifact associated with the hardware obscuring visualization\nof adjacent structures. Evaluation of the bilateral neural foramina is\nsuboptimal. There is no spinal canal stenosis or abnormal enhancement to\nsuggest recurrent herniation.\n\nS1-S2: Postsurgical changes are seen related to posterior spinal fusion with\nsusceptibility artifact associated with the hardware obscuring visualization\nof adjacent structures. Evaluation of the bilateral neural foramina is\nsuboptimal. There is no spinal canal stenosis.\n\nOTHER: There is moderate right and small left-sided pleural effusions.", "output": "1. Incomplete examination with lack of postcontrast images of the cervical and\nthoracic spine as the patient could not tolerate the entirety of the exam. \nWithin the confines of the study, no evidence of an epidural fluid collection\nor abnormal enhancement.\n2. 6 lumbar-type vertebral bodies with lumbarization of S1. Accounting for\nthis anatomic labeling, patient is status post posterior spinal fusion of L5\nthrough S2 level, with susceptibility artifact associated with the hardware\nobscuring visualization of the neural foramina.\n3. Mild degenerative changes of the lumbar spine without evidence of\nhigh-grade spinal canal or neural foraminal stenosis within the confines of\nthis study." }, { "input": "Since the previous MRI examination, the patient has undergone laminectomy and\nspinal fusion at L4-5 level.\n\nFrom T11-12 to L2-3 mild degenerative changes are identified. At L3-4 level,\nmild bulging identified without spinal stenosis or foraminal narrowing.\n\nAt L4-5 level spinal fusion is seen. Mild bulging identified with mild\nnarrowing of the foramina. There is no recurrent spinal stenosis seen.\nEnhancing soft tissues around the thecal sac and at the laminectomy site\nindicate postoperative granulation tissue.\n\nAt L5-S1 level disc bulging is identified with mild retrolisthesis. Mild\nnarrowing of the right and moderate to severe narrowing of the left foramen\nseen which is unchanged from the prior study.\n\nThe distal spinal cord shows normal signal intensity. There is no abnormal\nenhancement seen.", "output": "Postoperative changes of spinal fusion identified at L4-5 level. No evidence\nof recurrent spinal stenosis seen. Multilevel degenerative changes are\nidentified with moderate-to-severe left foraminal narrowing at L5-S1 level as\nbefore." }, { "input": "There is unchanged 4 mm anterolisthesis of C3 on C4 and 3 mm retrolisthesis of\nC4 on C5 when compared to prior CT examination of ___. Disc heights are\npreserved. There is no suspicious marrow signal allowing for heterogeneous\ndegenerative changes. Severe loss of disc height and signal of C3-C4 through\nC6-C7 is noted. The craniocervical junction and anterior atlantodental\ninterval are unremarkable. The visualized posterior fossa is within expected\nlimits.\n\nThere is a 6 mm T2/STIR hyperintense T1 level central cord signal abnormality\n(series 7, image 8; series 8, image 32).\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: There is uncovering of the disc secondary to anterolisthesis. A small\ncentral protrusion and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. Uncovertebral facet arthropathy results in mild left\nworse than right neural foraminal narrowing.\n\nC4-C5: A central protrusion and retrolisthesis of the C4 vertebral body\nresults in mild spinal canal narrowing. There is moderate left and mild right\nneural foraminal narrowing.\n\nC5-C6: A central protrusion and thickening of the ligamentum flavum results\nin mild spinal canal narrowing. There is severe left and mild right neural\nforaminal narrowing.\n\nC6-C7: Intervertebral osteophyte results in mild spinal canal narrowing. \nThere is no significant neural foraminal narrowing.\n\nC7-T1: Unremarkable.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. There is a 6 mm T2/STIR hyperintense central cord signal abnormality at the\nT1 vertebral level, which may represent syringohydromyelia. There is no\nassociated spinal canal narrowing. No other definitive cord signal\nabnormality is noted.\n2. Repeat examination with contrast is recommended for further evaluation. \nPotentially MRI thoracic spine may also be performed to assess for other\nlesions.\n3. Mild multilevel multifactorial cervical spondylosis without severe spinal\ncanal or neural foraminal narrowing.\n\nRECOMMENDATION(S): Contrast-enhanced MRI of the thoracic spine is recommended\nfor further evaluation of a 6 mm STIR hyperintense central cord signal\nabnormality at the T1 vertebral level.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:44 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The patient is status post bilateral laminectomy and posterior fusion of\nL4-L5, the appearance of which is similar to prior exam.\n\nVery minimal levoconvex curvature of the lumbar spine with apex at L3 and mild\n2 mm retrolisthesis of L1 on L2 are unchanged from prior exam. Otherwise, the\nremainder of the lumbar alignment is anatomic. Vertebral body heights are\npreserved. There is unchanged heterogeneous marrow signal, likely\nrepresenting degenerative changes without focal suspicious lesion. There is\nsevere loss of L1-L2 and L5-S1 disc height. Mild L4-L5 loss of disc height\nand signal is identified. The conus medullaris terminates at the T12\nvertebral level, within expected limits. There is no signal abnormality or\nenhancement of the visualized cord, conus medullaris or cauda equina.\n\nL1-L2 through L3-L4: Mild degenerative changes do not result in significant\nspinal canal narrowing. There is no significant neural foraminal narrowing.\n\nL4-L5: Enhancing granulation tissue contacts the ventral and lateral epidural\nspace without significant encroachment upon the spinal canal. There is no\nsignificant neural foraminal narrowing.\n\nL5-S1: A disc protrusion crowds the bilateral subarticular recesses worse on\nthe right, contacting but not posteriorly displacing the right traversing S1\nnerve root (series 8, image 36). Although evaluation is limited secondary to\nmetallic artifact from posterior fusion hardware, there appears to be mild to\nmoderate right and severe left neural foraminal narrowing.\n\nThe above findings are not significantly changed from the prior exam.\n\nAllowing for post surgical findings, including atrophy and STIR hyperintense\nsignal of the bilateral paraspinal muscles, prevertebral and paraspinal soft\ntissues are unremarkable.", "output": "1. The patient is status post L4-L5 posterior laminectomy and fusion. Mild\nenhancing granulation tissue is noted in the dorsal and lateral epidural space\nwithout encroachment on the spinal canal. There is no significant neural\nforaminal narrowing at this level.\n2. There is mild to moderate right and severe left neural foraminal narrowing\nat L5-S1, unchanged from prior exam. A disc protrusion contacts the the\nbilateral traversing S1 nerve roots, slightly worse on the right.\n3. Additional chronic findings as described above." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body heights are normal. There is no bone\nmarrow signal abnormality. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration. Multilevel degenerative\nchanges are as follows:\n\nC2-3: There is no spinal canal or neural foraminal narrowing.\nC3-4: A disc bulge with superimposed central disc protrusion indents the\nanterior thecal sac and results in mild spinal canal narrowing. There is no\nneural foraminal narrowing.\nC4-5: A disc bulge effaces the anterior CSF space and results in moderate\nspinal canal narrowing. There is mild-to-moderate bilateral neural foraminal\nnarrowing.\nC5-6: A disc bulge results in mild spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing.\nC6-7: A disc bulge results in minimal spinal canal narrowing. There is\nmoderate bilateral neural foraminal narrowing.\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nThere is no prevertebral soft tissue edema. There is no epidural or\nparaspinal collection. There is no abnormal enhancement.\n\nTHORACIC:\nAlignment is normal. Vertebral body heights and signal intensity appear\nnormal. The spinal cord appears normal in caliber and configuration. Multiple\nsmall disc bulges are seen throughout the thoracic spine without significant\nspinal canal or neural foraminal narrowing. There is no evidence of\ninfection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nLUMBAR:\nAlignment is normal. Vertebral body heights are normal. Marrow edema in the\nlamina and spinous process of L4 (10:11) and articular pillar of L5 is likely\nreactive to the adjacent facet arthrosis. There is no bone marrow signal\nabnormality otherwise. The distal spinal cord is normal in caliber and signal\nintensity. Conus medullaris terminates at the T12-L1 level. Nerve roots of\nthe cauda equina are unremarkable. Multilevel degenerative changes are as\nfollows:\n\nT12-L1: There is moderate loss of disc height and a small disc bulge. No\nspinal canal narrowing. Mild bilateral neural foraminal narrowing.\nL1-2: There is mild loss of disc height and Schmorl's nodes. There is a disc\nbulge. There is no spinal canal narrowing. There is mild bilateral neural\nforaminal narrowing.\nL2-3: There is moderate loss of disc height. There is a disc bulge. There\nis mild spinal canal narrowing. There is mild bilateral neural foraminal\nnarrowing.\nL3-4: There is minimal disc bulging. No spinal canal narrowing. There is\nmild-to-moderate bilateral neural foraminal narrowing.\nL4-5: There is mild loss of disc height and a disc bulge resulting in severe\nspinal canal. There is mild right and severe left neural foraminal narrowing.\nL5-S1: There is a diffuse disc bulge with mild spinal canal narrowing. There\nis no neural foraminal narrowing.\n\nThere is no epidural or paraspinal fluid collection. There is no abnormal\nenhancement after contrast administration.", "output": "1. No evidence of epidural or paraspinal fluid collection or abscess.\n2. Multilevel degenerative changes as described above.\n3. At L4-5, there is a disc bulge with severe spinal canal narrowing and\nsevere left neural foraminal narrowing." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc height and signal are maintained. \nThe visualized posterior fossa is unremarkable. There is no abnormal\nenhancement or signal of the cord.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3-C4: A small central protrusion minimally narrows the spinal canal. There\nis no significant neural foraminal narrowing.\n\nC4-C5: A small central protrusion with intervertebral osteophytes results in\nmild spinal canal narrowing. Uncovertebral and facet arthropathy results in\nmild bilateral neural foraminal narrowing.\n\nC5-C6: A small central protrusion and intervertebral osteophytes results in\nmild spinal canal narrowing. Uncovertebral and facet arthropathy results in\nmild bilateral neural foraminal narrowing.\n\nC6-C7 and C7-T1: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic.Minimal anterior wedge shape of T11 and T12 are\nchronic. Otherwise, vertebral body heights are preserved. There is no focal\nsuspicious marrow lesion. The disc height and signal are preserved.There is\nno abnormal enhancement or signal of the thoracic cord.Mild degenerative\nchanges do not result in high-grade spinal canal or neural foraminal\nnarrowing.The visualized prevertebral and paraspinal soft tissues are\nunremarkable. There is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nMinimal 2 mm anterolisthesis of L4 on L5 is unchanged. Otherwise, lumbar\nalignment is anatomic.\n\nSoft tissue edema and small fluid collection measuring approximately 0.8 by\n1.4 x 4.0 cm (TRV, AP, SI) in the subcutaneous fat posterior to the L3 through\nL5 spinous processes does not demonstrate significant peripheral rim of\nenhancement (series 8, image 10 ; series 16, image 10), presumably\nrepresenting postoperative seroma from dome biopsy performed approximately 1\nmonth prior to this examination based upon clinical records. There remains\nbone marrow edema pattern of the L4 spinous process, similar to prior\nexamination and new L3 spinous process edema pattern, presumably postoperative\nin nature.\n\nVertebral body heights are preserved. There is no focal suspicious marrow\nlesion. Degenerative loss of disc height and signal spanning L1-L2 through\nL4-L5 is mild-to-moderate, similar to prior examination. No abnormal\nenhancement of the disc or adjacent marrow is identified. Marrow edema\npattern of the L5 bilateral pedicles is unchanged from prior examination,\ncompatible with degenerative changes. The conus medullaris terminates at the\nT12-L1 level, within expected limits. There is no abnormal signal were\nenhancement of the terminal cord, conus medullaris or cauda equina.\n\nL1-L2: A disc bulge with right central superiorly migrating protrusion is\nidentified, without significant spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing.\n\nL2-L3 and L3-L4: Disc bulges do not significantly narrow the spinal canal. \nThere is mild bilateral neural foraminal narrowing.\n\nL4-L5: A central protrusion and thickening of the ligamentum flavum results\nin moderate spinal canal narrowing. There is new peripherally enhancing focus\nin the left central zone (series 14, image 30 ; series 16, image 12) which\ndemonstrates T2 intermediate intensity, felt to most likely represent a new\ndisc extrusion/fragment which crowds the subarticular zone, likely compressing\nthe traversing left L5 nerve root. The lack of adjacent marrow edema or other\nabnormal enhancement makes infectious process much less however given the\npatient's clinical history not entirely excluded. Degenerative changes\nresults in severe left and moderate right neural foraminal narrowing.\n\nL5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nAllowing for post biopsy changes, prevertebral paraspinal soft tissues are\notherwise unremarkable.", "output": "1. At L4-L5 there is interval development of a small left subarticular zone T2\nintermediate intensity peripherally enhancing focus, felt to most likely\nrepresent any new disc extrusions/fragment. This severely crowds the left\nsubarticular zone, likely compressing the traversing left L5 nerve root. The\nlack of adjacent abnormal enhancement or bone marrow edema makes infectious\nprocess much less likely however given the patient's clinical history, not\nentirely excluded. Would have low threshold for reimaging if patient's\nsymptoms progresses.\n2. A nonenhancing fluid collection in the subcutaneous tissues spanning the L3\nthrough L5 levels posterior to the spinous processes compatible with\npostoperative seroma from recent bone biopsy described in clinical records.\n3. There are no findings to suggest discitis osteomyelitis.\n4. Degenerative changes are most prominent at L4-L5 where there is moderate\nspinal canal and severe left and moderate right neural foraminal narrowing.\n5. Additional findings as described above." }, { "input": "Lumbar spine numbering is established by prior examinations. Again seen is\nlumbarization of S1. There is 2 mm retrolisthesis of L5 on S1. Alignment is\notherwise anatomic. Hemangioma in T12 appears similar to prior. There is\nminimal disc desiccation at L4-5 and mild disc desiccation at L5-S1. \nVertebral body and intervertebral disc signal intensity otherwise appear\nnormal. The conus terminates at L1-2. The spinal cord appears normal in\ncaliber and configuration. There is no signal abnormality of the visualized\ncord or conus.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing.\n\nAt L4-5, there is mild disc bulge to the left with facet arthropathy causing\nmild left neural foraminal narrowing. There is no significant spinal canal\nnarrowing.\n\nAt L5-S1, there is large left central disc protrusion resulting in mild to\nmoderate neural foraminal narrowing with severe crowding of the left\nsubarticular zone, posteriorly displacing the traversing S1 nerve root. In\ncombination with facet arthropathy there is severe left neural foraminal\nnarrowing. Mild right neural foraminal narrowing is identified.\n\nVisualize prevertebral paraspinal soft tissues are unremarkable.", "output": "Multilevel left neural foraminal narrowing, most prominent at L5-S1, similar\nappearance to prior exam of ___, where there is severe crowding of\nthe left subarticular zone, posteriorly displacing the traversing left S1\nnerve root. There is also severe left neural foraminal narrowing at this\nlevel." }, { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nGrossly stable grade 1 L3 on L4 anterolisthesis and grade 1 L5 on S1\nretrolisthesis is again noted. 25% chronic L4 anterior compression deformity\nis again noted. T12 inferior, L4 superior and L5 superior endplate Schmorl's\nnodes are present. L1 vertebral body probable hemangioma is noted. \nAdditional areas of patchy fatty marrow replacement are noted throughout the\nlumbar spine. L5 superior endplate probable type ___ ___ changes without\ndefinite associated epidural collection are present.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc signal throughout the lumbar spine. \nThere is loss of intervertebral disc height at T12-L1, L3-4, L4-5, L5-S1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection. Bilateral\nprobable renal cysts are noted.\n\nAt T12-L1 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canaland mild rightneural foraminal narrowing.\n\nAt L1-2 there is ligamentum flavum hypertrophy and prominent epidural fat,\nnovertebral canal or neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, prominent epidural fat, mildvertebral canal and no neural\nforaminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, prominent epidural fat, moderatevertebral canal and no neural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge, prominent epidural fat, facet joint hypertrophy,\nligamentum flavum hypertrophy, nonspecific bilateral facet fluid and suggested\nbilateral facet synovial cysts, mildvertebral canal and mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge which contacts the transiting left S1 nerve root\nbilateral nonspecific facet fluid, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal and moderate bilateral neural foraminal\nnarrowing.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel lumbar spondylosis as described, most pronounced at L3-4, where\nthere is moderate vertebral canal narrowing.\n3. L5-S1 mild vertebral canal and moderate bilateral neural foraminal\nnarrowing, with disc bulge that contacts transiting left S1 nerve root.\n4. Nonspecific L4-5 and L5-S1 bilateral facet effusions with no definite\nosseous destruction, likely degenerative, with differential considerations of\ninfectious or inflammatory etiology.\n5. L4 chronic 25% chronic anterior compression deformity." }, { "input": "Alignment is normal. Vertebral body signal intensity appear normal. Decrease\nin intervertebral disc T2 signal suggesting desiccation. The spinal cord\nappears normal in caliber and configuration. No myelopathic signal changes of\nthe cord or cord expansion. The imaged posterior fossa appears normal.\nNo abnormal enhancement postcontrast administration.\n\nLevels C2-3: No spinal cord or nerve root compromise.\n\nLevel C3-4: Mild degenerative changes, with disc bulge and right uncovertebral\nhypertrophy resulting in mild narrowing of the right neural foramina but no\nspine cord or nerve root compromise.\n\nLevel C4-5: Mild degenerative changes but no spinal cord or nerve root\ncompromise:\n\nLevel C5-6: Degenerative changes in the form of broad-based disc protrusion\nand mild facet arthropathy results in mild neural foraminal narrowing\nbilateral, but no cord compromise in the spinal canal or obvious nerve root\ncompromise in the neural foramina.\n\nLevel C6-7: Degenerative changes with an asymmetric disc protrusion into the\nleft neural foramina with associated facet joint arthropathy results in\nmoderate stenosis of the left C6-7 neural foramina and left C7 nerve root\ncompromise should be excluded. No compromise of the cord in the spinal canal\nor compromise of the right C7 nerve root.\n\nAt the level C7-T1: No spinal cord or nerve root compromise.\n\nNo extra-spinal findings of note.", "output": "1. No spinal cord signal abnormality or focal cord lesion. No compromise of\nthe spinal cord in the spinal canal.\n2. Marked (moderate to severe) narrowing of the left C6-7 neural foramina and\ncompromise of the left C7 nerve root should be excluded.\n3. Mild degenerative changes with mild neural foraminal narrowing at other\nlevels as described above." }, { "input": "The study appears similar to the examination of ___. The\nalignment is normal.\n\nAgain seen Is abnormal low T1 and low T2\nsignal along the anterior aspect of the inferior endplate of L4 vertebral body\nwith mild peripheral T2 hyperintensity with corresponding hypointense signal\non T1 weighted images . This again represents a Schmorl's node with ___\ntype I changes. There is loss of signal of the intervertebral disc at L4-5 on\nthe T2 weighted images, again consistent with degenerative disc disease.\n Otherwise, the remainder bone marrow signal is unremarkable. The\nvertebral body heights are grossly preserved. The conus medullaris terminates\nat T12-L1 and has normal signal and configuration.\n\nAt L 3 4, axial images demonstrate no significant abnormalities.\n\n\nAt L4-L5, there is a diffuse disc bulge with an annular tear and a\nsuperimposed central disc protrusion extending into the canal causing severe\nspinal canal narrowing in conjunction with prominent epidural fat. These\nfindings are unchanged since the prior study. Small bilateral facet\nosteophytes are again noted.\n.\n\nAt L5-S1, there is a mild diffuse disc bulge effacing the anterior thecal sac.\nThis level is below the usually cranial termination of the thecal sac,\nunchanged.", "output": "1. Unchanged appearance of degenerative disc disease with disc protrusion and\nspinal stenosis at L4-5." }, { "input": "5 lumbar-type vertebrae are visualized. Vertebral body heights are preserved.\nAlignment is normal. Unchanged signal abnormality in the anterior inferior\nendplate of L4 compared to the ___ MRI, corresponding to or Schmorl's\nnode with extensive surrounding sclerosis on the ___ CT. No evidence\nfor diskitis, osteomyelitis, epidural collection, or paravertebral collection.\nPosterior subcutaneous fat edema is again seen, a finding commonly related to\nbody habitus.\n\nThe distal spinal cord appears unremarkable in morphology and signal\nintensity, with the conus medullaris terminating at T12. There is no abnormal\nintrathecal contrast enhancement.\n\nProminent posterior epidural fat is again seen from L1-L2 through L3-L4, with\ncircumferential epidural fat prominence below the level of L3-L4.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: Minimal left facet arthropathy and mildly prominent epidural fat. No\nsignificant spinal canal or neural foraminal narrowing.\n\nL2-L3: Minimal disc bulge and facet arthropathy. Mildly prominent epidural\nfat. No significant spinal canal narrowing. Mild bilateral neural foraminal\nnarrowing. No interval change.\n\nL3-L4: Mild disc bulge and facet arthropathy, and prominent posterior epidural\nfat. Thecal sac is mildly narrowed without compression of the intrathecal\nnerve roots. Subarticular zones are narrowed with possible abutment, but no\ncompression of the traversing L4 nerve roots. Mild bilateral neural foraminal\nnarrowing. No interval change.\n\nL4-L5: Disc bulge, central disc herniation, mild facet arthropathy, and\nprominent epidural fat cause severe spinal canal stenosis with crowding of the\nintrathecal nerve roots, as well as abutment and possible impingement of the\ntraversing L5 nerve roots in the subarticular zones. No significant neural\nforaminal narrowing. No interval change.\n\nL5-S1: Prominent posterior epidural fat severely effaces the thecal sac with\ncrowding of the intrathecal nerve roots. The traversing right S1 nerve root\nappears flattened, image 6:35. Mild disc bulge, mild right and moderate left\nfacet arthropathy are also present. No significant neural foraminal\nnarrowing. No interval change.", "output": "1. No evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection. No abnormal intrathecal contrast enhancement.\n2. Epidural lipomatosis and multilevel degenerative disease appear unchanged\ncompared to the ___ MRI, as detailed above. The thecal sac is\nseverely narrowed at L4-L5 and L5-S1 with crowding of the intrathecal nerve\nroots. Traversing L5 nerve roots are abutted and may be impinged at L4-L5. \nTraversing right S1 nerve root is flattened at L5-S1." }, { "input": "Diagnostic evaluation of the lumbar spine is extremely limited, particularly\non the axial views, due to significant patient motion. Within these\nlimitations, alignment appears normal. The conus medullaris terminates at L1\nand is unremarkable in appearance. Intervertebral disc signal intensity\nappears normal. There is no evidence of significant spinal canal or\nneuroforaminal narrowing.\nA small midline Tarlov cyst is identified.\n\nAt L4-L5, there appears to be a mild disc bulge without neuroforaminal\nstenosis. Moderate left facet joint hypertrophy is partially imaged on the\naxial views.\n\nAt L5-S1, there is mild left facet joint hypertrophy, without gross spinal\ncanal narrowing or neural foraminal narrowing.\n\nIn the sacrum at S2 level, there is a cystic formation detected on STIR and T2\nweighted sequences, measuring approximately 8 x 9 mm in sagittal projection\n(image 10, series 3 and 4), likely consistent with a perineural cyst (Tarlov\ncyst).", "output": "1. Diagnostic evaluation the lumbar spine is extremely limited due to\nsignificant patient motion causing severe image degradation. Within these\nlimitations, no gross spinal canal or neuroforaminal narrowing is identified.\n\n2. In the sacrum at the level of S2 on the right, there is a cystic formation,\nmeasuring approximately 8 x 9 mm, likely consistent with a perineural cyst." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nAlignment is normal. No concerning bone marrow signal abnormalities are\nidentified.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity. \nThe conus medullaris terminating near the L2 lower endplate. There is no\nevidence for a fatty or thickened filum terminale.\n\nSagittal images through the T10-11 level demonstrate a minimal disc bulge and\nmild right facet arthropathy without spinal canal the neural foraminal\nnarrowing. No axial images through this level.\n\nAt T11-12, there is no spinal canal or neural foraminal narrowing. Mild facet\narthropathy is present.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-2, there is a minimal disc bulge and mild bilateral facet arthropathy,\nwithout spinal canal or neural foraminal narrowing.\n\nAt L2-3, there is mild bilateral facet arthropathy without spinal canal or\nneural foraminal narrowing.\n\nAt L3-4, there is a minimal disc bulge and mild facet arthropathy without\nspinal canal or neural foraminal narrowing.\n\nAt L4-5, there is a mild disc bulge and mild to moderate bilateral facet\narthropathy, without spinal canal narrowing or significant neural foraminal\nnarrowing.\n\nAt L5-S1, there is moderate to severe bilateral facet arthropathy without\nspinal canal or neural foraminal narrowing.\n\nThere is dural ectasia remodeling the visualized upper sacrum, without\nevidence for aggressive features on the ___ abdominal/ pelvic CT. \nThe CT better demonstrates a small defect between the laminae of S1.\n\nThe common bile duct is mildly dilated, measuring 8 mm, with normal distal\ntapering as seen on the ___ abdominal and pelvic CT. The CT\ndemonstrates evidence of cholecystectomy, which likely explains the mild\ndilatation of the common bile duct, and no intra hepatic biliary ductal\ndilatation.", "output": "1. Mild degenerative changes in the lumbar spine without spinal canal\nnarrowing, neural foraminal narrowing, or neural impingement.\n2. Dural ectasia remodeling the visualized upper sacrum. Small defect between\nthe laminae of S1, likely congenital, is better demonstrated on the ___ abdominal/ pelvic CT.\n3. The conus medullaris terminates near the lower endplate of L2. The filum\nterminale does not appear thickened or fatty.\n4. Mild dilatation of the common bile duct with normal distal tapering,\nwithout intra hepatic biliary ductal dilatation, is most likely secondary to\ncholecystectomy.\n\nRECOMMENDATION(S): With regard to the mild dilatation of the common bile\nduct, which is most likely secondary to cholecystectomy, correlation with\nliver function tests is recommended, particularly since the requisition for\nthe ___ abdominal/pelvic CT stated that the patient had right\nabdominal pain.\n\nNOTIFICATION: The impression item 4 and recommendation above were entered by\nDr. ___ on ___ at approximately 13:30 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." }, { "input": "CERVICAL:\nAlignment is normal. There is diffuse T2 and T1 hypointense signal of the\nvisualized cervical vertebral bodies. Vertebral body heights are well\nmaintained. Intervertebral disc signal intensity and heights are also within\nnormal limits. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nAt C2-C3: Posterior disc bulge and ligamentum flavum hypertrophy is seen\nwithout evidence of significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4: Posterior disc bulge and ligamentum flavum hypertrophy without\nevidence of significant spinal canal or neural foraminal narrowing.\n\nAt C4-C5: Left paracentral disc bulge impresses upon the thecal sac without\nevidence of severe spinal canal or neural foraminal narrowing.\n\nAt C5-C6: Right paracentral disc bulge impresses upon the anterior thecal sac\nresulting in mild spinal canal narrowing and moderate to severe right neural\nforaminal narrowing.\n\nAt C6-C7: Mild left paracentral disc bulge results in mild left neural\nforaminal narrowing. No significant spinal canal stenosis.\n\nAt C7-T1: No significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nAlignment is normal. Diffuse T2 and T1 hypointense signal of the thoracic\nvertebral bodies. Vertebral body heights are preserved. Intervertebral disc\nsignal intensity and heights are also within normal limits. The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing. There is no evidence of infection or\nneoplasm. There is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal. Diffuse T2 and T1 hypointense signal of the visualized\nlumbar spine. Vertebral body heights are relatively well preserved. \nIntervertebral disc signal intensity and heights are also within normal\nlimits. The conus terminates at the level L2. The spinal cord appears normal\nin caliber and configuration. There is no evidence of infection or neoplasm.\nThere is no abnormal enhancement after contrast administration.\n\nAt T12-L1: No significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2: Posterior disc bulge and ligamentum flavum hypertrophy impress upon\nthe thecal sac without evidence of significant spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nAt L2-L3: Posterior disc protrusion and ligamentum flavum hypertrophy. No\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L3-L4: Posterior disc protrusion ligamentum flavum hypertrophy. Mild left\nneural foraminal narrowing. No significant spinal canal stenosis.\n\nAt L4-L5: Posterior disc bulge and ligamentum flavum hypertrophy with mild\nbilateral neural foraminal stenosis. No spinal canal stenosis.\n\nAt L5-S1: No spinal canal or neural foraminal stenosis.\n\n\nOTHER: Mild edema is demonstrated in the posterior subcutaneous tissues of the\nthoracolumbar spine. Atelectasis and dependent changes of the bilateral lungs\nare partially evaluated. There is a 6 mm left renal cyst (13:26).", "output": "1. Mild multilevel degenerative changes of the spine are most pronounced at\nC5-C6 where there is mild spinal canal narrowing and moderate to severe right\nneural foraminal narrowing.\n2. Diffuse low marrow signal on T2 and T1 weighted sequences may be secondary\nto anemia. No focal abnormality is demonstrated on the postcontrast\nsequences.\n3. Dependent changes and atelectasis of the visualized lungs." }, { "input": "Note, study is limited due to lack of axial and post - contrast images, and\nsome sagittal sequences are mild to moderately degraded by motion. Within this\nlimitation:\n\nCERVICAL:\nThere is a gently lobulated circumscribed approximately 2.1 x 1.7 cm (series\n4, image 6) homogeneously T2 hyperintense, T1 hypointense lesion expanding the\nmedulla (see series 4, image 6 and series 6, image 6). More inferiorly, there\nis a similar gently lobulated circumscribed T2 hyperintense T1 hypointense 2.6\nx 1.0 cm lesion in the region of the upper cervical spinal cord at the level\nof C2-3 (series 4, image 7). There is no definite intervening continuity.\n\nThe intervening cervical spinal cord as well as the cervical spinal cord\nvisualized to the level of C6 appears expanded and mildly T2/STIR hyperintense\nwith lack of visualization of normal CSF around the cord from C2-6. In\nparticular, the spinal cord in the region of C1 to C2 demonstrates\nheterogeneous signal, and demonstrated abnormal heterogeneous enhancement on\nprior brain MR; although today study is limited, findings are concerning for\nunderlying mass at this location. The spinal cord inferior to C6 is normal in\ncaliber and signal intensity.\n\nMild anterolisthesis of C4 with respect to both C3 and C5 is unchanged. \nOtherwise, alignment in the cervical spine is normal. The imaged cervical\nvertebral bodies demonstrate preserved height and normal signal intensity\ncharacteristics. Diffuse T2 hypointensity of the imaged cervical\nintervertebral discs is consistent with desiccation/degenerative change. \nThere is mild disc height loss worst at C3-4, most prominent posteriorly.\n\nCanal narrowing is difficult to assess given lack of axial images. Lack of\nnormal CSF signal surrounding the cervical spinal cord at least the level of\nC6-7 is felt to be due to an expanded appearance of the cord in the setting of\nmultifocal T2 hyperintense lesions (detailed above), rather than genuine canal\nnarrowing. Neural foraminal narrowing cannot be assessed on this study.\n\nTHORACIC:\nThere is marked dextroscoliosis centered in the lower thoracic spine. \nAlignment is within normal limits otherwise. Vertebral body heights are\npreserved. No concerning foci of abnormal marrow signal are seen. The imaged\nthoracic spinal cord is normal in caliber and signal intensity. Diffuse T2\nhypo intensity of the imaged thoracic intervertebral discs is consistent with\ndesiccation/ degenerative change. Mild height loss seen at multiple levels,\nmost prominent near the thoracolumbar junction.\n\nLUMBAR:\nOnly a single sagittal T2 weighted sequence of the lumbar spine is provided. \nWithin this limitation: There is marked levoscoliosis of the lumbar spine\ncentered at approximately L1-2. Otherwise, alignment is normal within the\nlumbar spine. Vertebral body heights are preserved. No concerning focal\nmarrow signal abnormalities are seen. The distal spinal cord and conus\nmedullaris is difficult to assess given extent of levoscoliosis, however\nappears within normal limits and terminates at L1-2 (series 10, image 18). \nThe cauda equina appear normal. There is mild lumbar spine degenerative\nchange. There are small posterior disc bulges at L3-4 and L4-5 which may\nmildly narrow the spinal canal and appears to cause mild left L4-5 neural\nforaminal narrowing (series 10, image 3).", "output": "1. Limited examination due to lack of axial and post-contrast images in the\nsetting of patient discomfort during exam.\n2. Expanded medulla, cervicomedullary junction, and cervical spinal cord\ncontaining at least two gently lobulated cystic areas, as above. The\nintervening upper cervical spinal cord is expanded demonstrates heterogeneous\nsignal, and was demonstrated to be heterogeneously enhancing on prior brain\nMR. ___ concerning for underlying mass at this location. Although\ndifferential includes metastasis, hemangioblastoma, astrocytoma, and\nependymoma, given patient's age, lack of additional lesions, lack of brain\nlesions, and appearance, ependymoma or astrocytoma are felt to be most likely.\n3. More inferior cervical spinal cord is expanded and edematous. Thoracic and\nlumbar spinal cord, and cauda equina, is normal. No additional lesions seen.\n4. Thoracolumbar S-shaped scoliosis and mild lumbar spine discogenic\ndegenerative changes, as above.\n\nRECOMMENDATION(S): Consider contrast-enhanced MR of the cervical spine if\nfurther characterization is indicated." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is no marrow\nsignal abnormality or acute fracture. The visualized portion of the spinal\ncord is preserved in signal and caliber. Intervertebral disc signal intensity\nand heights are preserved.\nThere is no evidence of spinal canal or neural foraminal narrowing. Within the\nlimits of this noncontrast examination, there is no evidence of infection or\nneoplasm.\nThe cervical calcification above the right transverse process of C7 that was\nseen on prior radiograph is not seen on the axial T2 weighted images of this\nMR exam, which may be due to the calcific composition or slice thickness. The\nsagittal images do not cover the area.", "output": "1. Normal evaluation of the cervical spine.\n2. Limited evaluation of the previously seen previously seen calcification." }, { "input": "Study is mildly degraded by motion.\n\nCERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.The visualized portion of the spinal cord is preserved in signal\nand caliber.\n\nAt C3-4 there is a disc bulge with no vertebral canal or neural foraminal\nnarrowing.\n\nAt C4-5 there is disc bulge with mild vertebral canal and no neural foraminal\nnarrowing.\n\nAt C5-6 there is asymmetric right disc bulge, uncovertebral hypertrophy, and\nfacet joint hypertrophy, with mild to moderate vertebral canal and moderate\nright neural foraminal narrowing.\n\nAt C6-7 there is asymmetric right disc bulge and uncovertebral hypertrophy\nwith mild vertebral canal and moderate right neural foraminal narrowing.\n\n Otherwise no spinal canal stenosis or neural foraminal narrowing. There is\nno abnormal enhancement after contrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.The visualized portion of the spinal cord is preserved in signal\nand caliber.\n\nAt T2-3 there is central disc protrusion with deformation of the ventral\nthecal sac and spinal cord without definite associated cord signal\nabnormality, mild vertebral canal and no neural foraminal narrowing.\n\nAt T3-4 there is central disc protrusion with no vertebral canal or neural\nforaminal narrowing.\n\nAt T4-5 there is central disc protrusion with no vertebral canal or neural\nforaminal narrowing.\n\nOtherwise, there is no evidence of spinal canal or neural foraminal\nnarrowing.Subcentimeter perineural cysts are seen at T6-7 right neural\nforamina, T8-9 left neural foramina, and T9-10 left neural foraminal.There is\nno abnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.Conus terminates at L1-2. No terminal cord signal\nabnormalities. There is no abnormal enhancement after contrast\nadministration.\n\nAt T12-L1, no substantial degenerative changes, spinal canal stenosis, or\nneural foraminal narrowing.\n\nAt L1-2, there are mild ligamentum flavum thickening and facet osteophytes. \nNo spinal canal stenosis or neural foraminal narrowing.\n\nAt L2-3, there are mild ligamentum flavum thickening and facet osteophytes. \nNo spinal canal stenosis or neural foraminal narrowing.\n\nAt L3-4, there are mild ligamentum flavum thickening and facet osteophytes. \nNo spinal canal stenosis or neural foraminal narrowing.\n\nAt L4-5, mild ligamentum flavum thickening and facet osteophytes cause mild\nspinal canal stenosis. Facet osteophytes cause mild bilateral neural\nforaminal narrowing. There is no compression of the traversing nerve roots.\n\nAt L5-S1, disc bulge with annular fissure, ligamentum flavum thickening and\nfacet osteophytes cause mild-to-moderate spinal canal stenosis with crowding\nof the traversing nerve roots. Disc bulge and facet osteophytes cause\nmild-to-moderate bilateral neural foraminal stenosis without compression of\nthe exiting L5 nerve roots. Disc bulge indent the bilateral traversing S1\nnerve roots at the subarticular zone. Nonspecific bilateral facet joint fluid\nis noted.\n\nOTHER:\nThere is bilateral dependent atelectasis.\nThere is no definite evidence of paravertebral or paraspinal mass.\nLimited imaging of the suboccipital soft tissues demonstrate postoperative\nchanges related to patient's known posterior fossa mass resection, with\nsuggested 3.4 x 1.1 x4.2 cm nonspecific fluid collection adjacent to surgical\nsite.", "output": "1. Study is mildly degraded by motion.\n2. No definite evidence of paraspinal or paravertebral mass.\n3. No definite evidence of spinal cord lesion or enhancement.\n4. Multilevel cervical, thoracic and lumbar spine degenerative changes as\ndescribed, most pronounced at L5-S1 where there is disc bulge with annular\nfissure contacting bilateral transiting S1 nerve roots with mild-to-moderate\nvertebral canal and moderate bilateral neural foraminal narrowing.\n5. C5-6 and C6-7 moderate right neural foraminal narrowing.\n6. Otherwise, no definite evidence of moderate or severe vertebral canal or\nneural foraminal narrowing.\n7. Limited imaging of the suboccipital soft tissues demonstrate postoperative\nchanges related to patient's known posterior fossa mass resection, with\nsuggested 3.4 x 1.1 x4.2 cm nonspecific fluid collection adjacent to surgical\nsite. While finding may represent evolving postoperative change, CSF cyst\nformation is not excluded on the basis of this examination." }, { "input": "There is mild retrolisthesis of C5 on C6 likely due to degenerative changes\nand unchanged from previous examination.\n\nVertebral body heights are preserved. There is no marrow signal abnormality or\nacute fracture. The visualized portion of the spinal cord is preserved in\nsignal.\n\nAt C2-C3, there is no significant spinal canal stenosis or neuroforaminal\nnarrowing.\n\nAt C3-C4, there is no significant spinal canal stenosis or neuroforaminal\nnarrowing.\n\nAt C4-C5, a bulging disc and ligamentum flavum hypertrophy causes effacement\nof the thecal sac without distortion of the cord or abnormal cord signal. \nThere is moderate left neuroforaminal narrowing.\n\nAt C5-C6, there is mild spinal canal stenosis with distortion of the cord but\nno abnormal signal within the cord and moderate to severe left neuroforaminal\nnarrowing.\n\nAt C6-C7, there is no significant spinal canal stenosis or neural foraminal\nnarrowing due to ligamentum flavum and facet hypertrophy.\n\nAt C7-T1, there is no significant spinal canal stenosis or neural foraminal\nnarrowing. Incidentally noted is a left perineural cyst.\n\nWithin the limits of this noncontrast examination, there is no evidence of\nbony metastasis. Multilevel degenerative changes are present including joint\nspace narrowing, osteophytosis, facet arthropathy, and subchondral cystic\nchange.", "output": "1. C4-C5 moderate left neuroforaminal narrowing.\n2. C5-C6 mild spinal canal stenosis and moderate to severe left neuroforaminal\nnarrowing." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nThere is levoscoliosis of the lumbar spine.\n\nThere is a comminuted burst fracture of the L4 vertebral body with\napproximately 40% loss of height. This is associated with approximately 9-10\nmm of retropulsion of the posterior cortex and severe vertebral canal\nnarrowing.\n\nThere is also cortical step-off and irregularity of the superior endplate of\nthe L2 vertebral body with diffuse hyperintense STIR signal compatible with a\nsuperior endplate fracture. There is approximately 10% loss of height of the\nL2 vertebral body.\n\nAdditional hyperintense STIR signal is noted in the superior T12 vertebral\nbody with a T1 and T2 hypointense band along the superior endplate. This is\nmost consistent with a superior endplate fracture especially given the\ncoarsened and thickened trabecular appearance on the prior CT abdomen and\npelvis. There is minimal loss of height.\n\nThere is irregularity of the posterior longitudinal ligament along the L4\nvertebral body concerning for disruption.\n\nThe remaining lumbar vertebral body heights are maintained.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal throughout lumbar\nspine. Nonspecific facet fluid is noted at multiple levels of the lumbar\nspine.\n\nA small amount of edema within the L3-L4 interspinous ligaments is concerning\nfor partial to complete disruption of the interspinous ligament.\n\nAt L1-2 there is posterior disc protrusion, epidural fat, ligamentum flavum\nthickening, mild facet hypertrophy, mildvertebral canal and mild bilateral\nneural foraminal narrowing.\n\nAt L2-3 there is posterior disc protrusion, epidural fat, ligamentum flavum\nthickening, mild facet hypertrophy moderatevertebral canal and mild bilateral\nneural foraminal narrowing.\n\nAt L3-4 there is posterior disc protrusion, epidural fat, ligamentum flavum\nthickening, facet hypertrophy severevertebral canal and moderate bilateral\nneural foraminal narrowing.\n\nAt L4-5 there is posterior disc protrusion, ligamentum flavum thickening,\nfacet hypertrophy, moderatevertebral canal and moderate bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is posterior disc protrusion, ligamentum flavum thickening,\nfacet hypertrophy, mildvertebral canal and mild bilateral neural foraminal\nnarrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Examination is moderately degraded by motion.\n2. L4 burst fracture with approximately 40% loss of height and 10 mm of\nretropulsion of the posterior cortex with severe vertebral canal narrowing.\n3. L2 superior endplate fracture with approximately 10% loss of height.\n4. T12 superior endplate fracture with minimal loss of height.\n5. Question discontinuity of posterior longitudinal ligament at L4.\n6. Question partial to complete tear of the interspinous ligament at L3-L4.\n7. Multilevel multifactorial degenerative disc disease of the lumbar spine as\ndescribed above, most pronounced at L3-4 where there is severe vertebral canal\nand moderate bilateral neural foramina narrowing.\n8. L4-5 moderate vertebral canal and moderate bilateral neural foraminal\nnarrowing." }, { "input": "There is mild anterior subluxation of C7 upon T1 due to degenerative disease. \nOtherwise, alignment is normal. There are extensive changes of degenerative\ndisc disease with loss of height of the intervertebral discs, loss of signal\nof the discs on the T2 weighted images and bulging of the discs at multiple\nlevels.\nA disc bulge minimally indents the anterior surface of the spinal cord at\nC3-4.\nAt C4-5, there is slight flattening of the anterior surface of the cord due to\nbulging disc.\nAt C5-6, there is flattening of the anterior surface of the spinal cord due to\ndisc bulge.\nAt C6-7 bulging disc flattens the anterior surface of the spinal cord.\nThere is no canal encroachment at C7-T1.\n\nAgain seen is a broad focus of hyperintensity on the T2 weighted images in the\nspinal cord extending from mid C3 to lower C4 levels. The lesion is in the\nmidline posteriorly, overlying the dorsal columns. This appears unchanged\nsince the prior study and is again compatible with the history of\ndemyelinating disease. No new lesions are identified.\n\nThe spinal cord otherwise appears normal in caliber and configuration.\n There is no evidence of infection or neoplasm.", "output": "1. Dorsal column hyperintensity at the C3 and C4 levels on the T2 weighted\nimages appears unchanged and remains compatible with demyelinating disease.\n2. No new lesions identified.\n3. Degenerative disc disease unchanged since the prior study." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL, THORACIC, LUMBAR SPINE:\n\nThere is minimal levoscoliosis of lumbar spine. There is transitional anatomy\nwith partial sacralization of L5. Vertebral body heights are preserved.\nThere is no definite focal marrow signal abnormality. There is no prevertebral\nsoft tissue swelling.\n\nExtending from the C7-T1 through T2-3 levels, a T2 heterogeneous, water ideal\nheterogeneous, right dorsal lateral extramedullary intradural heterogeneously\nenhancing mass measuring approximately 1.2 (AP) x 1.5 (TV) x 3.8 (SI) cm, with\nmass effect on cervical and thoracic spinal cord is seen (see 3, 4, 5, 13:8;\n10, 16: ___. C6-7 through C7-T1 levels of the cervical spinal cord\ndemonstrate central cord signal abnormality (see 9: ___.\n\nExtending from the mid T4 through T4-5 level there is central approximately\n2.6 mm maximum diameter T2 hyperintense lesion without definite enhancement is\nnoted (see 10, 18: ___.\n\nExtending from the T4-5 through T8-9 levels, a second heterogeneously\nenhancing dorsal extramedullary intradural structure measuring approximately\n0.9 (AP) x 1.5 (TV) x 10.6 (SI) cm, exerting mass effect on the thoracic\nspinal cord is seen (see 3, 4, 5, 13:7; 10, ___ 11, 17: ___. Question\nfocal central spinal cord signal abnormality at the T6-7 through mid T9 levels\n(see 10:29; 11: ___.\n\nExtending from the T9-10 through mid T12 level a third dorsal intradural\nextramedullary heterogeneously enhancing structure with mass effect on the\nthoracic spinal cord, measuring approximately 0.8 (AP) x 1.2 (TV) x 8.2 (SI)\ncm (see 6, 7, 8, 14:10; 11, 17:28).\n\nAdditional central cord signal abnormality is seen at the mid T9 level (see\n11, 17:19).\n\nThe conus noted at approximately the L1-2 level. Irregular heterogeneous\nenhancement is seen along the length of the thecal sac starting from the\ncervicomedullary junction to approximately the mid T12 level, with enhancement\nsuggested along the lumbar spinal cord and caudal lumbar nerve roots inferior\nto the T12 level. Additional foci of intrathecal enhancement versus artifact\nis noted at the L4 through L5 levels (see 6, 7, 8, 14:7).\n\nIntervertebral disc heights and signal are preserved.\n\nThere is no definite evidence of extradural sources of moderate or severe\nvertebral canal narrowing. There is no definite evidence of moderate or\nsevere neural foraminal narrowing.\n\nOTHER:\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues. On limited imaging lungs, question small right-sided pleural\neffusion versus artifact (see 11:23). On limited imaging of the skull base,,\nminimal nonspecific right-sided mastoid fluid is present. Limited imaging of\nthe kidneys demonstrates left at least partially T2 hyperintense structure\nversus artifact, incompletely characterized (see 11: 34-35).", "output": "1. Study is moderately degraded by motion.\n2. Three extramedullary intradural enhancing masses versus multiple loculated\nenhancing smaller lesions with mass effect on adjacent spinal cord and\nmultiple areas of cord signal abnormality concerning for spinal drop\nmetastases, as described.\n3. T4 through T4-5 probable syringohydromyelia.\n4. Enhancement of thecal sac, spinal cord, and lumbar nerve roots, as\ndescribed concerning for additional intrathecal metastatic lesions as\ndescribed.\n5. On limited imaging lungs, question small right-sided pleural effusion\nversus artifact.\n6. Additional findings as describ" }, { "input": "There is overall interval decrease in size, enhancement and resultant mass\neffect of previously identified intradural extramedullary enhancing\nconglomerate abnormality spanning the thoracic spine predominantly centered at\ndorsal aspect of the thecal sac. The maximum thickness at the level of T1-T2\nlevel measuring about 7 mm compared to 10 mm on previous examination dated ___. There is redemonstration of focal intradural enhancement adjacent to\nconus medullaris and along cauda equina fibers measuring about 4 mm;\nunchanged.\n\nThere is a faint intramedullary T2/stir hyperintensity spanning the included\nspinal cord more pronounced at cervicothoracic junction and lower thoracic\nregions; which is difficult to assess on previous examination related to\nprevious abnormal cord deformation.\n\nThere is interval resolution of previously identified resultant anterior\ndisplacement of the thoracic cord and resultant mass effect with residual\nmoderate ventral thoracic cord displacement and residual mild-to-moderate\nspinal canal stenosis.\n\nThere is interval increase in extent of intramedullary presumably\nsyringohydromyelia at the T4-T5 levels of less than 2-3 mm on maximum\nanterior-posterior diameter. However; there is interval decrease in size of\npreviously identified intramedullary presumably syringohydromyelia at T1 level\nmeasuring now less than 1 mm on maximum anterior-posterior diameter compared\nto 3 mm on previous examination.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. There is no evidence of neural foraminal narrowing.", "output": "1. Overall interval decrease in size and resultant mass effect of previously\nidentified intradural extramedullary conglomerate enhancing abnormalities\nspanning the thoracic spine predominantly centered at dorsal aspect of the\nthecal sac.\n2. Faint thoracic patchy cord intramedullary nonenhancing signal abnormality\nwhich may be related to previous cord compression versus post treatment\nchanges.\n3. Interval increase in the extent of syringohydromyelia at T4-T5 level." }, { "input": "The alignment is normal. No concerning bone marrow signal abnormalities\nidentified. Left L5 spondylolysis is better evaluated on the prior CT from ___. The intervertebral discs overall demonstrate normal T2 signal. \nMild intervertebral disc height loss is seen at L5-S1. The cord terminates at\nT12-L1. No terminal cord signal abnormalities identified.\n\nT12-L1: There is no spinal canal or neural foraminal narrowing.\n\nL1-L2: Mild disc bulge is seen, which in conjunction with facet joint\nosteophytes and ligamentum flavum thickening results in mild spinal canal\nnarrowing. Facet joint osteophytes contribute to mild bilateral neural\nforaminal narrowing.\n\nL2-L3: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nFacet joint osteophytes contribute to mild bilateral neural foraminal\nnarrowing.\n\nL3-L4: Mild disc bulge, facet joint arthropathy and ligamentum flavum\nthickening is seen resulting in mild spinal canal narrowing. Facet joint\nosteophytes contribute to mild bilateral neural foraminal narrowing, right\ngreater than left.\n\nL4-L5: There is disc desiccation and diffuse disc bulge, causing anterior\nthecal sac deformity, contacting the traversing nerve roots bilaterally (image\n15, series 6), and also causing moderate bilateral neural foraminal narrowing,\narticular joint facet hypertrophy ligamentum flavum thickening are present.\n\nL5-S1: Disc bulge with a focal central disc protrusion is seen resulting in\nmild spinal canal narrowing. Facet joint arthropathy contributes to severe\nright and moderate left neural foraminal narrowing.\n\nOverall, the extent of lumbar spondylosis has mildly progressed compared to\nthe prior exam from ___. No paraspinal or paravertebral soft tissue\nabnormalities are identified.", "output": "1. Disc degenerative changes identified at L4-L5 level, causing moderate\nbilateral neural foraminal narrowing.\n2. Severe right and moderate left neural foraminal narrowing at L5-S1, has\nmildly progressed compared to the prior exam.\n3. No terminal cord signal abnormalities identified.\n4. Left L5 spondylolysis, is better evaluated on the prior CT of the abdomen\nand pelvis performed in ___." }, { "input": "Vertebral body alignment is preserved with exaggeration of the normal cervical\nlordosis. Vertebral body heights are preserved.There is no marrow signal\nabnormality. There is mild intervertebral disc height loss at C5-6. The\nvisualized portion of the spinal cord is preserved in signal and caliber. \nIncluded portion of the posterior fossa is unremarkable.\n\nCraniocervical junction is unremarkable. At C2-3 and C3-4 there is no canal\nor foraminal narrowing.\n\nAt C4-5 there is mild ligamentum flavum thickening and central small disc\nprotrusion without canal narrowing or neural foraminal stenosis.\n\nAt C5-6 there is adisc bulge and ligamentum flavum thickening resulting in\nmoderate canal narrowing. There is mild bilateral neural foraminal stenosis\ndue to uncovertebral hypertrophy.\n\nAt C6-7 there is ligamentum flavum thickening without canal or neural\nforaminal stenosis.\n\nAt C7-T1 there is no canal or neural foraminal stenosis.\n\nIncluded paraspinal soft tissues are unremarkable.", "output": "Degenerative changes, most notable at the C5-C6 level, with disc bulge and\nligamentum flavum thickening resulting in moderate canal narrowing and mild\nbilateral neural foraminal stenosis due to uncovertebral hypertrophy." }, { "input": "The craniocervical junction, and at C2-3 and C3-4 levels, mild degenerative\nchanges seen. At C4-5 mild degenerative changes identified.\n\nAt C5-6 level, disk and uncovertebral degenerative changes seen with moderate\nbilateral foraminal narrowing and mild spinal stenosis. The disk bulging is in\ncontact with the spinal cord with minimal deformity and resulting in\nmild-to-moderate spinal stenosis.\n\nAt C6-7 level, a central disc protrusion identified. There is also a\nright-sided disc herniation extending into foramen which may affect the right\nC7 nerve root. There is no left foraminal narrowing. There is mild to moderate\nspinal stenosis and deformity of the spinal cord by the central disc\nprotrusion.\n\nAt C7-T1, T1-2 and T2-3 levels, no abnormality is identified.\n\nThe spinal cord shows a normal intrinsic signal.", "output": "1. Severe right foraminal narrowing at C6-7 level due to disk herniation which\ncould affect the right C7 nerve root.\n2. Mild to moderate spinal stenosis at C5-6 and C6-7 levels with mild\ndeformity of the spinal cord.\n3. Moderate bilateral foraminal narrowing at C5-6 level." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of the lumbar spine. At T11-___ there is minimal\nexaggeration of the thoracic kyphosis. T12 chronic 30% anterior compression\ndeformity is noted with Schmorl's nodes in the superior and inferior\nendplates. There is no marrow signal abnormality. L3-4 and L4-5 nonspecific\ninterspinous ligament T2 and ideal water hyperintensities noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal at T11-12. There is\nloss of intervertebral disc signal at L3-4, L4-5, L5-S1.\n\nAt T11-12 there is prominence of epidural fat, disc bulge, with mild vertebral\ncanal and no neural foraminal narrowing.\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 facet joint hypertrophy, novertebral canal and no neural\nforaminal narrowing. Nonspecific bilateral facet joint fluid is noted.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, prominent epidural fat, mild-to-moderatevertebral canaland\nmoderate leftneural foraminal narrowing. Nonspecific bilateral facet joint\nfluid is noted.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, prominent epidural fat, moderate to severevertebral\ncanal,moderate left and mild rightneural foraminal narrowing. Nonspecific\nbilateral facet joint fluid is noted. Right facet joint probable synovial\ncyst is noted (see 05:15).\n\nAt L5-S1 there is disc bulge and central disc protrusion which contacts\ntransiting right S1 nerve root, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal and mild bilateral neural foraminal\nnarrowing. Nonspecific bilateral facet joint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. T12 chronic 30% anterior compression deformity without definite evidence of\nbony retropulsion.\n3. Multilevel lumbar spondylosis as described, most pronounced at L4-5, where\nthere is moderate to severe vertebral canal, moderate left and mild right\nneural foraminal narrowing.\n4. L3-4 mild-to-moderate vertebral canal and moderate left neural foraminal\nnarrowing.\n5. L5-S1 disc bulge and central disc protrusion contacts transiting right S1\nnerve root, with mild vertebral canal and mild bilateral neural foraminal\nnarrowing.\n6. Nonspecific L3-4 and L4-5 interspinous ligament probable edema without\ndefinite evidence of adjacent spinous process edema. Differential\nconsiderations include degenerative, posttraumatic, infectious and\ninflammatory etiologies. If clinically indicated, consider correlation with\nCBC and inflammatory markers.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "CERVICAL:\nPostsurgical changes after anterior spinal fusion of C5 through C7 are noted,\nnew from the MRI in ___. Hardware artifact partially obscures the C5,\nC6 and C7 vertebral bodies. Vertebral body height and alignment appears\notherwise normal.\nThere is loss of signal of the intervertebral discs at C2-3, C3-4 and C4-5\nwith small bulges and posterior osteophytes. These are all due to\ndegenerative disease. Bone marrow signal intensity is within normal limits. \nThere is no abnormal enhancement after contrast administration.\n\nAt C2-C3, there is no spinal canal stenosis or neural foraminal narrowing.\n\nAt C3-C4, there is a central disc protrusion mass results in moderate spinal\ncanal stenosis with remodeling of the ventral cord but no definitive cord\nsignal abnormality, new from prior studies. In addition, there is mild facet\njoint arthropathy and uncovertebral hypertrophy which results in mild\nbilateral neural foraminal narrowing.\n\nAt C4-C5, there is a midline and right-sided disc protrusion that results in\nmild spinal canal stenosis with remodeling of the ventral cord but no\ndefinitive cord signal abnormality, new from prior studies. In addition,\nthere is mild facet joint arthropathy and uncovertebral hypertrophy but no\nsignificant neural foraminal narrowing.\n\nAt C5-C6, there are posterior endplate osteophytes which results in mild\nspinal canal stenosis with remodeling of the ventral cord but no cord signal\nabnormality, findings appear similar to the prior MRI. In addition, there is\nmild facet joint arthropathy and uncovertebral hypertrophy which results in\nmoderate bilateral neural foraminal narrowing, similar to prior.\n\nAt C6-C7, there are small posterior endplate osteophytes which results in mild\nspinal canal stenosis and remodeling of the ventral cord but no definitive\ncord signal abnormality, findings appear improved from the prior MRI. In\naddition, there is mild facet joint arthropathy and uncovertebral hypertrophy\nbut no significant neural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal stenosis or neural foraminal narrowing.\n\n\nTHORACIC:\nThere is a mild superior endplate compression deformity of the T12 vertebral\nbody with approximately 25% vertebral body height loss. There is no\nassociated bone marrow edema, suggestive of a chronic finding. There is a\nsmall Schmorl's node along the superior endplate of the T12 vertebral body. \nVertebral body height and alignment is otherwise preserved. It intervertebral\ndisc spaces appear grossly maintained. Bone marrow signal intensity is within\nnormal limits.\n\nAt T6-T7, there is a right right-sided disc protrusion that remodels the\nventral cord but without cord signal abnormality. There is no spinal canal\nstenosis or neural foraminal narrowing at this level.\n\nAt T11-T12, there is a shallow disc bulge with the results in mild flattening\nof the ventral cord but without cord signal abnormality. There is no spinal\ncanal stenosis or neural foraminal narrowing at this level.\n\nThe spinal cord appears otherwise normal in caliber and configuration. There\nis no abnormal enhancement after contrast administration.\n\nOtherwise, there is no evidence of cord compression, severe spinal canal\nstenosis or significant neural foraminal narrowing along the remaining\nthoracic levels.\n\nLUMBAR:\nVertebral body height and alignment is preserved. There is mild multilevel\ndegenerative disc disease with grossly preserved disc space heights. Bone\nmarrow signal intensity is within normal limits.\n\nThe spinal cord appears normal in caliber and configuration. The conus\nterminates normally at the L1-L2 level. The cauda equina nerve roots appear\nunremarkable.\n\nAt L1-L2 and L2-L3, there is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nAt L3-L4, there is a shallow disc bulge, facet joint arthropathy with\nbilateral small facet joint effusions and moderate ligamentum flavum\nthickening which results in mild spinal canal stenosis and mild bilateral\nneural foraminal narrowing.\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy with bilateral facet\njoint effusions and severe ligamentum flavum thickening which results in mild\nto moderate spinal canal stenosis as well as severe left and moderate right\nneural foraminal narrowing. There is also effacement of the lateral recesses\nbilaterally with compression of the traversing L5 nerve roots.\n\nAt L5-S1, there is a central disc protrusion which likely compresses the right\ntraversing S1 nerve root and contacts the left traversing S1 nerve root. \nThere is also mild bilateral facet joint arthropathy but no spinal canal\nstenosis or neural foraminal narrowing.", "output": "1. Postsurgical changes after anterior spinal fusion of C5-C7 with stable or\nimproved mild residual spinal canal narrowing and remodeling of the ventral\ncord but without cord signal abnormality.\n2. New central disc protrusions at C3-C4 and C4-C5 with mild and moderate\nneural foraminal narrowing as well as remodeling of the ventral cord but\nwithout definitive cord signal abnormality.\n3. Chronic appearing mild T12 superior endplate compression deformity.\n4. Mild thoracic spondylosis without evidence of cord compression, severe\nspinal canal stenosis or significant neural foraminal narrowing.\n5. Multilevel lumbar spondylosis, most pronounced at L4-L5 where there is\nsevere left and moderate right neural foraminal narrowing with compression of\nthe neural traversing L2 nerve roots as well as at L5-S1 where there is a\ncentral disc protrusion that compresses the right traversing S1 nerve root." }, { "input": "There is transitional anatomy, with 6 non-rib-bearing lumbar spine vertebral\nbodies. For the purposes of this exam, the lowest non-rib-bearing vertebral\nbody will be demarcated L5. This is pseudoarthrosis of the sacrum on the\nright.\n\nThere is a moderate scoliotic curvature, convex to the left with the apex at\nL2-3. Allowing for this, the alignment is normal.\n\nA chronic T12 compression fracture results in close to 70% vertebral body\nheight loss. There is an acute to subacute intravertebral disc herniation\ninto the L4 superior endplate.\nThere is no evidence of acute fracture.\n\nThe background bone marrow signal is heterogeneous. Hemangioma will nearly\ncompletely replaces the L5 vertebral body. There are no suspicious marrow\nreplacing lesions.\n\nThe conus terminates at T12-L1. The distal spinal cord, conus medullaris, and\ncauda equina nerve roots appear normal.\n\nIndividual levels are as follows:\nT11-12: Mild disc bulge. Otherwise unremarkable.\nT12-L1: Mild disc bulge, eccentric to the left. No significant spinal canal\nstenosis. Mild left neural foraminal narrowing.\nL1-2: Mild disc bulge. No significant spinal canal stenosis. Neural foramina\nare patent.\nL2-3: Disc bulge with superimposed osteophytes. Effacement of the right\nsubarticular recess. No significant spinal canal stenosis. Severe right\nneural foraminal narrowing. Left neural foramen is patent.\nL3-4: Circumferential disc bulge. Bilateral facet hypertrophy and infolding\nof the ligamentum flavum combine with epidural fat to produce is moderate\nspinal canal stenosis and moderate/ severe bilateral neural foraminal\nnarrowing.\nL4-5: Disc bulge, eccentric to the left. No significant spinal canal\nstenosis. Mild left neural foraminal narrowing. Right neural foramen is\npatent.\nL5-S1: Pseudoarthrosis on the right. Otherwise unremarkable.\n\n3 cm left adnexal cyst. Bilateral T2 hyperintense renal lesions, probably\ncysts, some of which are present on CTA from ___.", "output": "1. Transitional anatomy and pseudoarthrosis.\n2. Moderate rotatory scoliosis.\n3. No evidence of acute compression fracture. Chronic compression deformities\nat T12 and L4.\n4. Multilevel degenerative changes, detailed above. Severe right neural\nforaminal narrowing at L2-3. Moderate spinal canal stenosis and\nmoderate/severe bilateral neural foraminal narrowing at L3-4.\n5. A 3 cm left adnexal cyst and bilateral presumed renal cysts are similar to\nprior CTA from ___." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nC6 inferior endplate Schmorl's node is noted. There is no marrow signal\nabnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nIntervertebral disc heights and signal are preserved.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C3-4 and C5-6 there is a disc bulge with mild vertebral canal and no neural\nforaminal narrowing.\n\nOtherwise, there is no evidence of cervical vertebral canal or neural\nforaminal narrowing.\n\n\nOTHER:\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm.", "output": "1. Study is moderately degraded by motion.\n2. Mild multilevel cervical spondylosis as described, most pronounced at C3-4\nand C5-6, where there is mild vertebral canal narrowing, progressed compared\nto ___ prior cervical spine MRI.\n3. Within limits of study, no definite evidence of cervical spinal cord\nlesion." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Marrow signal\nintensity appears normal. There is loss of signal of the intervertebral discs\non the T2 weighted images at every imaged level. This is a manifestation of\ndegenerative disc disease.\n\nThere is a tiny midline protrusion of the C2-3 intervertebral disc that just\ntouches the anterior surface of the spinal cord. The neural foramina appear\nnormal at this level.\n\nThere are small intervertebral osteophytes and a tiny midline disc protrusion\nat C3-4. These just touch the anterior surface of the spinal cord. \nUncovertebral and facet osteophytes produce moderate right and mild left\nneural foraminal narrowing.\n\nAt C4-5, a midline and slightly left-sided disc protrusion touches and\nslightly indents the spinal cord just to the left of midline. The neural\nforamina appear normal bilaterally.\n\nAt C5-6, a disc protrusion in the midline and slightly greater on the left\nthan right flattens the left anterior surface of the spinal cord. \nUncovertebral osteophytes produce mild left neural foraminal narrowing.\n\nAt C6-7, a broad midline disc protrusion encroaches on the spinal canal and\nflattens the spinal cord, greater on the left than right. Uncovertebral\nosteophytes produce mild left neural foraminal narrowing.\n\nAt C7-T1, a broad protrusion of the disc encroaches on the spinal canal and\nflattens the anterior surface of the spinal cord. There is moderate right and\nmild left neural foraminal narrowing.\n\nSpinal cord signal intensity appears normal.\nWithin the limits of this noncontrast examination, there is no evidence of\ninfection or neoplasm.", "output": "1. Degenerative disc disease at multiple levels with neural foraminal\nnarrowing. Multiple intervertebral disc protrusions with flattening of the\nspinal cord." }, { "input": "The study is moderately degraded by motion artifact.\n\nVertebral body heights and alignment are maintained. There is no bone marrow\nsignal abnormality. The spinal cord is normal in caliber and there is no\nevidence of cord compression. Conus medullaris terminates at L1-2 and nerve\nroots of the cauda equina are within normal limits. Evaluation of spinal cord\nsignal is limited by extensive artifact. There is no high-grade spinal canal\nor neural foraminal narrowing. There is dorsal epidural lipomatosis spanning\nthe T1 through T8 levels, resulting in mild to moderate spinal canal\nnarrowing. Degenerative changes are worst at L4-5 where a broad-based\nposterior disc bulge with a superimposed central disc protrusion approaches,\nbut does not displace the traversing L5 nerve roots bilaterally and results in\nmild spinal canal narrowing and mild bilateral neural foraminal narrowing.\n\nThere is no prevertebral or paraspinal soft tissue edema or fluid collection. \nBilateral kidneys are atrophic and multiple cysts are present in the right\nkidney.", "output": "The examination is moderately degraded by motion. Within this confine:\n\n1. No evidence of cord compression or cord signal abnormality.\n\n2. There is dorsal epidural lipomatosis spanning T1 through T8 resulting in\nmild-to-moderate spinal canal narrowing at these levels.\n\n3. Mild degenerative changes are most severe at L4-5 where a posterior disc\nbulge/protrusion results in mild spinal canal and mild bilateral neural\nforaminal narrowing.\n\n4. Additional findings as described above." }, { "input": "There is normal cervical spine lordosis. Vertebral body heights are\nmaintained. There is no evidence of acute fracture or subluxation. Rounded T2\nand T1 hyperintense lesions are seen in the C2 and C5 vertebral bodies which\nbecomes hypointense on the STIR sequence compatible with areas of focal fat.\nNo suspicious marrow signal is identified. There is no abnormal signal in the\ncervical spinal cord. The craniocervical junction is unremarkable.\n\nAt C3/C4, there is uncovertebral and facet hypertrophy causing mild to\nmoderate left and mild right neural foraminal narrowing.\n\nAt C4/C5, there is a posterior disc bulge without spinal canal stenosis. There\nis uncovertebral and facet hypertrophy without neural foraminal narrowing.\n\nAt C5/C6, there is uncovertebral and facet hypertrophy, left greater than\nright, without significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nIncidental note is made of small left extra foraminal perineural cyst at C6/C7\nand bilaterally at C7/T1.\n\nEndotracheal and enteric tubes are partially visualized. Increased T2 signal\nin the left lung apex is noted.", "output": "1. No evidence of acute injury to the cervical spine. Normal cord signal.\n\n2. Mild multilevel cervical spine degenerative changes, most prominent at\nC3/C4.\n\n3. Increased T2 signal at the left lung apex, not fully characterized on this\nstudy. Correlate with CTA neck performed on the same day." }, { "input": "There are five lumbar-type vertebral bodies. There is minimal anterolisthesis\nof L4 on L5 as seen on prior plain film. There is also minimal retrolisthesis\nof L2 on L3. Vertebral bodies are otherwise well aligned. No focal\nsuspicious marrow lesions identified. Intervertebral disc desiccation is seen\nthroughout the lumbar spine with mild associated height loss at L4-5. The\nconus terminates at the L1-L2 level.\n\nAt T12-L1 there is a central annular fissure and facet joint hypertrophy with\nbilateral facet joint effusions though no significant canal or foraminal\nnarrowing.\n\nAt L2-3, there is mild disc bulge with a central annular fissure and facet\njoint hypertrophy with facet joint effusions. There is secondary narrowing of\nthe subarticular recesses, crowding the traversing L3 nerve roots though no\noverall canal narrowing. There is mild bilateral foraminal narrowing.\n\nAt L3-4, there is mild disc bulge and facet joint hypertrophy with facet joint\neffusions resulting in mild narrowing of the subarticular recesses. There is\nno canal narrowing though there is mild bilateral foraminal narrowing.\n\nAt L4-5, there is a disc bulge with a right subarticular annular fissure and\nfacet joint hypertrophic changes. There is mild overall canal narrowing and\nsubarticular recess narrowing. There is apparent contact of the traversing\nleft L5 nerve root. No significant foraminal narrowing.\n\nAt L5-S1, there is a disc bulge and mild facet joint hypertrophy with small\nbilateral effusions. No overall canal or foraminal narrowing.\n\nIncluded retroperitoneal paraspinal soft tissues are unremarkable.", "output": "Multilevel degenerative changes noted for disc bulges and facet joint\nhypertrophic changes with facet joint effusions resulting in up to mild\nbilateral foraminal narrowing at L2-3 and L3-4." }, { "input": "From T11-12 to L3-4 levels, no significant abnormalities are seen.\n\nAt L4-5 level, there is disc bulging and a broad-based central protrusion\nminimally indenting the thecal sac with mild narrowing the left subarticular\nrecess without foraminal narrowing.\n\nAt L5-S1 level left-sided broad based disc protrusion is seen with minimal\ndisplacement of the left S1 nerve root. Minimal indentation on the thecal sac\nis seen. There is no spinal stenosis or foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Broad-based left-sided disk protrusion at L5-S1 level minimally displacing\nthe left S1 nerve root.\n2. Mild disk bulging and mild left subarticular recess narrowing at L4-5\nlevel.\n3. No evidence of high-grade thecal sac compression." }, { "input": "There is diffuse spinal cord atrophy. There are more discrete T2 hyperintense\nspinal cord lesions at the cervicomedullary junction, C2-C3, and C4-C5 levels\n(2:7, 8). The additional areas of STIR hyperintensity in the spinal cord may\nbe artifactual. There is no abnormal enhancement to suggest active\ndemyelinating process.\n\nThe alignment of the cervical spine is maintained. There is congenital fusion\nof the left occiput and C1 arch. There are T2 and STIR hyperintense lesions\nwithin pons and medulla, likely related to infratentorial lesions related to\ndemyelinating process.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: There is a mild disc protrusion with facet and uncovertebral joint\narthropathy resulting in mild right greater than left bilateral neural\nforaminal narrowing without spinal canal stenosis.\n\nC4-C5: There is a disc protrusion with bilateral facet and uncovertebral joint\narthropathy resulting in moderate right and mild left neural foraminal\nnarrowing without spinal canal stenosis.\n\nC5-C6: There is a right paracentral disc protrusion with facet and\nuncovertebral joint arthropathy resulting in moderate to severe right and no\nleft neural foraminal narrowing.\n\nC6-C7: There is no neural foraminal or spinal canal stenosis.", "output": "1. Diffuse atrophy of the spinal cord with multiple spinal cord lesions as\ndescribed above, likely related to patient's history of multiple sclerosis. \nNo evidence of active demyelinating process.\n2. Lesions within the pons and medulla likely reflect infratentorial\ndemyelinating plaques.\n3. Cervical spondylosis as described above, most prominent at C5-C6 where\nthere is moderate severe right neural foraminal narrowing. No high-grade\nspinal canal narrowing is noted." }, { "input": "Severe, diffuse atrophy is noted throughout the visualized cervical spinal\ncord. Areas of increased T2/stir signal are noted at the cervicomedullary\njunction, at the level of C2-3, and at C3-4 the overall extent of these\nlesions appears roughly similar to the previous examination. Additional areas\nof T2/FLAIR hyperintensity are noted within the pons and medulla. There is no\nevidence of enhancement following the administration of intravenous gadolinium\nto suggest active demyelination.\n\nThere is no evidence of appreciable vertebral body height loss to suggest\ncompression fracture. The cervical spinal alignment is within normal limits.\nThe bone marrow signal is normal.\n\nMultilevel degenerative changes are as follows:\n\nC1-C2: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nC2-3: A posterior disc bulge indents the ventral thecal sac resulting in mild\ncanal stenosis. No appreciable neural foraminal narrowing.\n\nC3-C4: A posterior disc bulge results in mild canal stenosis and mild right\nneural foraminal narrowing.\n\nC4-C5: An asymmetric right posterior disc bulge combines with right greater\nthan left uncal vertebral joint and facet hypertrophy resulting in mild canal\nstenosis and mild to moderate right neural foraminal narrowing.\n\nC5-C6: A posterior disc bulge results in moderate canal stenosis and combines\nwith right greater than left uncovertebral joint and facet joint hypertrophy\nto result in moderate to severe right neural foraminal narrowing.\n\nC6-C7: Right-sided uncovertebral joint and facet joint hypertrophy results in\nmild right neural foraminal narrowing. No appreciable canal stenosis.\n\nC7-T1: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nThe prevertebral and paraspinal soft tissues are grossly within normal limits.", "output": "1. Diffuse chronic atrophy of the cervical spinal cord with numerous T2/STIR\nhyperintense spinal cord lesions compatible with the patient's history of\nmultiple sclerosis. The overall extent of these lesions appears similar to\nthe previous examination.\n2. No evidence of contrast enhancing lesion to suggest active demyelination.\n3. T2 hyperintensities within the pons and medulla for compatible with\ninfratentorial demyelinating disease.\n4. Cervical spondylosis, as detailed above. Findings are most significant at\nC5-6 with moderate to severe right neural foraminal narrowing. No associated\nhigh-grade spinal canal narrowing is identified at this level." }, { "input": "The thoracic spine has normal curvature vertebral body height, bone marrow\nsignal and alignment. There are multiple levels of disc height loss and disc\nbulges. Of particular note in the thoracic spine are:\nT7-8: There is a minimal disc bulge. There is no significant spinal canal or\nforaminal stenosis.\nT8-9: There is a central disc protrusion that compresses the spinal cord.\nThere is no cord signal abnormality. There is no significant foraminal\nstenosis.\nThe thoracic spinal cord is normal in signal. The conus is normal in\nappearance and position. There is mild diffuse facet degenerative joint\ndisease. The paraspinal soft tissues are normal.\n\nIn the incompletely imaged cervical spine, there is a disc bulge or protrusion\nat C6-7 and a disc bulge at C7-T1.", "output": "1. Degenerative disc disease with a protrusion at T8-9 causing compression of\nthe spinal cord but no cord signal abnormality.\n2. Mild multilevel facet degenerative joint disease. If clinically indicated,\nthis could be better characterized by noncontrast CT." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen. The craniovertebral junction is\nunremarkable. The cord is normal in signal intensity and morphology. There\nis reversal of normal cervical lordosis.\n\nAxial images at C2-C3 are unremarkable.\n\nAt C3-C4 there is a disc bulge with effacement of ventral thecal sac and mild\ncentral stenosis. There is mild to moderate right foramen narrowing from\nuncovertebral hypertrophy.\n\nAt C4-C5 there is a disc bulge with mild effacement ventral thecal sac. No\nsignificant foramen narrowing.\n\nAt C5-C6 there is a disc bulge and osteophyte eccentric to the right with\neffacement of the ventral thecal sac. There is mild to moderate right foramen\nnarrowing.\n\nAt C6-C7 with the disc bulge without significant stenosis.\n\nAt C7-T1 no significant abnormality.\n\nThe visualized soft tissues of the neck are unremarkable. There is prominent\nlymphoid tissue at the base of tongue and prominent left level 2 lymph node\nwhich should be correlated clinically .", "output": "Mild degenerative changes as described.\n\nThere is prominent lymphoid tissue at the base of tongue and prominent left\nlevel 2 lymph node which should be correlated clinically ." }, { "input": "CERVICAL:\n2 mm retrolisthesis C5 on C6 is identified. Otherwise, cervical alignment is\nanatomic. Vertebral body heights are preserved. Mild degenerative loss of\ndisc height at C4-C5 through C6-C7 is noted. There is no focal suspicious\nmarrow lesion. The visualized posterior fossa is unremarkable.\n\nThere is a 5 mm enhancing extramedullary nodule at the C7-T1 right dorsal cord\n(series 31, image 23), likely representing a nerve sheath tumor given the\nhistory of schwannomatosis. No other abnormal enhancement or signal of the\ncervical cord.\n\nC2-C3: No significant spinal canal narrowing. Uncovertebral facet\narthropathy results in moderate left neural foraminal narrowing. There is no\nsignificant right neural foraminal narrowing.\n\nC3-C4: No significant spinal canal narrowing. Uncovertebral facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nC4-C5: A central protrusion mildly remodels the left ventral aspect of the\ncord and results in mild spinal canal narrowing. Uncovertebral facet\narthropathy results in moderate to severe right and moderate left neural\nforaminal narrowing.\n\nC5-C6: A central protrusion results in mild to moderate spinal canal\nnarrowing, minimally remodeling the ventral aspect of the cord. Uncovertebral\nfacet arthropathy results in severe right and moderate left neural foraminal\nnarrowing.\n\nC6-C7: A central protrusion results in mild to moderate spinal canal\nnarrowing, minimally remodeling the ventral aspect of the cord. There is no\nsignificant neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal narrowing. There is no\nsignificant neural foraminal narrowing. As described above, there is a right\ndorsal extramedullary 5 mm enhancing nodule.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc height and signal are preserved. \n.\n\nThere is incompletely characterize 4.3 x 2.4 x 2.5 cm (SI, TRV, AP) left\naxillary T2 hyperintense lesion, likely representing a nerve sheath tumor.\n\nThe following extramedullary enhancing lesions are noted:\nA right dorsal T9-T10 2 mm lesion (series 34, image 10).\nA 5 mm left T10 dorsal lateral lesion (series 34, image 12), exerting mild\nmass effect on the cord without underlying cord signal change.\nA 7 mm left L1 lateral lesion (series 34, image 29).\nA likely right sided L1 enhancing lesion measuring approximately 4 mm not\nwithin the field of view of axial sequences, which appears extra foraminal\n(series 32, image 6).\n\nThere is no intrinsic abnormal signal were enhancement of the cord. The\nterminal cord terminates at the T12-L1 level.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nIn the left inferior renal pole, presumably representing a simple cyst seen on\nprior CT examination of ___.", "output": "1. No priors are available for comparison on PACS.\n2. Extramedullary enhancing lesions at the C7-T1, T9-T10, T10 and L1 levels,\ncompatible with nerve sheath tumors given the clinical history.\n3. A partially visualized left axillary T2 hyperintense mass is also noted,\npresumably representing a nerve sheath tumor.\n4. Degenerative changes of the cervical spine, most prominent at C5-C6 where\nthere is mild to moderate spinal canal narrowing, minimally remodeling the\nventral aspect of the cord without underlying cord signal change. There is\nsevere right and moderate left neural foraminal narrowing at this level.\n5. Additional findings described above." }, { "input": "CERVICAL: Mild retrolisthesis is seen involving C5 on C6. The vertebral body\nmarrow signal is unremarkable. Diffuse degenerative disc desiccation is seen\nthroughout the cervical spine. No cord signal abnormalities are identified. \nAn enhancing lesion is seen at the level of the C7/T1 interspace measuring 0.5\ncm, likely secondary to a nerve sheath tumor overall similar to the prior exam\nfrom ___.\n\nC2-C3: There is no significant spinal canal or neuroforaminal narrowing.\n\nC3-C4: There is no significant spinal canal or neuroforaminal narrowing.\n\nC4-C5: Mild central disc bulge, with a focal left central disc protrusion is\nseen resulting in mass effect on the left aspect of the cord. Moderate canal\nnarrowing is seen at this level. Uncovertebral and facet joint arthropathy\ncontributes to moderate right and mild left neuroforaminal narrowing.\n\nC5-C6: Mild central disc bulge is seen, resulting in mild-to-moderate canal\nnarrowing. Uncovertebral and facet joint arthropathy contributes to moderate\nto severe left and moderate right neuroforaminal narrowing.\n\nC6-C7: Mild central disc bulge is seen resulting in mild canal narrowing. \nModerate left and mild right neuroforaminal narrowing is seen secondary to\nuncovertebral facet arthropathy.\n\nC7-T1: There is no spinal canal or neuroforaminal narrowing.\n\nThoracic: The alignment is normal. Vertebral body and intervertebral disc\nsignal is unremarkable. No cord signal abnormalities are identified. At the\nlevel of the T10 vertebral body, a 0.5 cm x 0.6 cm rounded enhancing lesion is\nseen likely secondary to a nerve sheath tumor overall not significantly\nchanged compared to the prior exam from ___. At the level of T2-T3,\nsmaller enhancing lesions measuring up to 6 mm, series 18, image 10, 12, are\nunchanged compared to the prior exam.\n\nIncidental note is made of a large T2 hyperintense mass within the left\naxillary region measuring 3.4 cm x 2.9 cm.\n\nLUMBAR:\nIn the region of the L1 vertebral body, an enhancing rounded lesion measures\n0.8 cm x 0.7 cm, and in the region of the L2 vertebral body, an enhancing\novoid rounded lesion measures approximately 2.3 cm x 1.4 cm, also likely\nsecondary to a nerve sheath tumor, unchanged compared to the prior exam from\n___. No new enhancing lesions are identified. Incidental note is\nmade of cystic lesions within the kidneys bilaterally, with the largest cyst\nwithin the lower pole the right kidney measuring up to 2.9 cm.", "output": "1. Multiple enhancing lesions throughout the cervical, thoracic, and lumbar\nspine, are unchanged compared to the prior exams from ___ and ___, likely secondary to nerve sheath tumors, with the largest in the region\nof the L2 vertebral body measuring up to 2.3 cm.\n2. Incidental 3.4 cm large T2 hyperintense mass within the left axillary\nregion, is incompletely evaluated on this exam. An MRI of the left axilla is\nrecommended for further evaluation.\n\nRECOMMENDATION(S): MRI of the left axilla is recommended for further\nevaluation of an incidental 3.4 cm T2 hyperintense mass." }, { "input": "The patient is status post upper lumbar laminectomies for resection of\npreviously seen dominant intradural mass. There are postsurgical changes in\nthe paraspinal musculature and edema in the subcutaneous tissues as well as a\npostoperative fluid collection that extends into the epidural space measuring\n15 x 20 x 16 mm (AP x TV x SI) and demonstrating a hematocrit level, likely\nrepresenting a hematoma. The fluid collection extends from approximately L1-2\nL3 along the laminectomy defects the results in substantial mass effect on the\nthecal sac and in combination with disc bulging at L1-L2 causes severe\nnarrowing of the spinal canal and crowding of the nerve roots at this level\n(series 3, image 9; series 7, image 18). Within the fluid collection there is\na millimetric nonenhanced focus that shows low signal on all sequences\nprobably represents postsurgical air (series 7, image 24).\n\nVertebral heights and alignment are maintained. Aside from moderate loss of\nheight and diffuse disc bulging at L1-L2, the remaining lumbar intervertebral\ndisc heights are relatively preserved.\n\nThe lower spinal cord is normal in morphology and signal intensity. Conus\nmedullaris terminates at T12-L1. Two rounded intradural enhancing nodule at\nthe level of T12-L1 along the nerve roots, largest measuring 7 mm, likely\nrepresenting nerve sheath tumor, are unchanged (series 13, image 13 ; series\n11, image 7). Another intradural lesion along the left side of the thecal sac\nat the level of the resected larger mass measuring 5 mm was present on the\nprior study (series 13, image 20). Diffuse enhancement of the dura is in\nkeeping with postsurgical changes. Slight nodularity along the cauda equina\nnerve roots on axial postcontrast T1 weighted images suggests that additional\ntiny lesion may also be present.", "output": "1. Interval postsurgical changes of upper lumbar laminectomies for resection\nof dominant intradural mass.\n2. A postsurgical fluid collection in the laminectomy defect, likely\ncombination of postoperative blood and fluid, measuring 15 x 20 x 16 mm\nextends into the at posterior epidural space and exerts substantial mass\neffect on the thecal sac which in combination with diffuse disc bulging at\nL1-L2 results in severe narrowing of the spinal canal at this level and\ncrowding of the cauda equina nerve roots.\n3. Multiple additional enhancing intradural nodules associated with the nerve\nroots are unchanged." }, { "input": "Alignment is normal. The patient is status post upper lumbar laminectomies. \nThe previously seen postoperative fluid collection has resolved. The spinal\ncord appears normal in caliber and configuration. The conus terminates at\nT12-L1 and is unremarkable.\n\nApproximately 4 mm right and 7 mm left ovoid enhancing intradural nodules at\nthe level of L1 (02:12) are similar to ___. 7 mm ovoid enhancing\nleft intradural nodule at the level of L2 (10:13) is also similar to ___. Approximately 6 mm enhancing intradural nodule at the level of\nT10 (09:11) is only seen on sagittal images, but is not significantly changed\nsince ___.\n\nThere is no evidence of spinal canal narrowing. There is no evidence of\ninfection.\n\nAt T12-L1, there is no neural foraminal narrowing.\n\nAt L1-2, there is moderate disc height loss and diffuse bulging which is\nsimilar to prior. Degenerative endplate change is new since prior. No neural\nforaminal narrowing.\n\nAt L2-3, there is no neural foraminal narrowing.\n\nAt L3-4, there is mild-to-moderate disc bulge worse on the left, causing mild\nright and moderate left neural foraminal narrowing and contacting the exiting\nleft L3 nerve root.\n\nAt L4-5, there is mild left posterolateral disc protrusion causing moderate\nleft neural foraminal narrowing.\n\nAt L5-S1, there is no significant disc bulge or neural foraminal narrowing.\n\n3 cm medial right lower pole renal cyst is again seen. There are scattered\nsmaller renal cysts bilaterally. A medial left renal cyst is T1 hyperintense,\nsuggesting proteinaceous content.", "output": "1. Multiple millimetric enhancing intradural nodules are not significantly\nchanged since priors.\n2. Interval resolution of the postoperative fluid collection.\n3. Mild to moderate degenerative change." }, { "input": "THORACIC SPINE:\n\n12 rib-bearing vertebrae are visualized. Vertebral body heights are\npreserved. Alignment is normal. There is no evidence for metastatic disease\nin the vertebral bodies. There is a hemangioma in the left aspect of the T2\nvertebral body and a hemangioma in the right aspect of the T6 vertebral body.\n\nIn the right pedicle of T12, there is a small focus of high signal on\nfat-suppressed T2 weighted images and low signal on precontrast T1 weighted\nimages, 4:14 and 5:14, nonspecific but concerning for a small metastasis.\n\nFat-suppressed T2 weighted images also demonstrate high signal projecting over\nthe distal spinous process ease of T9 through T12, 04:10. However, no\ncorresponding signal abnormalities are seen on precontrast the postcontrast T1\nweighted images, suggesting artifact on the fat-suppressed T2 weighted images.\nThese spinous processes appear intact on the preceding CT.\n\nThere is an incompletely assessed T2 hyperintense lesion in the left posterior\nthird rib, corresponding to a lytic lesion on the ___ chest CT.\n\nThere is no thoracic spinal canal stenosis. At T5-6, there is a small right\nparacentral disc protrusion which does not contact the spinal cord. The spinal\ncord maintains normal morphology and signal intensity, with the conus\nmedullaris terminating at T12-L1. There is no thoracic neural foraminal\nnarrowing.\n\nThe localizer sequence demonstrates degenerative changes in the lower cervical\nspine with some degree of spinal canal narrowing at C5 and C6, incompletely\nassessed.\n\nThere is a right pleural effusion, trace left pleural effusion, partially\nvisualized subcarinal lymphadenopathy, and partially visualized opacities in\nthe right lung, better assessed on the ___ chest CT.\n\nLUMBAR SPINE:\n\nThere are 5 lumbar-type vertebrae.\n\nL1 vertebral body is completely replaced by a metastatic lesion. There is an\nassociated pathologic fracture with mild loss of height and retropulsion,\ngreater on the right, moderately effacing the thecal sac on the right and\ncompressing the traversing right L2 nerve root. Right L1 pedicle, lamina, and\ntransverse process also replaced by tumor, with expansion of the pedicle. The\ntumor does not extend into the neural foramina, which are not narrowed.\n\nThere are metastatic lesions abutting the superior, inferior, and posterior\nendplates of the L2 vertebral body, without evidence for acute pathologic\nfractures, though there is mild anterior wedging of the L2 vertebral body.\nThere also hemangiomas in the L2 vertebral body.\n\nAt L2-3, there is a mild retrolisthesis with a disc bulge, left lateral disc\nprotrusion, facet arthropathy, and thickening of the ligamentum flavum,\nresulting in moderate spinal canal narrowing, impingement of the traversing\nleft L3 nerve root in the subarticular zone, mild right and moderate left\nneural foraminal narrowing.\n\nThere is a metastatic lesion abutting the anterior and superior endplates of\nthe L3 vertebral body, without evidence for pathologic fracture or loss of\nheight.\n\nAt L3-4, there is a mild retrolisthesis, a disc bulge, moderate facet\narthropathy, and thickening of the ligamentum flavum, resulting in moderate to\nsevere spinal canal stenosis with crowding of the intrathecal nerve roots,\nimpingement of bilateral traversing L4 nerve roots in the subarticular zones,\nsevere right and moderate to severe left neural foraminal narrowing with\nimpingement of the exiting L3 nerve roots.\n\nThere is an expansile metastatic lesion in the spinous process of L4. There is\nalso a small metastatic lesion abutting the L4 inferior endplate, without\nevidence for pathologic fracture or loss of height.\n\nAt L4-5, a large disc bulge, a small central disc extrusion extending\ninferiorly, severe, right greater than left facet arthropathy, and thickening\nof the ligamentum flavum. There is severe spinal canal narrowing with crowding\nof the intrathecal nerve roots, compression of bilateral traversing L5 nerve\nroots in the subarticular zones, worse on the right, severe right neural\nforaminal narrowing with compression of the exiting right L4 nerve root, and\nmoderate left neural foraminal narrowing with abutment of the exiting left L4\nnerve root.\n\nAt L5-S1, there is a disc bulge, a left paracentral disc herniation, and\nmoderate right and severe left facet arthropathy. The traversing left S1\nnerve root is impinged in the subarticular zone. The remainder of the spinal\ncanal is not significantly narrowed. There is mild right and moderate to\nsevere left neural foraminal narrowing with impingement of the exiting left L5\nnerve root.\n\nBone marrow in the visualized upper sacrum and medial iliac bones is diffusely\nheterogeneous. Sagittal fat-suppressed T2 weighted images through the upper\ncentral sacrum demonstrate no evidence for metastases.\n\nThe known left adrenal mass is visualized but partially obscured by artifacts.", "output": "1. Tiny signal abnormality in the right T12 pedicle, compatible with a small\nmetastasis. No other evidence for metastatic disease in the thoracic spine.\n2. Large metastasis completely replacing L1 vertebral body, right pedicle,\ntransverse process, and lamina, with mild loss of vertebral body height and\nright greater than left retropulsion, as well as expansion of the pedicle,\nmoderately effacing the right aspect of the thecal sac and compressing the\ntraversing right L2 nerve root.\n3. Additional metastatic lesions within L2, L3, and L4 vertebral bodies\nwithout evidence for pathologic fractures. Expansile metastatic lesion within\nthe L4 spinous process.\n4. Multilevel degenerative disease in the lumbar spine, as detailed above,\nwith severe spinal canal stenosis and impingement of multiple nerve roots, as\ndetailed above.\n5. Metastatic lesion in the left posterior third rib.\n6. Intrathoracic and intra-abdominal abnormalities are partially visualized,\nbut better assessed on the ___ chest and abdomen/ pelvis CTs." }, { "input": "Examination is limited secondary to artifact from patient motion. There is\nmultilevel loss of disc height and signal. There are multilevel degenerative\nendplate changes, greatest at the C4-C5 level. There is focal fatty marrow\nwithin the T2 vertebral body. There is mild retrolisthesis of C5 on C6.\n\nThere is no definite spinal cord signal abnormality although motion artifact\nmarkedly limits evaluation of the spinal cord. There is no clearly abnormal\ncord parenchymal or leptomeningeal enhancement. Multiple enhancing lesions are\nseen within the bilateral cerebellar hemispheres and left occipital lobe.\n\nThere are bilateral pleural effusions, right greater than left. The remaining\nparaspinal and prevertebral soft tissues are unremarkable.\n\nAt the C2-C3 level, uncovertebral and facet osteophytes cause moderate\nbilateral neural foraminal narrowing.\n\nAt the C3-C4 level, there is a broad-based posterior disc protrusion which\nmildly narrows the spinal canal. Uncovertebral and facet osteophytes cause\nsevere right and moderate left neural foraminal narrowing.\n\nAt the C4-C5 level, broad-based posterior disk protrusion, as well as\nintervertebral osteophytes, causes moderate spinal canal narrowing with\nflattening of the ventral surface of the spinal cord. Uncovertebral and facet\nosteophytes cause moderate bilateral neural foraminal narrowing.\n\nAt the C5-C6 level, broad-based posterior disc protrusion, as well as\nintervertebral osteophytes, cause moderate spinal canal narrowing with\nremodeling of the ventral surface of the spinal cord. Uncovertebral and facet\nosteophytes cause severe right and moderate left neural foraminal narrowing.\n\nAt the C6-C7 level, broad-based posterior disc protrusion and intervertebral\nosteophytes cause mild spinal canal narrowing. Uncovertebral and facet\nosteophytes cause moderate left and mild right neural foraminal narrowing.\n\nAt the C7-T1 level, the spinal canal and neural foramina appear normal.", "output": "1. No evidence of metastatic disease within the cervical spine.\n2. Multiple intracranial metastatic lesions are seen, compatible with prior\nMRI brain findings.\n3. Multilevel cervical spondylosis, greatest at the C4-C5 and C5-C6 levels\nwhere disc protrusions and intervertebral osteophytes remodels the ventral\nsurface of the spinal cord. There is no definite cord signal abnormality;\nhowever, evaluation is markedly limited secondary to motion." }, { "input": "The alignment of the lumbar spine is normal. The bone marrow is normal in\nsignal. The height of the vertebral bodies and intervertebral disc spaces are\nmaintained. The spinal cord is normal in signal. The conus medullaris\nterminates at T12-L1. No masses or fluid collections are identified. The\nparaspinal soft tissues are normal\n\nAt T11-T12 and 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 no spinal canal or neural foraminal stenosis.\n\nAt L3-L4, there is no spinal canal or neural foraminal stenosis.\n\nAt L4-L5, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis.\n\nAt L5-S1, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis.", "output": "Mild degenerative changes of the lower lumbar spine without spinal canal or\nneural foraminal stenosis." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc height and signals are maintained. The\nvisualized posterior fossa is unremarkable. There is no cord signal\nabnormality.\n\nC2-C3: There is no significant spinal canal narrowing. Bilateral facet\narthropathy results in mild right neural foraminal narrowing and no\nsignificant left neural foraminal narrowing.\n\nC3-C4: Small central protrusion does not significantly narrow the spinal\ncanal. Facet and uncovertebral arthropathy results in mild right greater than\nleft neural foraminal narrowing.\n\nC4-C5 and C5-C6: There is no significant spinal canal narrowing. Bilateral\nuncovertebral facet arthropathy results in mild neural foraminal narrowing.\n\nC6-C7: There is a central protrusion and thickening of the ligamentum flavum\nresults in mild spinal canal narrowing. Uncovertebral facet arthropathy\nresults in moderate right neural foraminal narrowing and mild left neural\nforaminal narrowing.\n\nC7-T1 through T2-T3: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nThe adenoids are more prominent than would be expected for the patient's age\nas are the lingual tonsils. There is a 1.2 cm T2 hyperintense T1 isointense\nnodule adjacent to the right aspect of the esophagus (series 6, image 36)\nlikely representing a lymph node. The remainder of the prevertebral and\nparaspinal soft tissues are unremarkable.", "output": "1. Mild multilevel multifactorial cervical spondylosis resulting in mild to\nmoderate bilateral neural foraminal narrowing at multiple levels, most\nprominent at C6-C7.\n2. There is also mild spinal canal narrowing at C6-C7 secondary to a central\ndisc protrusion.\n3. The adenoids and lingual tonsils are more prominent than would be expected\nfor the patient's age. This may be reactive in nature. Correlation with\nprior imaging and clinical history is recommended." }, { "input": "There are 5 lumbar-type vertebral bodies which are maintained in height and\nalignment. No focal suspicious marrow lesion identified. Intervertebral disc\ndesiccation seen at L5-S1. Remaining discs are preserved in signal and they\nare preserved in height throughout.\n\nThe conus terminates at T12-L1, in normal anatomic position.\n\nAt T11-T12 through L3-4, there is no significant canal or foraminal narrowing.\n\nAt L4-5, there is a mild diffuse disc bulge and facet joint hypertrophy\nresulting in narrowing of the subarticular recesses, crowding the traversing\nL5 nerve roots. No significant overall canal or foraminal narrowing is\nidentified.\n\nAt L5-S1, there is a posterior disc bulge with central disc protrusion. There\nis secondary narrowing of the subarticular recesses bilaterally but no\nsignificant canal or foraminal narrowing.\n\nIncluded paraspinal and retroperitoneal soft tissues are unremarkable.", "output": "Degenerative changes most notably at L4-5 and L5-1 as above without\nsignificant canal or foraminal narrowing." }, { "input": "The lumbar lordosis is preserved. Alignment is normal. There is no loss of\nvertebral body height. The conus demonstrates normal signal and morphology and\nterminates at the level of L1. Increased T1/T2 signal intensity in the\ninferior portion of L5 and about the superior endplate of S1 represent ___\ntype II changes. Other small foci with the same signal characteristics (i.e.\nalong the inferior endplate of L2) also represent ___ type II changes.\nIncreased T2 signal along the superior endplate of L4 is compatible with ___\nType I changes.\n\nThere is generalized intervertebral disc decreased T2 signal indicative of\ndegenerative disc disease.\n\nT12-L1: No evidence of significant disc herniation, spinal canal or neural\nforaminal narrowing.\n\nL1-L2: There is a midline and right disc protrusion with a fragment migrating\ninferiorly along the posterior aspect of the vertebral body of L2, new from\nthe previous exam. This causes impingement upon the thecal sac with no\nsignificant spinal canal stenosis. There is no neural foraminal narrowing at\nthis level.\n\nL2-L3: There is disc protrusion with minimal superior migration of the\nprotruded disc along the posterior aspect of the vertebral body of L2. Facet\njoint hypertrophy is also present. There is no spinal canal stenosis or neural\nforamina narrowing at this level.\n\nL3-L4: There is disc bulge with extraformainal disc protrusion and facet joint\nhypertrophy resulting in moderate neural foramen narrowing in the right, with\nthe bulging disc contacting the exiting right L3 nerve root (4:17). The left\nneural foramen is unremarkable. There is no spinal canal stenosis.\n\nL4-L5: There is disc bulge with foraminal and extraforaminal protrusion which,\nalong with facet joint hypertrophy, result in moderate neural foramen\nnarrowing in the left, with the bulging disc contacting the exiting left L4\nnerve root (4:6). Mild neural foramen narrowing is seen in the left. There is\nno spinal canal stenosis.\n\nL5-S1: There is complete collapse of the disk with concentric disk bulge and\nassociated facet joint hypertrophy resulting in bilateral neural foraminal\nnarrowing, left worse than right.", "output": "Degenerative disc disease with disc herniation at multiple levels resulting in\nmultilevel neural foraminal narrowing described in detail in the body of the\nreport. Compared with exam from ___ the most conspicuous interval change is\nthe new protrusion of the L1-L2 disc with inferior migration of the protruded\nfragment." }, { "input": "Craniocervical junction no significant abnormalities are seen.\nAt C2-3 and C3-4 levels, no abnormality is identified.\n\nAt C4-5 and C5-6 levels mild disk bulging identified.\n\nAt C6-7 disc bulging identified with broad-based shallow on the right without\nsignificant foraminal narrowing.\n\nAt C7-T1, T1-2 and T2-3 no abnormality is identified.\n\nSpinal cord shows normal intrinsic signal.", "output": "Mild degenerative changes in the cervical region. No evidence of spinal\nstenosis or high-grade foraminal narrowing. No evidence of spinal cord\ndeformity or intrinsic spinal cord signal abnormalities." }, { "input": "Alignment remains anatomic. There are no significant degenerative changes and\nno evidence of high-grade spinal canal or foraminal narrowing.\n\nThe foci of abnormal signal within the right spinal cord at the T6 level and\nleft anterior spinal cord at the T4 level persist on the STIR and on the axial\nT2-weighted images. The possible abnormal signal within the conus is less well\nseen and may be artifactual.", "output": "Demyelinating plaques within the thoracic spine most prominent at\nthe T4, T6 levels; no definite enhancement was seen on the recent\ncontrast-enhanced MRI." }, { "input": "From T12-S5 level, but the but bony structures demonstrate normal signal\nwithout evidence of focal abnormalities suspicious for metastatic disease or\nan infiltrative process.\n\nFrom T12-L1 to L2-3 levels no significant disc bulge or herniation seen. At\nL3-4 mild disc bulging is seen without spinal stenosis or foraminal narrowing.\n\nAt L4-5 and L5-S1 levels minimal disc bulging identified without spinal\nstenosis. There is no foraminal narrowing. There is no nerve root\ndisplacement or focal disc herniation. There is no spondylolisthesis.\n\nThe conus is at a normal level. The paraspinal soft tissues are unremarkable.", "output": "1. No focal bony abnormalities suspicious for infiltrative process such as\nmetastatic disease.\n2. No intraspinal mass or abnormal enhancement.\n3. Mild degenerative changes in the lumbar region without spinal stenosis,\nforaminal narrowing or focal disc herniation. No evidence of nerve root\ndisplacement." }, { "input": "Degenerative changes cervical spine. Narrowed C4-C5, C5-C6, C6-C7 disc\nspaces. Disc osteophyte complex C3-C4 through C6-C7 levels. Posterior\nelement hypertrophic changes. No cord T2 signal abnormality.\n\nAt C2-C3 level central canal, foramina are patent.\n\nAt C3-C4 level central canal is patent. Mild-to-moderate bilateral foraminal\nnarrowing.\n\nAt C4-C5 level there is mild central canal narrowing. Mild left,\nmild-to-moderate right foraminal narrowing.\n\nAt C5-C6 level there is moderate central canal narrowing. Mild flattening of\nthe ventral cord. Incomplete effacement of CSF about cord. Patent left\nforamen. Mild right foraminal narrowing.\n\nAt C6-C7 level there is moderate central canal narrowing, preserved CSF about\ncord, minimal ventral cord effacement. Mild-to-moderate bilateral foraminal\nnarrowing.\n\nAt C7-T1 level central canal is patent mild left foraminal narrowing. Patent\nright foramen.", "output": "1. Degenerative changes cervical spine.\n2. Moderate central canal narrowing C5-C6, C6-C7 levels.\n3. Foraminal narrowing, as above." }, { "input": "Cervical alignment is anatomic. Vertebral body and intervertebral disc signal\nintensity appear normal.\n\nC2-C3: No significant spinal canal or foraminal narrowing.\nC3-C4: A disc bulge is seen with mild bilateral uncovertebral and facet\narthropathy. There is no significant spinal canal narrowing. There is mild\nleft foraminal narrowing.\nC4-C5: Mild right-sided uncovertebral arthropathy is seen causing mild right\nforaminal narrowing. There is no significant spinal canal or left foraminal\nnarrowing.\nC5-C6: A large central disc protrusion is seen, distorting the ventral cord\nand causing moderate spinal canal narrowing. There is normal signal intensity\nof the cord. Bilateral uncovertebral arthropathy is seen with mild left\nforaminal narrowing.\nC6-C7: A disc bulge is seen with a right paracentral disc protrusion. There\nis mild spinal canal narrowing without foraminal narrowing.\nC7-T1: No significant spinal canal or foraminal narrowing.\n\nVisualized prevertebral and paraspinal soft tissues are within expected\nlimits.", "output": "1. Large central disc protrusion at C5-6 distorts the ventral cord and causes\nmoderate spinal canal narrowing. Given the normal signal intensity of the\ncord, this may represent a chronic process.\n2. Moderate cervical spondylosis, worst at C5-6 and C6-7, as above, without\nhigh-grade neural foraminal narrowing." }, { "input": "The vertebral body height and alignment is maintained. The bone marrow has a\nnormal signal intensity. Intervertebral discs are normal in height. There is\ndisc desiccation at L4-5, new from prior MRI on ___. Discs are\notherwise normal in signal.\n\nT12-L1: There is no spinal canal or foraminal stenosis.\n\nL1-L2: There is no spinal canal or foraminal stenosis.\n\nL2-L3: There is no spinal canal or foraminal stenosis.\n\nL3-L4: There is a mild disc bulge, unchanged. There is no spinal canal or\nforaminal stenosis.\n\nL4-L5: There is a disc bulge with a new annular tear compared to the prior\nMRI. There is new disc desiccation. There are bilateral facet joint effusions,\nincreased from prior MRI. There is a right facet joint synovial cyst extending\ninto the spinal canal in causing right lateral recess stenosis. This cyst\ncurrently measures 9 x 4 mm, increased from 4 x 4 mm on ___. There\nis no significant foraminal stenosis.\n\nL5-S1: Facet arthropathy is unchanged. There is no spinal canal or foraminal\nstenosis.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1. The posterior elements and\nparaspinal soft tissues are normal.\nThere is an incompletely imaged T2 hyperintensity within the pelvis. This may\ncorrespond to ovarian cysts demonstrated on CT from ___ and\nultrasound from ___.", "output": "1. Degenerative disc disease and facet arthropathy, progressive at L4-5\ncompared to prior MRI from ___. Interval enlargement of the right L4-5 facet\njoint cyst, now measuring 9 mm from 4 mm and causing right lateral recess\nstenosis.\n2. Incompletely imaged cystic structure within the pelvis, possibly\ncorresponding to an ovarian cyst demonstrated on prior CT and ultrasound." }, { "input": "For the purposes of numbering, the lowest well-formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThe vertebral body height and alignment within the lumbar spine are normal.\nThe bone marrow signal of the lumbar spine is mildly heterogenous.\n\nThe conus medullaris is normal in signal and morphology and terminates at the\nT12-L1 level, as seen on sagittal imaging.\n\nAt the L3-L4 level, there is bilateral facet arthropathy. The spinal canal and\nneural foramina appear normal.\n\nAt the L4-L5 level, there is a diffuse disc bulge, ligamentum flavum\nthickening, bilateral facet arthropathy, and bilateral facet joint effusions\nalthough the spinal canal appears normal. There is mild bilateral neural\nforaminal narrowing. There is a synovial cyst arising from the right L4-L5\nfacet joint, which contacts the traversing right L5 nerve root, and is\nunchanged from prior exam.\n\nAt the L5-S1 level, there is a diffuse disc bulge, tiny superimposed posterior\ndisc protrusion, and bilateral facet arthropathy without significant spinal\ncanal or neural foraminal narrowing.\n\n Within the limits of this noncontrast study there is no paravertebral mass\nidentified and there is no evidence of infection or neoplasm. The visualized\nportion of the sacroiliac joints are preserved.", "output": "1. Spondylosis of the lower lumbar spine as described.\n2. Right L4-L5 facet synovial cyst which contacts the traversing right L5\nnerve root and appears unchanged when compared to prior exam." }, { "input": "THORACIC:\n2 mm anterolisthesis of C7 on T1, T1 on T2 and T8 on T9 is unchanged, likely\ndegenerative. Alignment is otherwise preserved.Vertebral body heights are\npreserved. There is no evidence of fracture. There is no evidence of\nligamentous injury. Schmorl's nodes are noted at multiple levels. \nCircumscribed T2 hyperintense lesions within the anterior aspects of the T6\nand T8 vertebral bodies are T1 hypointense, and demonstrate subtle internal\ntrabeculation pattern, also seen on prior CT, most likely representing\natypical hemangioma. No other focal bone marrow lesions are identified.\n\nThere is loss of T2 signal and height of multiple intervertebral discs, a\nmanifestation of degenerative disc disease. There is up to moderate disc\nheight loss at T3-T4 and T4-T5.\n*** SERIES 6, IMAGE 1 DEMONSTRATES HYPOINTENSE MATERIAL POSTERIOR TO THE C7\nBODY . THIS MAY BE A DISC FRAGMENT FROM AT C6-7 OR THICKENING OF THE\nPOSTERIOR LONGITUDINAL LIGAMENT. IT SLIGHTLY FLATTENS THE ANTERIOR SURFACE OF\nTHE SPINAL CORD.\nALTHOUGH I SEEM DISC BULGES AT ALL LEVELS THROUGHOUT THE THORACIC SPINE, I DO\nNOT SEE EVIDENCE OF DISC PROTRUSIONS AT OTHER LEVELS.\n\n The spinal cord appears normal in caliber and configuration. There is no\ndefinite epidural collection.\n\nDisc bulges and protrusions are seen throughout the thoracic spine, indenting\nthe ventral thecal sac without significant spinal canal narrowing, or cord\ncontact. Facet osteophytes are present at multiple levels, producing up mild\nneural foraminal narrowing multiple levels. There is no high-grade neural\nforaminal narrowing. There is otherwise no evidence of infection or neoplasm.\n\nLUMBAR:\nGrade 1 retrolisthesis of L1 on L2, L2 on L3, and L3 on L4 is mildly\nprogressed since ___, likely degenerative, no definite pars defects are seen.\nAlignment is otherwise preserved.Vertebral body heights are preserved. There\nis no evidence of fracture. There is no evidence of ligamentous injury. T2\nhyperintense lesions with a rim of T1 hyperintensity in the L1 and L2\nvertebral bodies likely represent atypical hemangiomas. There are type 1/\ntype ___ ___ endplate degenerative changes at L1-L2 and type ___ ___ endplate\ndegenerative changes at L5-S1. No other focal bone marrow lesion is seen.\n\nThe terminal spinal cord appears normal in caliber and configuration. There\nis some clumping and thickening of the nerve roots inferiorly, which may\nrepresent arachnoiditis (8:9).\n\n*** I THINK THE NERVE ROOTS ARE CLUMPED DUE TO THE SPINAL STENOSIS AT L3-4,\nRATHER THAN DUE TO ARACHNOIDITIS. ***\n\nThe conus medullaris terminates at the L1 level. There is otherwise no\nevidence of infection or neoplasm. There is no definite epidural collection.\n\nAt T12-L1, mild disc bulge indents the ventral thecal sac without significant\nspinal canal or neural foraminal narrowing.\n\nAt L1-L2, disc bulge, endplate osteophytes and ligamentum flavum thickening\nmildly narrow the spinal canal. The neural foramina are patent.\n\nAt L2-L3, disc bulge, endplate osteophytes, retrolisthesis and superimposed\nprotrusion to the left of midline extending inferiorly along with ligamentum\nflavum thickening produces moderate spinal canal narrowing. There is\neffacement of the subarticular zones with possible compression of the\ntraversing L3 nerve roots against the facets (09:17). Facet and endplate\nosteophytes produce severe bilateral neural foraminal narrowing.\n\n*** I DO NOT SEE ANYTHING FOCAL ENOUGH TO CALL A DISC PROTRUSION AT THIS\nLEVEL. I AGREE THERE IS COMPRESSION OF THE TRAVERSING NERVE ROOTS AT THE\nLEVEL OF THE INTERSPACE. THE TERM SUBARTICULAR ZONE IS DISCOURAGED BY THE\nCONSENSUS NOMENCLATURE BECAUSE IT IS SO VAGUELY DEFINED\n\nAt L3-L4, disc bulge, endplate and facet osteophytes and ligamentum flavum\nthickening produce severe spinal canal narrowing with impingement of the\ntraversing cauda equina nerve roots and loss of the surrounding CSF (09:23).\n\n*** THIS HAS PROGRESSED SINCE THE STUDY OF ___. ***There is\nredundancy of the cauda equina nerve roots inferiorly. There is severe\nbilateral neural foraminal narrowing with impingement of the exiting nerve\nroots.\n\nAt L4-L5, disc bulge, endplate osteophytes and ligamentum flavum thickening\nproduce moderate spinal canal narrowing. Disc bulge COMPRESS THOSE THE\nBILATERAL TRAVERSING L5 NERVE ROOTS AGAINST THE SUPERIOR FACET OSTEOPHYTES. \nFacet and endplate osteophytes produce severe left and moderate right neural\nforaminal narrowing.\n\nAt L5-S1, disc protrusion and endplate osteophytes indent the ventral thecal\nsac without significant spinal canal narrowing. Facet and endplate\nosteophytes and foraminal component of disc bulge produce severe bilateral\nneural foraminal narrowing with impingement of the exiting nerve roots.\n\nOverall lumbar degenerative changes have significantly progressed since ___.\n\nOTHER: There are trace bilateral pleural effusions. Scattered renal T2\nhyperintense lesions most likely represent cysts.", "output": "1. No fracture or ligamentous injury.\n2. No EVIDENCE OF epidural collection. .\n3. Severe multilevel lumbar spondylosis, progressed since ___, most\nnotable for severe spinal canal STENOSIS at L3-L4 with compression of the\ntraversing cauda equina nerve roots.\n4. Possible compression of the traversing bilateral L3 nerve roots, and severe\nneural foraminal narrowing at the bilateral L3-L4, left L4-L5 and bilateral\nL5-S1 levels with compression of the exiting nerve roots.\n5. Mild thoracic spondylosis, as described, without significant spinal canal\nnarrowing or high-grade neural foraminal narrowing.\n6. Circumscribed T2 hyperintense bony lesions at T6, T8, L1 and L2 most likely\nrepresenting atypical hemangioma.\n7. Multiple levels of spondylolisthesis, as described, mildly progressed since\n___." }, { "input": "Limited examination due to patient motion, the images were obtained in right\nlateral side position due to extreme low back pain. In comparison with the\nmost recent examination (CT of the chest dated ___, there is a\nnew compression fracture identified at the superior endplate of L1 with\nunderlying bone edema throughout the vertebral body and mild soft tissue\nswelling with no evidence of retropulsion or spinal canal stenosis. The conus\nmedullaris appears unremarkable, prior compression deformity at T11 remains\nunchanged.\n\nT11-T12 level, there is disc desiccation and unchanged posterior spondylosis\nand mild disc bulge causing mild anterior thecal sac deformity\n\nAt T12-L1 level, there is no evidence of neural foraminal narrowing spinal\ncanal stenosis.\n\nAt L1/L2 level, there is disc desiccation and minimal diffuse disc bulge with\nno evidence of neural foraminal narrowing or spinal canal stenosis.\n\nAt L2/L3 level there is disc desiccation and diffuse disc bulge causing\nminimal anterior thecal sac deformity with no evidence of nerve root\ncompression or spinal canal stenosis.\n\nL3-L4 level, there is mild diffuse disc bulge, causing minimal bilateral\nneural foraminal narrowing, there is no evidence of spinal canal stenosis.\n\nAt L4-5 level, there is disc desiccation and minimal disc bulge with no\nevidence of neural foraminal narrowing or spinal canal stenosis.\n\nL5-S1 level remains unchanged with no evidence of neural foraminal narrowing\nor spinal canal stenosis. Heterogeneous signal in the bone marrow at multiple\nlevels is consistent with bone marrow replacement for fat and non expansile\nhemangiomas including a hemangioma in the anterior aspect of S1 on the right.\n\nThe sacrum is partially evaluated due to patient motion, however grossly there\nis no evidence of fracture, the coccyx is not included in the field of view of\nthis exam, please consider obtaining a dedicated MRI of the sacrum if\nclinically warranted.", "output": "1. New compression fracture identified at the superior endplate of L1 with\nbone edema, there is no evidence of retropulsion or spinal canal stenosis at\nthis level.\n\n2. No focal changes are identified in the conus medullaris and the lower\naspect of the thoracic spinal cord appears unremarkable.\n\n3. Relatively stable multilevel degenerative changes throughout the lumbar\nspine, and unchanged compression fracture at T11 vertebral body.\n\n4. High-signal on the T1 sequence at the different vertebral bodies in the\nlumbar spine and S1 level suggest focal fat deposit versus non expansile\nhemangiomas.\n\n5. No sacral fractures are identified in this exam, however the examination\nis limited due to patient motion, the coccyx is not visualized in this exam,\nplease considering obtaining dedicated MRI of the lumbar spine if clinically\nwarranted.\n\nNOTIFICATION: The findings were discussed ___ M.D. by\n___, M.D. on the telephone on ___ at 3:59 pm, 5 minutes after\ndiscovery of the findings.\n\nRECOMMENDATION(S): The coccyx is not visualized in this exam, please consider\na dedicated MRI of the sacrum and coccyx if clinically warranted." }, { "input": "There is scoliosis of lumbar spine convex to the right in the lower lumbar and\nto the left in the upper lumbar region.\n\nFrom T10-T11 through L1-2 levels mild degenerative disc disease seen.\n\nAt L2-3 level disc and facet degenerative changes result in minimal spinal\ncanal narrowing and mild narrowing of the right foramen.\n\nAt L3-4 level disc bulging and facet degenerative changes and thickening of\nthe ligaments result in mild spinal stenosis and moderate right and mild left\nforaminal narrowing.\n\nAt L4-5 level, disc and facet degenerative changes result in severe spinal\nstenosis as seen on the previous study with moderate bilateral foraminal\nnarrowing.\n\nAt L5-S1 level disc bulging is seen with moderate to severe left and mild\nright foraminal narrowing without spinal stenosis unchanged from the previous\nstudy.\n\nThere is no compression fracture or marrow edema.\n\nThe distal spinal cord shows normal signal intensities. The paraspinal soft\ntissues are unremarkable.", "output": "1. Overall minimal change since the previous MRI of ___.\n2. Severe spinal stenosis at L4-5 level due to disc and facet degenerative\nchanges and mild spinal stenosis at L3-4 level as before.\n3. Moderate-to-severe left foraminal narrowing at L5-S1 level with other\nforaminal changes as above also unchanged." }, { "input": "Study is moderately degraded by motion. Within this confine:\n\nCERVICAL, THORACIC, AND LUMBAR:\nVertebral body alignment is preserved.There is no definite focal marrow signal\nabnormality.\n\nA central syrinx is seen spanning C6-T8, measuring up to 1 mm maximal width. \nOtherwise, the visualized portion of the spinal cord is preserved in signal\nand caliber. Subtle subcentimeter enhancement is seen involving the cord at\nT5 (16:10, 19:21).\n\nA central disc protrusion is seen at C4-5.\n\nBilateral uncovertebral osteophytes are seen at C5-6 and C6-7.\n\nThere is moderate right foraminal narrowing at C5-6 and moderate left\nforaminal narrowing at C6-7.\n\nDisc bulges and bilateral facet osteophytes are seen at L2-3, L3-4, L4-5 and\nL5-S1, resulting in mild right foraminal narrowing at L3-4 and L4-5 and\nmild-to-moderate left foraminal narrowing at L3-4 and L4-5.\n\nOtherwise, no moderate or severe spinal canal or foraminal narrowing is seen.\n\nOTHER:\nVolume loss is seen involving the inferior right medial cerebellum, in the\nposterior inferior cerebellar artery distribution. There is no paravertebral\nor paraspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. Small central syrinx versus central canal prominence spanning C6-T8,\nmeasuring up to 1 mm in maximal width.\n3. Subtle subcentimeter enhancement involving the cord at T5, concerning for\nleptomeningeal enhancement secondary to metastatic disease.\n4. Within limits of study, no definite evidence of enhancing paravertebral,\nparaspinal or osseous mass.\n5. Degenerative changes of the cervical and lumbar spine, as above.\n6. Volume loss involving the right ___ artery distribution." }, { "input": "The patient is status post bilateral laminectomies of T10-L1 and resection of\nan extra medullary mass at T11-T12. There is no intra or extramedullary mass.\nThe enhancing soft tissue in the post laminectomy bed does not enter the\nspinal canal and represents granulation tissue, is unchanged from the prior\nexamination.\n\nThe alignment of the thoracic spine is normal. The bone marrow in the\nthoracic spine is heterogeneous, related to focal fatty marrow deposition. A\n1.6 x 3.3 x 1.1 cm focal area of T1 hypointense, T2/IDEAL hyperintense,\nenhancing signal in the anterior and superior endplate of the L1 vertebral\nbody has increased in size dating back to ___ and likely\nrepresent progressive degenerative type ___ ___ changes. Heterogeneous signal\nat the endplates of L1-L2 likely represent mixed degenerate type 1 and type 2\n___ changes. The height of the vertebral bodies are maintained. The\nintervertebral discs are diffusely desiccated. The spinal cord is normal in\nsignal and caliber. There are small disc bulges at T5-T6, T6-T7, T7-T8, and\nT12-L1 without spinal canal or neural foraminal stenosis.\n\nThe left kidney is slightly atrophic in size relative to the right kidney,\nunchanged from the prior examination. Both kidneys contain multiple small,\nround, T1 hypointense, T2 hyperintense, nonenhancing lesions, the largest\nmeasuring 1.0 cm in the left upper pole and likely represent cysts.\n\nA 6 mm T2 hyperintense lesion in the right hepatic lobe is too small to\ncharacterize.", "output": "Postsurgical changes in the thoracic spine with no evidence of residual or\nrecurrent neoplasm." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Again, there is\ndiffuse heterogeneity of the bone marrow, related to fatty replacement without\nsuspicious focal lesion. There are ___ type 1 endplate changes at T12-L1\nand ___ type ___ endplate changes at L1-L2. There are postsurgical changes\nfrom T10 through L1 laminectomy. Subtle areas of enhancement within the\nlaminectomy bed are unchanged, representing granulation tissue and do not\nextend to the spinal canal.\n\nThere is subtle loss of T2 signal of numerous thoracic intervertebral discs, a\nmanifestation of degenerative disc disease. The intervertebral disc heights\nare otherwise relatively well-preserved.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nabnormal focus of post gadolinium enhancement. There is no evidence of\ninfection or neoplasm.\n\nThere is a mild posterior disc bulge at T12-L1 with a right paracentral\nannular fissure (16:12). There is no significant spinal canal or neural\nforaminal narrowing.\n\nSeveral bilateral T2 hyperintense nonenhancing lesions in the kidneys measure\nup to 10 mm in the left upper pole kidney, and likely represent cysts. There\nis mild dependent atelectasis in the right lung base.", "output": "1. Postsurgical changes from T10 through L1 laminectomy without evidence of\nresidual or recurrent neoplasm.\n2. Mild thoracic spondylosis as described, notable for a T12-L1 posterior disc\nbulge with right paracentral annular fissure.\n3. No significant spinal canal or neural foraminal narrowing.\n4. No thoracic spinal cord signal abnormality." }, { "input": "Patient is status post bilateral C1 laminectomies and instrumented posterior\nfusion of C1-C2. The hardware is not assessed by MRI. There is associated\nsusceptibility artifact which limits the diagnostic utility of axial gradient\necho images.\n\nThere is enhancing tissue in the anterior aspect of the atlantoaxial joint\nwhich may represent synovial proliferation or phlegmon, given the known septic\njoint. This is similar to the prior MRI.\n\nThere is a rim enhancing fluid collection contiguous with the posterior\nsynovial space of the atlantoaxial joint, larger on the left where it measures\n2.9 SI x 1.6 AP cm on image 16:7. The fluid collection has decreased in size\nsince the prior MRI and. Previously noted cord compression has resolved. There\nis minimal residual deformity of the left ventral cord at the level of C1. The\nspinal cord maintains normal signal intensity. The fluid collection extending\nsuperiorly to the clivus, better seen on the concurrent brain MRI. Thin\nventral epidural contrast enhancement without fluid extends inferiorly to the\nlevel of C3-C4. There is also abnormal contrast enhancement along the tip of\nthe dens in the region of the apical ligament and anterior to the dens.\n\nThere is new high T2 signal in the dens which may represent reactive bone\nmarrow edema or osteomyelitis .\n\nThe vertebral body heights are preserved. Again noted is minimal\nretrolisthesis of C6 on C7. Bone marrow is diffusely heterogeneous without\nfocal suspicious signal abnormality. There is diffuse disk desiccation, with\ncomplete loss of disc height at C3-C4. Degenerative disease from C3 through\nC6 7 was described in detail in the prior MRI report.", "output": "1. Fluid collection with peripheral enhancement contiguous with the posterior\nsynovial space of the atlantoaxial joint, concerning for an abscess, is\nsimilar in size or slightly larger compared to ___, larger on the\nleft. It extends from superiorly along the clivus, as described in the\nconcurrent brain MRI report. However, mass effect on the spinal cord has\nmarkedly decreased due to interim C1 laminectomies.\n2. Abnormal enhancement is also noted along the tip of the dens in the region\nof the apical ligament, anterior to the dens, and in the ventral epidural\nspace extending inferiorly to C3-4, suggesting phlegmon.\n3. New bone marrow edema within dens may be reactive in the setting of septic\natlantoaxial joint, or it may represent osteomyelitis.\nThe findings were discussed by Dr. ___ with Dr. ___ telephone on\n___ at 11:34 AM." }, { "input": "Again seen are postsurgical changes of bilateral C1 laminectomies and\ninstrumented posterior fusion of C1-C2. There is a small are rim enhancing\nfluid collection at the atlantoaxial joint, posterior to the synovial space,\nwhich measures approximately 15 mm TR x 12 mm SI x 7 mm AP. This is improved\nin size compared to prior study of ___, when it measured 29 mm SI x\n16 mm AP. There is enhancing tissue in the anterior aspect of the atlantoaxial\njoint which may represent synovial proliferation or phlegmon and is unchanged\ncompared to prior study. There is also enhancing tissue extending along the\nposterior aspect of the clivus and anterior to the brainstem, without evidence\nof rim enhancement of the visualized posterior fossa components. Enhancing\ntissue is again seen along the tip of the dens, in the region of the apical\nligament and anterior to the dens.\n\nAs described before, there is a T2/STIR signal hyperintensity in the dens, not\nsignificantly changed from prior study, which may represent reactive bone\nmarrow edema although osteomyelitis cannot be excluded. There is no other\nevidence of to suggest bone marrow edema. There is STIR hyperintensity along\nthe soft tissues posterior to the C1 laminectomy site, as well as enhancement,\nmost likely related to postsurgical changes. No definite enhancement fluid\ncollection is identified within the paraspinal soft tissues.\n\nThere is no evidence of cord compression, new focus of enhancement or epidural\ncollection.\n\nOtherwise, there are stable moderate to severe degenerative changes of the\ncervical spine with straightening of the normal cervical lordosis and mild\nreversal centered at C3-C4. Intervertebral disc space height loss is seen\nthroughout the cervical spine, particularly at C3-C4 where there is complete\nloss of disc space.\n\nThere is diffuse intervertebral disk desiccation with disc bulges,\nparticularly at C3-C4, C5-C6 and C6-C7, with an asymmetric disc bulge,\nuncovertebral osteophytes and facet arthropathy at C5-C6 contributing to\nbilateral moderate to severe neural foraminal narrowing and mild to moderate\nspinal canal narrowing with mild remodeling of the left anterolateral cord.\n\nEndplate osteophytes, facet arthropathy and ligamentum flavum thickening are\nseen are multiple levels, with uncovertebral osteophytes and facet arthropathy\ncontributing to moderate to severe neural foraminal narrowing at left C3-C4\nand bilateral C6-C7. There is also mild to moderate spinal canal narrowing at\nC6-C7.", "output": "1. Postsurgical changes of bilateral C1 laminectomies and fusion at C1-C2 with\ninterval decrease in size of the enhancing fluid collection at the\natlantoaxial joint, posterior to synovial space, compared to prior study of ___. Enhancing tissue extends along the clivus, as well as anteriorly\nin the atlantoaxial joint and the anterior to the dens, without other definite\nenhancing the collection identified. No evidence of cord compression. No new\nenhancing fluid collection or abscess is identified. Enhancement and cisterns\nappear prominent secondary to resolution of fluid. No new enhancement is seen.\n\n2. Stable bone marrow edema at the dens, may represent reactive changes\nalthough osteomyelitis cannot be excluded. This finding is stable compared to\n___.\n\n3. Otherwise, unchanged moderate to severe degenerative changes of the\ncervical spine with mild to moderate spinal canal narrowing at C5-C6 and C6-C7\nand multilevel neural foraminal narrowing which is severe at the left C3-C4,\nand bilateral C5-C6 and C6-C7." }, { "input": "Axial T2 sequences are mildly to moderately motion degraded. Within these\nconfines:\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. No\nfocal suspicious marrow lesion. Mild degenerative changes do not\nsignificantly narrow the spinal canal or neural foramina. There is no cord\ncompression.\n\nNot seen on examination of ___ is a 9 mm long segment of T1 central cord\nsignal measuring approximately 1-2 mm in greatest diameter (series 4, image\n10), although not definitively confirmed on axial sequences which may\nrepresent syringohydromyelia/prominent central canal, of uncertain clinical\nsignificance.\n\nLUMBAR:\nLumbar alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Degenerative loss of disc height and signal is mild\nat L5-S1. The conus medullaris terminates at the L2 level, within expected\nlimits. There is no definitive signal abnormality of the terminal cord.\n\nL1-L2 through L4-L5: No significant spinal canal or neural foraminal\nnarrowing.\n\nL5-S1: A right eccentric disc bulge crowds the right greater than left\nsubarticular zone contacting but not definitively displacing the traversing\nright S1 nerve root (series 13, image 36). In conjunction with facet\narthropathy, there is mild bilateral neural foraminal narrowing.\n\nT2 hyperintense cystic lesions in the left kidney measuring up to 1 cm are\nstatistically most likely simple cysts. The liver demonstrates nodular\ncontour compatible with cirrhosis. The spleen is enlarged. Ascites is\nidentified.", "output": "1. There is no high-grade spinal canal or neural foraminal narrowing of the\nthoracic or lumbar spine. No compression of the cord or cauda equina.\n2. Degenerative changes are most prominent at L5-S1 where a right eccentric\ndisc bulge crowds the right greater than left subarticular zone contacting but\nnot posteriorly displacing the traversing right S1 nerve root.\n3. There is 9 mm long segment of T2 hyperintense central cord signal at the T1\nlevel on sagittal sequences, not seen on prior examinations and not confirmed\non motion degraded axial sequences. This could represent syringohydromyelia\nor prominent central canal of uncertain clinical significance. This could be\nfurther evaluated with contrast enhanced study.\n4. Additional findings described above including sequela of known cirrhosis.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:31 am, 30 minutes after\ndiscovery of the findings." }, { "input": "There is minimal retrolisthesis of L3 on L4. The vertebral body heights and\nalignment are otherwise normal. The bone marrow signal of the lumbar spine\nappears unremarkable. There is multilevel loss of disc height and signal\ncompatible with degenerative disc disease, increased when compared to prior\nexam.\n\nThe conus medullaris is normal in position and morphology and terminates at\nthe T12-L1 level.\n\nThe paraspinal and prevertebral soft tissues appear unremarkable.\n\nAt the T11-T12 level, the spinal canal and neural foramina appear normal.\n\nAt the T12-L1 level, the spinal canal and neural foramina appear normal.\n\nAt the L1-L2 level, the spinal canal and neural foramina appear normal.\n\nAt the L2-L3 level, there are bilateral facet osteophytes, ligamentum flavum\nthickening, a diffuse disc bulge and right foraminal disc protrusion causing\nnarrowing of the right aspect of the spinal canal, likely compressing the\ntraversing L3 nerve root between disc material and superior facet osteophyte. \nAdditionally, the disc bulge contacts the traversing left L3 nerve root. \nThere is also mild bilateral neural foraminal narrowing.\n\nAt the L3-L4 level, there are bilateral facet osteophytes, ligamentum flavum\nthickening, and a diffuse disc bulge causing mild spinal canal narrowing,\ncontact of the traversing L4 nerve roots between disc bulge and facet\nosteophytes, as well as moderate bilateral neural foraminal narrowing without\ndeformity of the nerve roots.\n\nAt the L4-L5 level, there are bilateral facet osteophytes, ligamentum flavum\nthickening, and a diffuse disc bulge, with superimposed posterior disc\nprotrusion causing moderate to severe spinal canal narrowing with compression\nof the traversing L5 nerve roots between disc material and superior facet\nosteophytes, as well as moderate left and moderate to severe right neural\nforaminal narrowing with deformity the exiting right L4 nerve root.\n\nAt the L5-S1 level, there are bilateral facet osteophytes, ligamentum flavum\nthickening, diffuse disc bulge, and posterior disc protrusion, greater along\nthe left aspect of the spinal canal, extending toward the neural foramen and\ncompressing the traversing left S1 nerve root between disc material and\nsuperior facet osteophytes, as well as mild right and moderate left neural\nforaminal narrowing with contact of the exiting left L5 nerve root.", "output": "1. Lumbar spondylosis, greatest at the L4-L5 level where degenerative disc\ndisease and facet osteophytes cause spinal canal narrowing, likely affecting\nthe traversing nerve roots in the spinal canal as well as the exiting right L4\nnerve root within the neural foramen.\n2. Additional multilevel degenerative disc disease causing mild and moderate\nspinal canal and neural foraminal stenoses, as described above." }, { "input": "1-2 mm retrolisthesis of L3 on L4 and 1-2 mm anterolisthesis of L4 on L5 is\nunchanged from prior examination. Otherwise, lumbar alignment is anatomic. \nVertebral body heights are preserved. There is interval increased ___ type\n1 L4-L5 and L5-S1 endplate changes when compared to the prior examination. \nDegenerative loss of disc height and signal is severe at L4-L5, minimally\nprogressed from prior examination. Moderate loss of L2-L3, L3-L4 and L5-S1\ndisc height is overall similar to prior exam. The conus medullaris terminates\nat T12-L1 level, within expected limits. There is no signal abnormality of\nthe terminal cord.\n\nT12-L1: Unremarkable.\n\nL1-L2: Small disc bulge does not significantly narrow the spinal canal. In\ncombination with facet arthropathy there is mild left and no significant right\nneural foraminal narrowing.\n\nL2-L3: A bilobed disc bulge greater on the right results in mild spinal canal\nnarrowing. The disc contacts the traversing right L3 nerve root in the\nsubarticular zone with mild posterior displacement (series 5, image 16,\nsimilar to prior examination. In combination with facet arthropathy there is\nmild right greater than left neural foraminal narrowing.\n\nL3-L4: A disc bulge and thickening little flavum results in mild spinal canal\nnarrowing. In combination with facet arthropathy there is mild bilateral\nneural foraminal narrowing, unchanged from prior exam.\n\nL4-L5: A disc bulge and thickening ligamentum flavum results in moderate\nspinal canal narrowing with crowding of the bilateral subarticular zones. In\ncombination with facet arthropathy, there is moderate right and mild left\nneural foraminal narrowing, overall similar to prior examination.\n\nL5-S1: A left eccentric disc inferiorly migrating extrusion posteriorly\ndisplaces the left traversing S1 nerve root (series 5, image 35), similar to\nprior examination. In combination with facet arthropathy there is moderate to\nsevere left and no significant right neural foraminal narrowing.\n\nA left renal mid pole T2 hyperintense 7 mm cystic lesion is statistically most\nlikely a simple cyst. The visualized prevertebral and paraspinal soft tissues\nare wise unremarkable.", "output": "1. Interval mild increased loss of L4-L5 disc space with increased endplate\n___ 1 changes.\n2. Multilevel lumbar spondylosis, most prominent at L2-L3 where a disc bulge\nposteriorly displaces the right L3 nerve root, at L4-L5 where there is\nmoderate spinal canal narrowing with moderate right neural foraminal narrowing\nand at L5-S1 where a left eccentric disc extrusion displaces the left\ntraversing S1 nerve root with moderate to severe left neural foraminal\nnarrowing. These findings are overall similar to examination of ___.\n3. Additional findings as described above." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL SPINE:\nThere is normal cervical alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. The intervertebral discs demonstrate\nnormal signal and height. There small central disc protrusions at C4-C5,\nC5-C6, and C6-C7 causing mild spinal canal narrowing without significant\nneural foraminal stenosis. There is a right C7-T1 foraminal perineural cyst\n(11:33). The cervical cord demonstrates normal signal morphology. The\nparavertebral soft tissues are unremarkable.\n\nOn axial T1 postcontrast imaging there is heterogeneous T1 hyperintensity\nwithin the subarachnoid space, some which appears more focal such is in the\nright ventral thecal sac at the C2-C3 level (21:13), with focal enhancement\nmeasuring 3 mm. These areas of high signal are not seen on sagittal T1\npostcontrast or precontrast imaging.\n\nTHORACIC SPINE:\nThere is normal thoracic alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. There intervertebral discs demonstrate\nnormal signal height. There is no significant neural foramina or spinal canal\nstenosis. The thoracic cord demonstrates normal signal morphology. There is\nno abnormal postcontrast enhancement. The paravertebral soft tissues are\nunremarkable.\n\nOn axial T1 postcontrast imaging there is heterogeneous T1 hyperintensity\nwithin the subarachnoid space, some of which appears more focal such as at the\ndorsal left lateral aspect of the thoracic cord at the T8 level (08:34) where\nthere is nodular high signal measuring 4 mm. This is not seen on the sagittal\nT1 postcontrast ward noncontrast sequences.\n\nLUMBAR SPINE:\nThere is normal lumbar alignment. The vertebral body heights are preserved. \nThe marrow signal is unremarkable. The intervertebral disc spaces demonstrate\nnormal signal height. There is no significant neural foraminal or spinal\ncanal stenosis. The conus terminates appropriately at the mid L1 level. The\ncauda equina nerve roots demonstrate normal signal morphology. There is no\nabnormal postcontrast enhancement. Paravertebral soft tissues are\nunremarkable.", "output": "1. Study is moderately degraded by motion.\n2. Heterogeneous high signal on axial postcontrast imaging within the cervical\nand thoracic spine with more focal nodular high signal at the C2-C3 and T8\nlevels, as described with now all corresponding findings on sagittal\npostcontrast imaging. While findings may be artifactual in nature,\nsubarachnoid tumor seeding is not excluded on the basis of this examination. \nConsider correlation with CSF analysis and attention on followup imaging.\n3. Mild degenerative changes of the cervical spine." }, { "input": "Study is degraded by motion. Fat-suppressed imaging of the cervical and\nthoracic spine are specially degraded by motion. Within these confines:\n\nCervical vertebral body alignment is preserved. There is dextroscoliosis of\nthe cervical and lumbar spine. Vertebral body heights are preserved. \nSchmorl's nodes are seen at multiple levels throughout the cervical, thoracic,\nand lumbar spine. There is no prevertebral soft tissue swelling.\n\nType ___ ___ changes seen at multiple levels throughout the spine. L1\nvertebral body T2 and STIR hyperintense, T1 hypointense, partially enhancing\nmass with extension right pedicle and epidural enhancing soft tissue\ncontributing to approximately mild vertebral canal narrowing at T12-L1 is seen\n(see 8, 9, 10, 17:10). Multiple additional sacral T2 and STIR hyperintense,\nT1 hypointense, enhancing masses are seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Area of suggested epidural enhancement at C7-T1 level seen on series\n19, image 2 has no definite correlate on same imaging area on series 22:28,\nand is likely artifactual.\n\nThere is loss of intervertebral disc signal throughout the cervical spine. \nThere is loss of intervertebral disc height and signal at L3-4 through L5-S1. \nOtherwise, intervertebral disc heights and signalare grossly preserved.\nNonspecific facet joint fluid is noted at multiple levels of the lumbar spine.\n\nRight C2-3 facet joint probable synovial cyst is noted (see 11:13; 5:3).\n\nAt T12-L1 there is epidural enhancing mass with approximately 3 mm extension\ninto ventral thecal sac, with mild vertebral canaland no neural foraminal\nnarrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, with mild vertebral canal \nand moderate bilateral neural foraminal narrowing.\n\nOtherwise, there is multilevel degenerative changes of the cervical, thoracic,\nlumbar spine without definite evidence of moderate or severe vertebral canal\nor neural foraminal narrowing.\n\nOTHER:\nOn limited imaging the abdomen, nonenhancing approximately 9 mm cystic lesion\nalong the posterior tip of the spleen is noted (see 14, 21:5).", "output": "1. Study is degraded by motion.\n2. Enhancing metastatic lesions of L1 vertebral body and sacrum as described\ncompatible patient's history of lung cancer. Mass at L1 level contributes to\nmild vertebral canal narrowing at T12-L1. If clinically indicated, consider\ndedicated sacral MRI for further evaluation of metastatic disease.\n3. Multilevel lumbar spondylosis as described, most pronounced at L5-S1,\nwhere there is moderate bilateral neural foraminal narrowing.\n4. Otherwise, multilevel cervical, thoracic, and lumbar spondylosis as\ndescribed without definite evidence of moderate or severe vertebral canal or\nneural foraminal narrowing.\n5. Probable splenic cyst as described. If concern for splenic cystic\nmetastatic lesion, consider dedicated abdominal imaging for further\nevaluation.\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. The vertebral body heights and intervertebral disc\nspaces are preserved. There is loss of signal of the intervertebral discs on\nthe T2 weighted images, most prominent at L2-3, L3-4 and L5-S1. There are\n___ type 1 signal intensity changes of the inferior endplate of the L1\nvertebral body and at L3-4.\nImaging from T10 through L2 demonstrates no spinal canal or neural foraminal\ncompromise. There are prominent facet osteophytes at T12-L1 and L1-2.\n\nAt L2-3, there is a mild bulge of the disc that slightly encroaches on the\nspinal canal. Bilateral facet osteophytes are present but do not produce\nneural foraminal narrowing.\n\nAt L3-4 there is a broad bulge of the disc. On the right, this compresses the\ntraversing L4 nerve root against the superior facet. The bulge does not\nappear to contact the left L4 nerve root. Will the neural foramina appear\nnormal. There is an annular fissure of the disc adjacent to the right neural\nforamen touching the right L3 dorsal root ganglion. This is best seen on\nimage 31 of series 100 and series 5 of image 43\n\nAt L4-5, there is bulging of the disc, facet osteophytes and ligamentum flavum\nthickening. These produce minimal encroachment on the spinal canal. The disc\nbulges into the neural foramina, producing bilateral foraminal narrowing. \nThere is a right foraminal annular fissure adjacent to the exiting right L4\nnerve root without evidence of root compression.\n\nAt L5-S1 again seen are bilateral pars defects without spondylolisthesis. \nThere is no encroachment on the spinal canal or neural foramina.\n\n There is no evidence of infection or neoplasm.", "output": "Degenerative disease at multiple levels similar to the lumbar spine CT of\n___" }, { "input": "Axial images are limited by motion artifact.\n\nMild anterolisthesis at C3-4, C4-5, disruption of the anterior longitudinal\nligament at C7-T1, as well as discontinuity between the bridging anterior\nosteophytes at C5-6, are not significantly changed compared to the CT from ___. There is edema in the anterior C5-6 disc without disc space\nwidening. The anterior longitudinal ligament appears disrupted anterior to C5.\nThere is prevertebral edema from C3-4 through C7-T1. There is possible mild\nedema in the anterior aspect of the C5 vertebral body. There is no loss of\nvertebral body height. There is no evidence for an epidural hematoma. There is\nno evidence for posterior ligamentous complex edema.\n\nMild T2 superior endplate deformity is unchanged compared to ___.\nThere is minimal marrow edema along the T2 superior endplate.\n\nHigh T2 signal in the right pons suggests a chronic infarct, given the\npatient's age. Global volume loss is noted in the visualized portion of the\nbrain, likely age-related.\n\nThe craniocervical junction appears unremarkable.\n\nAt C2-3, ligamentum flavum thickening mildly indents the left posterior thecal\nsac without mass effect on the spinal cord. Bilateral neural foraminal\nnarrowing is present due to uncovertebral and facet osteophytes.\n\nAt C3-4, a central disc osteophyte complex minimally indents the ventral\nspinal cord. Neural foramina are suboptimally evaluated, but appear narrowed\nby uncovertebral and facet osteophytes on the preceding CT.\n\nAt C4-5, a disc osteophyte complex moderately narrows the spinal canal and\nabuts the spinal cord. There is no evidence for cord edema on sagittal images.\nAxial images are degraded by motion. Preceding CT demonstrates that the neural\nforamina are narrowed by uncovertebral and facet osteophytes.\n\nAt C5-6, a disc osteophyte complex mildly narrows the spinal canal. Neural\nforamina are narrowed by uncovertebral and facet osteophytes.\n\nAt C6-7, a disc osteophyte complex mildly narrows the spinal canal. Neural\nforamina are narrowed by uncovertebral and facet osteophytes.\n\nAt C7-T1, there is no significant spinal canal narrowing. Neural foramina are\nnarrowed by uncovertebral and facet osteophytes.\n\nAt T1-2 and T2-3, there are small disc bulges without significant spinal canal\nnarrowing.\n\nAt T3-4, there is a disc bulge and a right paracentral disc osteophyte\ncomplex, incompletely evaluated in the absence of axial images through this\nlevel.\n\nAt T4-5, a small disc bulge is noted without spinal canal narrowing.", "output": "1. Disruption of the anterior longitudinal ligament at C5 and edema in the\nanterior aspect of C5-6 disc, as well as mild prevertebral edema in the\ncervical spine, indicating acute ligamentous and disc injury.\n2. Possible mild bone marrow edema in the anterior aspect of C5 vertebral body\nwithout loss of height or evidence for acute fracture on the preceding CT,\nsuggesting possible contusion.\n3. Chronic mild T2 superior endplate deformity with mild bone marrow edema.\n4. Unchanged mild anterolisthesis at C3-4,, C4-5, and C7-T1.\n5. Multilevel degenerative disease. Moderate spinal canal stenosis with spinal\ncord abutment at C4-5, without evidence for cord edema." }, { "input": "There are 12 rib-bearing vertebrae. Again seen is mild anterior wedging of T7\nvertebral body, and mild T8 and T9 vertebral body loss of height, without\nmarrow edema. There is no subluxation. No suspicious bone marrow signal\nabnormalities are seen.\n\nThere is no spinal canal narrowing.\n\nThere is fluid within bilateral T5-T6 facet joints without significant neural\nforaminal narrowing.\n\nThere is T8-T9 facet arthropathy with fluid in the left facet joint, and\nmoderate left neural foraminal narrowing.\n\nThere is mild T9-T10 facet arthropathy, right greater than left, with mild\nright neural foraminal narrowing.\n\nThere is mild T11-T12 facet arthropathy without significant neural foraminal\nnarrowing.\n\nThere is no edema in the soft tissues along the thoracic facet joints.\n\nThere is T2 hyperintensity in the gray matter of the spinal cord from T7-T8\nlevel through the conus medullaris, which terminates at T12-L1. \nDiffusion-weighted images through the lower thoracic spinal cord are distorted\nby artifacts, likely from the aortic endograft, limiting evaluation for acute\ninfarction. However, the pattern of signal abnormality in the setting of the\nknown aortic abnormality is concerning for infarction.\n\nAdditional faint T2 hyperintensity versus artifact is seen in the of the\nspinal cord at the level of T2-T3 on axial images only, image 13:12.\n\nAgain seen are small pleural effusions, heterogenous in attenuation on the\nleft. Airspace opacity in the left lower lobe adjacent to the aorta appears\nincreased compared to ___ CT. The patient is intubated. Large\nright hepatic cyst is again partially visualized.", "output": "1. T2 hyperintensity in the gray matter of the spinal cord from T7-T8 level\nthrough the conus medullaris, which in the setting of the known aortic\nabnormality is concerning for infarction. Diffusion-weighted images through\nthe lower thoracic cord are distorted by artifacts, likely secondary to the\naortic endograft.\n2. Questionable additional focus of signal abnormality in the gray matter of\nthe spinal cord at the level of T2-T3 on axial images only, which may also\nrepresent infarction, versus artifact.\n3. Fluid within thoracic facet joints at several levels is a nonspecific\nfinding which may be seen secondary to degenerative disease. While\nsuperimposed infection cannot be excluded in the setting of systemic\ninfection, there is no evidence for edema in the surrounding soft tissues to\nsuggest infection.\n4. Partially visualized small pleural effusions, heterogenous and possibly\nhemorrhagic or infected on the left, appear increased compared to the ___ CT torso. Pulmonary opacity in the left lower lobe adjacent to\nthe aorta has also increased, but is not fully evaluated.\n\nNOTIFICATION: The final interpretation, which was discrepant from the\npreliminary report, was discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 9:18 am, 5 minutes after discovery of the\nfindings.\n\nThe following preliminary report was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:31 am, at the time\nof image review:\nCORD OR CAUDA EQUINA COMPRESSION: No\nCORD SIGNAL ABNORMALITY: No\nEPIDURAL COLLECTION: No" }, { "input": "There is 25% anterolisthesis of C4 on C5 with associated chronic facet\ndegeneration. There is fusion of the C6-C7 vertebral bodies. The vertebral\nbody heights are preserved. There is heterogeneous degenerative endplate\nchanges at C4-C5. There is a likely subcortical cyst at the C2 vertebral\nbody. The vertebral body heights are preserved.\nMild type ___ ___ changes are noted at multiple levels.\n\nAt C2-C3 there is no significant neural foraminal or spinal canal stenosis.\n\nAt C3-C4 there is disc bulge with uncovertebral, intervertebral, facet\narthropathy causing mild spinal canal narrowing and mild right and\nmoderate-severe left neural foraminal stenosis.\n\nAt C4-C5 there is anterolisthesis of C4, disc uncovering, intervertebral\nuncovertebral and facet arthropathy causing moderate to severe canal stenosis\nwhich effaces the thecal sac and mildly deforms the cord without associated\nintrinsic cord signal abnormality. There is severe left and mild right neural\nforaminal stenosis.\n\nAt C5-C6 there is central disc protrusion, uncovertebral and facet arthropathy\ncausing mild spinal canal narrowing and moderate bilateral neural foraminal\nstenosis.\n\nAt C6-C7 there is interbody vertebral fusion, uncovertebral and facet\narthropathy causing mild left neural foraminal stenosis without significant\nspinal canal stenosis.\n\nAt C7-T1 there is no significant neural foraminal or spinal canal stenosis.\n\nThe paravertebral soft tissues are unremarkable. Vaguely increased signal\nintensity in the posterior spinous soft tissues on the STIR sequence, can\nrelate to mild edema or related to trauma along with vascular structures.\nThere is no evidence ligamentous injury within the limitations of pulsation\nand motion artifacts on the STIR sequence. Small amount of fluid in the\nmastoid air cells left more than right.\nRight vertebral artery is dominant and the left is diminutive, also seen on\nthe prior MR angiogram study of ___", "output": "1. 25% anterolisthesis of C4 on C5 secondary to degenerative spondylosis. \nAssociated moderate-to-severe spinal canal stenosis at C4-C5 which contacts\nand mildly deforms the cord. No associated cord signal abnormality to suggest\nsignificant acute edema or chronic myelomalacia allowing for the motion and\nblurring on STIR and T2 sequences . Additional degenerative changes as\ndescribed. Moderate to severe canal narrowing at C4-5. Moderate to severe\nforaminal narrowing from C3- C7 levels.\n2. No evidence of ligamentous injury within the limitations of pulsation and\nmotion artifacts on the STIR sequence.\n3. Followup can be considered if needed for cord changes .\n4. Possible thyroid nodules" }, { "input": "CERVICAL:\nNormal cervical cord, no demyelination.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.Mild degenerative changes, multilevel mild disc osteophyte\ncomplexes, posterior mid hypertrophic changes.\nWidely patent central canal in the cervical spine.\nMultilevel mild-to-moderate foraminal narrowing, most prominent and moderate\nat the left C6-7 foramen.\n\nTHORACIC:\nNo definite cord T2 signal abnormality.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nMild disc bulges are seen at T6-T7 and T8-T9. Few tiny disc protrusions. No\nmass effect on the cord. Widely patent central canal and thoracic spine. \nMultilevel mild foraminal narrowing. No abnormal enhancement.", "output": "1. No definite cord abnormality.\n2. Degenerative changes, as above." }, { "input": "The alignment is normal. ___ type 2 changes are seen at L5-S1. No cord\nsignal abnormalities are seen. The cord terminates at T12-L1. Diffuse loss\nof normal T2 signal is seen throughout the intervertebral discs of the lower\nlumbar spine.\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: There is no spinal canal narrowing. Facet joint osteophytes results in\nmild bilateral neural foraminal narrowing.\n\nL3-L4: Mild disc bulge, facet joint arthropathy and ligamentum flavum\nthickening results in mild spinal canal narrowing. Facet joint osteophytes\nresult in moderate to severe left and moderate right neural foraminal\nnarrowing.\n\nL4-L5: Mild disc bulge results in bilateral subarticular zone narrowing. \nFacet joint osteophytes and ligamentum flavum thickening contribute to mild\nspinal canal narrowing. Facet joint osteophytes contribute moderate right\nmild left neural foraminal narrowing.\n\nL5-S1: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nFacet joint osteophytes results in moderate to severe severe bilateral neural\nforaminal narrowing, right greater than left.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. No evidence of significant spinal canal stenosis.\n2. Moderate to severe left neural foraminal narrowing is seen at L3-L4 and\nmoderate to severe bilateral neural foraminal narrowing is seen at L5-S1.\n3. Moderate right neural foraminal narrowing is seen at L4-L5.\n4. No terminal cord signal abnormalities identified." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nVertebral body alignment is preserved.\n\nVertebral body heights are preserved. Unchanged type ___ ___ changes are noted\nin the inferior endplate of the L4 vertebral body. A small hemangioma in the\nT12 vertebral body is unchanged. Grossly stable overall low marrow signal is\nagain noted.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThe conus medullaris terminates at the inferior aspect of T12.\n\nLoss of the normal T2 signal is most pronounced in the L3-4, L4-5 and L5-S1\nintervertebral discs, suggestive of degenerative disc disease.\n\nL1-2: There is no definite vertebral canal or neural foraminal narrowing.\n\nL2-3: A posterior disc bulge results in mild vertebral canal narrowing. There\nis no definite neural foraminal narrowing.\n\nL3-4: A posterior disc bulge and ligamentum flavum thickening results in mild\nvertebral canal narrowing. The disc bulge also results in mild bilateral\nneural foraminal narrowing.\n\nL4-5: A posterior disc bulge and ligamentum flavum thickening results in mild\nvertebral canal narrowing. The disc bulge in combination with facet joint\nhypertrophy causes mild bilateral neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge results in mild vertebral canal narrowing. This\ndisc bulge also results in moderate right and left neural foraminal narrowing.\nOn the left, this disc bulge contacts the exiting L5 nerve root. A\nright-sided disc protrusion mildly displaces the traversing S1 nerve root.\n\nThere is no evidence of infection or neoplasm. The paravertebral soft tissues\nare unremarkable.", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable multilevel lumbar spondylosis compared to ___\nprior exam, most severe at L5-S1 where there is moderate bilateral neural\nforaminal narrowing and disc contacting the exiting left L5 nerve root.\n3. Grossly stable overall low marrow signal is nonspecific, and may be seen in\nthe setting of anemia. If clinically indicated, consider correlation with\nCBC." }, { "input": "There are 5 lumbar-type vertebral bodies which are maintained in height and\nalignment. There is diffusely decreased bone marrow signal throughout. Some\nheterogeneity is also noted with several T1 and T2 hyperintense lesions which\nare likely hemangiomas. Intervertebral disc desiccation seen at L3-4 through\nL5-S1 with associated height loss at L5-S1. The conus terminates at the L2\nlevel, in normal anatomic position.\n\nAt T11-T12 through L2-3, there is no significant canal or foraminal narrowing.\n\nAt L3-4, there is mild diffuse disc bulge with superimposed bilateral\nforaminal disc protrusions. There is secondary narrowing of the left\nsubarticular recess but no significant canal or foraminal narrowing. There is\nmild facet joint hypertrophy with bilateral facet joint effusions.\n\nAt L4-5, there is a diffuse disc bulge eccentric to the left foramen. There\nis secondary narrowing of the subarticular recesses, crowding the traversing\nleft L5 nerve root. There is facet joint hypertrophy with small facet joint\neffusions. No significant overall canal or foraminal narrowing.\n\nAt L5-S1, there is a right central disc protrusion and facet joint\nhypertrophy. These changes cause subarticular recess narrowing on the right,\ncrowding the traversing S1 nerve root. There is also mild right foraminal\nnarrowing without canal narrowing. Mild facet joint hypertrophy noted with\nfacet joint effusions.\n\nIncluded paraspinal and retroperitoneal soft tissues are unremarkable. \nMultiple T2 hypointense lesions seen throughout the myometrium compatible with\nfibroids.", "output": "1. Degenerative changes in the lower lumbar spine most notably at L5-S1 with a\nright central disc protrusion with secondary mild right foraminal narrowing\nand crowding of the traversing right S1 nerve root in the subarticular recess.\nRemaining degenerative changes as above including facet joint hypertrophy with\nfacet joint effusions in the lower lumbar spine.\n2. Diffusely decreased T1 signal in the bone marrow. This is nonspecific but\ncan be seen in setting of obesity, smoking or anemia. Infiltrative processes\nwould also be possible.\n3. Multiple T2 hypointense uterine lesions, incompletely visualized but likely\nfibroids." }, { "input": "There is mildly exaggerated kyphosis. Otherwise, thoracic alignment is\nanatomic. Since examination of ___, there is interval\ndevelopment of mild anterior wedge compression deformity of T10 with\napproximately 30% loss of vertebral body height without associated marrow\nedema pattern and of T12 with approximately 40% loss of vertebral body height\nwith very mild linear superior endplate edema pattern with an associated\nSchmorl's node (series 18, image 10). There is no prevertebral soft tissue\nswelling. No epidural hematoma is identified. The findings are compatible\nwith chronic compression fractures. Chronic T5 compression deformity with\nless than 20% loss of vertebral body height is also identified. There is no\nsuspicious marrow signal. A T6 hemangioma is noted. Mild increased\ndegenerative T11-T12 disc signal is identified. There is no cord signal\nabnormality. The conus medullaris terminates at the L1 level, within expected\nlimits.\n\nMinimal retropulsion of the T12 superior endplate does not significantly\nnarrow the spinal canal. Multilevel mild degenerative changes does not result\nin significant spinal canal or neural foraminal narrowing.\n\nA 6 mm T2 hyperintense incompletely characterized lesion of hepatic segment 7\nrepresent a cyst or hemangioma. The remainder of the visualized prevertebral\nand paraspinal soft tissues are unremarkable.", "output": "1. Chronic compression deformities of T5 and T10. Although there is mild\nsuperior endplate marrow edema of T12, the compression deformity is most\nlikely chronic with marrow edema secondary to a Schmorl's node.\n2. No significant spinal canal or neural foraminal narrowing. Additional\nfindings as described above." }, { "input": "There is exaggerated thoracic kyphosis, otherwise alignment is anatomic. The\nsignal intensity throughout the thoracic spinal cord is normal with no\nevidence of focal or diffuse lesions, the conus medullaris terminates at the\nlevel of T12-L1 and is unremarkable.\nThere is new loss of height of T11 with superior endplate irregularity and\nvertebral body edema suggesting acute compression fracture. Similarly, there\nis new loss of height of the L1 and L2 vertebral bodies with edema concerning\nfor acute compression fracture. There is also mild diffuse edema of the\nsuperior endplate of L3 and inferior endplate of L4 also concerning for\nnoncompression fractures (24:7).\nChronic loss of height of T5, T10, and T12 are again seen. Anterior wedging\nof T7 has progressed compared to prior, now measuring 13 mm, previously 17 mm,\nwithout edema to suggest acute injury. A Schmorl's node is again seen along\nthe superior endplate of T12 with mild surrounding edema (24; 10).\nT1 and T2 hyperintense lesions in the T6 and T10 vertebral bodies are\nconsistent with vertebral body hemangiomas.\nIncreased degenerative disc signal is seen in multiple levels in the thoracic\nand lumbar spine. There is no significant spinal canal narrowing.\n\nAt L3-4 and L4-5 a posterior disc bulge causes mild left neural foraminal\nnarrowing.\nAt L5-S1 a posterior disc bulge and facet hypertrophy causes moderate right\nand moderate to severe left neural foraminal narrowing.\n\nA sacral Tarlov cyst is noted (21; 6). There is fatty atrophy of the lower\nlumbar paraspinal muscles. The urinary bladder appears distended. There is\nno evidence of infection or neoplasm.", "output": "1. New loss of height with vertebral body edema in T11, L1, and L2 are\nconcerning for acute compression fractures. Bone edema is also noted at the\nendplates of L3 and L4 concerning for noncompression fractures as described\nabove.\n2. Chronic compression deformities of T5, T10, and T12. Chronic appearing\nprogression of T7 anterior wedging.\n3. Multilevel degenerative changes of the thoracolumbar spine, most severe at\nL5-S1 with moderate right and moderate to severe left neural foraminal\nnarrowing.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:30 pm, 20 minutes after\ndiscovery of the findings." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere are numerous T2 hyperintense, T1 hypo intense vertebral body lesions\nthroughout the cervical and imaged portions of the upper thoracic spine. \nThere is no evidence of a soft tissue component to these lesions and they do\nnot cause encroachment on the spinal canal. Although atypical hemangiomas are\npossible, given the history, concern such as amyloidosis or multiple brown\ntumors appear more likely. Diffuse metastatic disease could produce this\nappearance, but appears less likely, again considering the clinical history.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of T2 signal in multiple cervical intervertebral discs. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nWithin the limits of this noncontrast study there is no evidence of infection.\nThere is no definite epidural collection. There is no prevertebral soft\ntissue swelling.. The visualized portion of the posterior fossa and\ncervicomedullary junction are preserved.\n\n At C2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is minimal disc bulging indenting the ventral thecal sac without\ncontacting the cord. Facet and uncovertebral arthropathy produce mild left\nneural foraminal narrowing. The right neural foramen is patent..\n\nAt C4-5 there is a small midline disc protrusion touching the anterior surface\nof the cord. Facet and uncovertebral arthropathy produce mild\nleft-greater-than-right neural foraminal narrowing.\n\nAt C5-6 there is central disc protrusion flattening the ventral spinal cord\nwithout underlying signal abnormality which in conjunction with ligamentum\nflavum thickening effaces the surrounding CSF. Facet and uncovertebral\narthropathy produce mild bilateral neural foraminal narrowing.\n\nAt C6-7 there is no significant spinal canal narrowing. Facet and\nuncovertebral arthropathy produce mild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is no significant spinal canal or neural foraminal narrowing.\n\nLimited sagittal views of T1-T2, T2-T3 and T3-T4 levels demonstrate no\nsignificant spinal canal or neural foraminal narrowing.", "output": "1. Numerous lesions throughout the visualized vertebral bodies without\nencroachment on the spinal canal. While these may represent vertebral body\natypical hemangioma, alternative diagnoses including brown tumors or\namyloidosis are alternate possibilities. Metastatic disease could produce a\nsimilar pattern, but appears less likely. If these are hemangiomas, they may\nshow typical diagnostic findings on CT of the spine. Multilevel cervical\nspondylosis, as described, most notable for disc protrusion at C5-C6\nflattening the spinal cord without underlying signal abnormality, with\neffacement of the surrounding CSF without cord impingement. No high-grade\nneural foraminal narrowing.\n2. No fracture or evidence of infection.\n\nRECOMMENDATION(S): Consider spine CT for further evaluation of numerous bone\nlesions." }, { "input": "THORACIC SPINE:\nThere is mild dextroconvex curvature and moderate kyphosis of the thoracic\nspine. Alignment is otherwise normal. The spinal cord is normal in caliber\nand configuration, without signal abnormality. There are innumerable T1\nheterogeneous, T2 and water IDEAL hyperintense lesions throughout the thoracic\nspine vertebral bodies and posterior elements. These lesions do not extend\ninto the epidural space or result in spinal canal compromise. There is no\nevidence of infection. There is no spinal canal or neural foraminal narrowing\nthroughout the thoracic spine.\n\nLUMBAR SPINE:\nThere is grade 1 anterolisthesis of L5 on S1. As in the thoracic spine, there\nare innumerable T1 hypointense, water IDEAL hyperintense ovoid lesions\nthroughout the vertebral bodies and posterior elements of the lumbar spine\nwithout epidural invasion or canal compromise. The terminal spinal cord is\nnormal in caliber and configuration, and the conus medullaris terminates at\nL1. There is no evidence of infection. There is moderate disc desiccation\nfrom L3-4 through L5-S1.\n\nAt T12-L1 through L3-4, there is no spinal canal or neural foraminal\nnarrowing.\n\nAt L4-5, there is a broad disc bulge that results in mild spinal canal\nnarrowing and mild left and moderate right neural foraminal narrowing.\n\nAt L5-S1, there is grade 1 anterolisthesis without canal compromise. There is\nmild left and moderate right neural foraminal narrowing.\n\nOTHER:\nLarge bilateral pleural effusions are noted. There is extensive fluid\nthroughout the esophagus, which could be related to esophageal dysmotility. \nThe kidneys are atrophic bilaterally with scattered T2 hyperintense cysts. \nThere is small volume free fluid in the pelvis, which is nonspecific.", "output": "1. No evidence of infection in the thoracic or lumbar spine on this\nnon-contrast study.\n2. Innumerable T1 heterogeneously intense, T2/water IDEAL hyperintense lesions\nthroughout the thoracic and lumbar spine are essentially unchanged in\ncomparison with the abdominal MRI of ___. The differential\ndiagnosis continues to include brown tumors versus amyloidosis in the setting\nof chronic renal insufficiency. Bone metastatic lesions may have similar\nappearance, however this possibility is less likely in relation with the\nclinical history.\n3. Mild degenerative changes predominantly of the lumbar spine, as described\nabove. No high-grade spinal canal or neural foraminal narrowing.\n4. Large bilateral pleural effusions.\n5. Trace fluid in the pelvis is nonspecific, possibly related to third\nspacing.\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": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc signal at all levels of the cervical\nspine. There is loss of intervertebral disc height at C4-5, C5-6 and C6-7.\n\nWithin 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.\n\n At C2-3 there is central disc protrusion withno vertebral canal or neural\nforaminal stenosis.\n\nAt C3-4 there is disc bulge withno vertebral canal or neural foraminal\nstenosis.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy and facet arthropathy\nresulting in moderate right neural foraminal and mild vertebral canal\nstenosis.\n\nAt C5-6 there is disc bulge and facet joint arthropathy with mild vertebral\ncanal and and no neural foraminal stenosis.\n\nAt C6-7 there is disc bulge and uncovertebral hypertrophy resulting in mild\nleft neural foraminal stenosis and no vertebral canal stenosis.\n\nAt C7-T1 there is disc bulge withno vertebral canal or neural foraminal\nstenosis. A right neural foraminal perineural cyst is noted.", "output": "1. Multilevel degenerative changes as described, most pronounced at C4-5,\nwhere there is moderate right neural foraminal and mild vertebral canal\nstenosis.\n2. C5-6 mild vertebral canal stenosis.\n3. C6-7 mild left neural foraminal stenosis." }, { "input": "Alignment is preserved. Vertebral body heights are preserved. Areas of\nendplate degenerative signal are noted from the L1-L2 through L5-S1 levels. \nScattered areas of fatty marrow placement are seen. A few Schmorl's nodes are\nseen. There is otherwise no suspicious focal bone marrow signal abnormality. \nThere is no prevertebral soft tissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is moderate intervertebral disc height loss\nfrom the L1-L2 through L5-S1 levels.\n\nThe distal visualized spinal cord is preserved in signal and caliber. The\nconus medullaris terminates at the distal L1 level.\n\nMild facet degenerative changes are noted at multiple levels.\n\nLimited sagittal view of the T11-T12 level demonstrates trace disc bulge\nwithout significant spinal canal or neural foraminal narrowing.\n\nAt T12-L1 level, there is desiccation and minimal diffuse disc bulge with no\nevidence of neural foraminal narrowing or spinal canal stenosis.\n\nAt L1-L2, there is mild disc bulge and endplate osteophyte formation indenting\nthe ventral thecal sac without significant spinal canal narrowing. Endplate\nosteophytes produce minimal right neural foraminal narrowing. The left neural\nforamina is patent. A perineural cyst is seen on the left.\n\nAt L2-L3, there is disc desiccation, diffuse disc bulge with left paracentral\ndisc protrusion, and small amount of disc material extruded inferiorly on the\nleft (image 18, series 5, and image 13, series 2),endplate osteophytes more\nprominent on the left and ligamentum flavum thickening are present indenting\nthe ventral thecal sac without significant spinal canal narrowing. Facet and\nendplate osteophytes produce moderate left neural foraminal narrowing. There\nis mild right-sided neural foraminal narrowing.\n\nAt L3-L4, there is mild disc bulge and endplate osteophyte formation without\nsignificant spinal canal narrowing. Facet and endplate osteophytes produce\nmild left-greater-than-right neural foraminal narrowing.\n\nAt L4-L5, there is trace disc bulge, slightly eccentric to the right,\ncontacting the traversing nerve roots, without significant spinal canal\nnarrowing. Facet and endplate osteophytes produce moderate right and mild\nleft neural foraminal narrowing.\n\nAt L5-S1, there is no significant spinal canal narrowing. Facet and endplate\nosteophytes produce mild left-greater-than-right neural foraminal narrowing.\n\nAn unchanged perineural cyst (Tarlov cyst), is identified at S2 level on the\nright.\n\nOverall degree of degenerative change appears minimally progressed compared to\n___, mainly with progression of degenerative disc disease.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "Minimal progression of degenerative disc disease compared to ___,\nwith most notable findings at L2/L3 level with left paracentral disc\nprotrusion, and moderate neural foraminal narrowing at the right L4-L5 level. \nNo significant spinal canal narrowing." }, { "input": "There is a 2.3 x 3.5 x 6.5 cm fluid collection in the right neck\ndeep to the right sternocleidomastoid muscle, medial to the carotid vessels,\nand extending posteriorly to the operative bed. Fluid also tracks into the\nsuperior mediastinum, partially visualized, adjacent to the esophagus.\n\nAn endotracheal and esophageal tube are partially visualized. In addition,\nright greater than left abnormal intensities in the lungs are partially\nvisualized corresponding to the patient's known pneumonia.\n\nThere has been definite interval improvement in the edematous changes within\nthe spinal cord, with decrease in expansion and T2 signal both superior and\ninferior to the striking abnormality at the level of the corpectomy. This\ndecrease in edema allows better definition of the abnormal contour of the\nspinal cord at the level of the corpectomy, likely corresponding to residual\nsevere deformity from the large ossification within the posterior longitudinal\nligament at the C5-C6 level, with superimposed edema. Posterior osteophytes\nremain at the T1 and T2 levels with persistent moderate spinal canal narrowing\nand flattening of the ventral spinal cord. This narrowing is most prominent\nat the C7-T1 level where there is slight flattening of the posterior cord as\nwell. Abnormal cord signal persists but has improved as described above. \nOtherwise, alignment is near anatomic.", "output": "1. Slight interval improvement in spinal cord edema. This allows better\ndefinition of the markedly abnormal contour of the spinal cord at the level of\nthe corpectomy. This may be residual severe deformity from the large\nosteophyte which has since been removed.\n\n2. Right anterior paraspinal fluid collection extending into the right neck. \nThis could represent a pseudomeningocele or a seroma. Either of those\nstructures could be superinfected. Fluid extends inferiorly posterior to the\nesophagus, with the inferior extent not fully visualized." }, { "input": "There is disc desiccation and mild loss of disc height at L3-4 and L4-5. Disc\ndesiccation and moderate loss of disc height at L5-S1 is also noted. Vertebral\nbody heights are maintained. There is no suspicious marrow signal. The conus\nterminates at the inferior endplate of L1, within expected limits. There is no\nsignal abnormality of the visualized cord.\n\nT11-12: There is a concentric disc bulge and prominent dorsal epidural fat\nresulting in moderate spinal canal narrowing. There is mild to moderate facet\narthropathy. These changes results in mild left neural foraminal narrowing and\nno significant right neural foraminal narrowing.\n\nT12-L1 through L2-3: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nL3-4: There is a concentric disc bulge, bilateral facet arthropathy with\nthickening of the ligamentum flavum as well as prominent epidural fat. These\ndegenerative changes results in moderate to severe spinal canal narrowing\n(series 6, image 4), with crowding of the nerve roots. There is right greater\nthan left mild bilateral neural foraminal narrowing. There is an apparent 4\nmm synovial cyst arising from the right facet joint which is not confirmed on\nthe sagittal STIR images.\n\nL4-5: There is a disc bulge with superimposed central disc protrusion as well\nas severe bilateral facet arthropathy and thickening of the ligamentum flavum.\nThese degenerative changes results in mild spinal canal narrowing. The disc\nbulge contacts the bilateral traversing L5 nerve root (series 5, image 13),\ngreater on the right. The disc protrusion effaces the ventral aspect of the\nthecal sac.\n\nL5-S1: There is a broad disc bulge as well as bilateral facet arthropathy and\nthickening of the ligamentum flavum. The disc bulge contacts and minimally\nremodels the ventral aspect of the thecal sac without significant spinal canal\nnarrowing. There is bilateral moderate to severe neural foraminal narrowing\nwhich impinges on the exiting nerve roots.\n\nOther: T2 hyperintense cystic lesions measuring up to 2.1 cm in the bilateral\nkidneys, are incompletely characterized but likely representing simple cysts.", "output": "Multilevel multifactorial degenerative changes described above, most prominent\nat L5-S1 where there is moderate to severe bilateral neural foraminal\nnarrowing which impinges on the exiting nerve roots and at L3-4 where there is\nmoderate to severe spinal canal narrowing." }, { "input": "The visualized elements of the posterior fossa and craniocervical junction are\nunremarkable. There is increased signal on T2 weighted and STIR sequences as\nwell as T1 hyperintensity along the posterior longitudinal ligament, extending\nfrom C2 through C4/C5 level (image number 9, series 2, 3 and 4), likely\nconsistent with ligamentous strain and underlying associated edema, also the\npossibility of small fluid collection is a consideration, and close followup\nwith MRI of the cervical spine is advised. There is no evidence of abnormal\nsignal throughout the cervical spinal cord to indicate spinal cord edema or\ncord expansion, there is no evidence of significant spinal canal stenosis or\nneural foraminal narrowing, the visualized paravertebral structures are\nunremarkable as well as the prevertebral soft tissues, there is no evidence of\nabnormal signal throughout the osseous structures to suggest cervical spine\nfracture or bony edema.", "output": "There is increased signal on T1, T2 weighted and STIR sequences along the\nposterior longitudinal ligament from C2 through C4/C5 level, likely consistent\nwith ligamentous strain and underlying associated edema and probably small\nfluid collection, there is no evidence of spinal cord signal abnormality or\nevidence of significant spinal canal or neural foramina stenosis.\n\nRECOMMENDATION(S): There is increased signal on T2 weighted and STIR\nsequences as well as T1 hyperintensity along the posterior longitudinal\nligament, extending from C2 through C4/C5 level (image number 9, series 2, 3\nand 4), likely consistent with ligamentous strain and underlying associated\nedema, also the possibility of small fluid collection is a consideration,\nclose followup and correlation with MRI of the cervical spine with and without\ncontrast is recommended to demonstrate stability or progression." }, { "input": "Diffusely atrophic cord. Mild central T2 signal abnormality versus artifact\nupper thoracic cord may be sequela of chronic demyelination. No enhancement.\n\nThere is mildly exaggerated kyphosis of the thoracic spine. Alignment is\notherwise unremarkable. A T1 and T2 hyperintense lesion, which enhances\nfollowing administration of contrast in the anterior aspect of the T5\nvertebral body is compatible with a hemangioma. Otherwise, the marrow is\nwithin normal limits.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nBilateral thyroid nodules are incompletely evaluated. Few benign simple\nhepatic cysts. Indeterminate 1.5 cm enhancing lesion right hepatic lobe was\nbetter characterized on MRI ___. Linear T2 hyperintense lesion at\nthe right lung base likely represents atelectasis (series 7, image 15). \nExophytic simple right renal cyst. Small right pleural effusion.", "output": "1. Significant diffuse cord atrophy, may be sequela of chronic demyelination. \nNo focal lesions or cord enhancement.\n2. Minimal degenerative changes.\n3. Partially visualized thyroid nodules are incompletely imaged and\ncharacterized. If not previously performed recommend ultrasound for further\nevaluation.\n4. Indeterminate right hepatic lobe lesion, better evaluated on MRI ___" }, { "input": "Alignment is normal. There is mild loss of signal of the L1-2, L4-5 and L5-S1\nintervertebral discs on the T2 weighted images, these are manifestations of\ndegenerative disc disease. Axial images from T12 through L4 demonstrate\nminimal changes of degenerative disease with no spinal canal or neural\nforaminal compromise.\n\nAt L4-5, there is minimal bulging of the disc into the left neural foramen\nwith contact with the exiting left L4 nerve root. The spinal canal and right\nneural foramen appear normal.\n\nAt L5-S1, there are postoperative changes after right-sided hemilaminectomy. \nPostoperative scarring is noted along the posterior, lateral, and right\nanterior epidural space at this level. Scarring extends into the right neural\nforamen. There is minimal residual bulging of the intervertebral disc into\nand lateral to the right neural foramen. This scarring surrounds the exiting\nright L5 and the traversing right S1 nerve roots. There is no compression of\nthe thecal sac and the left neural foramen appears normal.\nThe spinal cord appears normal in caliber and configuration.\nThere is no evidence of infection or neoplasm.", "output": "1. Postoperative changes after right L5 laminectomy.\n2. Postoperative scarring at the right-sided surgical site extending into the\nright L5-S1 neural foramen.\n3. Minimal residual disc material extending into and lateral to the right\nL5-S1 foramen." }, { "input": "Study is mildly degraded by motion.\n\nLevels were established by counting down from the C2 level using series 1,\nimage 3..\n\nTHORACIC:\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nT6 superior endplate type ___ ___ changes are seen. T11 hemangioma versus\nfocal fat is noted. The visualized portion of the spinal cord is preserved in\nsignal and caliber. No epidural fluid collection or enhancing mass. No\nabnormal intramedullary or leptomeningeal enhancement.\n\n Intervertebral discheightsandsignalare preserved.\n\nAt T4-5 and T11-12 there is facet joint hypertrophy with mild vertebral canal\nand no neural foraminal narrowing.\n\nAt T9-10 there is bilateral facet joint hypertrophy and ligamentum flavum\nhypertrophy with mild-to-moderate vertebral canal and no neural foraminal\nnarrowing.\n\nAt T10-___ there is bilateral facet joint hypertrophy and ligamentum flavum\nhypertrophy with mild-to-moderate vertebral canal narrowing and deformation of\nthe dorsal thecal sac and spinal cord without definite associated cord signal\nabnormality.\n\nOtherwise, there is no definite vertebral canal or neural foraminal narrowing\nof the thoracic spine.\n\nLUMBAR:\nThere is mild lumbar levoscoliosis. Vertebral body heights are preserved. \n___ type 1 degenerative endplate changes are most prominent at L3-L4. \nMultiple probable hemangiomas versus focal fat are noted throughout the lumbar\nspine. The conus medullaris terminates at L1-L2. There is loss of\nintervertebral disc height and signal at L3-4.\n\nMild multilevel spondylosis and prominent epidural fat is seen throughout the\nlumbar spine, with multiple disc bulges and mild facet arthropathy. However,\nthere is no evidence for moderate or severe canal stenosis. Moderate neural\nforaminal or narrowing is seen on the left at L4-L5 and L5-S1 with a disc\nbulge minimally contacting the exiting nerve root at these levels. There is\nno evidence of severe lumbar spine neural foraminal narrowing.\n\nWithin the lumbar spine, there is no evidence of abnormal intramedullary,\nleptomeningeal, or epidural enhancement. No epidural mass or collection is\nidentified.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified. Probable dependent\nedema is noted within the lumbar dorsal soft tissues.", "output": "1. Study is mildly degraded by motion.\n2. No evidence for abnormal epidural enhancement, mass, or epidural abscess.\n3. Multilevel thoracic and lumbar spondylosis and prominent epidural fat as\ndetailed above, without definite evidence for severe canal stenosis or neural\nforaminal narrowing.\n4. Nonspecific lumbar probable dependent edema." }, { "input": "There are findings suggestive of discitis and osteomyelitis at L5-S1. These\ninclude high signal intensity of the vertebral endplates and the\nintervertebral disc at this level on the STIR images, hypointensity on the T1\nweighted images, enhancement after contrast administration, and a fluid\ncollection anterior to the sacrum, best seen on image 13 of series 3. This\narea demonstrates peripheral enhancement with a central fluid signal as well\nas broad prevertebral soft tissue swelling.\n\nAlignment is normal. There are ___ type 2 signal intensity changes of the\nendplates at L3-4 and L4-5 with less prominent involvement at L1-2 and L2-3. \nThere is loss of signal of the intervertebral discs on the T2 weighted images\ndue to degenerative disease. Axial imaging from T12-L3 demonstrates facet\nosteophytes and intervertebral osteophytes but no more than mild narrowing of\nthe spinal canal. The neural foramina appear normal.\nAt L3-4 there is bulging of the disc, a tiny midline protrusion, ligamentum\nflavum thickening and facet osteophytes. These combine to produce\nmoderate-severe spinal canal narrowing. There is narrowing of the left neural\nforamina.\nAt L4-5 bulging of the disc, facet osteophytes and ligamentum flavum\nthickening encroach on the traversing L5 nerve roots bilaterally. The neural\nforamina appear normal.\n\nThe spinal cord appears normal in caliber and configuration and ends at L1-2.", "output": "1. Findings suggesting discitis and osteomyelitis at L5-S1 with an anterior\nabscess.\n2. There is no spinal canal encroachment at this level and no evidence of an\nepidural abscess.\n\nNOTIFICATION: The findings were discussed with Dr. ___ by telephone, by Dr.\n___ at 8 pm ___, immediately upon reviewing the images." }, { "input": "THORACIC SPINE:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal, consistent with\nmild-to-moderate degenerative change.\n\nAt C7-T1, there is mild posterior disc bulge causing mild spinal canal and\nbilateral neural foraminal narrowing.\n\nAt T1-T2, there is left paracentral disc bulge, which causes mild-to-moderate\nleft neural foraminal narrowing and mild spinal canal narrowing. There is no\nright neural foraminal narrowing.\n\nAt T2-T3, there is mild posterior disc bulge causing no spinal canal or neural\nforaminal narrowing.\n\nAt T3-T4, there is ligamentum flavum thickening causing mild spinal canal\nnarrowing. There is no neural foraminal narrowing.\n\nAt T4-T10, there is no spinal canal or neural foraminal narrowing. Of note,\nat the T6 and T7 levels, there is a T1 isointense, T2/STIR hyperintense\nlesions, likely vertebral body hemangiomas.\n\nAt T10-T11, there is mild irregular contour of the endplates suggestive of\nSchmorl's node, additionally, there is T2/STIR high-signal intensity at the\nendplates and intervertebral disc space, with avid enhancement after contrast\nadministration, suggesting an active inflammatory process, the possibility of\nan acute Schmorl's node is a consideration, however a early discitis\nosteomyelitis changes at this level is also a possibility, there is mild\nposterior disc bulge and ligamentum flavum thickening, causing\nmild-to-moderate spinal canal narrowing and bilateral neural foraminal\nnarrowing.\n\nAt T11-T12, there is ligamentum flavum thickening and posterior disc bulge\ncausing mild-to-moderate neural foraminal narrowing on the right and\nmild-to-moderate spinal canal narrowing. There is no left-sided neural\nforaminal narrowing.\n\nLUMBAR SPINE:\n\nAgain seen are findings suggestive of discitis and osteomyelitis at L5-S1\nlevel, mildly improved compared to ___. STIR hyperintensity\nthroughout the L5 and S1 vertebral bodies as well as the intervertebral disc\npersist, but have improved compared to prior. Post-contrast enhancement at\nthese levels, persists but also has improved compared to prior. No fluid\ncollection is seen on water:IDEAL images to suggest persistent prevertebral\nabscess. Also again seen are ___ type 2 changes of L3-4 and L4-5, with less\nprominent volumen of L1-2 and L2-3.\n\nThere is mild retrolisthesis of L1 on L2, L2 on L3, and L3 on L4. L4 through\nS1 alignment is anatomic. Vertebral body alignment is preserved. Vertebral\nbody heights are preserved. The visualized portion of the spinal cord is\npreserved in signal and caliber.\n\nThere is moderate loss of intervertebral disc height and signal, consistent\nwith moderate degenerative change, most notable at L5-S1.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is mild posterior disc bulge, ligamentum flavum thickening, and\nfacet arthropathy, which causes mild spinal canal narrowing, and moderate\nbilateral neural foraminal narrowing..\n\nAt L2-3 there is posterior disc bulge, ligamentum flavum hypertrophy, and\nfacet arthropathy, resulting in mild-to-moderate spinal canal narrowing and\nmoderate bilateral neural foraminal narrowing, left greater than right..\n\nAt L3-4 there is posterior osteophytosis, mild-to-moderate disc bulge,\nligamentum flavum hypertrophy, and facet arthropathy, which causes\nmild-to-moderate spinal canal narrowing and moderate bilateral neural\nforaminal narrowing..\n\nAt L4-5 there is posterior disc bulge, mentum flavum hypertrophy, facet\narthropathy, causing moderate spinal canal narrowing and moderate bilateral\nneural foraminal narrowing.\n\nAt L5-S1 there is posterior disc bulge, facet arthropathy, and ligamentum\nflavum hypertrophy, which causes minimal spinal canal narrowing moderate right\nneural foraminal narrowing and moderate to severe left neural foraminal\nnarrowing..\n\nThere 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.", "output": "1. At T10-T11 level, there is mild irregular contour of the endplates\nsuggestive of Schmorl's node, additionally, there is T2/STIR high-signal\nintensity at the endplates and intervertebral disc space, with avid\nenhancement after contrast administration, suggesting an active inflammatory\nprocess, the possibility of an acute Schmorl's node is a consideration,\nhowever a early discitis osteomyelitis changes at this level is also a\npossibility.\n2. Interval improvement of L5-S1 discitis and osteomyelitis with interval\nresolution of anterior abscess. No epidural abscess identified.\n3. Moderate degenerative change throughout the thoracic and lumbar spine, most\nsevere at L5-S1, with moderate to severe neural foraminal narrowing on the\nright, as above.\n4. No severe neural foraminal or spinal canal narrowing throughout the\nthoracic or lumbar spine.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:32 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Fusion of anterior and posterior elements of C2 and C3 is again noted, likely\ncongenital. Vertebral body heights are preserved. Minimal retrolisthesis of C5\non C6 and minimal retrolisthesis of C6 on C7 are unchanged. There are multiple\nhemangiomas and focal fat deposits in the bone marrow, as well as discogenic\nbone marrow changes at C5-6 and C6-7. There are no suspicious bone marrow\nsignal abnormalities.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa appears unremarkable.\n\nAt the craniocervical junction, C1-C2, and C2-C3 levels, there is no spinal\ncanal or neural foraminal narrowing.\n\nAt C3-C4, there is a tiny disc protrusion to the right of midline without\nspinal canal narrowing. There is minimal left facet arthropathy without\nsignificant neural foraminal narrowing.\n\nAt C4-C5, there is no spinal canal narrowing. There is mild left neural\nforaminal narrowing by uncovertebral osteophytes\n\nAt C5-C6, there is a broad-based central disc osteophyte complex which\nminimally indents the ventral spinal cord. Cord signal remains normal. There\nis mild spinal canal narrowing. There is moderate right and severe left neural\nforaminal narrowing by uncovertebral osteophytes.\n\nAt C6-C7, there is a broad-based central disc osteophyte complex which indents\nthe ventral thecal sac but does not contact or deform the spinal cord. There\nis mild right and severe left neural foraminal narrowing by uncovertebral\nosteophytes.\n\nC7-T1 and T1-T2 levels demonstrate no evidence for spinal canal or neural\nforaminal narrowing. There are minimal disk bulges at T1-T2 and T2-3 levels.\nThere are small nerve root sleeve diverticula at C7-T1 on the right, at T1-T2\nbilaterally, and at T2-T3 on the left.\n\nSagittal images through the T3-T4 level demonstrate a small disc bulge which\nminimally indents the ventral spinal cord but does not appear to significantly\nnarrow the spinal canal. Cord signal appears normal. There are no axial images\nthrough this level.", "output": "1. Multilevel degenerative disease, most significant at C5-C6, C6-C7, and\nT3-T4 levels, as detailed above.\n2. Fusion of C2 and C3 anterior and posterior elements, likely congenital." }, { "input": "CERVICAL SPINE:\nThe visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.\n\nThere is no evidence of appreciable vertebral body height loss to suggest\ncompression fracture. The cervical spinal alignment is within normal limits.\nThe bone marrow signal is normal.\n\nThe cervical cord is normal in morphology and signal intensity.\n\n\nMultilevel degenerative changes are as follows:\n\nC1-C2, C2-C3: There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nC3-C4: There is a posterior disc bulge indenting thecal sac, contacting and\ndeforming the spinal cord without underlying signal abnormality. Spinal canal\nstenosis is mild to moderate at this level. Bilateral uncovertebral joint\nhypertrophy results in moderate right and mild left neural foraminal\nnarrowing.\n\nC4-C5: A posterior disc osteophyte complex results in moderate severe spinal\ncanal stenosis, contacting and deforming the spinal cord without abnormal\nsignal. There is bilateral uncovertebral joint hypertrophy with moderate left\nand moderate severe right neural foraminal narrowing.\n\nC5-C6: An asymmetric left posterior disc bulge results in mild to moderate\ncanal stenosis, with mild to moderate right and moderate left neural foraminal\nnarrowing.\n\nC6-C7: There is a posterior disc bulge with mild spinal canal stenosis and\nmild bilateral neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nMultiple cystic nodules within the thyroid gland measure up to 1.6 cm in\nmaximum diameter (05:12). Several additional cystic appearing lesions within\nthe right supraclavicular space measure up to 1.4 cm (11:23).\n\n\nTHORACIC SPINE:\n\nThere is focal kyphosis centered at T4 with mild to moderate associated loss\nof T4 vertebral body height. No increased T2/STIR signal acute fracture at\nthis level. Otherwise, there is no additional areas of loss of vertebral body\nheight. Vertebral body alignment is anatomic. There is no significant spinal\ncanal or neural foraminal narrowing visualized within the thoracic spine.\n\nThe imaged paraspinal soft tissues demonstrate multiple T2 hyperintensities\nwithin the bilateral kidneys and liver, incompletely characterized but likely\nrepresenting simple cysts. Also noted is a 3.4 x 3.2 cm abdominal aortic\naneurysm at the level of the kidneys, with associated mural thrombus versus\ndissection.\n\n\nLUMBAR SPINE:\nThere is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nThe bone marrow signal is diffusely heterogeneous, largely demonstrating fatty\nmarrow reconversion. The conus medullaris terminates at the level of L1.\nThere is no spinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1, L1-L2: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: A posterior disc bulge with bilateral facet hypertrophy and thickening\nflavum results in no appreciable spinal canal stenosis, but with mild\nbilateral neural foraminal narrowing.\n\nL3-L4: There is a posterior disc bulge with bilateral facet hypertrophy and\nthickening of the ligamentum flavum resulting in moderate to severe spinal\ncanal stenosis with moderate bilateral neural foraminal stenosis. The disc\nbulge at this level contacts the left traversing L3 nerve root and bilateral\ndescending L4 nerve roots.\n\nL4-L5: A posterior disc bulge with thickening of the ligamentum flavum and\nfacet hypertrophy result in moderate canal stenosis with moderate right and\nmild left neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge is noted without appreciable spinal canal\nstenosis or neural foraminal narrowing.\n\nIncidentally noted is fatty atrophy of the bilateral paraspinal musculature.", "output": "1. Focal kyphosis within the thoracic spine with associated moderate loss of\nheight of the T4 vertebral body, a finding which appears chronic in nature.\n2. Multilevel spondylosis of the cervical spine, as detailed above, most\nsignificant at C4-5 with moderate severe spinal canal stenosis, moderate left\nand moderate severe right neural foraminal narrowing.\n3. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most notable at L3-L4 with moderate severe spinal canal stenosis and\nmoderate bilateral neural foraminal stenosis. The disc bulge at this level\ncontacts the left traversing L3 and bilateral descending L4 nerve roots.\n4. Suprarenal abdominal aortic aneurysm measuring 3.4 x 3.2 cm and\ndemonstrating internal mural thrombus versus dissection. If clinically\nindicated, evaluation by dedicated CTA torso is recommended.\n5. Multiple cystic thyroid nodules and cystic right supraclavicular lesions,\nincompletely characterized. Recommend correlation with nonurgent focused\nultrasound evaluation." }, { "input": "There is widening of the C6-C7 spinous processes as well as left facet joint\nwidening, indicative of a left joint capsular injury. The C6 facet is\nsubluxed over C7 on the right. Re-demonstrated is a fracture of the right C7\nsuperior facet. Fluid signal is seen in the bilateral facet joints of C6-7. \nAbnormal STIR signal in the C7/T1 intervertebral disc suggests injury. \nIncreased signal on STIR images posterior to the C7 vertebral body is\nindicative of edema. The ligamentum flavum is intact but infolded into the\nspinal canal with encroachment on the cord. The posterior longitudinal\nligament is not well seen, which is equivocal for injury. The anterior\nlongitudinal ligament is intact. There is complete disruption of the\ninterspinous ligaments at C6-7. Fluid signal within the paraspinal muscles\nindicates partial tearing.\nThere is possible increased signal within the spinal cord, however motion\nartifact degrades the axial images.\n\nNarrowing of the spinal canal at C5-C7 is likely secondary to degeneration.\nThere is intervertebral disc bulging at C5/6 and C6/7 with moderate spinal\ncanal narrowing. No significant neural foraminal narrowing. No evidence of\ninfection or neoplasm.", "output": "1. Complete disruption of the interspinous ligaments at C6-7.\n2. Possible injury to posterior spinal ligament over the region of C6-T1. The\nALL is intact, the PLL is not well seen, equivocal for injury. Partial\ntearing of the local posterior paraspinal muscles.\n3. There is widening of the C6-C7 facet joints suggesting injury to the joint\ncapsule.\n4. Unilateral C7 superior facet fracture with bilateral widening of the facet\njoints suggestive of injury to both joint capsules.\n5. Moderate narrowing of the spinal canal at C5-C7 secondary to degenerative\ndisease with intervertebral disc bulging at C5/6 and C6/7.\n6. Possible increased signal within the spinal cord suggesting contusion,\nalthough images are degraded by motion artifact.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by Dr.\n___. on the telephone on ___ at 11:08 am, 5 minutes after\ndiscovery of the findings." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \n___ type 2 changes are noted in the inferior endplate of L5 vertebral body. \nOtherwise, there is no marrow signal abnormality. The visualized portion of\nthe spinal cord is preserved in signal and caliber.\n\nThere is disc desiccation in L5-S1. Otherwise, intervertebral disc heightsare\npreserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identifie. The visualized portion of the sacroiliac joints\nare preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is unchanged mild diffuse disc bulge causing mild left neural\nforaminal narrowing with no vertebral canal stenosis.\n\nAt L3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is unchanged diffuse disc bulge associated with a left\nparacentral disc protrusion causing mild bilateral neural foraminal narrowing,\nleft greater than right withno vertebral canal stenosis.\n\nAt L5-S1 there is diffuse disc bulge associated with an increased left sided \ndisc protrusion impinging on the left S1 nerve root. There is mild bilateral\nforaminal narrowing and no vertebral canal stenosis..", "output": "Mild degenerative changes in the lumbar spine, with increased left sided disc \nprotrusion in L5-S1 impinging on the left S1 nerve root." }, { "input": "CERVICAL:\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is multilevel disc desiccation, with preserved intervertebral disc\nheight.\n\nThere is no prevertebral soft tissue swelling. The visualized portion of the\nposterior fossa, and cervicomedullary junction are unremarkable.\n\n At C2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is a tiny midline protrusion that slightly indents the anterior\nsurface of the spinal.\n\nAt C4-5 there is mild diffuse disc bulge with hypertrophic changes in the\nuncovertebral joints with no vertebral canal or neural foraminal stenosis.\n\nAt C5-6 there is mild disc diffuse disc bulgewith no vertebral canal or neural\nforaminal stenosis.\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.\n\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing.", "output": "1. Mild degenerative changes in the cervical spine.\n2. Normal thoracic spine." }, { "input": "Please note the study is moderately degraded by motion.\n\nCERVICAL:\nAlignment is normal. There is multilevel disc space height loss and decreased\nsignal. There is heterogeneous bone marrow signal with no focal bone marrow\nreplacing lesion is identified. The spinal cord appears normal in caliber\nand configuration. There is no evidence of spinal canal or neural foraminal\nnarrowing.\n\n At C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is uncovertebral hypertrophy, facet arthropathy and disc\nprotrusion resulting in mild spinal canal and probable moderate bilateral\nneural foraminal stenosis, although limited by motion artifact.\n\nAt C4-5 there is disc protrusion and facet arthropathy with no significant\nspinal canal stenosis. Limited evaluation for neural foraminal stenosis given\nmotion.\n\nAt C5-6 there is disc protrusion, facet arthropathy and uncovertebral\nhypertrophy resulting in mild spinal canal stenosis. Evaluation for neural\nforaminal stenosis is limited by artifact.\n\nAt C6-7 there is disc protrusion, uncovertebral hypertrophy and facet\narthropathy resulting in mild to moderate spinal canal stenosis, severe right\nand moderate left neural foraminal stenosis.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.\n\nTHORACIC:\nThere is mild dextroscoliosis of the mid thoracic spine with compensatory\nlevoscoliosis of the upper thoracic spine. A hemangioma is seen in the T1\nvertebral body. There is multilevel disc space height loss and decreased\nsignal. There is approximately 30% loss of height of the T1 and T4 vertebral\nbody with no internal STIR hyperintense signal. Multilevel ___ type 2\nchanges are seen. The spinal cord appears normal in caliber and\nconfiguration.\n\nThere is loss of height of the T12 vertebral body with no internal STIR\nhyperintense signal.\n\nThere is a small right paracentral disc protrusion at T3-4 with no significant\nspinal canal or neural foraminal stenosis. There are disc bulges seen at T7-8\nand T10-11 with a left paracentral disc protrusion at T8-9 with no significant\nspinal canal neural foraminal stenosis. A left paracentral disc protrusion at\nT9-10 is seen with ligamentum flavum hypertrophy resulting in mild spinal\ncanal stenosis and questionable mild left neural foraminal stenosis.\n\nLUMBAR:\n\nThere is diffuse T1 hypo intense signal and STIR hyperintense signal in the L4\nvertebral body with a linear band of higher STIR signal at the fracture line,\nbetter visualized on the prior CT. No osseous retropulsion is seen. There is\nminimal prevertebral STIR hyperintense signal this level. The visualized\nportion of the spinal cord is preserved in signal and caliber. There is loss\nof intervertebral disc height and signal at multiple levels. The visualized\nportion of the sacroiliac joints are preserved. There is sacralization of the\nL5 vertebral body.\n\nAt T12-L1 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in mild spinal canal stenosis, severe left subarticular\nzone stenosis, severe left neural foraminal stenosis and mild right neural\nforaminal stenosis.\n\nAt L1-2 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in moderate right subarticular zone stenosis and mild\nbilateral neural foraminal stenosis.\n\nAt L2-3 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in moderate bilateral subarticular zone stenosis, mild\nspinal canal stenosis and mild bilateral neural foraminal stenosis.\n\nAt L3-4 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in mild spinal canal stenosis, mild right subarticular\nzone stenosis and mild right, moderate left neural foraminal stenosis.\n\nAt L4-5 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting and moderate to severe spinal canal stenosis, severe\nright and mild left neural foraminal stenosis.\n\nAt L5-S1 there is facet arthropathy with no significant spinal canal and mild\nright neural foraminal stenosis.\n\nOTHER: The 2.6 cm right adrenal and 1.8 cm left adrenal adenoma are again\nseen. Scout imaging suggests nonspecific bilateral shoulder joint fluid (see\n01:12). Additionally, scout imaging suggests a distended bladder (see 3:1). \nQuestion small right lower lobe opacity versus artifact (see 14:12).", "output": "1. Study is moderately degraded by motion.\n2. Chronic compression fractures of the T1, T4 and T8-12 vertebral bodies with\nno osseous retropulsion at these levels.\n3. Redemonstration of L4 vertebral body fracture with diffuse bone marrow\nedema, minimal prevertebral edema and no osseous retropulsion.\n4. Within limits of study, no definite evidence of ligamentous injury. \nNonspecific edema noted along the L4 vertebral body anterior superior endplate\nmay indicate small area of ligamentous injury without definite visualization\nof anterior longitudinal ligament disruption.\n5. Degenerative changes throughout the spine, as described above, worse at\nL4-5 resulting in moderate to severe spinal canal stenosis and severe right\nneural foraminal stenosis.\n6. Scout imaging suggests nonspecific bilateral shoulder joint fluid and\nbladder dilatation.\n7. Redemonstration of known 2.6 cm right and 1.8 cm left adrenal lesions.\n8. Question small nonspecific right lower lobe opacity versus artifact." }, { "input": "Study is moderately degraded by motion, especially limiting evaluation\ncervical spinal cord for lesions.\n\n There is straightening of cervical lordosis.\n\nThere is a dark line extending through the anterior arch of C1, eccentric to\nthe right with adjacent marrow edema, as evidenced by STIR hyperintense signal\nin this region, consistent with known nondisplaced C1 fracture, better\nappreciated on the preceding CT (series 6, image 8; series 3, image 4).\n\nThe vertebral bodies are normal in height and alignment.\n\nThere is trace edema in the prevertebral soft tissues extending from\napproximately C3 to the craniocervical junction (series 3, image 8). No\ndiscrete tear is identified. The posterior longitudinal ligament and\nligamentum flavum are intact. There is no abnormal signal in the posterior\nligamentous complex.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. There is no abnormal focus of slow diffusion within the spinal\ncord.\n\n Intervertebral discheightsandsignalare preserved.\n\nNo vertebral canal or neural foraminal narrowing is noted.\n\nThere is minimal posterior trachea intraluminal fluid, possibly representing\naspiration. Within the limits of this noncontrast study there is no evidence\nof infection or neoplasm. The visualized portion of the posterior fossa,\ncervicomedullary junction and lung apicesare preserved.", "output": "1. Study is moderately degraded by motion.\n2. Nondisplaced fracture of the C1 anterior arch is better appreciated on\npreceding CT.\n3. Trace prevertebral edema from approximately C3 to the craniocervical\njunction is nonspecific, but may be seen in the setting of anterior\nlongitudinal ligament injury.\n4. Within limits of study, no definite evidence of cervical spinal cord\nlesion.\n5. Minimal tracheal fluid concerning for aspiration." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThe vertebral body height and alignment within the lumbar spine are normal.\nThere is diffusely heterogenous bone marrow signal which is likely on the\nbasis of a combination of areas of focal fat and/or hemangiomas, hematopoietic\nbone marrow, and degenerative endplate changes. Specifically, there type ___\n___ degenerative endplate changes at the L5-S1 level.\n\nThe conus medullaris terminates at the L1-L2 level. There is no clear spinal\ncord signal abnormality or edema.\n\nThere are multiple bilateral cystic renal lesions many of which were present\non prior CT. The remaining paraspinal and prevertebral soft tissues are\nunremarkable.\n\nAt the T12-L1 level, there is bilateral facet arthropathy. The spinal canal\nand neural foramina appear normal.\n\nThe L1-L2 level, there is a large disc extrusion with caudal migration along\nthe posterior aspect of the L2 vertebral body, severely narrowing the spinal\ncanal and compressing the distal conus medullaris and traversing nerve roots.\nThere is no clear spinal cord edema. There is bilateral facet arthropathy\nligamentum flavum thickening. The neural foramina appear normal.\n\nAt the L2-L3 level, there is bilateral facet arthropathy and ligamentum flavum\nthickening. The spinal canal and neural foramina appear normal.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge with superimposed foraminal disc\nprotrusions and annular fissure which cause moderate spinal canal narrowing\nwith contact of the traversing bilateral L4 nerve roots, as well as moderate\nbilateral neural foraminal narrowing, likely contacting the exiting L3 nerve\nroots, right greater than left.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, and a diffuse disc bulge with left foraminal disc protrusion and\nannular fissure causing mild spinal canal narrowing, moderate right neural\nforaminal narrowing, and moderate left neural foraminal narrowing with contact\nof the exiting left L4 nerve root.\n\nAt the L5-S1 level, there is bilateral facet arthropathy and ligamentum flavum\nthickening. There is loss of disc height and signal, diffuse disc bulge, and\nsuperimposed posterior disc protrusion and intervertebral osteophytes which\nmoderately narrow the spinal canal and contact of the traversing bilateral S1\nnerve roots. Intervertebral osteophytes cause moderate to severe bilateral\nneural foraminal narrowing with compression of the exiting bilateral L5 nerve\nroots.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.", "output": "1. L1-L2 disc protrusion with caudal migration, severely narrowing the spinal\ncanal, and compressing the distal conus medullaris and nerve roots. There is\nno clear evidence of spinal cord edema.\n2. Additional multilevel lumbar spondylosis, greatest from the L3-L4 through\nL5-S1 levels, including moderate spinal canal narrowing at the L3-L4 level,\nlikely affecting the traversing L4 nerve roots, and moderate to severe\nbilateral neural foraminal narrowing at the L5-S1 levels, likely compressing\nthe exiting bilateral L5 nerve roots.\n3. Multiple bilateral renal cystic structures as described, the some of which\nare noted to be present on the. While these findings may represent renal\ncysts, other etiologies cannot be excluded on the basis of this noncontrast\nexamination. Recommend clinical correlation. If clinically indicated, further\nevaluation may be obtained via renal ultrasound." }, { "input": "Alignment is anatomic in the sagittal plane. Vertebral body height\nis similar to prior with mild anterior wedging of T12. There is no evidence\nof acute fracture.\n\nAgain demonstrated is degenerative marrow signal changes, predominantly ___\ntype 2, most prominent at L4-5 but also seen at numerous other levels.\n\nDisc desiccation is also again demonstrated at numerous levels also most\nsevere at L4-5.\n\nThe conus medullaris terminates at the level of L1 with normal contour and\nsignal.\n\nThere is no epidural fluid collection and no suspicious intradural enhancement\nto suggest abscess. Furthermore, there is no disc enhancement to suggest\ndiscitis.\n\nDegenerative changes include:\n\nAt L2-3, there is a mild disc bulge, unchanged compared to prior, with mild\nbilateral facet and ligamentum flavum hypertrophy and left lateral recess\nnarrowing.\n\nAt L3-4, there is diffuse disc bulge and central disc protrusion with\nbilateral facet and ligamentum flavum hypertrophy, also similar to prior, with\nmoderate bilateral foraminal narrowing.\n\nAt L4-5, there is diffuse disc bulge and a central disc protrusion, also\nsimilar to prior, with severe bilateral foraminal narrowing, bilateral facet\nand ligamentum flavum hypertrophy, and mild central canal narrowing.\n\nAt L5-S1, disc bulge and bilateral facet hypertrophy/arthropathy are\nunchanged. There is mild right foraminal narrowing also similar to prior.", "output": "1. No evidence of epidural abscess or osteomyelitis/discitis.\n\n2. Severe degenerative disc and facet disease, similar to ___." }, { "input": "Vertebral body height and alignment are preserved.\n\nThe conus medullaris terminates at the L1-L2 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nAt L1-L2, there is intervertebral disc desiccation and a left paracentral disc\nprotrusion without spinal canal or neural foraminal narrowing.\n\nAt L5-S1, there is intervertebral disc desiccation and a central disc\nprotrusion without spinal canal or neural foraminal narrowing. The midline\nannular fissure enhances after contrast administration.\n\nThere are small facet joint effusions at left L4-L5 and bilateral L5-S1.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Intervertebral disc desiccation and small disc protrusions at L1-L2 and\nL5-S1, without spinal canal or neural foraminal narrowing.\n2. Small facet joint effusions at left L4-L5 and bilateral L5-S1." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nDegenerative changes lumbar spine. Mild narrowing L5-S1 disc space. \nMultilevel mild diffuse disc bulges. Lower lumbar facet arthritis.\n\nAt L1-L2 level there is shallow broad-based left paramedian disc protrusion,\nsimilar to prior. Mild central canal narrowing, similar. Patent foramina.\n\nAt L2-L3, L3-L4, L4-5 levels central canal, foramina are patent\n\nAt L5-S1 level there is small central disc protrusion, minimally more\nprominent since prior. Patent central canal. No mass effect on traversing S1\nnerves. Mild bilateral foraminal narrowing, similar to prior.", "output": "1. Mild degenerative changes lumbar spine.\n2. Small disc protrusion L1-L2 level, similar.\n3. Small disc protrusion L5-S1 level, minimally more prominent.\n4. Mild bilateral L5-S1 foraminal narrowing." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nare maintained at all levels. There are are ___ type 2 changes at C4-C5 and\nC5-C6. The marrow signal is otherwise unremarkable. Spinal cord signal is\nnormal. There is loss of intervertebral disc height and signal at all levels\nin keeping with disc degeneration.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt C2-C3, there is central disc protrusion indenting the ventral thecal sac. \nBilateral neural foramen are patent.\n\nAt C3-C4, there is central and left paracentral disc protrusion indenting the\nventral aspect of the cord. Also seen is bilateral uncovertebral and facet\narthropathy causing mild right and moderate left neural foraminal narrowing.\n\nAt C4-C5, there is central disc protrusion and intervertebral osteophytes\nindenting the ventral aspect of the cord and remodeling it. Also seen is\nbilateral uncovertebral and facet arthropathy causing mild bilateral neural\nforamen narrowing.\n\nAt C5-C6, there is no encroachment on the spinal canal or neural foramina.\n\nAt C6-C7, there is central and right-sided disc protrusion and intervertebral\nosteophytes remodeling the right ventral aspect of the cord with severe spinal\ncanal stenosis at this level. Bilateral uncovertebral and facet arthropathy\nis causing mild bilateral neural foraminal narrowing.\n\nAt C7-T1, bilateral neural foramen and spinal canal are patent.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm. There is\natelectasis in bilateral visualized lung bases. The remaining visualized lung\nparenchyma and mediastinal structures appear unremarkable. The prevertebral,\nparavertebral and paraspinal soft tissues appear unremarkable.\n\nThere is mild right facet arthropathy at T3-T4 and T4-T5 causing mild right\nneural foraminal narrowing. Also seen is mild bilateral facet arthropathy at\nT8-T9, T9-T10 and T10-T11 causing mild bilateral neural foramen narrowing.\n\nAgain seen is a large hiatal hernia.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. The marrow signal is slightly heterogeneous\nwith focal areas of marrow fat.\n\nThere is loss of intervertebral disc height and signal at multiple levels in\nkeeping with disc degeneration.\n\nThe lower visualized spinal cord appears unremarkable with the conus\nterminating at L1-L2.\n\nThere is a atrophy of bilateral kidneys with a simple cyst in the upper pole\nof right kidney measuring approximately 1 cm. The remaining visualized\nretroperitoneal, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt L1-L2, there is loss of disc height and signal with broad-based disc bulge\nand bilateral facet arthropathy causing mild bilateral neural foramen\nnarrowing. The spinal canal is patent.\n\nAt L2-L3, there is loss of disc height and signal with broad-based disc bulge,\nbilateral facet arthropathy and ligamentum flavum thickening causing moderate\nspinal canal stenosis and mild bilateral neural foramen narrowing.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc bulge,\nbilateral facet arthropathy and ligamentum flavum thickening causing mild\nspinal canal stenosis.\n\nAt L4-L5, there is loss of disc height and signal with broad-based disc bulge,\nbilateral facet arthropathy and ligamentum flavum thickening causing moderate\nspinal canal stenosis and mild bilateral neural foramen narrowing.\n\nAt L5-S1, there is loss of disc height and signal with broad-based disc bulge\nbut, bilateral facet arthropathy and ligamentum flavum thickening causing mild\nbilateral neural foramen narrowing. The spinal canal is patent.", "output": "1. No evidence of vertebral body fractures.\n2. Multilevel multifactorial degenerative disease of the cervical spine with\ndisc protrusions and osteophytes compressing the spinal cord at multiple\nlevels. This is worst at C6-7.\n3. Mild degenerative disease involving the thoracic spine with facet\narthropathy in the lower thoracic spine resulting in mild neural foramen\nnarrowing as described above. No spinal canal stenosis is seen.\n4. Multilevel multifactorial degenerative disease of the lumbar spine, worst\nat L2-L3 and L4-L5 with moderate spinal canal stenosis." }, { "input": "Unchanged levoconvex scoliosis of the lumbar spine and component of most\nlikely congenital narrowing of the lumbar spinal canal. Vertebral body height\nand alignment is otherwise maintained. There is multilevel degenerative disc\ndisease with moderate to severe disc space height loss throughout the lumbar\nspine. Again seen is a L1 vertebral body hemangioma. Bone marrow signal\nintensity is otherwise within normal limits.\n\nAt T11-T12, there is a a disc bulge, facet joint arthropathy and ligamentum\nflavum thickening, no spinal canal stenosis, severe right and mild left neural\nforaminal narrowing. The right T11 nerve root is compressed in the\nneuroforamen (series 3, image 46).\n\nAt T12-L1, there is a disc bulge, facet joint arthropathy and ligamentum\nflavum thickening, moderate spinal canal stenosis, moderate to severe left and\nmild right neural foraminal narrowing. There is remodeling of the left T12\nnerve root in the neuroforamen (series 3, image 46).\n\nAt L1-L2, there is a disc bulge, facet joint arthropathy and uncovertebral\nhypertrophy, moderate spinal canal stenosis with crowding of the cauda equina\nnerve roots, moderate right and mild left neural foraminal narrowing. There\nis remodeling of the right L2 nerve root in the neuroforamen (series 3, image\n42).\n\nAt L2-L3, there is a left paracentral disc protrusion, facet joint arthropathy\nand ligamentum flavum thickening, severe spinal canal stenosis with\ncompression of the cauda equina nerve roots, similar to ___, mild bilateral\nneural foraminal narrowing.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, severe spinal canal stenosis with compression of the cauda equina\nnerve roots, similar to ___, moderate left and mild right neural foraminal\nnarrowing. There is remodeling of the undersurface of the left L3 nerve root\nin the neuroforamen (series 3, image 50).\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, severe spinal canal stenosis with compression of the cauda equina\nnerve roots, similar to ___, moderate left and mild right neural foraminal\nnarrowing. There is remodeling of the undersurface of the left L4 nerve root\nin the neuroforamen (series 3, image 50).\n\nAt L5-S1, there is a disc bulge, facet joint arthropathy and ligamentum flavum\nthickening, moderate spinal canal stenosis, similar to ___, severe bilateral\nneural foraminal narrowing with remodeling of the undersurface of the\nbilateral L5 nerve roots in the neuroforamen (series 3, image 52 and 27).", "output": "1. Multilevel degenerative changes of the lumbar spine in combination with\nlevoconvex scoliosis and likely component of congenital narrowing of the\nlumbar spinal canal. Findings are not significantly changed when compared to\n___.\n2. Severe spinal canal stenosis at L2-L3, L3-L4 and L4-L5 with compression of\nthe cauda equina nerve roots and moderate left neural foraminal narrowing at\nL3-L4 and L4-L5 with remodeling of the left nerve roots in the neuroforamen at\nthese levels.\n3. Moderate spinal canal stenosis at T12-L1, L1-L2 and L5-S1 with moderate and\nsevere neural foraminal narrowing and remodeling of the nerve roots the\nneuroforamen at these levels.\n Please note that imaging can make the anatomic diagnosis of cauda equina\nCOMPRESSION, but that cauda equina SYNDROME is a clinical diagnosis based on\nthe patient examination and clinical history. Imaging alone cannot make a\ndiagnosis of cauda equina SYNDROME." }, { "input": "Levoconvex scoliosis is best seen on the scout film and is similar\nto prior. Stippled elevated T1 and T2 signal within the L1 vertebral body is\nlikely a hemangioma, similar to prior. There are no suspicious osseous\nlesions. Alignment is unchanged. The conus medullaris is at the level of the\nL1 vertebral body with similar appearance to the prior examination, with\nnormal signal.\n\nAt T11-T12, a broad-based disc bulge combines with vertebral body osteophytes\nto mildly narrow the spinal canal and indent the anterior spinal cord, which\nmaintains normal signal.\n\nAt T12-L1, a broad-based disc bulge combines with posterior vertebral body\nosteophytes to mildly narrow the spinal canal. In addition, right greater\nthan left facet buckling combines with the scoliotic deformity to moderately\nnarrow the right lateral aspect of the spinal canal with mild deformity of the\ncauda equina.\n\nAt L1-L2, a moderate in size posterior disc protrusion combines with\ncongenitally short pedicles to moderately narrow the spinal canal with cauda\nequina crowding and moderate right and mild left foraminal narrowing. \n\nAt L2-L3, a moderate in size left paracentral disc protrusion combines with\nshort pedicles and moderate bilateral facet buckling to cause moderate spinal\ncanal narrowing with crowding of the cauda equina, greater on the left side. \nThere is moderate left and mild right foraminal narrowing as well.\n\nAt L3-L4, a moderate in size disc bulge combines with congenital short\npedicles and moderate bilateral facet degeneration to cause severe spinal\ncanal narrowing, with crowding of the cauda equina. There is also mild\nbilateral foraminal narrowing.\n\nAt L4-L5, a moderate in size, broad-based disc bulge combines with severe\nfacet buckling and congenitally short pedicles to severely narrow the central\nspinal canal with severe crowding of the cauda equina and no visible CSF at\nthis level. There is moderate left and mild right foraminal narrowing as\nwell.\n\nAt L5-S1, a moderate in size disc bulge combines with bilateral moderate facet\nbuckling and a congenital short pedicles to moderately narrow the central\ncanal and bilateral foramina.\n\nThe visualized paravertebral soft tissues are unremarkable.", "output": "Multilevel degenerative disc and facet disease with congenitally\nshort pedicles combine to create multilevel severe spinal canal narrowing,\nmost prominent at L4-L5. Overall, there has been little change compared to\nthe ___ examination." }, { "input": "Levoconvex scoliosis is again noted. There is a stable hemangioma in the L1\nvertebral body. There are no concerning focal lesions. Alignment is unchanged.\nNormal signal is noted in the conus medullaris, which is located at L1. There\nis multilevel degenerative change, the overall extent of which is similar to\nthat seen on the prior study from ___.\nAt T11-T12, a broad-based disc bulge and osteophyte encroachment is present,\nwith no significant spinal stenosis. This, along with facet joint arthropathy\nand scoliosis, causes moderate right neural foraminal stenosis. There is no\nleft neural foraminal stenosis. At T12-L1, a broad-based disc bulge and\nosteophyte encroachment causes moderate spinal canal stenosis. This, along\nwith facet joint arthropathy and scoliosis, causes mild right neural foraminal\nstenosis. There is no neural foraminal stenosis (series 7, image 21). At\nL1-L2, a moderate-sized disc protrusion and prominent posterior osteophytes,\nalong with facet joint arthropathy and ligamentum flavum hypertrophy cause\nmoderate spinal canal stenosis, crowding of the cauda equina, and left greater\nthan right moderate neural foraminal stenosis (series 7, image 16). At L2-L3,\na large left paracentral disc protrusion causes severe spinal canal stenosis\nand marked compression of the cauda equina. There is mild right and moderate\nleft neural foraminal stenosis (series 7, image 10). At L3-L4, a midline disc\nprotrusion along with congenitally short pedicles and bilateral facet joint\narthropathy causes severe spinal canal stenosis and mild bilateral neural\nforaminal stenosis (series 6, image 27). At L4-L5, a moderate central disc\nbulge with congenitally short pedicles, ligamentum flavum hypertrophy, and\nfacet joint arthropathy cause severe spinal stenosis and nerve root\ncompression at this level (series 6, image 22). There is moderate left and\nmild right neural foraminal stenosis. At L5-S1, posterior disc bulging, along\nwith congenitally short pedicles, ligamentum flavum hypertrophy, and facet\njoint arthropathy cause moderate spinal stenosis and left greater than right\nneural foraminal stenosis (series 6, image 22).The sclerotic lesion seen in\nthe left sacral ala has no MRI correlate. There is no bone marrow signal\nabnormality in this location to suggest presence of a focal lesion.", "output": "1. Non-specific sclerotic lesion in left sacral ala has no MRI correlate.\n2. Severe multilevel degenerative disc disease with severe spinal stenosis at\nmultiple levels and severe neural foraminal stenosis, worst at L4-L5, where\nthere is evidence of bilateral nerve root compression.\n3. No significant interval change in severity from prior MRI performed in\n___." }, { "input": "Cervical spine: Acute widening of the anterior aspect of the C6/C7\nintervertebral disc space is concerning for a hyperextension injury with fluid\nseen within the intervertebral disc space. Extensive prevertebral soft tissue\nedema is seen. There is disruption of the anterior and posterior longitudinal\nligaments at this level. Extensive paraspinal STIR signal abnormality is seen\nspanning throughout the cervical spine concerning for intraspinous ligamentous\ninjury. Increased STIR signal involving the left C7 transverse process,\nlamina and superior articular process with displacement of the fracture\nfragment into the left neural foramen consistent with patient's known\nfractures on the prior CT scan.\n\nSevere spinal canal narrowing at C6-C7 is caused by the patient's osseous\nligamentous injuries described above. The spinal cord is enlarged, edematous\nfrom C5 through T1 with likely a small focus of intra cord hemorrhage at the\nlevel of C6-C7 interspace. A small amount of epidural hemorrhage is also seen\nthis level.\n\nThoracic spine:\n\nThe alignment is normal. Vertebral body heights are preserved. \nIntervertebral disc signal appears to be unremarkable. Spanning from T5\nthrough T8, increased T2/stir signal abnormality is seen involving the\nthoracic cord. This is likely caused by an epidural collection extending from\nthe C6/C7 trauma/fracture, contributing to severe canal narrowing. Epidural\nhematoma is seen extending from C6/C7 interspace to the level of T7/T8.\n\nDependent atelectasis is seen with the lungs bilaterally.", "output": "1. Hyperextension fracture with widening of the anterior aspect of C6/C7\nintervertebral disc space and fluid, has contributed to severe spinal canal\nnarrowing caused by the osseous and ligamentous injuries, with resulting\nspinal cord enlargement and edema as well as foci of hemorrhage within the\ncord at C6/C7, consistent with a hemorrhagic cord contusion. A small amount\nof epidural hemorrhage is also seen.\n2. Ligamentous injury is seen involving the anterior and posterior\nlongitudinal ligaments, the ligamentum flavum and interspinous ligaments at\nC6/C7.\n3. Spinal cord edema is seen extending from T5 through T8, with a posterior\nepidural collection resulting in severe spinal canal narrowing, likely\ntracking from the region of the C6/C7 traumatic injuries to the level of\nT7/T8. Alternatively, the cord edema could be secondary to vascular supply\ninjury, resulting in a focal cord infarction.\n4. Known fracture of the C7 superior articular facet and left C7 transverse\nprocess, and lamina are better evaluated on the prior CT scan.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 11:50 AM, 5 minutes after\ndiscovery of the findings." }, { "input": "There is scoliosis of lumbar spine convex to the right in the lower lumbar and\nto the left in the upper lumbar region.\n\nAt T10-T11 and T11-12 levels disc degenerative changes are identified. The\nT12 vertebra demonstrates anterior wedging with low signal anteriorly which\ncould be related to kyphoplasty clinical correlation recommended. There is\ndiffuse disc bulge seen at T12-L1 without spinal stenosis.\n\nThe L1 vertebra shows hemangioma unchanged from the previous CT. At L1-2 and\nL2-3 disc bulging is identified without spinal stenosis with mild-to-moderate\nnarrowing of the right foramen at L2-3 level.\n\nAt L3-4 disc and facet degenerative changes are seen. There is\nmoderate-to-severe left foraminal narrowing seen with mild spinal stenosis and\nmild right foraminal narrowing.\n\nAt L4-5 level, diffuse disc bulge and thickening of the ligaments with facet\ndegenerative changes result in severe spinal stenosis with severe left and\nmild-to-moderate right foraminal narrowing.\n\nAt L5-S1 level disc and facet degenerative changes are seen with moderate left\nand mild-to-moderate right foraminal narrowing.\n\nThe distal spinal cord shows normal signal intensities.\n\nEvaluation of the paraspinal soft tissues demonstrate the cholecystolithiasis\nwhich is incompletely evaluated.", "output": "1. Scoliosis of lumbar spine.\n2. Severe spinal stenosis and left foraminal narrowing at L4-5 level.\n3. Moderate-to-severe left foraminal narrowing and mild spinal stenosis at\nL3-4 level.\n4. Other degenerative changes as described above have progressed from the\nprevious MRI of ___." }, { "input": "S-shaped scoliosis of the lumbar spine is similar to ___. Minimal\nretrolisthesis of L2 on ___ and L3 on ___ similar to ___. Alignment is\notherwise normal. Anterior collapse of the T12 vertebral body appears similar\nto ___, please note that the patient is status post vertebroplasty at\nthis level. Hemangioma in the L1 vertebral body is again seen. The spinal\ncord appears normal in caliber and configuration.\n\nAt T12-L1, the collapsed T12 vertebral body and diffuse disc bulge causes mild\nposterior displacement of the spinal cord without cord signal abnormality. \nThere is moderate right neural foraminal narrowing.\n\nAt L1-2, there is mild disc bulge without spinal canal or neural foraminal\nnarrowing.\n\nAt L2-3, there is mild diffuse disc bulge with minimal spinal canal narrowing\nand mild-to-moderate right neural foraminal narrowing.\n\nAt L3-4, there is mild diffuse disc bulge, moderate left ligamentum flavum\nhypertrophy, and moderate facet arthropathy. There is spinal canal narrowing\nand mild right and moderate to severe left neural foraminal narrowing.\n\nAt L4-5, there is mild diffuse disc bulge with mild to moderate left\nligamentum flavum hypertrophy and moderate to severe facet arthropathy. There\nis moderate right and severe left neural foraminal narrowing.\n\nAt L5-S1, there is mild diffuse disc bulge and severe facet arthropathy. \nThere is moderate right and moderate to severe left neural foraminal\nnarrowing.\n\nThere is mild vertebral body edema surrounding the S1-2 disc with associated\nvague T1 hypointensity. There appears to be anterior step-off of the S1\nvertebral body over the S2 vertebral body while the posterior aspects of S1\nand S2 remain aligned.\n\nGallstones and left posterior renal cortical cyst is again seen.", "output": "1. Findings at S1-2, in the setting of trauma, are most suggestive of\ncompression fracture. This could also represent subacute stress fracture. \nAlthough considered less likely, in the appropriate clinical scenario,\ninfection would have to be considered and additional contrast enhanced images\ncould be helpful in that situation.\n2. Other extensive multilevel degenerative changes are similar to ___.\n3. No cord signal abnormality." }, { "input": "There are 5 lumbar-type vertebrae. Again seen are bilateral pedicle screws at\nL5 and S1; the hardware is not well assessed by MRI. Alignment is anatomic. \nVertebral body heights are preserved. No suspicious bone marrow signal\nabnormalities are seen. There is disc desiccation and mild loss of disc\nheight at L4-L5 and L5-S1, as seen on the prior radiographs. The conus\nmedullaris terminates at T12.\n\nT12-L1, L1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: Mildly prominent posterior epidural fat. Mild facet arthropathy. The\nthecal sac is mildly narrowed without crowding of the intrathecal nerve roots.\nNo significant neural foraminal narrowing.\n\nL3-L4: Mild disc bulge, mildly prominent posterior epidural fat, and\nmild-to-moderate facet arthropathy. The thecal sac is mildly narrowed without\ncrowding of the intrathecal nerve roots. Traversing L4 nerve roots are\nabutted in the subarticular zones. There is a left foraminal annular tear and\ndisc protrusion, contacting the exiting left L3 nerve root in the mildly to\nmoderately narrowed left neural foramen. No significant right neural\nforaminal narrowing.\n\nL4-L5: There is a disc bulge, endplate osteophytes, and moderate facet\narthropathy, as well as mildly prominent posterior epidural fat. T2\nhypointense material in the right greater than left anterior epidural space\nmay reflect a disc protrusion versus postsurgical granulation tissue, unclear\nin the absence of intravenous contrast. This contacts the traversing L5 nerve\nroots, with displacement of the traversing right L5 nerve root. There is no\nmass effect on the intrathecal nerve roots. There is mild bilateral neural\nforaminal narrowing.\n\nL5-S1: There is a minimal disc bulge, endplate osteophytes, mild right and\nmild-to-moderate left facet arthropathy. There is no spinal canal narrowing. \nThere is mild bilateral neural foraminal narrowing.", "output": "1. Bilateral pedicle screws at L5 and S1. The hardware is not well assessed\nby MRI.\n2. L3-L4: Degenerative changes and mildly prominent posterior epidural fat. \nAbutment of traversing L4 nerve roots in the subarticular zones. Left\nforaminal disc protrusion contacts the exiting left L3 nerve root in the\nmildly to moderately narrowed left neural foramen.\n3. L4-L5: T2 hypointense material in the right greater than left anterior\nepidural space, contacting the traversing L5 nerve roots and displacing the\ntraversing right L5 nerve root, may reflect a disc protrusion versus\npostsurgical granulation tissue, unclear in the absence of intravenous\ncontrast." }, { "input": "The numbering of the cervical, thoracic and lumbar spine is based on the\ncount-down from the level of C2 vertebrae.\n\nCERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nare maintained at all levels. The marrow signal appears unremarkable without\nfocal suspicious marrow lesions. No evidence of ligamentous injury. The\nvisualized cervical spinal cord appears unremarkable. The posterior fossa\nstructures appear unremarkable.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt C2-C3, there is a central disc protrusion indenting the ventral aspect of\nthe cord and ligamentum flavum thickening encroaching posteriorly resulting\nmoderate spinal canal stenosis. Bilateral neural foramen are patent.\n\nAt C3-C4, there is mild bulging of the disc and ligamentum flavum thickening\nindenting the cord and flattening it. Bilateral uncovertebral and facet\narthropathy results in mild left neural foramen narrowing. Right neural\nforamen is patent.\n\nAt C4-C5, there is bulging of the disc and thickening of the ligamentum flavum\nindenting the ventral aspect of cord resulting in severe spinal canal\nstenosis. Bilateral uncovertebral and facet arthropathy results in mild\nbilateral neural foramen narrowing.\n\nAt C5-C6, a central disc protrusion indents the ventral aspect of cord\nresulting in moderate to severe spinal canal stenosis. Bilateral\nuncovertebral and facet arthropathy results in moderate right and mild left\nneural foramen narrowing.\n\nAt C6-C7, a left-sided disc protrusion indents the ventral thecal sac and\ncontacts the spinal cord. Bilateral neural foramen and spinal canal are\npatent.\n\nAt C7-T1, there is central disc protrusion indenting the ventral thecal sac. \nBilateral neural foramen and spinal canal are patent.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. No abnormal marrow signal is seen. The\nvisualized thoracic spinal cord appears unremarkable without focal cord signal\nabnormality or cord expansion.\n\nThere is loss of intervertebral disc signal at multiple levels in keeping with\ndisc desiccation.\n\nThere is atelectasis in bilateral lower lung zones with small bilateral\npleural effusions. The remaining visualized prevertebral, paravertebral and\nparaspinal soft tissues appear unremarkable.\n\nThere is right paracentral disc protrusion at T2-T3. The neural foramen and\nspinal canal are patent at all levels.\n\nLUMBAR SPINE:\nThe previously known fractures involving the right transverse process of L1,\nbilateral transverse processes of L2-L5 and sacrum are better evaluated on the\nprior CT scan. There is associated marrow edema involving the sacrum.\n\n\nThe vertebral body heights are maintained at all levels. The alignment of the\nlumbar spine is maintained. No evidence of ligamentous disruption. The the\nvisualized lower spinal cord appears unremarkable with the conus terminating\nat L2.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt T12-L1 to L3-L4, the neural foramen and spinal canal are patent.\n\nAt L4-L5, there is loss of disc height and signal with diffuse disc bulge,\nbilateral facet arthropathy resulting in moderate left and mild right neural\nforaminal narrowing. The spinal canal is patent.\n\nAt L5-S1, there is loss of disc height and signal with diffuse disc bulge\nresulting in mild bilateral neural foramen narrowing. The spinal canal is\npatent.", "output": "1. No evidence of cord or ligamentous injury involving the cervical, thoracic\nor lumbar spine.\n2. Multiple fractures involving the transverse processes of the lumbar\nvertebrae and sacrum is better evaluated on prior CT scan.\n3. Multilevel multifactorial degenerative disease of the cervical spine, most\nsevere at C4-C5 and C5-C6 with severe spinal canal stenosis and\nmild-to-moderate neural foramen narrowing as described above.\n4. Unremarkable MRI of the thoracic spine.\n5. Multilevel multifactorial degenerative disease of the lower lumbar spine\nwith moderate left and mild right neural foramen narrowing at L4-L5 as\ndescribed above." }, { "input": "Limited views of the paravertebral soft tissues demonstrates dilatation of the\ncommon bile duct measuring up to 8 mm in diameter, which is unchanged.\n\nThere is normal lumbar alignment. The vertebral body heights are preserved. \nThere is fat signal marginating the L2-L3 endplate articulations consistent\nwith type ___ ___ change. There is diffuse low signal throughout the\nvisualized intervertebral disc spaces with significant loss of height at\nL2-L3, L4-L5 and L5-S1. The conus demonstrates normal signal morphology\nterminating appropriately at the T12-L1 level.\n\nAt T11-T12 there is a small disc bulge without neural foraminal or spinal\ncanal stenosis.\n\nAt T12-L1 there is no neural foramina or spinal canal stenosis.\n\nAt L1-L2 there is a small disc bulge without neural foraminal or spinal canal\nstenosis.\n\nAt L2-L3 there is an asymmetric left disc bulge, facet arthropathy, and\nligamentum flavum thickening causing mild bilateral neural foraminal and\nspinal canal narrowing.\n\nAt L3-L4 there is no neural foramina or spinal canal stenosis.\n\nAt L4-L5 there is disc bulge with a superimposed central disc protrusion,\nfacet arthropathy, and ligamentum flavum thickening causing mild bilateral\nneural foraminal and spinal canal stenosis. There is lateral recess stenosis,\nright greater than left, which contacts the traversing right L5 nerve root.\n\nAt L5-S1 there is disc bulge and facet arthropathy without neural foraminal or\nspinal canal stenosis.", "output": "1. Multilevel degenerative changes of the lumbar spine, as described, most\nsevere at L4-L5 where there is lateral recess stenosis that contacts the\ntraversing right L5 nerve root.\n2. Dilated common bile duct, unchanged in comparison to ___ likely\nrelated to post cholecystectomy status." }, { "input": "There is grade 1 anterolisthesis of L5 on S1 which is slightly worse.\nBilateral chronic L5 pars interarticularis defects are again seen. Vertebral\nbody height is maintained and remaining vertebral bodies are aligned. There is\na small amount ___ type 2 degenerative endplate changes seen involving\nthe superior endplate of the L5 vertebral body unchanged. Bone marrow signal\nis otherwise unremarkable. There is loss of normal intervertebral disc signal\nand height at L5-S1. Remaining intervertebral disks are normal in height and\nsignal.\n\nThe spinal cord appears normal in caliber and configuration. The conus\nmedullaris terminates at the T12-L1 level.\n\nAt T11-T12, there is an a central/left paracentral disc protrusion indenting\nthe thecal sac and mildly narrowing the spinal canal. There is no significant\nneural foraminal narrowing at this level.\n\nFrom T12-L1 through L3-4, there is no significant disc protrusion, spinal\ncanal stenosis, or neural foraminal narrowing.\n\nAt L4-5 there is bilateral facet joint hypertrophy which crowds the\nsubarticular recesses without significant overall canal or foraminal\nnarrowing.\n\nAt L5-S1, there is uncovering of the disk with a superimposed posterior disc\nbulge and a left foraminal annular fissure. Combined with aforementioned\nanterolisthesis, and moderate to severe facet joint hypertrophy, there is\nbilateral subarticular zone narrowing and severe right and moderate to severe\nleft neural foraminal narrowing. Mass effect on the bilateral exiting L5 nerve\nroots is again noted.\n\nParaspinal soft tissues are unremarkable.\n\nA right adrenal nodule measures approximately 1.2 x 2.0 cm, similar to prior\nMRI although appears slightly larger when compared to prior CT, this may be\ntechnical in nature.", "output": "1. Slightly progressed grade 1 anterolisthesis of L5 on S1 with bilateral L5\npars interarticularis defects. In combination with posterior disc bulge and\nfacet joint there severe right and moderate to severe left neural foraminal\nnarrowing grossly unchanged compared to prior study, potentially impinging the\nexiting L5 nerve roots\n\n2. T11-T12 central/left paracentral disc protrusion mildly narrowing the\nthecal sac also unchanged from prior study.\n\n3. Right adrenal nodule similar compared to prior MRI and incompletely\ncharacterized on prior CT. While statistically this is likely an adenoma,\nclinical correlation is suggested and if desired, dedicated CT or MR can\nfurther characterize." }, { "input": "At T11-12, there is re-demonstration of a moderate central disc herniation\nwhich contacts the ventral cord margin. The sagittal T2 weighted scans\nsuggests that there is elevated signal within the contiguous spinal cord. \nHowever, this signal abnormality is not confirmed on the normally more\nsensitive sagittal STIR images, raising the likelihood of an artifactual\netiology. Supporting this potential artifactual cause is a lack of\ndemonstration of the same signal abnormality on the axial T2 weighted studies.\nAs we discussed in a telephone consultation today, there was no clinical\nsuspicion for any patient complaints or abnormal neurological signs suggest\nspinal cord compression.\n\nAt L5-S1, there is re-demonstration of prominent disc space desiccation and a\ngrade 1 spondylolisthesis of L5 upon S1, due to associated bilateral pars\ninterarticularis defects at L5. As was the case previously, there is\nprominent bilateral neural foraminal stenosis.\n\nNo other abnormalities of the visualized distal spinal cord, conus medullaris,\ncauda equina or limited lumbar paraspinal soft tissue imaging are apparent.", "output": "Re-demonstration of lower thoracic and lumbar degenerative changes, described\nin detail above. Please also note comments related to the spinal cord signal\npattern.\n\nNOTIFICATION: We discussed all findings by telephone at the time of this\nreport." }, { "input": "CERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is no focal bone marrow signal abnormality.\n\nThere is loss of T2 signal of the intervertebral disc, a manifestation of\ndegenerative disc disease. There is mild-to-moderate intervertebral disc\nheight loss at C4-C5 and C5-C6.\n\nThe spinal cord is preserved in signal and caliber. There is no epidural\ncollection. There is no abnormal focus of post contrast enhancement. The\nvisualized posterior fossa and cervicomedullary junction is preserved.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is trace central disc protrusion without significant spinal\ncanal narrowing. Facet and uncovertebral osteophytes produce mild left neural\nforaminal narrowing. The right neural foramen is patent.\n\nAt C4-C5, there is trace disc bulge and endplate osteophytes indenting the\nventral thecal sac without significant spinal canal narrowing. Facet and\nuncovertebral osteophytes produce mild to moderate bilateral neural foraminal\nnarrowing.\n\nAt C5-C6, there is trace bulge and ligamentum flavum thickening without\nsignificant spinal canal narrowing. Facet and uncovertebral osteophytes\nproduce moderate bilateral neural foraminal narrowing.\n\nAt C6-C7, there is trace disc protrusion and endplate osteophytes without\nsignificant spinal canal narrowing. Facet and uncovertebral osteophytes\nproduce moderate left and mild-to-moderate right neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nMild scattered areas of endplate heterogeneity are secondary to degenerative\nchange. There is otherwise no focal bone marrow signal abnormality.\n\nThere is mild loss of T2 signal of the intervertebral disc, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nThe spinal cord is preserved in signal and caliber.\n\nAnterior epidural collection with subtle rim enhancement spans the T10 through\nL2 levels, producing up to moderate spinal canal narrowing thoracic levels.\n\nOtherwise minimal disc bulges and protrusions are seen at multiple levels\nwithout significant spinal canal or neural foraminal narrowing at other\nlevels.\n\nLUMBAR:\nMillimetric grade 1 retrolisthesis of L3 on L4 is likely degenerative. \nAlignment is otherwise preserved. Vertebral body heights are preserved. 24\nmm T1 and T2 hyperintense lesion with incomplete fat suppression is compatible\nwith hemangioma corresponding to lytic lesion seen on CT. Another 11 mm T1\nand T2 hyperintense lesion in the L4 vertebral body appears completely\nsuppressed on the STIR images and is compatible with focal fat, corresponding\nto the ill-defined lytic focus seen on the CT examination. Multiple areas of\ntype ___ ___ endplate degenerative change are noted throughout the lumbar\nspine, most prominent at the L3-L4 level. Other areas of fatty marrow\nplacement are seen.\n\nThere is fluid signal seen within the L1-L2 intervertebral disc space with\ntrace rim enhancement extending to the anterior epidural space were there is a\nroughly 13.7 x 0.7 cm rim enhancing epidural collection spanning the T10\nthrough L2 levels (17:11). There is also involvement of the right posterior\nepidural space at the level of L1-L2 measuring approximately 4.4 x 0.8 cm\n(8:9). There is minimal associated STIR hyperintensity, T1 hypointensity and\nminimal enhancement abutting the L2 superior endplate. There is also\nirregular rim enhancing prevertebral fluid collection spanning the L1 through\nL3-L4 levels measuring approximately 9.0 x 1.8 x 2.2 cm (9:9, 14:36). \nAdditionally, there is elongated fluid collection within the right psoas\nmusculature during up to 1.4 x 1.2 cm in maximal axial dimension (15:25) the\nL1 through L5 levels. This demonstrates equivocal peripheral rim of\nenhancement. Epidural collection produces mild to moderate spinal canal\nnarrowing at the involved levels.\n\nThe terminal spinal cord is preserved in signal and caliber.\n\nAt L1-L2, there is severe spinal canal narrowing secondary to epidural\ncollection. Enhancing epidural component appears to extend into the proximal\nneural foramina, greater on the right, producing mild narrowing on the right. \nThe left neural foramen is patent.\n\nAt L2-L3, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L3-L4, disc bulge, ligamentum flavum thickening and facet osteophytes\nproduce mild to moderate spinal canal narrowing. Effacement of the\nsubarticular zones with likely compression of the traversing left L4 nerve\nroot. Facet and endplate osteophytes produce mild bilateral neural foraminal\nnarrowing.\n\nAt L4-L5, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L5-S1, there is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: There are areas of heterogeneous signal within the bilateral lung bases\nalong with trace bilateral pleural effusions. There is a wedge-shaped area of\nhypoattenuation within the visualized portion of the spleen, corresponding to\nlikely splenic infarct as seen on CT examination. The remainder of the\nvisualized retroperitoneum is grossly unremarkable.", "output": "1. L1-L2 intervertebral disc abscess with large anterior epidural abscess\ncomponent measuring up to 13.7 x 0.7 cm spanning the T10 through L2 levels\nwith involvement of the posterior epidural space at the level of L1-L2. \nMinimal signal abnormality abutting the L2 superior endplate may represent\ndeveloping osteomyelitis. Epidural collection produces up to severe spinal\ncanal narrowing at L1-L2, with mild-to-moderate narrowing at the other\ninvolved levels.\n2. Up to 9.0 x 1.8 x 2.2 cm rim enhancing prevertebral abscess spanning the L1\nthrough L3-L4 levels.\n3. Equivocally rim enhancing right psoas fluid collection measuring up to 1.4\nx 1.2 cm in maximal axial ___ spanning the L1 through L5 levels, likely\nrepresenting additional abscess.\n4. Areas of heterogeneous signal abnormality within the bilateral lung bases\nwith trace bilateral pleural effusions, better characterized on the same-day\nCT examination, likely refer reflecting infection.\n5. Wedge-shaped hypoenhancing focus of the visualized spleen, corresponding to\nsplenic infarct, better characterized on the concurrent CT examination.\n6. Lytic lesions in the T12 and L4 vertebral bodies as seen on the same-day CT\nexamination correspond to hemangioma and focal fat, respectively.\n7. Other multilevel spinal degenerative changes, as described.\n\nNOTIFICATION: Findings discussed with ___ by ___ phone at 01:00 on\n___, 10 minutes following discovery." }, { "input": "Despite repeat acquisition, sagittal diffusion-weighted sequences of the\ncervical spine is severely motion degraded and nondiagnostic below the C4\nlevel. Sagittal T1 postcontrast and axial T1 postcontrast and T2 sequences\nare also at least moderately motion degraded. Within these confines:\n\nMinimal 2 mm retrolisthesis of C4 on C5 is unchanged from prior examination. \nOtherwise, cervical alignment is anatomic. Vertebral body heights are\npreserved. Degenerative loss of disc height at C4-C5 through C6-C7 is mild. \nThe visualized posterior fossa is unremarkable. There is no cord signal\nabnormality or definitive evidence of abnormal enhancement. There is no\nevidence of diffusion-weighted hyperintense signal of the visualized posterior\nfossa and upper cervical cord to the C4 level.\n\nThere is STIR hyperintense marrow signal of the left C3-C4 facet with mild\nfluid within the joint (series 3, image 13) with associated surrounding soft\ntissue STIR hyperintensity and associated enhancement, although comparison to\nprior examination is difficult given the degree of motion artifact. \nOtherwise, there is no suspicious marrow lesion.\n\nAllowing for motion degradation, no interval change from cervical spondylosis\ncompared to examination ___.\n\nThere is a moderate left and mild right pleural effusion. Known pulmonary\nlesions compatible with septic emboli are better evaluated on prior\nexaminations. The remainder of the visualized prevertebral and paraspinal\nsoft tissues are grossly unremarkable.", "output": "1. Sagittal diffusion-weighted sequences of the cervical spine is severely\nmotion degraded and nondiagnostic below the C4 level. There is no evidence of\ncord infarct from the craniocervical junction to the C4 level.\n2. Sagittal and axial T1 postcontrast sequences are at least moderately motion\ndegraded. Within these confines: There is no evidence of abnormal T2/STIR\nhyperintense signal or enhancement of the cervical spine.\n3. There is STIR hyperintense marrow signal of the left C3-C4 facet with mild\nfacet effusion and surrounding enhancing soft tissue. This is similar in\nappearance to prior examination of ___, allowing for motion\ndegradation on today's examination. This may represent degenerative\nfacetitis, however, given the patient's history of septic emboli, close\nattention and clinical correlation is recommended to exclude septic joint.\n4. Moderate left and mild right pleural effusion and additional findings as\ndescribed above." }, { "input": "Patient is status post anterior fusion of the L1 and L2 vertebral bodies.\nSlight focal kyphosis at L1-L2 is likely secondary to anterior fusion. There\nis bone marrow edema involving the L1 and L2 vertebral bodies (3:8) with\nassociated enhancement. There is no prevertebral edema at this level or\nelsewhere. There is a T1 and T2 hyperintense foci in the left lateral aspect\nof the T12 vertebral body measuring 2.1 x 1.8 cm (12:19) likely representing a\nhemangioma.\n\nPosterior to the thecal sac spanning from T10-T11 level to L2 level, there is\na T2 hyperintense nonenhancing collection measuring 0.8 x 2.5 x 10.7 cm (AP x\nTV x CC, 5:26, 3:8). There are mixed T1 and T2 endplate changes involving the\nL3-L4 and L4-L5 levels likely representing type 1 and type ___ ___ changes.\n\nThe conus medullaris terminates at L1-L2. The appearance of the filum\nterminale is unchanged from total spine MRI ___ and could\nrepresent a lipoma of the filum terminale.\n\nAt T12-L1, there is minimal posterior disc bulge. There is no spinal canal or\nneural foraminal narrowing.\n\nAt L1-L2, there is no significant disc bulge. There no spinal canal or\nneural foraminal narrowing.\n\nAt L2-L3, there is minimal posterior disc bulge. There is mild ligamentum\nflavum hypertrophy. There is mild spinal canal narrowing. There is no neural\nforaminal stenosis.\n\nAt L3-L4, there is a moderate posterior disc bulge as well as ligamentum\nflavum hypertrophy resulting in moderate spinal canal narrowing. There is\nalso moderate bilateral left greater than right neural foraminal stenosis. \nThis is unchanged from ___\n\nAt L4-L5, there is no spinal canal or neural foraminal stenosis.", "output": "1. Status post anterior fusion at L1-L2. There is bone marrow edema with\nassociated enhancement involving the L1 and L2 vertebral bodies. Given the\nabsence of significant prevertebral edema at this level, this likely\nrepresents reactive post-surgical change. However close attention on\nfollow-up imaging is recommended.\n2. Posterior to the thecal sac spanning from the level of T10-T11 to L2, there\nis a fluid density non-enhancing collection measuring 0.8 x 2.5 x 10.7 cm. \nThis likely represents a seroma. However, accumulation of CSF due to small\nunderlying CSF fistula cannot be completely cannot be ruled out.\n3. Moderate posterior disc bulge at L3-L4 resulting in moderate spinal canal\nand bilateral neural foraminal stenosis. This is grossly unchanged from total\nspine MRI ___.\n4. No evidence of an epidural collection or phlegmon." }, { "input": "From T10-T11 through L3-4 levels, no significant abnormalities are seen.\n\nAt L4-5 level diffuse disc bulging is identified. There is no spinal stenosis\nor foraminal narrowing.\n\nAt L5-S1 level there is disc bulging and a central and left-sided disc\nherniation with narrowing of the left subarticular recess which could result\nin irritation of left S1 nerve root. There is no foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Central and left-sided disc herniation at L5-S narrowing the left lateral\nrecess which could result in irritation of left S1 nerve root. Degenerative\nchanges at L4-5 level." }, { "input": "At the craniocervical junction and C2-3 and C3-4 levels no significant\nabnormalities are seen.\n\nAt C4-5 level there is a central disc herniation which indents the anterior\naspect of the spinal cord with mild-to-moderate spinal canal narrowing. The\nforamina are patent.\n\nAt C5-6 level, disc bulging is seen with mild narrowing of the right foramen. \nThere is mild spinal stenosis without deformity of the spinal cord.\n\nAt C6-7, C7-T1 and inferiorly to T3-4 minimal degenerative changes seen\nwithout spinal stenosis.\n\nThe spinal cord shows normal intrinsic signal.", "output": "1. Central disc herniation at C4-5 level which slightly indents the anterior\naspect of the spinal cord.\n2. No evidence of intrinsic spinal cord signal abnormalities.\n3. No evidence of high-grade foraminal narrowing." }, { "input": "Evidence of prior anterior C4-5 cervical fusion. Mild cervical kyphosis\ncentered at the C4-5 levels. Vertebral body heights are normal. Vertebral\nbody signal intensity appear normal. Disc degeneration from the C2-3 to the\nC6-7 levels.\n\nThere is a central disc protrusions at the C4-5 level which has improved when\ncompared to the preoperative MRI. Residual mild deformity of the spinal cord\nat this level but no abnormal signal within the spinal cord. Mild right C4-5\nneural exit foraminal narrowing.\n\nCentral disc protrusion at the C5-6 level causing moderate spinal canal\nstenosis and mass effect on the anterior aspect of the spinal cord which has\nslightly worsened when compared to the MRI ___.. No abnormal\nsignal within the spinal cord.\n\nNo abnormal enhancement on the postcontrast images. There is no evidence of\ninfection or neoplasm.", "output": "1. Evidence of prior anterior C4-5 fusion with a residual small central disc\nprotrusion at this level which has improved when compared to the preoperative\nMRI. Mild right C4-5 neural exit foraminal narrowing.\n2. Central disc protrusion at the C5-6 level causing moderate canal stenosis\nwith mass effect on the anterior aspect of the cervical spine that is slightly\nworsened when compared to the MRI from ___. No abnormal signal\nwithin the spinal cord." }, { "input": "Alignment is normal. There is heterogeneous bone marrow signal. There is\nmild loss of height of the anterior T7 vertebral body with heterogeneous bone\nmarrow signal and no significant STIR hyperintense signal. No evidence of\nosseous retropulsion or spinal canal stenosis at this level is seen. In\naddition, there is STIR hyperintense signal in the superior T10 vertebral body\nwith mild associated loss of height. No osseous retropulsion is seen at this\nlevel either. Extensive loss of height of the T12 vertebral body is seen with\nno significant STIR hyperintense signal within the bone marrow and osseous\nretropulsion effacing the ventral thecal sac and resulting in mild spinal\ncanal stenosis.\n\nThere is a small disc protrusion at T6-T7, T8-T9, and T10-T11 with no\nsignificant spinal canal or neural foraminal stenosis. The spinal cord\nappears normal in caliber and configuration.\n\nA T2 hyperintense lesion is seen in the left kidney, likely representing a\nsimple cyst. There is a small right pleural effusion. Patchy right airspace\ndisease is seen. The mediastinum is shifted the left with questionable left\npneumonectomy. The esophagus is patulous and fluid-filled. An enteric tube\nis seen within the esophagus.", "output": "1. Acute compression fracture of the T10 vertebral body. Abnormal bone marrow\nsignal in the T7 vertebral body which may represent an underlying hemangioma\nversus a subacute/chronic compression fracture. Subacute to chronic\ncompression fracture of the T12 vertebral bodies. Mild osseous retropulsion\nof the level of T12 resulting in mild spinal canal stenosis.\n2. Small right pleural effusion and patchy right lung airspace disease. \nRecommend correlation with outside imaging, if not performed dedicated chest\nimaging is recommended.\n3. Shift of the mediastinum to the left with no normal left lung visualized,\nwhich may represent post pneumonectomy changes. Recommend correlation with\nprior surgical history.\n\nRECOMMENDATION(S): Small right pleural effusion and patchy right lung\nairspace disease. Recommend correlation with outside imaging, if not\nperformed dedicated chest imaging is recommended.\n\nShift of the mediastinum to the left with no normal left lung visualized,\nwhich may represent post pneumonectomy changes. Recommend correlation with\nprior surgical history." }, { "input": "The imaged cervical vertebral bodies demonstrate normal alignment. Multilevel\n___ type 2 endplate changes are noted throughout the imaged cervical spine. \nOtherwise, the imaged cervical and upper thoracic vertebral bodies and\nintervertebral discs demonstrate preserved height and normal signal intensity\ncharacteristics. The visualized spinal cord is normal in signal intensity and\ncaliber. There is no evidence of fracture or ligamentous injury.\n\nAt C3-4, a mild posterior disc bulge results in no spinal canal narrowing,\nflattening the ventral thecal sac slight deformity of the spinal cord (series\n5, image 9). At C4-5, a moderate, prominent left-sided posterior broad-based\ndisc bulge flattens the anterior thecal sac, causing moderate spinal canal\nstenosis and deformity of the spinal cord, and mildly narrows the left neural\nforamen (series 5, image 13). A left paracentral C5-6 posterior disc bulge\nmay minimally deform the left aspect of the ventral thecal sac and mildly\nnarrows the left neural foramen (series 5, image 18). There ranging cervical\nand upper thoracic intervertebral discs are normal in appearance. There is no\nevidence of significant spinal canal or neural foramina narrowing elsewhere.\n\nWithin the limits of this noncontrast examination, there is no evidence of\ninfection or neoplasm.", "output": "1. No evidence of fracture ligamentous injury,\n2. Discogenic degenerative disease, with moderate spinal stenosis at C3-4 and\nC4-5 level and mild spinal stenosis at C5-6 level.\n\n3. Foraminal changes as described above.\n4. This study is been dictated on ___. The previous dictation was\nlost." }, { "input": "CERVICAL SPINE: The vertebral body height is maintained. There is a normal\ncurvature. Vertebral soft tissue swelling is identified. The paraspinal soft\ntissues are unremarkable. Limited assessment of the posterior fossa and\naerodigestive tract do not demonstrate any abnormality.\n\nDisc desiccation and loss of disc height throughout the cervical spine is\ncompatible with degenerative disc disease.\n\nC2-C3: Disk bulge and ligamentum flavum hypertrophy result in mild spinal\ncanal stenosis without deformation of the spinal cord. No neural foraminal\nnarrowing is identified.\n\nC3-C4: Disc desiccation but no disc bulge. Minimal hypertrophy of the\nligamentum flavum. Uncovertebral and facet joint osteophytes resulting\nbilateral neural foraminal narrowing, severe in the left and mild in the\nright.\n\nC4-C5: No disk bulge, spinal canal stenosis, or neural foraminal narrowing.\n\nC5-C6: Minimal anterolisthesis of C5 on C6, without disc bulge. Uncovertebral\njoint osteophytes result in mild left neural foramen narrowing. The right\nneural foramen is unremarkable.\n\nC6-C7: Concentric disc bulge results in contact with the spinal cord and\nflattening of the ventral aspect of the cord. No cord signal abnormality\nidentified. Bilateral uncovertebral joint osteophytes result in mild bilateral\nneural foramina narrowing.\n\nC7-T1: No significant degenerative changes.\n\n\nLUMBAR SPINE: The vertebral body height and alignment is maintained. The cord\nends at the level of L1. No cord signal abnormality is identified. The roots\nof the cauda equina are normal in distribution within the thecal sac. The\nparaspinal soft tissues are unremarkable. No aortic aneurysm is identified.\nCystic lesions are incidentally noted in both kidneys.\n\nDisc desiccation and loss of disc height is compatible with degenerative disc\ndisease:\n\nT11-T12: Concentric disk bulge with focal protrusions at both neural\nforamina, right worse than left, resulting in moderate right neural foramen\nnarrowing. No spinal canal stenosis identified.\n\nT12-L1: No degenerative disc disease.\n\nL1-L2: Concentric disk bulge without spinal canal stenosis. Bilateral facet\njoint osteophytes contribute to moderate right neural foraminal narrowing and\nmild left neural foramen narrowing.\n\nL2-L3: Minimal concentric disc bulge. Significant ligamentum flavum\nhypertrophy resulting in moderate spinal canal stenosis at this level,\nmeasuring 8 mm of AP diameter. Bilateral facet joint osteophytes contribute to\nmoderate right and mild left neural foraminal narrowing.\n\nL3-L4: Minimal anterolisthesis of L3 on L4 without significant disc bulge. \nSevere ligamentum flavum hypertrophy and bilateral facet joint osteophytes\nresult in moderate to severe spinal canal stenosis with the thecal sac\nmeasuring approximately 7 mm of AP diameter at this level. There is severe\nbilateral subarticular recess narrowing with compression of the traversing L4\nroots. Facet joint osteophytes contribute to moderate to severe left neural\nforaminal narrowing. The right neural foramen is mildly narrowed.\n\nL4-L5: Minimal anterolisthesis of L4 on L5 without significant disc bulge. No\nspinal canal stenosis or neural foraminal narrowing is identified.\n\nL5-S1: Concentric disk bulge with focal protrusions at both neural foramina as\nwell as bilateral facet joint hypertrophy resulting in bilateral severe neural\nforaminal narrowing with contact between the osteophytes and the exiting\nbilateral L5 roots. No spinal canal stenosis identified.", "output": "1. Moderate degenerative disc disease of the cervical spine is more severe at\nC6-C7 with flattening of the ventral aspect of the spinal cord from a bulging\ndisc. Severe left neural foramen narrowing is seen at C3-C4. The remaining\nneural foramina are not significantly narrowed.\n\n2. Moderate to severe degenerative disc disease of the lumbar spine more\npronounced at L3-4 with severe bilateral subarticular recess narrowing\nresulting in compression of the traversing bilateral L4 roots. There is also\nbilateral severe neural foraminal narrowing at L5-S1 and moderate to severe\nneural foraminal narrowing in the left neural foramen at L3-L4." }, { "input": "There has been no significant interval change.\n\nThere is mild scoliosis of lumbar spine convex to right in the lower lumbar\nand to the left in the upper lumbar region. From T10-T11 to L1-2 levels, disc\ndegenerative change seen.\n\nAt L2-3 level, disc bulging and facet degenerative changes result in\nmild-to-moderate spinal stenosis unchanged from the prior study of. \nMild-to-moderate foraminal narrowing is also unchanged.\n\nAt L3-4 level, mild spondylolisthesis of L3 over L4 seen with severe facet\ndegenerative changes and moderate to severe spinal stenosis and\nmoderate-to-severe left foraminal narrowing unchanged from the previous MRI\nexamination.\n\nAt L4-5 level, there is mild spondylolisthesis of L4 over L5 without spinal\nstenosis. Mild narrowing of the foramina seen.\n\nAt L5-S1 level there is diffuse disc bulge without spinal stenosis but with\nmoderate narrowing of both foramina. There is no evidence of compression of\nexiting nerve roots.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. A simple\nappearing cysts are seen in both kidneys.", "output": "Multilevel degenerative changes seen with most pronounced changes at L3-4\nlevel there moderate-to-severe spinal stenosis identified with\nmoderate-to-severe left foraminal narrowing. Overall the examination is\nunchanged compared to the previous MRI." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is a mild rightward curvature of the lumbar spine. Grade 1\nanterolisthesis of L3-4 and L4-5 are unchanged since ___. Vertebral body\nheights are preserved. There is no marrow signal abnormality. The visualized\nportion of the spinal cord is preserved in signal and caliber. The conus\nterminates at the inferior endplate of L1. There is diffuse degenerative disc\nsignal with loss of disc height at L3-4, L4-5, and most severe at L5-S1. \nThere is no prevertebral soft tissue abnormality. Note is made of high signal\nin the posterior soft tissues, a nonspecific finding.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. Limited views\nof the abdomen demonstrate left T2 hyperintense renal lesions, statistically\nlikely simple cysts.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is a small disc bulge, ligamentum flavum hypertrophy, and facet\narthropathy result in mild bilateral neuroforamen narrowing, progressed from\n___. There is stable mild central canal narrowing.\n\nAt L2-3 there is a disc bulge, ligamentum flavum hypertrophy and facet\narthropathy resulting in mild-to-moderate spinal canal narrowing and mild to\nmoderate bilateral foraminal narrowing, unchanged.\n\nAt L3-4 there is a disc bulge, ligamentum flavum hypertrophy, and severe facet\narthropathy, combined with grade 1 anterolisthesis resulting in severe spinal\ncanal narrowing, worsened since prior. Both lateral recess narrowing is\npresent, worsened since prior. And mild right and severe left neural foramen\nnarrowing, worsened since prior.\n\nAt L4-5 there is a disc bulge, facet arthropathy, and mild ligamentum flavum\nhypertrophywithout significant spinal canal or neural foraminal narrowing..\n\nAt L5-S1 there is disc bulge and facet arthropathy without spinal canal\nnarrowing. There is moderate bilateral neural foramen narrowing, unchanged.", "output": "1. Mild progression of multilevel degenerative changes since ___, as\ndescribed above. The most affected level is at L3-4 where there is severe\nspinal stenosis and severe left neural foramen narrowing." }, { "input": "CERVICAL:\nEnhancing T1 hypointense lesions are seen involving the C3 vertebral body and\nthe C7 right posterior vertebral body with extension into the pedicle. There\nis no pathologic vertebral height loss. Alignment is normal.\n\nAreas of myelomalacia are seen spanning C5-C7.\n\n C2-C3: A disc bulge is seen with bilateral facet and uncovertebral\narthropathy. There is no spinal canal narrowing with no right and moderate\nleft foraminal narrowing..\n\nC3-C4: A disc bulge is seen effacing the ventral thecal sac and distorting the\nventral cord without cord signal abnormality. There is bilateral\nuncovertebral and facet arthropathy. There is mild spinal canal narrowing\nwith severe bilateral foraminal narrowing.\n\nC4-C5: A disc bulge is seen effacing the ventral thecal sac and distorting the\nventral cord without cord signal abnormality. There is bilateral\nuncovertebral and facet arthropathy. There is mild spinal canal narrowing with\nsevere bilateral foraminal narrowing.\n\nC5-C6: A disc bulge is seen effacing the ventral thecal sac and distorting the\nventral cord. Areas of myelomalacia are seen at this level. There is\nthickening of the ligamentum flavum and bilateral uncovertebral and facet\narthropathy. There is moderate spinal canal narrowing with severe bilateral\nforaminal narrowing.\n\nC6-C7: A disc bulge is seen effacing the ventral thecal sac and distorting the\nventral cord. There is a myelomalacia are seen at this level. There is\nbilateral uncovertebral and facet arthropathy. There is mild spinal canal\nnarrowing with severe bilateral foraminal narrowing.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\n\nTHORACIC:\nEnhancing T1 hypointense lesions are seen involving the anterior superior\naspect of T3, the posterior aspect of T4, including the left lamina and\npedicle, and the majority of the T6 and T12 vertebral bodies. There is ___\npathologic loss of the T6 vertebral height. Alignment is normal.\n\nMixed cystic and solid lesions are seen involving the posterior epidural space\nspanning C7-T5 and causing severe spinal canal narrowing and cord compression\nfrom T2 to T5. There is minimal T2 hyperintense signal within the cord at\nT4-T5. There is severe left foraminal narrowing at the T3-T4.\n\nLUMBAR:\nEnhancing T1 hypointense lesions are seen involving the anterior aspect of the\nL2 vertebral body, bilateral lamina and spinous process of L3, and the\nmajority of the L4 vertebral body. Additionally a Schmorl's node is seen\ninvolving the superior aspect of L4. Alignment is normal.\n\nThe cauda equina nerve roots are unremarkable.Disc bulges, thickening of the\nligamentum flavum and bilateral facet arthropathy are seen involving the lower\nlumbar spine. There is mild-to-moderate spinal canal narrowing at L3-4 and\nL4-5. There is moderate to severe bilateral foraminal narrowing at L3-4 L4-5\nand L5-S1.\n\n\nOTHER: A large necrotic lesion is seen in the left lung apex. A large new\ncarotic lesion is seen involving the right fourth rib. A subcentimeter\nenhancing lesion is seen in the right iliac wing.\n\nBilateral pleural effusions are seen, left larger than right. Multiple cystic\nrenal lesions are seen.", "output": "1. Diffuse enhancing metastatic lesions are seen throughout the spine.\n2. Posterior epidural involvement spans C7-T5, causing severe spinal canal\nnarrowing with cord compression from T2-T5 with minimal cord signal\nabnormality at T4-5 and severe left foraminal narrowing at T3-4.\n3. Large necrotic lesion in the lung apex. Large right fourth rib necrotic\nlesion, consistent with metastasis.\n4. Left larger than right bilateral pleural effusions.\n5. Degenerative changes of the cervical spine, worst at C5-6 and C6-7 levels\nwith moderate spinal canal and severe bilateral foraminal narrowing.\n6. Moderate to severe degenerative changes of the lower lumbar spine." }, { "input": "CERVICAL:\nAgain demonstrated 1.5 x 1.7 expansile lesion in the right occipital condyle.\n4 x 2.3 x 3.2 cm multi-cystic \"bubbly\" expansile mass centered at the C6\nvertebral body presents high T2/STIR signal abnormality and T1 hypointense and\nhas mild contrast enhancement. The mass extends toward the prevertebral soft\ntissues on the left, left transverse process and posterior lamina as well as\nadjacent posterior musculature. Invasion of the spinal canal at this level is\ndifficult to assess (8: 28 and 09:23), however there is no cord signal\nabnormality. Involvement of the left neural foramina and involvement of the\nleft C6 nerve root is seen, which traverses through the mass. The mass seems\nto be displacing the anterior longitudinal ligament anteriorly on the left.\n\nMultiple other lesions present similar characteristics involve the C4\nvertebral body with expansion of the posterior cortex of the vertebral body\ncausing mild canal narrowing without invasion, left transverse process of C1,\nspinous processes of C3 and C5. Abnormal T2 and STIR signal abnormality also\nnoted in the first left rib.\nThere is fusion of the C6 and C7 vertebral bodies.\n\n2 cm and 3 cm masses are noted in the right upper chest, abutting the pleura,\nare partially imaged but could represent rib lesions (09:32 and 09:37).\n\nThere is at least mild spinal canal narrowing at levels C3-C4 and C4-C5 due to\nsmall disc protrusion, and moderate at the level of C5 vertebral body without\ncord signal abnormality.\n\nCompression fracture of C5 vertebral body without STIR signal abnormality,\nlikely chronic.\n\nAlignment is normal. Intervertebral disc signal intensity appear normal.\n\nLUMBAR:\nThere are 5 non rib-bearing vertebral bodies.\n\nPartially visualized T2/STIR hyperintense lesion in the T11 vertebral body\ncauses severe canal narrowing, included in thoracic spine MRI from outside\nhospital.\nA 2.2 x 2.7 cm multi-cystic T2/STIR hyperintense lesion is noted in the left\nside of the sacrum and iliac bone (14:44 and 37). Similar findings are noted\nin L5 vertebral body and L3 vertebral bodies, with similar characteristics.\n\nThere is mild retrolisthesis of L4 on L5. There is mild narrowing of the\ncanal at L1-L2 due to disc bulging and L3-L4 and L4-L5 due to disc bulging and\nposterior osteophyte. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of significant neural foraminal narrowing.\nThe multiple bone lesions demonstrate a striking bubbly pattern with\ninhomogeneous mid ___ is hyperintensity on T2 weighted and FLAIR images. \nThe imaging characteristics suggest etiologies such as giant cell tumor,\nchondroblastoma or osteoblastoma. Hemangiomas are somewhat less likely due to\nthe mild contrast-enhancement. However, there is a focus of adipose tissue\nwithin the C6 vertebral body, which would support a diagnosis of hemangioma. \nThe sacral lesions were not detected on a CT from ___. This indicates\nrapid progression of these lesions, which would be most consistent with\nmetastatic disease. These findings may be better evaluated with CT scanning.\n\nOTHER: Multiple cystic structures are seen in the left kidney the largest\nmeasures 3 cm arising from the upper pole.", "output": "1. Multiple multi-cystic expansile masses at different levels of the spine,\nribs, right occipital condyle, sacrum and left iliac bone, in comparison with\nCT torso from ___, these masses have newly appeared and rapidly\nprogressed.\n2. Although the appearance of these lesions raises a less aggressive\nalternatives including hemangioma, rapid progression argues in favor of\nmetastatic disease.\n3. Thoracic masses in the region the right upper chest could represent rib\nlesions, incompletely imaged in this study.\n4. Partially visualized T11 vertebral body lesion causing severe canal\nnarrowing is partially visualized in current study and addressed on MRI\nT-spine from outside hospital.\n\nRECOMMENDATION(S):\n1. Spine team consultation.\n2. CT torso and CT cervical spine are recommended for oncologic workup and\nfurther evaluation of the involvement of the spine proceeding cord\ndecompression and likely biopsy." }, { "input": "Study is degraded by motion and spinal fusion hardware artifact. \nAdditionally, study is limited axial postcontrast imaging of thoracic and\nlumbar spine. Within these confines:\n\nCERVICAL:\n Vertebral body alignment is preserved. Again seen are enhancing multi-cystic\nvertebral masses, involving the majority of the C4 vertebral body (2.2 x 2.3 x\n1.2 cm), and a confluent 4.8 x 4.8 x 2.9 cm (AP by TV by SI) C6-C7 vertebral\nbody lesion expanding anterolaterally in the left paraspinal and prevertebral\nsoft tissues notably displacing the left vertebral artery anteriorly, which\nappears draped along the anterior margin of the mass (see series 17, image 28\nand 11:24 25, 26, 27). The mass obliterates the left C5-6, C6-7, and nearly\nobliterates the left C7-T1 neural foramina.\n\nThe C6-7 mass slightly buckles and minimally posteriorly displaces the\nposterior vertebral body cortices of C6 and C7 on the left, causing\nmild-to-moderate spinal canal narrowing and slight contact of the ventral\nspinal cord, slight cord remodeling, without cord compression or cord signal\nabnormality. There may be early epidural extension this location (series 11\nimage 29, series 17, image 29).\n\nThe visualized portion of the spinal cord is preserved in signal.\n\nDegenerative changes including multilevel disc bulges, ligamentum flavum\nthickening facet osteophytes, cause areas of spinal canal and neural foraminal\nnarrowing. Spinal canal narrowing appears worst (moderate) at C5-6 due to\nposterior disc bulge and ligamentum flavum thickening, slight cord remodeling.\n\nThere is an acute subdural hematoma within the lower cervical and upper\nthoracic spine dorsally (see series 12 images ___ and ___), measuring up to 6-7\nmm in thickness, extending within the dorsal spinal canal from the level of T3\nsuperiorly to approximately C5-6, over a 10 cm length of spinal canal. Please\nnote epidural extension is not excluded on the basis of this examination.\n\nThere is diffuse, marked edema within the neck soft tissues including the\nposterior paraspinal musculature, and the subcutaneous soft tissues. \nEndotracheal and enteric tubes are seen in situ, surrounded by aerodigestive\ntract secretions. Right occipital condyle lesion is partially visualized\n(7:7).\n\nTHORACIC:\n\nPostsurgical changes related to patient's known T3 through L1 fusion and T7\nand T11 laminectomies is noted.\nThere is minimal dextroscoliosis of the thoracic spine. T2/STIR hyperintense\nlesions are seen involving the T1 vertebral body (12 mm, 6:9); the T5\nvertebral body measuring 1.7 cm (06:11); multifocal in the T6 vertebral body,\ninvolving most of the vertebral body; involving the entirety of the T7\nvertebral body, likely with posterior epidural extension and buckling and\nposterior displacement of the posterior cortex of the T7 vertebral body into\nthe spinal canal by approximately 7-8 mm (05:11); although these areas are\nsomewhat obscured due to artifact, there are large T2/STIR hyperintense\nlesions involving much of the T8, T9, T10, and T11 vertebral bodies, as seen\non prior CT chest. Notably, there is also posterior extension into the spinal\ncanal by the T11 bass by approximately 0.7 cm (08:10), likely 0.6 cm posterior\nextension into the spinal canal by the T9 mass (08:10).\n\nSpinal canal narrowing in the thoracic spine is worst at the level of the T7\nlesion, however there is evidence of laminectomies at this level; nonetheless,\nthere remains severe canal narrowing with cord flattening/compression in the\nAP dimension (series 13, image 5, as well as series 5, image 10). The degree\nof spinal canal narrowing is unchanged from the CT chest from ___.\n\nThere is moderate to severe spinal canal narrowing at the level of the T11\nlesion, with posterior displacement of the cord, but no definite cord\ncompression, as although this area is not seen on axial T2 weighted images due\nto artifact, a CSF cleft is faintly identified both anterior and posterior to\nthe cord at this level (08:10).\n\nThere is a 4 cm long area of mildly expansile T2/STIR cord signal abnormality\nbeginning at the level of the spinal cord compression at T7, and extending\ncranially to the level of the mid T6 vertebral body (05:10) likely cord edema.\n\nThere are expected postsurgical changes in the posterior paraspinal soft\ntissues in the thoracic spine from recent interval posterior decompression at\nmultiple thoracic levels and posterior spinal fusion, not well visualized. \nThere is diffuse soft tissue edema.\nLUMBAR:\n\nAlignment is essentially anatomic. Vertebral heights are maintained. There\nare enhancing likely metastatic lesions within the superior and inferior\nendplates of L3, the inferior endplate of L5 posteriorly measuring 1.2 cm, 1.1\ncm, and 1.6 cm, respectively.\n\nThere are multilevel ___ degenerative endplate changes, most conspicuous\n___ type 2) at L4-5.\n\nThe distal spinal cord and conus medullaris is grossly preserved, terminating\nat L1-L2. Cauda equina nerve roots appear grossly preserved.\n\nThere is no definite evidence of lumbar spine epidural collection. There are\nmoderate to severe lumbar spine degenerative changes worst at L4-5. Lumbar\nspinal canal narrowing is worst (mild) at L3-4 and L4-5. Degenerative neural\nforaminal narrowing in the lumbar spine is worst (mild-to-moderate)\nbilaterally at L3-4 and L4-5.\n\nOTHER:\n\nThere are bilateral layering pleural effusions. There is subjacent\natelectasis. Incidental in note is made of a upper right lateral chest wall 3\ncm lesion, likely additional rib/chest wall metastasis (12:15).\n\n2.6 x 2.8 cm metastasis in the left sacrum is noted, partially visualized\n(14:43).\n\nDiffuse soft tissue edema is noted. There are multiple T2 hyperintensities in\nthe kidneys, possibly cysts, better evaluated on recent dedicated abdominal\nimaging.", "output": "1. Study degraded by motion and spinal fusion hardware, and further limited\nwith axial thoracic and lumbar spine postcontrast imaging not obtained for\nthis exam.\n2. 4 cm long T2/STIR cord signal abnormality, beginning at and extending\ncranially from the level of the T7 lesion where there is severe canal\nnarrowing and spinal cord compression. Notably, the degree of spinal canal\nnarrowing at this level is unchanged since ___, and the patient has\nnow undergone interval posterior decompression/laminectomies. Findings would\nbe compatible with a cord injury due to prior compression, however difficult\nto exclude other etiologies (e.g., cord ischemia), as appearance is\nnon-specific.\n3. Acute spinal subdural hematoma, 10 cm SI and 0.6 cm thick, from C5-6 to T3\nin the dorsal spinal canal; hematoma does not appear to compress the spinal\ncord, but abuts its dorsal surface, causing up to moderate to severe canal\nnarrowing.\n4. Multiple cervical, thoracic, and lumbar spine enhancing cystic metastases,\nsimilar to prior studies, causing areas of up to severe spinal canal\nnarrowing, with obliteration of neural foramina in the cervical spine.\n5. Additional probable metastatic lesions noted in the right upper chest wall,\noccipital condyle, left sacrum.\n6. Anasarca.\n7. Bilateral pleural effusions.\n8. Probable renal cysts.\n\nNOTIFICATION: The findings were discussed with ___, MD, by\n___, M.D. on the telephone on ___ at 10:48 am, 15\nminutes after discovery of the findings." }, { "input": "Alignment is normal. Vertebral body heights are preserved. The visualized\nportion of the spinal cord appears normal.\n\nThere is mild disc bulging at C3-C4, C5-C6, and C6-C7 without cord\ncompression. Mild osteophytes and degenerative changes at these levels.\n\nThere is disc bulging at L5-S1 without cord compression.\n\nAt C6, there is a nonenhancing, T1 hypointense, STIR hyperintense lesion that\nis indeterminate.\n\nNo neural foraminal narrowing. There is no evidence of infection or neoplasm.", "output": "1. No evidence of discitis, osteomyelitis, or T-cell lymphoma recurrence.\n2. Mild degenerative disease without cord compression..\n3. Nonenhancing focus at C6 that is of uncertain significance and is unlikely\nto represent a neoplasm, however could be followed if clinically concerned." }, { "input": "There is no evidence of marrow edema compression fracture or ligamentous\ndisruption. Minimal disc bulging is seen from T4-5 to T7-8 levels without\nspinal stenosis or foraminal narrowing. There is no evidence of discitis\nosteomyelitis or epidural abscess in the thoracic region. No evidence of\nintrinsic spinal cord signal abnormalities or extrinsic spinal cord\ncompression. A small hyperintensity to the left of T4 vertebra (3:6) likely\ndue to a prominent lymphatic duct, an incidental finding.", "output": "Except for minimal disc bulging in the mid thoracic region, no significant\nabnormalities are seen on MRI of the thoracic spine. No evidence of discitis\nosteomyelitis fracture epidural abscess or ligamentous disruption seen." }, { "input": "Loss of L4 vertebral body height by approximately 50% is unchanged since prior\nCT abdomen pelvis of ___. There is no evidence of associated STIR\nhyperintense signal to suggest acute process. Otherwise, the remainder of the\nlumbar alignment is anatomic. The remainder the vertebral body heights are\npreserved. There is diffuse STIR hyperintense signal along the left aspect of\nthe sacrum, with T2 and T1 hypointense serpiginous line along lateral aspect\nof S1 and S2 (series 5, image 33), most consistent with an insufficiency\nfracture. No definite abnormal signal along the left ilium to suggest\nsacroiliitis.\n\nThe marrow signal is mildly heterogeneous without focal suspicious lesion\notherwise. The conus medullaris terminates at the L1-L2 level, within\nexpected limits. There is no abnormal signal or enhancement of the visualized\nterminal cord or conus medullaris.\n\nT12-L1, L1-L2: There is no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: There is an anteriorly oriented disc osteophyte complex with associated\nanterior extrusion of disc material. Additionally, there is a posterior disc\nbulge which combines with thickening of ligamentum flavum and prominent dorsal\nepidural fat to result in moderate to severe spinal canal stenosis with\ncrowding of the cauda equina nerve roots. There is additionally mild right\nand mild-to-moderate left neural foraminal narrowing at this level.\n\nL3-L4: A posterior disc bulge combines with facet hypertrophy, thickening of\nthe ligamentum flavum, and prominent dorsal epidural fat to result in moderate\nto canal stenosis with compression of the cauda equina nerve roots. There is\nadditionally moderate right and moderate to severe left neural foraminal\nnarrowing at this level.\n\nL4-L5: Posterior disc bulge combines with facet hypertrophy, thickening of the\nligamentum flavum, and prominent dorsal epidural fat to result in moderate\nspinal canal stenosis with severe left-greater-than-right bilateral neural\nforaminal narrowing.\n\nL5-S1: A mild posterior disc bulge results in no definite spinal canal\nstenosis, but with moderate to severe left and severe right neural foraminal\nnarrowing. Of note, the exiting right L5 nerve root is compressed by the disc\nbulge at this level.\n\nThere is no convincing evidence for abnormal enhancement within the spinal\ncord, epidural space, or paraspinal soft tissues.\n\nMultiple prominent bilateral T2 hyperintense renal cysts are seen. There is\nfatty atrophy of the bilateral paraspinal musculature. The remainder the\nprevertebral and paraspinal soft tissues are unremarkable", "output": "1. Diffuse STIR hyperintense signal along the left aspect of the sacrum with\nserpiginous T1 and T2 hypointense line spanning the T1 and T2 left lateral\naspects, likely representing insufficiency fracture.\n2. No convincing evidence for metastatic disease within the lumbar spine. \nHowever, given the patient's clinical history, repeat CT pelvis in ___ months\nis recommended to document stability.\n3. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most prominent at L3-L4 with moderate to severe canal stenosis, moderate\nright and moderate severe left neural foraminal narrowing.\n4. L5-S1 disc bulge resulting in moderate severe left and severe right neural\nforaminal narrowing, with resultant compression of the exiting right L5 nerve\nroot.\n5. Additional findings described above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:01 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "CERVICAL:\nThe posterior fossa appears normal. The craniocervical junction appears\nnormal. The cervical vertebral bodies are normal in number and\ninterrelationship. Multilevel disc desiccation with associated disc osteophyte\ncomplexes, but no compromise of the cervical cord in the central canal. No\nmyelopathic signal changes of the cervical cord. Mild moderate narrowing of\nthe C5-6 and right C6-7 neural foramina with moderate narrowing of the left\nC6-7 neural foramina.\n\nTHORACIC:\nThe thoracic vertebral bodies are normal in number and interrelationship. \nPostsurgical changes at the T6-T8 levels. There is a T1 hyperintense, T2\nhyperintense rim enhancing postsurgical epidural collection extending from the\nT6-T8 level. This measures 46 mm in the craniocaudal plane and 8 mm in the\nsagittal plane and is in continuity with a smaller subcutaneous collection\nposterosuperiorly at the T5-6 level measuring 23 x 12 mm in the sagittal\nplane. This collection results in moderate severe spinal canal narrowing\nmaximally at the T7-8 level with the thecal sac measuring 9 mm in AP diameter\nwith mild (questionable) myelopathic signal changes at this level. There is\npossible discontinuation of the posterior dura at this T7 level, but this may\nvery likely be secondary to volume-averaging as there is no features of\nintracranial hypotension which would be expected in the setting of a dural\nleak.\n\nLUMBAR:\nPlease note that motion artifact mildly decreases the diagnostic sensitivity\nof the lumbar spine imaging. The conus terminates at the L2 level. Normal\nsignal intensity and morphology of the conus.\n\nThere is mild spondylotic changes of the lumbar spine but no compromise of the\nnerve roots in the spinal canal or neural foramina. Small left L5-S1 facet\njoint effusion.\n\nThe remainder the visualized prevertebral paraspinal soft tissues are\nunremarkable.", "output": "1. Please note that the study is slightly limited by motion artifact.\n2. Posted changes at the T6-T8 levels with an associated rim enhancing\npostsurgical epidural collection measuring 46 x 8 mm in the sagittal plane. \nThis collection results in moderate severe spinal canal narrowing at the T7-8\nlevel with the thecal sac measuring 9 mm in AP diameter with mild\n(questionable) myelopathic signal changes at this level.\n3. There is possible discontinuation of the posterior dura at this T7 level,\nbut this is may be secondary to volume averaging as there is no features of\nintracranial hypotension which would be expected in the setting of a dural\nleak. Clinical correlation is recommended.\n4. No other levels of spinal cord or nerve root compromise in the spinal\ncanal.\n5. Additional findings described above." }, { "input": "There is preservation of the normal the cervical lordosis. Disc and vertebral\nbody heights are maintained. The visualized posterior fossa is unremarkable.\nNo cord signal abnormalities.\n\nC2-3: No significant spinal canal or neural foraminal narrowing.\n\nC3-4: Small left paracentral disc protrusion with left greater than right mild\nuncovertebral osteophytes. There is no significant spinal canal narrowing.\nMild left neural foraminal narrowing. No significant right neural foraminal\nnarrowing.\n\nC4-5: There is a small right paracentral disc protrusion with posterior\nmarginal osteophytes extending transversely along the spinal canal and mild\nbilateral uncovertebral arthropathy. There is mild spinal canal narrowing and\nmild bilateral neural foraminal narrowing.\n\nC5-6: There is a moderate posterior disk disc bulge moderate to severe\nbilateral uncovertebral arthropathy. This results in moderate spinal canal\nnarrowing and moderate to severe bilateral neural foraminal narrowing. The\ndisc bulge contacts the ventral aspect of the cord and slightly remodels the\nwithout evidence of underlying signal abnormality.\n\nC6-7: There is a moderate posterior disc bulge and moderate bilateral\nuncovertebral arthropathy. This results in moderate spinal canal narrowing and\nmoderate to severe neural foraminal narrowing.\n\nC7-T1: There is a posterior disk bulge with prominent left paracentral and\nforaminal component, which mildly narrows the spinal canal. There is moderate\nto severe narrowing of the left neural foramen and mild narrowing of the right\nneural foramen.\n\nT1-2: There is a small posterior disc bulge without significant spinal canal\nor neural foraminal narrowing.\n\nThe remainder of the visualized levels are unremarkable.\n\nThe visualized paraspinal soft tissues and prevertebral soft tissues are\nunremarkable.", "output": "Multilevel degenerative changes as described above, most severe at C5-6 and\nC6-7. No evidence of acute cord compression." }, { "input": "There is diffusely T1 and T2 hypointense marrow signal throughout the\nvisualized spine and sacrum as well as the posterior elements.\n\nCERVICAL:\nCervical vertebral body heights and alignment are maintained. There are\nmultilevel degenerative changes with disc protrusions indenting the ventral\nthecal sac. There is mild spinal canal narrowing at C3-C4 and C5-C6.\n\nThere is moderate right and mild-to-moderate left neural foraminal narrowing\nat C3-C4. Mild bilateral neural foraminal narrowing is seen from C4-C5\nthrough C6-C7.\n\nEvaluation of the cervical spinal cord is limited due to motion artifact. \nThere are ill-defined somewhat hazy T2 hyperintense signal abnormalities on\nthe sagittal T2 images from C2 through C6, which are not definitely confirmed\non the axial images. These are likely artifactual.\n\nThere are no focal epidural fluid collections.\n\nTHORACIC:\nThe thoracic vertebral body heights and alignment are maintained. There are\nmultilevel degenerative changes with disc protrusions indenting the ventral\nthecal sac without significant spinal canal or neural foraminal narrowing.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nThere are no focal epidural fluid collections.\n\nLUMBAR:\nThe lumbar vertebral body heights and alignment are maintained. There is\nmild-to-moderate intervertebral disc height loss at L5-S1. Otherwise, the\nintervertebral disc heights are maintained.\n\nThe conus medullaris terminates at the level of T12.\n\nThere are multilevel degenerative changes with disc bulges, ligamentum flavum\nthickening, and facet osteophytes.\n\nThere is mild-to-moderate spinal canal narrowing at L3-L4 with narrowing of\nthe subarticular zones and possible impingement of the descending L4 nerve\nroots.\n\nOtherwise, there is mild multilevel spinal canal narrowing and\nmild-to-moderate multilevel neural foraminal narrowing from L2-L3 through\nL4-L5 bilaterally.\n\nThere are no focal epidural fluid collections. No definite abnormal fluid\nsignal or marrow signal involving the facets.\n\nOTHER:\nThere is mild STIR hyperintense signal of the right sternocleidomastoid\nmuscle, which may be artifactual versus strain or edema. Otherwise, the\nremainder of the paraspinal muscles are unremarkable.\nThere are small right and trace left pleural effusions.\nThere is an incompletely characterized 6 mm T2 hyperintense lesion in the\nposterior right hepatic lobe.\nIncompletely characterized subcentimeter T2 hyperintense lesion in the\ninterpolar region of the right kidney.\nThere is ill-defined heterogeneous T2 hyperintense signal abnormality\nthroughout the gluteus maximus, gluteus medius, and gluteus minimus visualized\nportions, which may relate to muscular edema/strain. Additionally, there is\nalso T2 hyperintense signal abnormality at the insertion of the right gluteus\nmaximus on the posterior right ilium (image 40 of series 18).", "output": "1. Diffusely hypointense bone marrow signal. Findings are nonspecific and may\nrelate to underlying anemia, abnormal calcium metabolism, or an underlying\nneoplastic process such as leukemia/lymphoma or a myeloproliferative disorder.\n2. No convincing evidence of osteomyelitis or discitis at this time.\n3. No focal epidural fluid collections. No definite abnormal marrow signal or\nfluid within the facets to suggest infectious synovitis of the spine.\n4. Multilevel degenerative changes of the spine without evidence of high-grade\nspinal canal or neural foraminal narrowing.\n5. Ill-defined signal abnormalities in the cervical spinal cord on the\nsagittal images are not confirmed on the axial images. These are likely\nartifactual, however clinical correlation is recommended. Otherwise, no\nevidence of cord signal abnormalities.\n6. Small right and trace left pleural effusions.\n7. STIR hyperintense signal of the bilateral lower lumbar paraspinal muscles\nand right sternocleidomastoid muscle, felt to likely represent muscle strain\nor edema, however infectious myositis is not excluded particularly given the\ncontext of septic hip joint." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nVertebral body heights and alignment are maintained. There are Schmorl's nodes\nin the superior endplate of T12, the inferior endplate of L3, the superior\nendplate of L4.\n\n The visualized portion of the spinal cord is preserved in signal and caliber,\nwith the conus noted at L2.\n\nThere is loss of intervertebral disc height at the L3-4, and L5-S1 levels.\n\nAt T11-12, T12-L1, L1-2, and L2-3 there is no spinal canal stenosis or neural\nforaminal stenosis.\n\nAt L3-4 there is a right paracentral disc protrusion with an annular tear\nresulting in mild spinal canal and moderate bilateral neural foraminal\nstenosis.\n\nAt L4-5 there is a disc bulge with ligamentum flavum hypertrophy and facet\njoint arthropathy resulting in moderate spinal canal is and severe bilateral\nneural foraminal stenosis.\n\nAt L5-S1 there is a disc bulge with ligamentum flavum hypertrophy and facet\njoint arthropathy resulting in mild spinal canal stenosis and severe bilateral\nneural foraminal stenosis.\n\nLimited visualization of the kidneys demonstrate large at least partially\ncystic structures in bilateral kidneys.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.", "output": "1. Multilevel degenerative changes, most pronounced at the L4-5 level where\nthere is moderate spinal canal stenosis and severe bilateral neural foraminal\nstenosis.\n2. L5-S1 mild spinal canal stenosis and severe bilateral neural foraminal\nstenosis. L3-4 disc bulge with annular tear, resulting in mild spinal canal\nstenosis and moderate bilateral neural foraminal stenosis.\n3. Degenerative endplate changes of T12, L3, and L4.\n4. Limited visualization of kidneys suggest bilateral renal cystic structures.\nWhile findings may be cysts, other etiologies cannot be excluded on the basis\nof this noncontrast examination. If clinically indicated, further evaluation\nmay be obtained via dedicated renal imaging." }, { "input": "Lumbar alignment is anatomic. . Vertebral body heights are preserved. Mixed\ntype 1 and ___ ___ changes are seen at L5-S1. The visualized portion of the\nspinal cord is preserved in signal and caliber. There is decreased signal and\ndisc space height loss at L5-S1. The visualize prevertebral paraspinal soft\ntissues are unremarkable. The visualized portion of the sacroiliac joints are\npreserved.\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is no spinal canal or neural foraminal stenosis.\n\nAt L2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt L3-4 there is no spinal canal or neural foraminal stenosis.\n\nAt L4-5 there is mild facet arthropathy withno significant spinal canal\nstenosis and mild left neural foraminal stenosis.\n\nAt L5-S1 there is a disc bulge and superimposed central disc protrusion, in\naddition to ventral epidural lipomatosis results in severe spinal canal\nstenosis and moderate bilateral neural foraminal stenosis.", "output": "1. L5-S1 degenerative changes with disc bulge and superimposed central disc\nprotrusion and marked ventral epidural lipomatosis resulting in severe spinal\ncanal and moderate bilateral neural foraminal stenosis.\n2. Mild lumbar spondylosis at the remainder levels." }, { "input": "Alignment is normal. Vertebral body signal intensity appears normal. There\nare mild changes of Degenerative disc disease with loss of signal of the\nintervertebral discs on T2 weighted images from C2 to the C7. There are\nminimal bulges of the discs at C3-4, C4-5 and C5-6 without contact with the\nspinal cord. There is no neural foraminal narrowing. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of infection or\nneoplasm.", "output": "1. Mild cervical spine degenerative disc disease. Otherwise normal study." }, { "input": "Alignment of the thoracic spine is anatomic. Bone marrow signal intensity\nappears within normal limits. An intrinsically T2 hyperintense 4 x 2 mm focus\nwithin the left and posterior aspect of the T3 vertebral body is most\nconsistent with a small vertebral body hemangioma (8:12).\n\nThe spinal cord appears normal in caliber and signal intensity. There is no\nexpansile spinal cord lesion. There is no evidence of spinal canal narrowing\nor stenosis. There is no evidence of neural foraminal narrowing. \nIntervertebral disc spaces appear preserved and discs normal in signal\nintensity. There is no abnormal prevertebral soft tissue thickening or edema.\nNo epidural abnormality.\n\nImaged soft tissue structures demonstrates no appreciable abnormality. There\nis no signal abnormality involving the paraspinal muscles or soft tissues.", "output": "No abnormality detected to explain patient symptomatology. No evidence of\nspinal canal or neural foraminal narrowing. No abnormal cord signal\nintensity." }, { "input": "Mild retrolisthesis of C5 over C6 is likely degenerative. Cervical alignment\nis otherwise unremarkable. Vertebral body signal intensity appear normal. No\nmarrow edema pattern. The spinal cord appears normal in caliber and\nconfiguration. The visualized posterior fossa is unremarkable. No evidence\nof ligamentous injury. No prevertebral soft tissue abnormality.\n\nMultilevel degenerative changes are notable for central disc protrusion at\nC5-6 causing mild spinal canal narrowing. Otherwise, there is no evidence of\nsignificant spinal canal narrowing. Mild uncovertebral facet arthropathy\nresults in mild bilateral neural foraminal narrowing at C4-C5 and C5-C6. The\nremainder of the neural foramina demonstrate no significant narrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. No evidence of spinal cord or ligament injury is identified. No bone\nmarrow edema pattern.\n2. Minimal degenerative changes as described above." }, { "input": "Again seen is prior L2 corpectomy with L1 through L3 instrumented posterior\nfusion. Surgical hardware appears intact with no evidence of hardware\ncomplication, although hardware integrity is better-assessed by radiography or\nCT. Large residual tumor remains present with extensive epidural tumor\ncausing severe spinal canal stenosis at L1 through L2 and moderate spinal\ncanal stenosis at L3, unchanged from the recent MRI of ___. Tumor\nis again noted to completely encase the thecal sac at L2 and L2-3, also\nunchanged. Tumor extends to occupy the L1-2 through L3-4 neural foramina,\nbilaterally, likely compressing several exiting nerve roots, and the extensive\nparaspinal tumor is also unchanged. There is no acute pathologic fracture, and\nthe overall alignment is preserved. No new site of tumor is identified.", "output": "1. Extensive metastatic disease at L1 through L3, with epidural tumor causing\nsevere spinal canal and foraminal stenosis and neural compression at multiple\nlevels, not significantly changed from the MR study of ___.\n\n2. No acute fracture or alignment abnormality, or new site of tumor\ninvolvement.\n\n3. No gross evidence of hardware complication." }, { "input": "Evaluation is limited as the patient terminated the study early due to pain\nand did not want to wait for pain medication to arrive. Only sagittal\nnoncontrast sequences were obtained.\n\nThere is a vertebral body cage at L2 with posterior fusion hardware at T12,\nL1, and L3. There is a 2.2 x 9.4 cm (AP x SI) collection of fluid within the\nspinal canal at L1-2 through L3-4 that extends into the laminectomy bed. This\nfluid is continuous with a larger pocket of fluid in the dorsal paraspinal\nmusculature and dorsal subcutaneous tissues (continuity well seen series 5,\nimage 7). The approximate size of the fluid collection in the subcutaneous\ntissues is 1.8 x 15.3 cm (AP x SI). All of the fluid collections are new\nsince MRI on ___. Tumor involving L1, L2, and L3 is not\nsignificantly changed from ___, although evaluation is markedly\nlimited without intravenous contrast and axial images. Epidural tumor is again\nnoted to cause spinal canal stenosis at L1.\nAlignment of the spine is preserved.\n\nAt L4-5: There is a central disc extrusion but no significant spinal canal or\nneural foraminal stenosis.", "output": "1. Markedly limited study due to the absence of axial images and intravenous\ncontrast (patient terminated the study early due to pain). Large fluid\ncollection extending from within the spinal canal at L1-2 through L3-4 into\nthe posterior paraspinal musculature and dorsal subcutaneous tissues, new from\nprior MRI on ___. This may be due to a CSF leak.\n2. Tumor at L1 through L3 with epidural tumor causing spinal canal stenosis at\nL1, grossly unchanged from prior MRI approximately one month ago." }, { "input": "A chronic appearing T2 hypointense nonenhancing pannus (7:3) measuring\napproximately 2.4 cm in the AP dimension surrounds the C1-C2 articulation. \nThis leads to chronic subluxation of the atlanto-dental interval, measuring up\nto 5 mm (5:8) and severe narrowing of the spinal canal at the C1 level with\nintrinsic T2 prolongation within the spinal cord (4:8). There is likely a\ncomponent of thickening of the transverse ligament.\n\nAt C3-C4 level, mild to moderate broad based disc bulge narrows the thecal sac\nwithout cord contact (7:13). There is moderate bilateral foraminal narrowing.\n\nAt C4-C5 level, mild to moderate right paracentral disc protrusion narrows the\nthecal sac without cord contact (7:17).\n\nAt C5-C6 level, moderate right paracentral disc protrusion narrows the thecal\nsac without cord contact (7:20). Moderate-to-severe bilateral foraminal\nnarrowing. Moderate bilateral foraminal narrowing is seen.\n\nAt C6-C7 level, mild to moderate left paracentral disc protrusion narrows the\nthecal sac without cord contact (7:25). Moderate bilateral foraminal\nnarrowing is seen.\n\nAt C7-T1 level, moderate broad-based disc bulge withoutcord contact (7:28). \nThe cord signal remains normal.", "output": "1. Pannus formation around the C1-C2 articulation, likely secondary to\ninflammatory or degenerative arthritis, exhibits severe narrowing of the\nspinal canal at the C1 level with intrinsic cord signal abnormality. The\nfocal well-defined appearance of T2 signal abnormality in the cord is\nsuggestive of myelomalacia rather than spinal cord edema.\n2. The aforementioned pannus also leads to chronic widening of the\natlanto-dental interval, which measures up to 5 mm suggestive of increased\nmobility. This can be further evaluated with flexion-extension plain\nradiographs. No evidence of acute injury.\n3. Multilevel degenerative changes of the cervical spine, most prominent at\nthe C5-6 level with moderate right paracentral disc protrusion. Multilevel\nforaminal changes as above.\n4. No evidence of metastatic disease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:56 pm, 30 minutes after\ndiscovery of the findings." }, { "input": "Re- demonstration of known fractures of the C2 pedicle bilaterally and of the\nright superior articular process of C7, better appreciated on the prior\noutside reference CT study. There is minimally increased fluid seen around\nthe articulation of the C1-C2 lateral masses, suggestive of injury to the\njoint capsules (12:5). A small amount of fluid is also seen adjacent to the\nright C7 superior articular process.\n\nThere is increased signal intensity seen on STIR sequences at the superior\nendplates of the C7, T1 and T3 vertebral bodies (3:8), consistent with\nminimally compressed fractures.\n\nThere is posterior extension of the C2-C3 intervertebral disc (3:9),\nconsistent with an annular fissure, without encroachment upon the spinal cord\nor narrowing of neural foramina. There is increased STIR signal intensity of\nthe interspinous ligaments between C1-C2, suggestive of edema. No discrete\nligamentous tear is detected.\n\nThere is trace anterolisthesis of C2 on C3. Alignment is otherwise preserved.\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of spinal canal or neural foraminal narrowing. There is no evidence\nof infection or neoplasm.", "output": "1. Minimally compressed fractures at the superior endplates of the C7, T1 and\nT3 vertebral bodies, as described above (series 3, image 8).\n2. Minimally increased fluid around the articulation of the C1-C2 lateral\nmasses, suggestive of injury to the joint capsules (series 12, image 5)\n3. Posterior annular fissure of the C2-C3 intervertebral disc.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:29 ___, 20 minutes after\ndiscovery of the findings." }, { "input": "The vertebral bodies are normal in height. Sagittal alignment is maintained. \nThere are multilevel degenerative endplate marrow signal changes and endplate\nosteophytes, with ___ type 1 signal changes noted at the L4-L5 level as to\nlesser extent at the L5-S1 level. There is diffuse disc desiccation and\nmild-to-moderate loss of intervertebral disc height. There are multiple small\nSchmorl's nodes. The largest is in the superior endplate L2.\n\nThe visualized distal spinal cord and conus medullaris are normal. The conus\nmedullaris terminates at T12-L1.\n\nThere is no evidence of infection or neoplasm.\n\n1.8 cm right adrenal gland nodule, as demonstrated on the previous CT of the\nabdomen and pelvis.\n\nT11-T12: Small left paracentral disc protrusion. No spinal canal or neural\nforaminal stenosis.\n\nT12-L1: Facet arthropathy. There is no significant narrowing of spinal canal\nor neural foramina.\n\nL1-L2: There is a diffuse disc bulge with a likely superimposed superiorly\nmigrated fragment which extends nearly to the superior endplate of L1. This\ndemonstrates intrinsic T1 hyperintensity, corresponding to dense calcification\non the previous CT. There is facet arthropathy and ligamentum flavum\ninfolding. Findings cause mild narrowing of the spinal canal and\nmild-to-moderate bilateral neural foraminal narrowing.\n\nL2-L3: Diffuse disc bulge with ligamentum flavum infolding and facet\narthropathy. There is superimposed central disc protrusion component. In\ncombination with slightly prominent posterior epidural fat and a congenitally\nnarrowed spinal canal, the findings cause severe spinal canal stenosis. The\ncauda equina nerve roots are redundant above and below this level. There is\nmoderate to severe bilateral neural foraminal narrowing, worse on the right.\n\nL3-L4: Diffuse disc bulge with ligamentum flavum infolding and facet\narthropathy causing moderate narrowing of spinal canal. There is narrowing of\nthe subarticular recesses, right more than left, with probable compression of\nthe bilateral traversing L4 nerve roots. There is moderate to severe\nbilateral neural foraminal narrowing.\n\nL4-L5: Diffuse disc bulge with central protrusion component, ligamentum flavum\ninfolding, and advanced facet arthropathy causing moderate to severe spinal\ncanal narrowing. There is narrowing of the subarticular recesses with\ncrowding of the bilateral traversing L5 nerve roots, left more than right. \nThere is moderate to severe bilateral neural foraminal narrowing.\n\nL5-S1: Diffuse disc bulge with a superimposed central protrusion component. \nThere is mild narrowing of the spinal canal. There is narrowing of the right\nsubarticular recess probable compression of the traversing right S1 nerve\nroot. There is moderate right and moderate to severe left neural foraminal\nnarrowing.", "output": "1. Advanced multilevel degenerative changes of the lumbar spine as described\nabove. There is severe spinal canal stenosis at the L2-L3 level due to\ncombination of degenerative findings superimposed on a congenitally narrowed\nspinal canal. There is also moderate to severe neural foraminal stenosis from\nthe L2-L3 through L5-S1 levels and moderate to severe spinal canal stenosis at\nL4-L5.\n2. Probable right adrenal adenoma as seen on recent CT." }, { "input": "CERVICAL:\nThe alignment is normal. The bone marrow is heterogeneous however node\nconcerning discrete lesions are seen. No cord signal abnormalities are seen. \nDiffuse loss of normal T2 signal seen throughout the intervertebral discs of\nthe cervical spine.\n\nC2-C3: There is no spinal canal or neural foramina narrowing.\n\nC3-C4: Central disc protrusion is seen resulting in mild spinal canal\nnarrowing. Facet joint and uncovertebral arthropathy results in moderate\nbilateral neural foraminal narrowing.\n\nC4-C5: Mild disc bulge and facet joint arthropathy results in moderate spinal\ncanal narrowing. Facet joint and uncovertebral arthropathy results in\nmoderate bilateral neural foraminal narrowing, left greater than right.\n\nC5-C6: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nFacet joint and uncovertebral arthropathy results in severe bilateral neural\nforaminal narrowing.\n\nC6-C7: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nFacet joint and uncovertebral arthropathy results in moderate to severe\nbilateral neural foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThe alignment is normal. No discrete bone marrow lesions are identified. No\ncord signal abnormalities are seen. Mild loss of the normal T2 signal is seen\nthroughout the thoracic spine intervertebral discs.\n\nThere is no significant spinal canal or neural foraminal narrowing within the\nthoracic spine.\n\nMultiple T2 hyperintense lesions are seen within the liver, incompletely\nevaluated on this exam.\n\nLUMBAR:\nThe alignment is normal. No discrete bone marrow lesions are seen. Diffuse\nloss of normal T2 signal is seen throughout the intervertebral discs of the\nlumbar spine. The cord terminates at T12-L1. No terminal cord signal\nabnormalities are seen.\n\nT12-L1: There is no spinal canal or neural foraminal narrowing.\n\nL1-L2: Disc bulge with a focal central disc protrusion is seen, which in\nconjunction with facet joint arthropathy and ligamentum flavum thickening\nresults in mild spinal canal narrowing. Facet joint arthropathy results in\nmild left neural foraminal narrowing.\n\nL2-L3: Disc bulge, facet joint arthropathy and ligamentum flavum thickening\nresults in mild spinal canal narrowing. Facet joint arthropathy results in\nmild bilateral neural foraminal narrowing.\n\nL3-L4: There is no spinal canal or neural foraminal narrowing.\n\nL4-L5: Disc bulge with a focal central disc protrusion is seen resulting in\nmild spinal canal narrowing. Facet joint osteophytes results in mild\nbilateral neural foraminal narrowing.\n\nL5-S1: Disc bulge with a focal central disc protrusion is seen resulting in\nmild spinal canal narrowing. Facet joint osteophytes results in mild\nbilateral neural foraminal narrowing.\n\nMultiple T2 hyperintense lesions are seen within the kidneys bilaterally. No\nother paraspinal or paravertebral soft tissue abnormalities identified.", "output": "1. No cord signal abnormalities identified.\n2. Cervical spondylosis most pronounced at C4-C5, with moderate spinal canal\nnarrowing. No underlying cord signal abnormalities are seen. Moderate\nbilateral neural foramina narrowing, left greater than right is seen at this\nlevel.\n3. Mild lumbar spondylosis." }, { "input": "There are 5 non rib-bearing lumbar type vertebrae. The sagittal vertebral\nbody alignment is unremarkable. Vertebral body height is grossly preserved,\nwithout evidence of compression fracture. There is no marrow signal\nabnormality. The visualized portion of the spinal cord appear unremarkable. \nConus medullaris terminates at L1 level. There are multilevel disc\ndesiccation with loss of intervertebral body height, more pronounced at L2-L3\nlevel.\n\nThere is no abnormal enhancement to suggest infection or neoplasm.\n\nThere are multiple perineural cysts of varying sizes at several neural\nforamina with the largest 1 of the level of S2.\n\nAt T12-L1 there is no significant disc disease, spinal canal or neural\nforaminal narrowing.\n\nAt L1-2 there is no significant disc disease, spinal canal or neural foraminal\nnarrowing.\n\nAt L2-3 there is broad-based disc bulge, bilateral facet arthropathy with\njoint effusion, ligamentum flavum thickening resulting in mild narrowing of\nthe spinal canal. There is mild bilateral foraminal disc protrusion resulting\nin mild narrowing of the neural foraminal bilaterally.\n\nAt L3-4 there is broad-based disc bulge, ligamentum flavum thickening,\nbilateral facet arthropathy resulting in mild narrowing of the spinal canal\nand mild bilateral neural foramina.\n\nAt L4-5 there is mild broad-based disc bulge ligamentum flavum thickening, and\nbilateral facet arthropathy, without significant spinal canal or neural\nforaminal narrowing.\n\nAt L5-S1 there is mild broad-based disc bulge, ligamentum flavum thickening,\nbilateral facet arthropathy without significant spinal canal or neural\nforaminal narrowing.\n\nOTHER: There is no paraspinal or paravertebral mass identified. Diffuse fatty\natrophy area of the paraspinal and gluteal musculature.", "output": "1. No evidence of acute fracture or metastatic disease.\n2. Multilevel degenerative changes of the spine as described above without\nsevere spinal canal or neural foraminal narrowing.\n3. Multiple perineural cysts of varying sizes at several neural foramina.\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": "There is severe levoscoliosis of the lumbar spine, partially limiting\nevaluation, with multilevel loss of vertebral body heights and intervertebral\ndisc spaces and disc desiccation. There are ___ type 2 endplate\ndegenerative changes at L3-L4. The conus terminates at L1.\n\nT12-L1: There is left facet osteophyte with mild spinal canal stenosis,\ncontacting and remodeling the adjacent spinal cord (6:2). There is no neural\nforaminal stenosis.\n\nL1-L2: There is a disc bulge with ligamentum flavum thickening. The left\nfacet osteophyte results in moderate left spinal canal stenosis with narrowing\nof the left subarticular zone with contact and mild posterior displacement of\nthe left traversing nerve roots, slightly progressed from the prior study. \nThere are bilateral facet and endplate osteophytes resulting in moderate left\nand mild right neural foraminal stenosis.\n\nL2-L3: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet osteophytes. There is resultant moderate spinal canal stenosis on the\nright with narrowing of the subarticular zone and narrowing of the traversing\nnerve roots, slightly progressed from the prior study. There is\nmoderate-to-severe right and no left neural foraminal stenosis.\n\nL3-L4: There is a disc bulge with ligamentum flavum thickening and bilateral\nosteophytes. There is mild spinal canal stenosis with narrowing of the right\nsubarticular zone, with displacement of the right traversing nerve roots,\nsimilar to the prior study. There is moderate right and no left neural\nforaminal stenosis.\n\nL4-L5: There is a disc bulge with a central disc protrusion component, with\nligamentum flavum thickening and bilateral facet osteophytes. There is\nresultant moderate spinal canal stenosis with narrowing of the left\nsubarticular zone, contacting and compressing the left traversing nerve roots,\nprogressed from the prior study. There is severe left and mild right neural\nforaminal stenosis.\n\nL5-S1: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet osteophytes. There is resultant mild spinal canal stenosis with\nmoderate-to-severe left and no right neural foraminal stenosis.\n\nThere is marked enlargement of the common bile duct similar to the prior\nstudies with the visualized gallbladder. Multiple probable bilateral renal\ncysts are seen.", "output": "1. No evidence of a lumbosacral mass or hematoma.\n2. Severe scoliosis of the lumbar spine with degenerative changes, slightly\nprogressed from the prior study, with multilevel moderate spinal canal and\nmoderate-to-severe neural foraminal stenosis, as detailed above.\n3. Nonspecific enlargement of the common bile duct similar to the prior CT\nfrom ___." }, { "input": "A limited number of sagittal sequences were obtained before the patient\nrefused to continue the examination. In the absence of a complete study, in\nparticular axial and postcontrast images through the T-spine and L-spine, this\nexamination is markedly limited.\n\nThere is severe thoracolumbar scoliosis with moderate to severe multilevel\ndegenerative changes which are incompletely characterized on this limited\nexamination. Decreased T1 marrow signal intensity adjacent to the C5-C6\nendplates are presumably related to degenerative changes. Mild disc bulges or\nprotrusions result in mild vertebral canal narrowing at C5-C6, C6-C7, and\nT10-T11. Disc bulges or protrusions resulting in mild-to-moderate vertebral\ncanal narrowing throughout the lumbar spine is similar to the prior\nexamination, but incompletely characterized on the limited sequences obtained.\nModerate to severe neural foraminal narrowing throughout the lumbar spine is\nsimilar to the prior examination, but incompletely characterized on the\nlimited sequences obtained. Limited evaluation for hematoma and infection in\nthe absence of T1 and postcontrast sequences.\n\nIncidental note is made of an incompletely characterized left renal cyst,\nbetter evaluated on prior lumbar spine MRI.", "output": "1. Markedly limited, incomplete evaluation of the thoracic and lumbar spine as\nthe patient could not tolerate the complete examination. Limited evaluation\nspecifically for hematoma and infection in the absence of T1 and postcontrast\nsequences. Recommend repeat evaluation when the patient is able to tolerate\nthe duration of a complete examination, if clinical concern persists.\n2. Severe thoracolumbar scoliosis with multilevel degenerative changes\nresulting in incompletely characterized mild-to-moderate multilevel vertebral\ncanal narrowing and moderate to severe lumbar spine neural foraminal\nnarrowing." }, { "input": "There is mild anterolisthesis of L4 on L5 and L5 on S1, similar to prior. \nAlignment is otherwise anatomic. Overall marrow signal is heterogeneous with\nsomewhat decreased signal on T1-weighted images. However, there is no\nsuspicious STIR abnormality and no evidence of osseous destruction. \nFurthermore, there is no suspicious osseous enhancement to suggest myeloma. \nMild endplate degenerative changes are demonstrated, most prominent at L3-4\nand L5-S1.\n\nMultilevel degenerative changes are again demonstrated.\n\nAt L1-L2, a large disc extrusion migrates superiorly and is left paracentral\nin location. This mildly effaces the anterior thecal sac but does not abut\nany nerve roots and causes only mild central canal narrowing.\n\nAt L2-L3, a broad-based disc bulge combines with moderate facet degeneration\nto cause mild spinal canal narrowing.\n\nAt L3-L4, broad-based disc bulge, larger on the left, combines with moderate\nligamentous buckling to cause mild right and moderate left foraminal\nnarrowing. Facet osteophytes also contribute to this process. The patient is\nstatus post decompressive laminectomy with no residual spinal canal stenosis\nat this level.\n\nAt L4-L5, a central disc protrusion within a broad-based disc protrusion\ncombines with mild anterolisthesis and unroofing of the disc. The patient is\nstatus post decompressive laminectomy at this level with no residual spinal\ncanal stenosis. However, severe facet arthropathy creates moderate bilateral\nforaminal narrowing. When compared to the prior examination, the synovial\ncyst at this level is no longer present and effacement of the thecal sac is\ndecreased. However, there remains left subarticular recess narrowing. There\nis persistent right greater than left facet effusion.\n\nAt L5-S1, a broad-based disc protrusion combines with mild bilateral facet\ndegeneration and mild anterolisthesis of L5 on S1 with unroofing of the cause\nto severe right and moderate left foraminal narrowing. There is abutment of\nthe exiting right L5 nerve root. The patient is status post decompressive\nlaminectomy at this level without residual spinal canal stenosis.\n\nThere is no suspicious intrathecal enhancement on the post-gadolinium images.", "output": "1. No evidence of focal bony abnormality to suggest myeloma deposits.\n2. Extensive degenerative and post-operative changes. The left L4-L5\nsynovial cyst is no longer present. New mild spondylolisthesis of L4 over L5\nseen. Otherwise, these changes are similar to ___." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T12 and is\nunremarkable.\n\nAt T12/L1 level, there is disc desiccation and minimal disc bulge with no\nevidence of neural foraminal narrowing or spinal canal stenosis.\n\nAt L1/L2 level, appears unremarkable with no evidence of spinal canal stenosis\nor neural foraminal narrowing.\n\nAt L2/L3 level, the intervertebral disc space appears maintained with no\nevidence of neural foraminal narrowing or spinal canal stenosis, an oval\nshaped area is noted on the left side at L3 vertebral body, with high signal\nintensity on T1 and T2, likely consistent with a non expansile hemangioma\n(image 13, series 2 and image 8, series 5).\n\nAt L3/L4 level, there is no evidence of neural foraminal narrowing or spinal\ncanal stenosis, mild articular joint facet hypertrophy is present at this\nlevel.\n\nAt L4/L5 level, there is disc desiccation and disc bulging, causing mild\nanterior thecal sac deformity, contacting the traversing nerve roots, more\nsignificant towards the left (image 19, series 5), moderate articular joint\nfacet hypertrophy and ligamentum flavum thickening are present at this level.\n\nAt L5/S1 level, there is disc desiccation and mild disc bulge, causing mild\nanterior thecal sac deformity, apparently contacting the S1 nerve root on the\nleft (image 24, series 5), moderate articular joint facet hypertrophy is\npresent.\n\nThe sacroiliac joints are normal. The visualized paravertebral structures are\nunremarkable.", "output": "Mild to moderate multilevel multifactorial degenerative changes throughout the\nlumbar spine, more significant at L4/L5 and L5/S1 levels, with no evidence of\nspinal canal stenosis or significant nerve root compression.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 1:48 ___, 5 minutes after discovery of the\nfindings." }, { "input": "Mild decreased signal along the superior endplate of T8 vertebra without\nincreased inversion rim of the signal indicates chronic compression fracture\nwhich was seen previously. The previously suspected T12 vertebral fracture is\nnot identified. No acute fractures are seen in the thoracic region. There is\nno retropulsion or spinal stenosis. Mild multilevel disc degenerative changes\nare seen without spinal stenosis. The spinal cord shows normal intrinsic\nsignal without extrinsic compression.", "output": "Chronic appearing minimal compression of the superior endplate of T8 vertebra\nwithout retropulsion. No acute compression fracture. Mild degenerative\nchanges. No spinal stenosis." }, { "input": "The localizer sequence demonstrates 7 cervical, 12 rib-bearing, and 5\nlumbar-type vertebrae. L5 is partially sacralized. The numbering is\ndocumented on images 4:3, 4:4, 5:10, 5:11, and 08:12. The localizer sequence\nalso demonstrates a dextroconvex curvature of the thoracic spine.\n\nCERVICAL:\n\nThere is no evidence for bone marrow edema, ligamentous edema, prevertebral\nedema, or paravertebral edema. There is no epidural collection. Vertebral\nbody heights are preserved. There is no subluxation.\n\nThe cerebellar tonsils are normally positioned, and the visualized posterior\nfossa and lower cerebrum appear unremarkable.\n\nThe spinal cord demonstrates normal signal intensity.\n\nAt C5-C6, a right paracentral disc protrusion with overlying endplate\nosteophytes indent the ventral thecal sac but do not contact the spinal cord.\n\nAt C6-C7, there is moderate to severe right and moderate left neural foraminal\nnarrowing by uncovertebral osteophytes.\n\nTHORACIC:\n\nT8 vertebral body demonstrates mild anterior superior corner deformity with\nedema parallel to the superior endplate, indicating an acute fracture. There\nis no retropulsion.\n\nT12 vertebral body demonstrates a well corticated Schmorl's node in the\nanterior superior endplate on the preceding CT. The present MRI demonstrates\nmarrow edema along the Schmorl's node extending posteriorly parallel to the\nsuperior endplate, suggesting a subtle nondisplaced fracture without any loss\nof height in addition to the Schmorl's node. There is no retropulsion.\n\nThere is no epidural collection. There is no spinal canal narrowing. Spinal\ncord signal is normal.\n\nLUMBAR:\n\nThere is no evidence for bone marrow edema. Vertebral body heights are\npreserved. There is no subluxation. The conus medullaris terminates near the\nL1 upper endplate and appears unremarkable.\n\nAt L3-L4, there is a mild disc bulge and mild facet arthropathy without spinal\ncanal narrowing. A tiny left foraminal disc protrusion minimally narrows the\nleft neural foramen.\n\nAt L4-L5, there is a disc bulge and facet arthropathy causing left greater\nthan right subarticular zone narrowing with abutment of the traversing left L5\nnerve root. There is no mass effect on the intrathecal nerve roots. There is\nmoderate bilateral neural foraminal narrowing with abutment of the exiting\nright L4 nerve root.\n\nL5-S1: There is mild facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nOTHER:\n\nThere is dependent atelectasis in the included portions of the lungs. There\nis a 1 cm T2 hyperintense cystic lesion in the upper pole of the right kidney,\nimage 13:33. The visualized distal common bile duct is dilated, measuring\n9-10 mm on images 14:2 and 14:6, likely secondary to the cholecystectomy\ndemonstrated on the preceding torso CT.", "output": "1. Acute fracture of T8 anterior superior corner with mild loss of height. No\nretropulsion.\n2. Well corticated Schmorl's node in the anterior superior endplate of T12 is\nchronic. Marrow edema parallel to the anterior and posterior superior\nendplate, without any loss of height in addition to the Schmorl's node,\nsuggests a subtle nondisplaced fracture versus contusion. No retropulsion.\n3. No evidence for acute traumatic injury in the cervical spinal lumbar spine.\n4. Normal appearance of the spinal cord.\n5. Disc protrusion at C5-C6 without mass effect on the spinal cord. Severe\nright and moderate left neural foraminal narrowing at C6-7.\n6. Left greater than right subarticular zone narrowing at L4-L5 with abutment\nof the traversing left L5 nerve root. Moderate bilateral L4-L5 neural\nforaminal narrowing with abutment of the exiting right L4 nerve root.\n7. Dilatation of the visualized distal common bile duct, most likely secondary\nto cholecystectomy. Please correlate with liver function tests.\n\nRECOMMENDATION(S): If there are no prior studies documenting stability of\ncommon bile duct dilatation, then correlation liver function tests may be\nconsidered, if they have not been performed recently.\n\nNOTIFICATION: The findings at T8 and T12 were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 1:15 ___,\n10 minutes after discovery of the findings." }, { "input": "Alignment is normal. Vertebral body heights are maintained. The conus\nterminates at the inferior endplate of T12, within normal limits. No abnormal\nsignal is seen in the visualize cord. There is no suspicious marrow signal. A\n10 mm rounded T2 hyperintense lesion is seen within the L5 vertebral body,\nlikely a hemangioma.\n\nNo significant degenerative changes are present from the T12/L1 to L2/L3\nlevels.\n\nAt L3/L4, there is a diffuse disc bulge without significant spinal canal\nstenosis or neural foraminal narrowing.\n\nAt L4/L5, there is a diffuse disc bulge without significant spinal canal\nstenosis or neural foraminal narrowing.\n\nAt L5/S1, there is disc desiccation with a posterior disc protrusion\ncontacting but not displacing the left S1 nerve roots. There is no\nsignificant spinal canal stenosis at this level.\n\nThe sacroiliac joints are preserved. Given the limitations of this noncontrast\nenhanced study, there is no evidence of infection or neoplasm. The noncontrast\nenhanced appearance of the paraspinal soft tissues is unremarkable.", "output": "Mild multilevel degenerative changes of the lumbar spine, most prominent at\nL5/S1 level with disc protrusion contacting but not displaced the left S1\nnerve roots. No spinal canal stenosis or neural foraminal narrowing." }, { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved. \nGrossly stable L5 vertebral body probable lipid poor hemangioma is again\nnoted. L5-S1 mixed probable type 1 and type ___ ___ changes are noted.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. The conus terminates at the T12 level.\n\nThere is loss of intervertebral disc height and signal at L5-S1, unchanged.\n\nAt the levels T12-L1, L1-2, L2-3, L3-4: No vertebral canal or neural foraminal\nnarrowing is noted.\n\nAt the level L4-5: There is disc bulge, prominent epidural fat, and mild facet\njoint arthropathy which results in mild narrowing of bilateral subarticular\nzones with mild vertebral canal and no neural foraminal narrowing.\n\nL5-S1: Postsurgical changes related to left L5 laminectomy is noted. Again is\nnoted disc bulge with left foraminal disc protrusion versus granulation\ntissue. This again results in narrowing of the left subarticular zone with\nposteromedial displacement of the left S1 nerve root. Associated facet joint\nosteophytosis results in mild narrowing of the left L5-S1 neural foramen. The\nright L5-S1 neural foramina is patent. Nonspecific bilateral facet joint\nfluid is noted.\n\nOTHER:\nLimited imaging the kidneys suggest right renal cysts probable cyst.", "output": "1. Study is mildly degraded by motion. Please note study is limited for the\nevaluation of granulation tissue versus recurrent disc due to lack of\nadministration of intravenous contrast.\n2. Postsurgical changes related to known left L5 laminectomy and\nmicrodiscectomy.\n3. Interval recurrence of the L5-S1 disc protrusion predominantly in the left\nforaminal zone displacing the left S1 nerve root posteromedially in the\nsubarticular zone versus granulation tissue formation. If clinically\nindicated, consider contrast lumbar spine MRI for further evaluation.\n4. Mild left L5-S1 neural foraminal narrowing.\n5. Limited imaging the kidneys suggest right renal cysts probable cyst. If\nclinically indicated, consider renal ultrasound for further evaluation." }, { "input": "The visualized elements of the posterior fossa and craniocervical junction are\nunremarkable, the cervical spine alignment appears maintained, the signal\nintensity throughout the cervical spinal cord is normal with no evidence of\nfocal or diffuse lesions.\n\nAt C2-C3 level,\nThere is no evidence of neural foraminal narrowing or spinal canal stenosis.\n\nAt C3-C4 level, there is mild diffuse disc bulge and mild bilateral\nuncovertebral hypertrophy causing mild bilateral neural foraminal narrowing\nwith no frank evidence of nerve root compression, there is no evidence of\ncentral spinal canal stenosis.\n\nAt C4-C5 level, there is unchanged mild diffuse disc bulge and mild bilateral\nuncovertebral hypertrophy, slightly more pronounced on the left causing mild\nleft side neural foraminal narrowing.\n\nAt C5-C6 level, there is mild unchanged posterior spondylosis and disc bulge,\nbilateral uncovertebral hypertrophy resulting in moderate to severe bilateral\nneural foraminal narrowing and mild spinal canal stenosis image 27, series 6,\nimage 23, series 7 and image 8, series 2).\n\nAt C6-C7 level, there is a grossly unchanged left paracentral disc protrusion,\nimpinging the thecal sac and resulting in severe left-sided neural foraminal\nnarrowing, moderate spinal canal stenosis towards the left there is mild\nunchanged right-sided neural foraminal narrowing.\n\nAt C7-T1 level, there is minimal disc bulge causing mild left-sided neural\nforaminal narrowing with no evidence of central spinal canal stenosis.\n\nThe visualized paravertebral structures are unremarkable.", "output": "1. Grossly unchanged, C6-7 disc bulge with a component of left paracentral\ndisc protrusion, resulting in severe canal narrowing towards the left, with\ncontact of the left anterior cord.\n2. Bilateral neural foraminal narrowing at C5-6 and C6-7 are mild-to-moderate.\nMultilevel additional degenerative changes are mild and remain unchanged\n3. No focal or diffuse lesions are visualized throughout the cervical spinal\ncord." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\n\nThere is a broad-based protrusion of the C6-7 intervertebral disc with\nextension into the left neural foramen. This just touches the anterior\nsurface of the spinal cord but appears to fill the foramen.\n\nThe sagittal images suggest small intervertebral osteophytes to the right of\nmidline at T2-3 and ___. These are incompletely evaluated.\n\nIncompletely evaluated is an apparent bilobed cystic structure in the left\naxilla measuring approximately 2 cm in greatest dimension. There are no T1\nweighted images through this area and contrast was not administered. It is\ndifficult to speculate on the nature of this lesion or whether it is related\nto the history of trauma. If further imaging characterization is indicated\nafter clinical evaluation, an MR of the shoulder may be helpful.\n\nImaging of the other cervical spinal levels reveals no other abnormalities. \nThere is no evidence of infection.", "output": "C6-7 disc protrusion touching the spinal cord and including the left neural\nforamen.\nTwo cm apparent cystic structure in the left axilla, incompletely evaluated." }, { "input": "The study is significantly limited by motion.\n\n There is homogeneously low T1 signal throughout the vertebral bodies, likely\nreactive. Mild lower lumbar facet arthritis. Normal visualized cord. Mild\ndiffuse disc bulges.\n\nMild bilateral L5-S1 foraminal narrowing. Otherwise foramina, central canal\nin the lumbar spine are patent.\n\nA 1.3 cm T1 hypointense lesion arising from the inferior pole of the right\nkidney is indeterminate assessment is limited by motion. There is mild\nintra-abdominal ascites.\n\nMild posterior paraspinal edema, may be reactive or inflammatory. No abscess.\nNo evidence of septic facet joint arthritis.", "output": "1. No evidence of discitis or osteomyelitis.\n2. Mild posterior paraspinal edema, may be reactive or inflammatory.\n3. Marrow signal appearance is likely reactive, infiltrative process is\nunlikely unless clinically suspected.\n4. Right renal lesion, better seen on recent CT..\n5. Ascites." }, { "input": "The cervical vertebral body heights and alignment are grossly maintained. \nThere is mild multilevel disc desiccation and intervertebral disc space loss. \nThere are multilevel ___ type 2 changes. The visualized portion of the\nspinal cord appears normal.\n\nThere is no evidence of infection or neoplasm. There is no evidence of\nabnormal contrast enhancement.\n\nC2-C3: Minimal disc bulge. No significant spinal canal or neural foraminal\nnarrowing.\n\nC3-C4: Mild disc bulge with slight effacement of the ventral CSF space. Mild\nleft greater than right neural foraminal narrowing. No significant spinal\ncanal narrowing.\n\nC4-C5: Mild disc bulge with slight effacement of the ventral CSF space. Mild\nbilateral uncovertebral joint hypertrophy with mild narrowing of the bilateral\nneural foramina. No significant spinal canal narrowing.\n\nC5-C6: Mild disc bulge with mild bilateral uncovertebral joint hypertrophy\nresult in mild bilateral neural foraminal narrowing. No significant spinal\ncanal narrowing.\n\nC6-C7: Minimal disc bulge. No significant spinal canal or neural foraminal\nnarrowing.\n\nC7-T1: No significant discogenic abnormalities. No significant spinal canal\nor neural foraminal narrowing.\n\nOther: There is a 3.3 x 0.9 x 2.5 cm fat intensity lesion in the left\nposterior neck overlying the left capital muscles compatible with a lipoma\n(5:9). There is a nasopharyngeal mucosal cyst (Thornwaldt cyst) measuring\napproximately 23 x 13 mm in sagittal projection (2:7).", "output": "1. Small lipoma in the left posterior neck overlying left capital muscles\nslightly difficult to assess due to increased fat in the region of interest\n(5:9).\n2. Mild multifactorial multilevel degenerative disc disease of the cervical\nspine, most notable from C3-C4 through C5-C6." }, { "input": "There are 5 lumbar-type vertebrae. Again seen are laminectomies and\ninstrumented anterior and posterior fusion of L4 through S1. The hardware is\nnot assessed by MRI. Within the laminectomy bed, there is a collection\nmeasuring 4.5 cm transverse by 2.0 cm AP x 5.7 cm craniocaudad, which has high\nT2 signal and intermediate T1 signal, and which contains small foci of low\nsignal on all sequences which may represent hemosiderin deposits, debris, or,\nless likely, air. In the absence of intravenous contrast, it is not possible\nto determine whether this collection is completely liquified, and is also not\npossible to assess for any rim enhancement. The collection is closely\nassociated with the posterior margin of the thecal sac at the L5-S1 level,\nbest seen on images 5:20 and 2:12. High T2 signal in the posterior\nparavertebral muscles and subcutaneous soft tissues is likely related to\npostsurgical change.\n\nVertebral body heights are preserved. Alignment is normal. Allowing for\nhardware related artifact, no concerning bone marrow signal abnormalities are\nidentified. The conus medullaris terminates near the upper margin of L1 and\nappears unremarkable.\n\nAt T12-L1, there is minimal degenerative irregularity within the facet joints\nwithout spinal canal or neural foraminal narrowing .\n\nAt L1-2, there is mild left facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nAt L2-3, there is mild left facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nAt L3-4, there is moderate facet arthropathy and mild thickening of the\nligamentum flavum, with minimal spinal canal narrowing, but no compression of\nthe nerve roots within the thecal sac. No definite impingement of the\ntraversing L4 nerve roots is seen. There is no neural foraminal narrowing.\n\nAt L4-5, the spinal canal is well decompressed by laminectomies. Subarticular\nzones appear unremarkable. The right neural foramen appears unremarkable. The\nleft neural foramen is suboptimally assessed on sagittal and axial images due\nto hardware related artifacts, but it was not significantly narrowed on the\npresurgical MRI from ___.\n\nAt L5-S1, the spinal canal is well decompressed by the laminectomies.\nPosterior endplate osteophytes and facet arthropathy is present. Subarticular\nzones and the left neural foramen are suboptimally visualized due to hardware\nrelated artifacts, and persistent narrowing by endplate and facet osteophyte\ncannot be excluded. Right neural foramen appears unremarkable.", "output": "1. Status post laminectomies with the anterior and posterior fusion of L4\nthrough S1 in anatomic alignment. The collection within the laminectomy bed\nmay represent a postsurgical seroma. Pseudomeningocele may also be considered,\ngiven the proximity to the thecal sac at the L5-S1 level. Superimposed\ninfection cannot be excluded by imaging, a than if MRI with intravenous\ncontrast was obtained, but MRI with intravenous contrast could help assessed\nthe degree to which this collection is liquified.\n2. The spinal canal at L4-5 and L5-S1 is well decompressed by the\nlaminectomies. Subarticular zones and the left neural foramen at L5-S1 are\nsuboptimally visualized due to hardware related artifacts, and persistent\nnarrowing by endplate and facet osteophytes cannot be excluded." }, { "input": "Thoracic spine:\nSince the previous study, extension of laminectomy identified from T4-T8\nlevel. There is fluid collection seen at the laminectomy site posterior to the\nspinal cord, predominantly at T5 and T6 level which indents and deforms the\nspinal cord from the posterior aspect. The signal intensities of the\ncollection are similar to cerebral spinal fluid. Although there is minimal\nsurrounding soft tissue enhancement this appears postoperative. Small amount\nof fluid is also seen in the subcutaneous fat which is also felt to be\npostoperative in nature. There is no abnormal signal seen within the spinal\ncord. Following contrast administration enhancement seen at the laminectomy\nsite and surrounding the thecal sac.\n\nNote is made of increased signal on inversion recovery posterior superior\nmargin of T5 vertebra. This is new since the previous MRI examination. There\nis also a linear low signal seen on the T2 weighted images at the junction of\nthe right pedicle and vertebral body at this level.\n\nMultilevel degenerative changes are seen in the thoracic region.\n\nLumbar spine:\n\nPostoperative changes are seen at L4-5 and L5-S1 levels. Pedicle screws and\ninterbody spacers are identified a small amount of fluid is seen at the\nlaminectomy site. The overall appearance is not significantly changed from the\nprevious MRI examination. There is no intraspinal fluid seen in the lumbar or\nhigh-grade thecal sac compression noted.", "output": "1. Laminectomy seen from T4 to the CT the level with fluid within the\nlaminectomy site at T5 and T6 level which indents the thecal sac and indents\nthe posterior aspect of the spinal cord. There is surrounding enhancement\nseen. This appears to be postoperative in nature. Although there is\nsurrounding enhancement, the appearance is not is not typical for infection.\nHowever, clinical correlation recommended.\n2. 3. Signal changes within the right posterior portion of the T5 vertebral\nbody suggestive marrow edema which is new since the previous study. The linear\nsignal area at the junction of the right pedicle and vertebral body of T5\nlevel could be secondary to a fracture. CT of the thoracic spine recommended\nfor further assessment." }, { "input": "CERVICAL:\nNormal alignment. Vertebral body heights are preserved. Marrow signal is\nwithin normal limits. Signal and height loss of cervical spine intervertebral\ndiscs is consistent with degenerative change, most pronounced at C5-6. No\nevidence of an epidural collection or abnormal enhancement. The cervical\nspinal cord is normal in caliber and signal intensity. There are\nmild-to-moderate multilevel cervical spine degenerative changes. More\nspecifically:\n\n-At C2-3, there is no spinal canal or neural foraminal narrowing.\n-At C3-4, there is a posterior intervertebral osteophyte which contacts and\nslightly deforms the ventral spinal cord without cord signal abnormality\n(12:17 and 8:9). There is likely mild bilateral neural foraminal narrowing\ndue to uncovertebral osteophytes at this level (12:16).\n-At C4-5, there is mild spinal canal and bilateral neural foraminal narrowing\ndue to intervertebral and uncovertebral osteophytes (12:19).\n-At C5-6, there is mild right neural foraminal narrowing due to uncovertebral\nand facet osteophytes. No significant spinal canal or left neural foraminal\nnarrowing.\n-At C6-7 and C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThe patient is status post laminectomies at T5 and T6. The imaged thoracic\nvertebral bodies are normally aligned, and demonstrate preserved height. \nLinear sclerosis which may be postsurgical is seen within the T5 and T6\nvertebral bodies, as on prior CT. Otherwise, marrow signal is within normal\nlimits. There is no evidence of an epidural collection within the thoracic\nspine. Postsurgical epidural fibrosis is noted posteriorly spanning T5-6. \nThe thoracic spinal cord is normal in caliber and signal intensity. There are\nmultiple multilevel thoracic spine degenerative changes. Specifically:\n\n-At T1-2, T2-3, T3-4, T4-5, there is no spinal canal or neural foraminal\nnarrowing.\n-At T5-6, there is no spinal canal or right neural foraminal narrowing; there\nis likely mild left neural foraminal narrowing due to epidural fibrosis\n(11:12).\n-At T6-7, there is mild-to-moderate spinal canal narrowing due to a\nposteriorly projecting prominent intervertebral osteophyte which contacts and\ndeforms the ventral spinal cord without cord signal abnormality (see series 8,\nimage 9 and series 13, image 32). No neural foraminal narrowing.\n-At T7-8, no spinal canal or neural foraminal narrowing.\n-At T8-9, there is a posterior intervertebral osteophyte which mildly narrows\nthe spinal canal but does not significantly encroach on the spinal cord\n(14:13). No neural foraminal narrowing.\n-At T9-10, there is a right of midline posterior projecting intervertebral\nosteophyte without spinal canal or neural foraminal narrowing (14:18).\n-At T10-11, T11-12, and T12-L1, there is no spinal canal or neural foraminal\nnarrowing.\n\nLUMBAR:\nThe patient is status post posterior spinal fusion with rods and\ntranspedicular screws spanning L4-S1. Hardware artifact somewhat limits\nevaluation in this region. Within this limitation, lumbar vertebral bodies\nare normally aligned and vertebral body heights are preserved. Marrow signal\nis within normal limits. Signal and height loss of lumbar spine\nintervertebral discs is consistent with degenerative changes. Interbody\nspacer seen at L4-5 and L5-S1. Distal spinal cord and conus medullaris is\nunremarkable and terminates at L1-2. Cauda equina nerve roots are within\nnormal limits. There is a minimally loculated extra-spinal collection\nposteriorly at L5 at the site of prior laminectomies which measures 28 x 8 x\n30 mm (TV by AP by CC) (15:40 and 10:12). No evidence of epidural collection.\n\nAt L1-2, L2-3, there is no disc herniation, spinal canal or neural foraminal\nnarrowing.\n\nAt L3-4, there is a posterior disc bulge, ligamentum flavum thickening and\nfacet osteophytes which cause mild spinal canal and mild bilateral neural\nforaminal narrowing.\n\nAt L4-5, there is no spinal canal narrowing. Hardware artifact limits\nevaluation of the neural foramina, likely moderately narrowed bilaterally by\nepidural fibrosis.\n\nAt L5-S1, there is no spinal canal narrowing. There is likely mild bilateral\nneural foraminal narrowing.\n\nOTHER: Incidentally noted 13 mm T2 hyperintensity in the right hepatic lobe\n(4:8 and 14:20) is not well evaluated on this exam and may reflect a hepatic\nhemangioma or a simple hepatic cyst, stable in size since at least ___.", "output": "1. 3.0 x 2.8 x 0.8 cm extra-spinal collection posteriorly at L5 at the site of\nprior laminectomies. Findings likely reflect chronic postoperative collection\nresidual from prior surgery. No evidence of epidural abscess.\n2. No spinal cord compression or cord signal abnormality.\n3. Mild-to-moderate cervical, thoracic, and lumbar spine degenerative changes,\nworst at C3-4, and T6-7 where there is contact and slight deformation of the\ncord by osteophytes without cord signal abnormality. Neural foraminal\nnarrowing is likely worst (moderate) bilaterally at L4-5.\n4. Expected postsurgical changes at T5-6 from prior laminectomies." }, { "input": "CERVICAL:\nMotion and metal artifact limits assessment. Status post C4-C6 anterior\ncervical discectomy and fusion. Postsurgical changes noted, including T2\nhyperintensity in the prevertebral space and epidural enhancement consistent\nwith granulation tissue. Alignment is normal.\n\nAt C3-C4, there is diffuse disc bulging, ligamentum flavum thickening, and\nbilateral facet osteophytes resulting in moderate bilateral neural foraminal\nnarrowing and moderate spinal canal narrowing.\n\nAt C4-C5 and C5-C6, there is diffuse disc bulging and increased fluid in the\nfacet joints. There is severe spinal canal narrowing at C5-C6, with a focal\nspinal cord signal abnormality on the T2 weighted image (5:7).\n\nTHORACIC:\nAlignment is normal.\n\nAt T10-T11 and T11-T12, there is ligamentum flavum thickening resulting in\nmild spinal canal narrowing. There are additional multilevel degenerative\nchanges, most notably loss of intervertebral disc height and facet\narthropathy.\n\nLUMBAR:\nAlignment is normal. The conus medullaris terminates at L1. Status post L3\nlaminectomy. Postsurgical changes noted, including 2.7 cm T2 hyperintense\ncollection likely representing a seroma (08:12) with extensive surrounding\nenhancement of the paraspinal soft tissue and epidural space consistent with\ngranulation tissue.\n\nAt L1-L2, there is diffuse disc bulging resulting in moderate bilateral neural\nforaminal narrowing.\n\nAt L2-L3, there are ___ type 2 endplate changes, diffuse disc bulging,\nligamentum flavum thickening, and bilateral facet joint osteophytes resulting\nin moderate bilateral neural foraminal narrowing and mild spinal canal\nnarrowing. The traversing left L3 nerve contacts the bulging disc and facet\njoint osteophyte.\n\nAt L3-L4, there are ___ type 1 and 2 endplate changes, diffuse disc bulging\nand bilateral facet joint osteophytes resulting in severe right and moderate\nleft neural foraminal narrowing, and moderate spinal canal narrowing.\n\nAt L4-L5, there are ___ type 2 endplate changes, diffuse disc bulging and\nbilateral facet joint osteophytes resulting in moderate to severe right and\nsevere left neural foraminal narrowing and mild spinal canal narrowing.\n\nAt L5-S1, there is diffuse disc bulging and bilateral facet joint osteophytes\nresulting in severe bilateral neural foraminal narrowing and mild spinal canal\nnarrowing.\n\nOTHER: There are multiple T2 hyperintense lesions in the right lobe of the\nliver, incompletely characterized but likely representing simple cysts. There\nare multiple subcentimeter nonenhancing, T1 hypointense, T2 hyperintense\nsimple renal cysts bilaterally.", "output": "1. No cervical, thoracic, or lumbar epidural hematoma.\n2. Severe cervical spinal canal narrowing with signal abnormality most notably\nat the C5-C6 level. Postsurgical changes from recent C4-C6 ACDF. Additional\ncervical findings as described above.\n3. Multilevel severe neural foraminal narrowing and moderate spinal canal\nnarrowing as described above. Postsurgical changes from L3 laminectomy. \nAdditional lumbar findings as described above." }, { "input": "Signal changes and endplate changes again identified at T11-T12 level. There\nis focal kyphosis at this level secondary to anterior wedging.\n\nSignal changes within the disc and paraspinal soft tissue abnormalities.\nFollowing gadolinium decreased enhancement within the disc paraspinal soft\ntissues but no evidence of focal collection suspicious for abscess identified.\nThe retropulsion of the vertebral bodies resulting in severe spinal stenosis\nand compression of the spinal cord. There is increased signal seen within the\nspinal cord. Compared with prior study, the kyphotic deformity at T11-level\nmay have slightly increased. Accounting for differences in slice selection and\ntechnique, paraspinal enhancement has not significantly changed.\n\nNo abnormal template signal abnormalities identified within the thoracic or\nlumbar region. No epidural abscess is identified. Disk degenerative change and\nmild bulging seen at L5-S1 level.", "output": "Changes of T11-12 discitis osteomyelitis are again noted. The degree of\nkyphotic deformity at this level has slightly increased with slight increase\nin degree of cord compression with increased signal seen within the spinal\ncord. The epidural and paraspinal enhancement has not changed and there is no\nevidence of epidural or paraspinal abscess." }, { "input": "7 cervical, 12 thoracic, and 5 lumbar-type vertebrae are demonstrated. The\nnumbering is documented on images 2:4, 3:7, and 9:10.\n\nTHORACIC SPINE:\n\nAlignment is normal. Vertebral body heights are preserved. No suspicious\nbone marrow signal abnormalities are seen. There is no evidence of\nsignificant spinal canal or neural foraminal narrowing. There are tiny disc\nbulges at several thoracic levels, most notable at T3-T4. The spinal cord\ndemonstrates normal morphology and signal intensity, terminating at T12-L1.\n\nSagittal images demonstrate degenerative changes at C5-C6 and C6-C7,\nincompletely evaluated, but without spinal cord compression.\n\nLUMBAR SPINE:\n\n alignment is normal. Vertebral body heights are preserved. No suspicious\nbone marrow signal abnormalities are seen. There is disc desiccation and loss\nof height at L4-L5 and L5-S1, with mild discogenic bone marrow changes at\nthese levels.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing. Minimal disc bulges and minimal facet arthropathy at L2-L3 and\nL3-L4.\n\nL4-L5: Mild disc bulge and moderate facet arthropathy cause mild narrowing of\nthe subarticular zones without clear compression of the traversing L5 nerve\nroots, and minimal narrowing of the thecal sac, without mass effect on the\nintrathecal nerve roots. A right foraminal and extraforaminal disc\nprotrusion, in combination with facet osteophytes, causes mild right neural\nforaminal narrowing without nerve root impingement.\n\nL5-S1: There are mild posterior endplate osteophytes, mild right and moderate\nleft facet arthropathy. There is no significant spinal canal narrowing. \nThere is mild bilateral neural foraminal narrowing without nerve root\nimpingement.\n\nOTHER:\n\nT2 hyperintense lesions are seen within the partially visualized right hepatic\nlobe measuring up to 1.6 cm x 1 cm, not fully characterized but likely cysts\nor biliary hamartomas.", "output": "1. No significant abnormalities in the thoracic spine. Normal appearance of\nthe thoracic spinal cord and conus medullaris.\n2. Mild lumbar spondylosis without mass effect on the intrathecal nerve roots,\nas detailed above.\n3. Partially visualized degenerative changes at C5-C6 and C6-C7 without spinal\ncord compression." }, { "input": "The alignment of the thoracic spine is maintained. The vertebral body height\nis maintained. The intervertebral disc height and signal is maintained.\n\nThere is an enhancing soft tissue mass in the paravertebral soft tissue,\nextending from the level of T6 to T11 through the neural foramen at all these\nlevels with mild narrowing of the spinal canal at the level of T6. From T7 to\nT9 levels, the mass is nearly completely encasing, the spinal cord exerting\nmass effect and displacing it to which the right. There is involvement of the\nleft neural foramen at T6-T7, bilateral neural foramina at T7-T8 and T8-T9,\nleft neural foramen at T9-T10. Also seen is abnormal marrow signal involving\nthe T8 vertebral body as well as the posterior element suggestive of marrow\ninfiltration. These findings are in keeping with an epidural extension of a\nparavertebral mass with the possible differential including lymphoma.\n\nAt the remaining levels, the thoracic spine appears unremarkable with no\nsignificant neural foramina or spinal canal narrowing. There is a hemangioma\nin the T5 vertebral body.", "output": "Enhancing paravertebral mass extending through the neural foramen into the\nspinal canal from T6-T11 vertebral bodies, causing spinal canal stenosis, mass\neffect and distortion of the spinal cord as described above. Also seen is\nabnormal signal in T8 vertebral body and its posterior elements in keeping\nwith marrow infiltration. These findings are associated with a paravertebral\nmass, possibilities including lymphoma with epidural extension.\n\nNOTIFICATION: Initial findings were discovered and discussed with Dr. ___\nby Dr. ___ telephone at 7:30 ___ on ___, and the patient was\nreferred to the ED for further management." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body height\nis maintained. The marrow signal is unremarkable. The cord appears\nunremarkable with no abnormal cord signal. The prevertebral soft tissues are\nunremarkable.\n\nLevel by level description of the cervical spine is as follows:\nAt C2-C3, the intervertebral disc height and signal is maintained. The facet\njoints are unremarkable. The uncovertebral joints are unremarkable. Neural\nforamina and spinal canal are patent.\n\nAt C3-C4, the intervertebral disc height and signal is maintained. The facet\nand uncovertebral joints are unremarkable. The neural foramen and spinal\ncanal are patent.\n\nAt C4-C5, there is mild loss of disc height with posterior disc osteophyte\ncomplex. The uncovertebral and facet joints are unremarkable. Neural foramina\nand spinal canal are patent.\n\nAt C5-C6, there is mild loss of disc height and signal with posterior disc\nosteophyte complex. The uncovertebral and facet joints are unremarkable. \nThere is mild right neural foramen narrowing. The left neural foramina and\nspinal canal are patent.\n\nAt C6-C7, there is mild loss of disc height and signal with posterior disc\nosteophyte complex. The facet and uncovertebral joints are unremarkable. \nNeural foramen and spinal canal patent.\n\nLUMBAR:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nAlignment is normal. Vertebral body height is maintained. No abnormal marrow\nsignal is seen. The conus is unremarkable and terminates at L1.\n\nNo abnormalities seen in the retroperitoneal soft tissues. No abnormal\nenhancement is seen on the post-contrast images.\n\nLevel by level description of the lumbar spine is as follows:\n- at T12 -L1, the intervertebral disc height and signal is maintained. The\nfacet joints are unremarkable. The neural foramen spinal canal are patent.\n\nAt L1-L2, the intervertebral disc height and signal is maintained. The facet\njoints are unremarkable. Neural foramen spinal canal are patent.\n\nAt L2-L3, the intervertebral disc height and signal is maintained. There is\nmild facet arthropathy. The neural foramina and spinal canal are patent.\n\nAt L3-L4, the intervertebral disc height and signal is maintained. There is\nmild bilateral facet arthropathy. The neural foramen spinal canal are patent.\n\nAt L4-L5, there is loss of disc signal with mild loss of disc height and an\nannular fissure with diffuse broad-based disc bulge and mild bilateral facet\narthropathy causing mild bilateral neural foramen narrowing. The spinal canal\nis patent.\n\nAt L5-S1, there is mild loss of disc height and signal with an annular fissure\nand diffuse broad-based disc bulge with mild bilateral facet arthropathy. The\nneural foramina and spinal canal are patent.", "output": "1. Mild degenerative changes involving the cervical and lumbar spine as\ndescribed above with no significant neural foramen and spinal canal narrowing\nat any level.\n2. No abnormal enhancement seen in the cervical and lumbar spine." }, { "input": "The patient is status post laminectomy from T6 through T9 with expected\npostoperative changes. Vertebral body signal intensity is uniformly\nhyperintense throughout the image portions of the thoracic spine on the T1\nweighted images. This is a change since the study of ___ and is\nlikely a consequence of radiation. There is hypo intensity in the T7\nvertebral body posteriorly on the precontrast images that does not enhance\nafter contrast administration. This may reflect slightly less extensive\nmarrow fat replacement than elsewhere. There is no abnormal enhancement after\ncontrast administration. There are no findings to suggest residual or\nrecurrent tumor.\n\nAlignment is normal. There is no evidence of canal encroachment. The spinal\ncord appears normal in caliber and configuration. There is no evidence of\ninfection.", "output": "1. Status post surgery and radiation with expected post treatment changes. No\nevidence of residual or recurrent tumor." }, { "input": "The prior radiographs confirm that there are 5 lumbar-type vertebrae. L3\nvertebral body demonstrates anterior wedging with approximately 20% loss of\nheight, but no retropulsion. There is mild edema along the deformed superior\nendplate. Other lumbar and visualized lower thoracic vertebral bodies\nmaintain normal heights. There is no subluxation. No suspicious bone marrow\nsignal abnormalities are seen.\n\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating near the L1 lower endplate.\n\nAt L1-2, there is no spinal canal or neural foraminal narrowing.\n\nAt L2-3, there is a mild disc bulge and a shallow left paracentral disc\nprotrusion, as well as mild bilateral facet arthropathy, without evidence for\nneural impingement. The ventral thecal sac is mildly indented. There is no\nsignificant neural foraminal narrowing.\n\nAt L3-4, there is a mild disc bulge and mild to moderate bilateral facet\narthropathy, without significant spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing with abutment of the exiting L3 nerve\nroots by facet osteophytes.\n\nAt L4-5, there is a disc bulge and a central disc extrusion extending\ninferiorly, as well as mild to moderate facet arthropathy. The traversing\nright L5 nerve root is abutted in the subarticular zone without evidence for\ncompression. The ventral thecal sac is indented without crowding of the\nintrathecal nerve roots. There is a moderate bilateral neural foraminal\nnarrowing with abutment of the exiting L4 nerve roots by facet osteophytes.\n\nAt L5-S1, there is a broad-based central, right paracentral and right\nforaminal disc protrusion, as well as mild bilateral facet arthropathy. There\nis no spinal canal narrowing. There is moderate bilateral neural foraminal\nnarrowing with abutment of the exiting L5 nerve roots.", "output": "1. Subacute L3 compression fracture with approximately 20% loss of height and\nno retropulsion.\n2. Multilevel lumbar degenerative disease, most pronounced in the lower lumbar\nspine, as detailed above." }, { "input": "There is dextroconvex curvature of the lumbar spine with apex at L2-L3. Grade\n___ mm anterolisthesis of L5 on S1 and 1-2 mm retrolisthesis of L2 on L3 are\nidentified. Otherwise, lumbar alignment is anatomic. There is bilateral\nL5-S1 spondylolysis.\n\nVertebral body heights are preserved. There is a 1.5 cm T1 hypointense T2\nslightly hyperintense marrow lesion along the left aspect of the L2 superior\nendplate, potentially representing an atypical hemangioma. There is\nsuggestion of a corresponding trabeculated focus on prior CT. Chest and\nabdomen of ___. ___ type 2 L2-L3 endplate changes with associated\nL3 superior endplate Schmorl's node is identified. T2 hyperintense signal of\nthe L3-L4 disc is almost certainly degenerative. Degenerative loss of disc\nheight and signal is mild at L4-L5 and severe at L5-S1. The conus medullaris\nterminates at the T12-L1 level, within expected limits.\n\nT12-L1: Unremarkable.\n\nL1-L2: A disc bulge with thickening of the common flavum results in mild\nspinal canal narrowing. In combination with facet arthropathy there is at\nleast moderate bilateral neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of ligamentum flavum results in severe\nspinal canal narrowing, resulting in buckling of the cauda equina superiorly. \nIn combination with facet arthropathy and dextroconvex curvature of the lumbar\nspine, there is severe left and moderate right neural foraminal narrowing. \nBilateral facet joint effusions are identified.\n\nL3-L4: STIR S a disc bulge results in mild spinal canal narrowing, but crowds\nthe bilateral subarticular zones contacting the traversing nerve roots,\nposteriorly displacing the left. There is bilateral facet arthropathy which\nresults in moderate to severe neural foraminal narrowing.\n\nL4-L5: There is is a left eccentric disc bulge which crowds the\nleft-greater-than-right subarticular zones. In combination with facet\narthropathy and dextroconvex curvature of the lumbar spine, there is moderate\nto severe left and mild to moderate right neural foraminal narrowing.\n\nL5-S1: The disc is uncovered secondary to anterolisthesis. A disc bulge does\nnot significantly narrow the spinal canal. The anterolisthesis and loss of\ndisc height, in combination with facet arthropathy results in severe bilateral\nneural foraminal narrowing, flattening the exiting nerve roots.\n\nThere are multiple bilateral cystic renal lesions measuring up to 3.3 cm in\nthe right kidney, statistically most likely representing simple cyst. The\nremainder the visualized prevertebral and paraspinal soft tissues are grossly\nunremarkable.", "output": "1. Bilateral L5-S1 spondylolysis, with grade 1 L5 on S1 anterolisthesis.\n2. Multilevel degenerative changes, most prominent at L2-L3 and L5-S1.\n3. At L2-L3, there is severe spinal canal narrowing, crowding the cauda equina\nwith buckling of the nerve roots superiorly with severe left and moderate\nright neural foraminal narrowing.\n4. At L5-S1, anterolisthesis and loss of disc height with facet arthropathy\nresults in severe bilateral neural foraminal narrowing flattening the exiting\nnerve roots.\n5. Additional findings as described above." }, { "input": "Study is moderately degraded by motion and artifact from metallic surgical\nscrews.\n\nAlignment is maintained. The patient is status post C3-C5 posterior fusion. \nSpinal cord signal intensity is within normal limits. Bone marrow signal\nintensity is within normal limits. Vertebral body heights are maintained. \nLoss of fluid signal within the intervertebral discs is suggestive of\ndegeneration.\n\nAt C2-3, a small posterior disc protrusion causes minimal spinal canal\nnarrowing. There is no significant neural foraminal narrowing.\n\nAt C3-4, a small central disc protrusion results in mild spinal canal\nnarrowing with indentation upon the anterior thecal sac. Mild bilateral\nneural foraminal narrowing results from uncovertebral and facet osteophytes.\n\nAt C4-5, there is no significant spinal canal narrowing. Moderate right and\nmild left neural foraminal narrowing results from uncovertebral and facet\nosteophytes.\n\nAt C5-6, a primarily central and left sided disc protrusion causes moderate to\nsevere spinal canal narrowing with indentation of the anterior thecal sac and\nremodeling of the anterior spinal cord, progressed compared to the prior exam.\nNeural foraminal narrowing is moderate bilaterally due to uncovertebral and\nfacet osteophytes.\n\nAt C6-7, a right disc protrusion results in severe spinal canal narrowing with\nremodeling of the right spinal cord and contacting the exiting C7 nerve root. \nThere is also severe left neural foraminal narrowing. This is slightly\nprogressed since ___.\n\nAt C7-T1, a small central disc protrusion results in minimal spinal canal\nnarrowing. No significant neural foraminal narrowing.", "output": "1. Slightly progressed appearance of a C6-7 right-sided disc protrusion with\nsevere spinal canal narrowing and remodeling of the spinal cord with contact\nof the exiting right C7 nerve root and severe left neural foraminal narrowing.\n2. Interval progression of moderate to severe spinal cord narrowing compared\nto the prior exam from ___ at C5-6 secondary to central and left sided disc\nprotrusion.\n3. Other unchanged degenerative changes as described above." }, { "input": "Posterior element postoperative changes, C3-C5 fusion with hardware in place. \nPatient motion mildly compromises exam. Degenerative changes cervical spine. \nMild congenital narrowing spinal canal. Disc osteophyte complex C3-C4 through\nC7-T1 level. Posterior element hypertrophic changes. Degenerative changes at\nC4-C5 disc space. Narrowed C6-C7 disc space. Minimal retrolisthesis C4-C5,\nprobably similar. No definite cord T2 signal abnormality.\n\nAt C2-C3, mild central canal narrowing. Mild bilateral foraminal narrowing.\n\nAt C3-C4 level, patent central canal. Mild bilateral foraminal narrowing.\n\nAt C4-C5 level, patent central canal. Evaluation of foramina is compromised\nsecondary to metal artifact. Probably mild left and mild-to-moderate right\nforaminal narrowing, similar.\n\nAt C5-C6 level, moderate central canal narrowing, completely efface CSF,\nminimal effacement of the ventral cord, similar. Moderate bilateral foraminal\nnarrowing, left greater than right, similar.\n\nAt C6-C7 level, probable right hemilaminectomy.. Previously seen right\nparamedian endplate osteophyte/disc protrusion is smaller. Moderate central\ncanal narrowing, mild effacement of the right ventral cord, improved. Severe\nbilateral foraminal narrowing, similar.\n\nAt C7-T1 level, tiny central disc protrusion, similar, mild central canal\nnarrowing. Mild bilateral foraminal narrowing, similar.", "output": "1. Degenerative, postoperative changes cervical spine.\n2. Congenital narrowing spinal canal.\n3. Moderate central canal narrowing C5-C6, C6-C7 levels.\n4. Multilevel foraminal narrowing, as above." }, { "input": "Study is mildly degraded by motion.\n\nAlignment is normal. There is loss of intervertebral disc height and T2\nsignal at the L5-S1 level accompanied by ___ type 1 degenerative endplate\nmarrow signal changes and endplate osteophytes. To lesser extent, there are\nsimilar findings at L4-L5 mostly to the left of the endplates. Otherwise,\nvertebral body and intervertebral disc signal intensity appear normal.\n\nThe visualized distal spinal cord appears normal in caliber and configuration.\nThe conus medullaris is normal and terminates L1.\n\nThere is no abnormal leptomeningeal enhancement. No abnormal nerve root\nenhancement within the confines of motion. The cauda equina nerve roots\nappear normal.\n\nAt L5-S1, there is a central to right paracentral disc protrusion which abuts\nthe right S1 nerve root sleeve but does not contact or displace the nerve\nroot. There is no significant narrowing of spinal canal. There is no\nsignificant neural foraminal narrowing. An enhancing annular fissure is\nnoted.\n\nAt the remaining levels, there is no evidence of spinal canal or neural\nforaminal narrowing.\n\nThere is a multi septated right lower pole renal cystic lesion, better\nassessed by the concurrently performed renal protocol abdominal MRI. There is\nno evidence of infection or spinal neoplasm.", "output": "1. Mild degenerative changes at the L5-S1 level with a disc protrusion\nabutting the right S1 nerve root sleeve, without nerve root displacement or\ncompression.\n2. Within the confines of motion, there is abnormal no nerve root enhancement\nor abnormal leptomeningeal enhancement.\n3. Multi septated right lower pole renal cystic lesion, better assessed by the\nconcurrent renal protocol abdominal MRI.\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 thoracic spine alignment appears maintained. Focal area of high signal\nintensity is identified at multiple vertebral bodies, more significant at T6\nlevel, suggestive of a non expansile hemangioma versus fat deposit, otherwise,\nthe vertebral body and intervertebral disc signal intensity is unremarkable.\nThe spinal cord appears normal in caliber and configuration with no evidence\nof focal or expansile lesions. There is no evidence of infection or neoplasm.\nDegenerative changes are visualized throughout the thoracic spine consistent\nwith posterior disc bulging at T2-3, T7-8, and T9-10 levels, causing mild\nanterior thecal sac deformity, however there is no evidence of spinal canal\nnarrowing or nerve root compressions. The visualized paravertebral structures\nare grossly unremarkable.", "output": "1. There is no evidence of discitis or osteomyelitis throughout the thoracic\nspine.\n2. Mild multilevel degenerative changes throughout the thoracic spine as\ndescribed above.\n3. There is no evidence of abnormal enhancement after contrast administration." }, { "input": "Please note, axial T2 images of the lumbar spine were acquired starting at L2\nlevel. Within the confines of the study:\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nand intervertebral disc spaces are preserved. There is loss of intervertebral\ndisc T2 signal at L4-L5 and L5-S1 related to degenerative process. The conus\nmedullaris terminates at L1-L2 level. The visualized prevertebral and\nparaspinal soft tissues appear unremarkable.\n\nL1-L2, L2-L3, and L3-L4: There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nL4-L5: There is a central disc protrusion contacting the bilateral traversing\nL5 nerve roots without compression. There is mild bilateral facet arthropathy\nwithout neural foraminal narrowing.\n\nL5-S1: There is a right paracentral disc protrusion contacting and posteriorly\ndisplacing the right traversing S1 nerve roots with moderate narrowing of the\nthecal sac. There is no neural foraminal narrowing.", "output": "1. Right L5-S1 paracentral disc protrusion causing posterior displacement of\nthe right traversing S1 nerve roots.\n2. L4-L5 central disc protrusion contacting the bilateral L5 traversing nerve\nroots without impingement.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:05 am, 10 minutes after discovery of\nthe findings." }, { "input": "The patient is status post posterior instrumentation and fusion from L3\nthrough L5 levels, with bilateral transpedicular screws, please note that the\nfixation hardware causes metallic/susceptibility artifacts and obscures the\nanatomical details at this levels, within this limitation: There is a grossly\nunchanged compression fracture deformity at L4 vertebral body with no\nsignificant retropulsion or central spinal canal stenosis, there is no\nevidence of bone edema at this level, mild prevertebral soft tissue edema\nidentified on the sagittal STIR sequence is likely postsurgical, no fluid\ncollections are seen. The visualized aspect of the lower thoracic spinal cord\nis normal, the conus medullaris terminates at the level of L1 and is\nunremarkable.\n\nAt L1-L2 level, there is diffuse disc bulge, slightly more pronounced towards\nthe left, causing moderate left-sided neural foraminal narrowing (8:13),\napparently contacting the left dorsal root ganglion, additionally there is\nmild bilateral articular joint facet hypertrophy.\n\nAt L2-L3 level, both neural foramina are patent, there is no evidence of\ncentral spinal canal stenosis.\n\nAt L3-L4 level, there is mild diffuse disc bulge, causing mild anterior thecal\nsac deformity towards the subarticular zones and mild left-sided neural\nforaminal narrowing (8:26). There is mild bilateral articular joint facet\nhypertrophy, there is no evidence of central spinal canal stenosis.\n\nAt L4-5 level, both neural foramina are patent, there is no evidence of nerve\nroot compression or central spinal canal stenosis.\n\nAt L5-S1 level, there is mild irregular contour at the inferior endplate of L1\nconsistent with Schmorl's node, mild diffuse disc bulge, slightly asymmetric\ntowards the left causing moderate left-sided neural foraminal narrowing,\ncontacting the traversing nerve root towards the subarticular zone on the left\nas well as the exiting nerve root of L5 on the left, there is mild bilateral\narticular joint facet hypertrophy (8:38).\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable.", "output": "1. The patient is status post posterior instrumentation and fusion from L3\nthrough L5 levels, with bilateral transpedicular screws, please note that the\nfixation hardware causes metallic/susceptibility artifacts and obscures the\nanatomical details at this levels.\n\n2. There is a grossly unchanged compression fracture deformity at L4\nvertebral body with no significant retropulsion or central spinal canal\nstenosis. The visualized aspect of the lower thoracic spinal cord is normal,\nthe conus medullaris terminates at the level of L1 and is unremarkable.\n\n3. At L1-L2 level, there is diffuse disc bulge, slightly more pronounced\ntowards the left, causing moderate left-sided neural foraminal narrowing\n(8:13), apparently contacting the left dorsal root ganglion, additionally\nthere is mild bilateral articular joint facet hypertrophy.\n\n4. At L3-L4 level, there is mild diffuse disc bulge, causing mild anterior\nthecal sac deformity towards the subarticular zones and mild left-sided neural\nforaminal narrowing. There is no evidence of central spinal canal stenosis.\n\n5. At L5-S1 level, there is mild irregular contour at the inferior endplate\nof L1 consistent with Schmorl's node, mild diffuse disc bulge, slightly\nasymmetric towards the left causes moderate left-sided neural foraminal\nnarrowing, contacting the traversing nerve root towards the subarticular zone\non the left as well as the exiting nerve root of L5 on the left, there is mild\nbilateral articular joint facet hypertrophy." }, { "input": "There is a mild dextroscoliosis of the thoracic spine with apex at T8-T9. The\nvertebral body heights are preserved.\n\nThere is edema throughout the T8 vertebral body extending into the posterior\nelements with associated postcontrast enhancement. There is irregularity of\nthe T8 endplates, inferior greater than superior. There is loss of height at\nthe T8-T9 intervertebral disc space which demonstrates fluid signal. There is\nmild edema and enhancement at the adjacent superior T9 endplate and sub\nendplate marrow which has mildly increased comparison to prior study.\n\nThere is an enhancing paravertebral phlegmon centered at T8-T9 and extending\nsuperiorly to T7 and inferiorly to T10. This measures up to 1.4 cm in\nthickness anteriorly at the T9 level and marginates the thoracic aorta, which\ndemonstrates a normal flow void.\n\nThere is T2 hyperintense soft tissue thickening and enhancement within the\nadjacent ventral epidural space at T8 and T9 measuring up to 4 mm in depth at\nthe T8-T9 level causing moderate spinal canal stenosis which contacts and\nmildly deforms the left aspect of the cord at this level. This is unchanged\nin thickness, but decreased in its extent as compared to prior study at which\npoint it extending superiorly to T6 and inferiorly to T10.\n\nThere are no central areas of nonenhancement to suggest a frank abscess.\n\nThere is minimal ill-defined T2 hyperintensity within the ventral mid cord at\nthe T8 and T9 levels (15:9). The degree of cord signal abnormality has\ndecreased in comparison to prior study from ___ at which point there\nis more extensive diffuse cord T2 hyperintensity.\n\nThe remaining levels are unremarkable without significant spinal canal or\nneural foraminal stenosis.\n\nThere are small bilateral pleural effusions, right greater than left, which is\nmildly decreased on the left and mildly increased on the right as compared to\nprior study.", "output": "1. Discitis and osteomyelitis at the T8-T9 level, predominantly involving the\nT8 vertebra. There is interval increased degree of edema and enhancement of\nthe T8 and superior T9 vertebral bodies. T8-T9 intervertebral disc space loss\nof height with small amount of fluid signal.\n2. Paravertebral enhancing phlegmon extending anteriorly marginating the\ndescending aorta which is relatively unchanged in comparison to prior study.\n3. Enhancing phlegmon involving the ventral epidural space of T8-T9 causing\nmoderate spinal canal stenosis which contacts and mildly deforms the left\naspect of the cord. This is unchanged in thickness but decreased in superior\nto inferior extent as compared to prior study. Associated minimal anterior\nmidline cord edema which has significantly decreased as compared to prior\nstudy.\n4. No evidence of large fluid collections within these areas of enhancing\nphlegmon.\n5. Small bilateral pleural effusions, right greater than left, which has\nmildly increased on the right and mildly decreased on the left.\n6. No new sites of disease, within normal appearance of the T1 vertebral body.\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:16 AM, 10 minutes after\ndiscovery of the findings." }, { "input": "The localizer sequence, a image 4:2, demonstrates 7 cervical, 12 thoracic, and\n5 lumbar-type vertebrae. The numbering is also documented on images 5:11,\n5:9, and 8:10.\n\n\nCERVICAL:\n\nThere is no evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection. Vertebral body heights and alignment are normal. \nThe spinal cord demonstrates normal morphology and signal intensity. The\ncerebellar tonsils are normally positioned, and visualized posterior fossa\nappears unremarkable.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nAt C3-C4: No spinal canal or neural foraminal narrowing.\n\nC4-C5: Mild left neural foraminal narrowing by uncovertebral osteophytes.\n\nC5-C6: Central/left paracentral disc protrusion indents ventral thecal sac but\ndoes not contact the spinal cord.\n\nC6-C7: No spinal canal or neural foraminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nTHORACIC:\n\nThere is progression of discitis osteomyelitis at T8-9 with interval\ndevelopment of extensive irregularity along the inferior endplate of T8 and\nsuperior endplate of T9, approximately 50% loss of the T8 vertebral body\nheight anteriorly and complete destruction of the intervertebral disc\npostcontrast enhancement in the disc space. There is persistent T2\nhyperintense signal and enhancement in the T8 and T9 vertebral bodies, with\nincreased extent at T9.\n\nEdema and enhancement in the prevertebral soft tissues extends from T6-T7 to\nT11-T12 with maximal thickness of up to 8 mm, similar to prior. In the right\nprevertebral soft tissues at C7, there is a 0.9 x 0.4 cm fluid pocket, images\n15:9 and 19:10. At T8-9, a small amount of enhancing material in the left\nanterior epidural space mildly indents the thecal sac without mass effect on\nthe spinal cord (18:35), less extensive than on ___.\n\nThere is no evidence for infection or spinal canal narrowing at other thoracic\nlevels. The thoracic spinal cord is normal in signal intensity.\n\nLUMBAR:\n\nThere is no evidence for diskitis, osteomyelitis, epidural collection, or\nparavertebral collection. Vertebral body heights and alignment are normal.\nConus medullaris terminates at L1. There is no abnormal intrathecal contrast\nenhancement, and no evidence for clumping of the intrathecal nerve roots. \nThere is no evidence of spinal canal or neural foraminal narrowing.\n\nOTHER:\n\nThere are trace bilateral pleural effusions, decreased in size since ___.", "output": "1. Compared to ___, there has been increased destruction of the disc\nand endplates at T8-9 with new T8 loss of height. Increased enhancement of\nthe T8 and T9 vertebral bodies and the intervening disc suggest interim\nprogression of discitis/osteomyelitis. Prevertebral phlegmon from T6-T7\nthrough T11-T12 is essentially unchanged, with a tiny new fluid pocket at T7\non the right. Small left anterior epidural phlegmon at T7-T8 appears\ndecreased in extent.\n\n2. No evidence for new sites of infection in the thoracic spine. No evidence\nfor infection in the cervical or lumbar spine." }, { "input": "CERVICAL SPINE:\n\n The visualized craniocervical junction is grossly unremarkable. There is no\nevidence of Chiari malformation.\n\nThere is no evidence of appreciable vertebral body height loss to suggest\ncompression fracture. The cervical spinal alignment is within normal limits.\nThe bone marrow signal is normal.\n\nThe cervical cord is normal in morphology and signal intensity.\n\nMultilevel degenerative changes are as follows:\n\nC1-C2, C2-C3: There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\nC3-C4: There is a mild disc bulge flattening the ventral thecal sac without\nsignificant canal stenosis or neural foraminal narrowing.\n\nC4-C5: A posterior disc bulge is noted without canal stenosis or neural\nforaminal narrowing.\n\nC5-C6: A posterior disc bulge indents the ventral thecal sac and results in\nmoderate canal stenosis with mild left neural foraminal narrowing.\n\nC6-C7, C7-T1: There is no significant spinal canal stenosis or neural\nforaminal narrowing.\n\n\nTHORACIC SPINE:\n\nWithin the thoracic spine, there is no loss of vertebral body height or\nevidence for subluxation. The bone marrow signal is unremarkable. No\nsignificant spinal canal stenosis or neural foraminal narrowing is identified.\n\n\nLUMBAR SPINE:\n\n There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L2-L3. There is no spinal cord signal\nabnormality detected.\n\nMinimal spondylosis is seen in the lumbar spine, without high-grade spinal\ncanal stenosis or neural foraminal narrowing.\n\n\nThere is no evidence for abnormal enhancement within the spinal cord, cauda\nequina, or epidural space. The visualized portions of the paraspinal soft\ntissues are grossly within normal limits.", "output": "1. No evidence for cord signal abnormality, epidural collection, or abnormal\nenhancement.\n2. Mild multilevel spondylosis of the cervical and lumbar spine, as detailed\nabove. No evidence for severe canal stenosis or neural foraminal narrowing." }, { "input": "Study is moderately degraded by motion, especially on postcontrast and axial\nimaging.\n\nCERVICAL:\nAlignment is preserved.Vertebral body and intervertebral disc signal intensity\nappear preserved.The spinal cord appears preserved in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nTHORACIC:\nAlignment is preserved.Vertebral body and intervertebral disc signal intensity\nappear preserved. The spinal cord appears preserved in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nLUMBAR:\nThere is levoscoliosis of lumbar spine.Vertebral body and intervertebral disc\nsignal intensity appear preserved. The spinal cord appears preserved in\ncaliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing. There is no evidence of infection or neoplasm. There is\nno abnormal enhancement after contrast administration.\n\nOTHER: Trace right-sided pleural effusion.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of spinal cord lesion or\ncompression.\n3. Trace right-sided pleural effusion versus artifact. If clinically\nindicated, consider correlation with dedicated chest imaging.\n4. Please see concurrently obtained brain MRI examination for description of\ncranial structures." }, { "input": "The examination is moderately degraded by patient motion, particularly\naffecting the axial sequences.\n\nCERVICAL:\nThe visualized elements of the posterior fossa and craniocervical junction are\ngrossly unremarkable. There is no evidence of Chiari malformation.\n\nThere is no evidence of vertebral body height loss. The cervical spinal\nalignment is within normal limits. The bone marrow signal is heterogeneous\nwith areas of low signal and high-signal intensity, likely consistent with a\ncombination of bone marrow replacement for fat, additionally bone marrow\nreconversion is also a consideration and can be seen in patients with anemia,\nplease correlate.\n\nMultilevel degenerative changes are as follows:\n\nC1-C2: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC2-3: There is a minimal central disc bulge indenting the ventral thecal sac\nwithout canal stenosis. Mild uncovertebral joint hypertrophy results in mild\nleft neural foraminal narrowing.\n\nC3-C4: A slightly asymmetric left posterior disc bulge contributes to mild\nleft neural foraminal narrowing without canal stenosis.\n\nC4-C5: A posterior disc bulge flattens the ventral thecal sac resulting in\nmoderate canal stenosis, combining with uncovertebral joint hypertrophy to\nresult in moderate right and severe left neural foraminal narrowing.\n\nC5-C6: A posterior disc bulge flattens the ventral thecal sac, resulting in\nmoderate canal stenosis, contacting the cord and combining with uncovertebral\njoint hypertrophy to result in moderate bilateral neural foraminal narrowing.\n\nC6-C7: A posterior disc bulge flattens the ventral thecal sac and causes\nmoderate spinal canal narrowing and apparently contacts the ventral aspect of\nthe spinal cord. Equivocal T2 hyperintensity seen within the cord subjacent\nto this. There is moderate right and probable severe left neural foraminal\nnarrowing seen at this level.\n\nC7-T1: An asymmetric left posterior disc bulge flattens the ventral thecal sac\nresulting in mild canal stenosis with mild left neural foraminal narrowing.\n\n\nTHORACIC:\nThe lumbar vertebral body heights are grossly maintained. Sagittal spinal\nalignment is also maintained.\n\n___ type 2 degenerative endplate changes are seen at multiple levels. \nAdditionally, there is a T2/STIR hyperintense, T1 hypointense, enhancing\nlesions seen along the right posterior aspect of the T2 vertebral body with\nextension into the facet (6:10, 5:10, 7:10, 17:12). Otherwise, no suspicious\nbone marrow signal is identified.\n\nAt T2-3, a posterior disc bulge flattens the ventral thecal sac resulting in\nmoderate canal stenosis, and contacts the spinal cord without underlying cord\nsignal abnormality. At T5-6, a posterior disc bulge results in a similar\ndegree of moderate canal stenosis, minimally contacting the cord at this\nlevel.\n\n\nLUMBAR:\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nThe signal intensity in the bone marrow is diffusely hypointense suggesting\nbone marrow reconversion. The conus medullaris terminates at the level of L1.\nThere is no spinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L3: There is no spinal canal or neural foraminal stenosis.\n\nL3-L4: There is a posterior disc bulge with superimposed central disc\nprotrusion indenting the ventral thecal sac, with facet hypertrophy and trace\nbilateral facet joint effusions. This combines with prominent dorsal epidural\nfat to result in moderate canal stenosis with subarticular zone narrowing but\nno significant neural foraminal narrowing.\n\nL4-L5: A posterior disc bulge with annular fissure flattens the ventral thecal\nsac resulting in mild canal stenosis with bilateral subarticular recess\nnarrowing, but only minimal bilateral neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge indents the ventral thecal sac without\nsignificant canal stenosis, and no neural foraminal narrowing.\n\nThere is no evidence for abnormal intramedullary or epidural enhancement. A\nsmall T2 hyperintense hepatic cyst is seen in the inferior right hepatic lobe.\nThe remainder of the paraspinal soft tissues are grossly unremarkable.", "output": "1. Limited examination due to patient motion, allowing for this, no convincing\nepidural collection is identified.\n2. Cervical spondylosis most significant at C6-7 level, causing moderate canal\nstenosis contacting the ventral aspect of the spinal cord, with equivocal T2\nhyperintensity seen within the cord at this level, and with moderate right and\nprobable severe left neural foraminal narrowing.\n3. T2/STIR hyperintense, enhancing lesion within the T2 vertebral body\nextending into the right facet. Findings may represent an atypical\nhemangioma, but attention on follow-up is recommended.\n4. Thoracic spondylosis with posterior disc bulges at T2-3 and T5-6 resulting\nin moderate canal stenosis.\n5. Lumbar spondylosis at multiple levels, as above. Findings are most notable\nat L3-L4 with moderate canal stenosis and bilateral subarticular recess\nnarrowing." }, { "input": "Vertebral body heights are preserved. There is partial fusion of the vertebral\nbodies and left facet joints at C2-3 and C3-4, which may be due to a\ncombination of congenital degenerative factors, and partial fusion of the\nvertebral bodies at C6-7, which could be degenerative. There is mild\nanterolisthesis of C4 and C5 and mild retrolisthesis of C6 on C7.\n\nVisualized portion of the posterior fossa and occipital poles appear\nunremarkable.\n\nThere is fluid along the articulations of the lateral masses of C1 with the\noccipital condyles, left greater than the right, and along the articulation\nbetween the left lateral mass of C1 and C2, likely degenerative.\n\nAt C2-3, there is no spinal canal narrowing. There is left greater than right\nfacet arthropathy with mild right and moderate to severe left neural foraminal\nnarrowing.\n\nAt C3-4, a disc osteophyte complex slightly indents the ventral thecal sac\nwithout mass effect on the spinal cord. There is severe right and moderate to\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C4-5 there is a mild anterolisthesis and a shallow disc osteophyte complex\nwhich indents the ventral thecal sac but does not contact the spinal cord.\nThere is moderate right and severe left neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nAt C5-6, there is a disc osteophyte complex, larger on the left, which\nslightly flattens the left ventral aspect of the spinal cord, causing mild to\nmoderate spinal canal stenosis. Spinal cord signal remains normal. There is\nsevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nAt C6-___, there is a disc osteophyte complex, broad-based but larger on the\nright, which flattens the ventral spinal cord, more on the right, and causes\nmoderate spinal canal stenosis. Spinal cord signal remains normal. There are\nsevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nAt C7-T1, there is no spinal canal narrowing. There is mild narrowing of the\nproximal right neural foramen by uncovertebral osteophytes.", "output": "Multilevel cervical degenerative disease, as detailed above. While there is\nmild deformation of the ventral spinal cord at C5-6 and C6-7, spinal cord\nsignal remains normal. Significant neural foraminal narrowing is present at\nmultiple levels." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is diffusely heterogeneous and speckled, likely representing\nunderlying multiple myeloma. No expansile lesion identified. The visualized\nposterior fossa is grossly unremarkable. There is no cord signal abnormality.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\nC3-C4: Small central protrusion does not significantly narrow the spinal\ncanal. Uncovertebral and facet arthropathy results in mild left greater than\nright neural foraminal narrowing.\nC4-C5: A small central protrusion does not significantly narrow the spinal\ncanal. Uncovertebral facet arthropathy results in mild bilateral neural\nforaminal narrowing.\nC5-C6: A central protrusion with thickening of the ligamentum flavum results\nin moderate spinal canal narrowing, minimally remodeling the ventral aspect of\nthe cord. Uncovertebral and facet arthropathy results in severe left and\nmild-to-moderate right neural foraminal narrowing.\nC6-C7: A central protrusion with thickening of the ligamentum flavum results\nin mild spinal canal narrowing. Uncovertebral and facet arthropathy results\nin moderate bilateral neural foraminal narrowing. Small bilateral perineural\ncysts identified.\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nThe visualized prevertebral and paraspinal soft tissues are grossly\nunremarkable.\n\nTHORACIC: Examination of the lower thoracic spine is suboptimal without axial\nimages. Within this confine:\nThoracic alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is diffusely heterogeneous in speckled, presumably representing\nunderlying multiple myeloma. A more confluent, minimally expansile lesion\ncentered in the left T10 posterior elements (series 9, image 16; series 10,\nimage 15 and 16 is identified. A large 1.8 cm lesion in the left T12 inferior\nvertebral body is also noted. There is no cord signal abnormality.\n\nThere is no high-grade spinal canal or neural foraminal narrowing. There are\nbilateral extraforaminal perineural cysts at T6-T7 inferior to the ribs\nmeasuring up to 1.6 cm. A 6 mm T8-T9 extraforaminal perineural cyst on the\nleft is noted.\n\nIncidental note is made of a 1.3 cm right parasagittal sebaceous cyst at the\nT6 level (series 12, image 32). Otherwise the remainder the visualized\nprevertebral paraspinal soft tissues are unremarkable.\n\nLUMBAR: No axial images of the lumbar spine obtained. Within this confine:\nLumbar alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is diffusely T1 heterogeneous and speckled compatible with\nunderlying multiple myeloma. A large 2 cm focal lesion along the right body\nof L4 is identified. The conus medullaris terminates at the L1 level, within\nexpected limits. There is no signal abnormality of the terminal cord.\n\nDegenerative loss of disc height is mild to moderate spanning L1-L2 through\nL5-S1 with associated loss of disc signal. There is no high-grade spinal\ncanal narrowing. Bilateral mild L4-L5 and L5-S1 neural foraminal narrowing is\nidentified.\n\nVisualized prevertebral and paraspinal soft tissues are grossly unremarkable.", "output": "Examination is suboptimal as no axial sequences of the lower thoracic spine\nand of the lumbar spine were obtained secondary to patient intolerance of the\nexamination. No postcontrast images were obtained. Within these confines:\n\n1. The marrow signal is diffusely T1 heterogeneous with larger focal lesions\nin the lower thoracic and lumbar spine as described above, compatible with\ngiven history of multiple myeloma. No evidence of encroachment on the spinal\ncanal or neural foramina at this time.\n2. There is no cord signal abnormality.\n3. Cervical spondylosis is most prominent at C5-C6 where degenerative changes\nresults in moderate spinal canal narrowing, minimally remodeling the cord. \nThere is also severe left neural foraminal narrowing at this level. At C6-C7,\nmoderate bilateral neural foraminal narrowing and mild spinal canal narrowing\nidentified.\n4. There is no high-grade spinal canal or neural foraminal narrowing of the\nthoracic and lumbar spine.\n5. Additional findings as described above." }, { "input": "Alignment is normal. A heterogeneous and speckled bone marrow signal is seen,\nlikely secondary to the patient's known multiple myeloma. The visualized\nportion of the spinal cord appears normal. Multilevel disc desiccation and\nloss of disc height are seen.\n\n C2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Disc bulge, posterior and bilateral facet and uncovertebral\nosteophytes, no spinal canal narrowing, moderate bilateral foraminal\nnarrowing.\n\nC4-C5: Disc bulge, posterior and bilateral facet and uncovertebral\nosteophytes, no spinal canal narrowing, moderate right and mild left foraminal\nnarrowing.\n\nC5-C6: Disc bulge, posterior and bilateral facet and uncovertebral\nosteophytes, distortion of the left ventrolateral cord without cord signal\nabnormality, mild spinal canal narrowing, moderate to severe right and severe\nleft foraminal narrowing.\n\nC6-C7: Disc bulge, posterior and bilateral facet and uncovertebral\nosteophytes, thickening of the ligamentum flavum, distortion of the ventral\ncord without cord signal abnormality, moderate spinal canal narrowing, mild to\nmoderate bilateral foraminal narrowing.\n\nC7-T1: Bilateral facet uncovertebral osteophytes, no spinal canal narrowing,\nmild bilateral foraminal narrowing.\n\nThere is no abnormal enhancement or mass to suggest metastatic disease.", "output": "1. No abnormal enhancement or masses suggest metastatic disease.\n2. Heterogeneous in speckle bone marrow signal, likely secondary to the\npatient's known multiple myeloma.\n3. Unchanged cervical spondylosis, as above." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Intervertebral\ndisc signal intensity is decreased, suggestive of desiccation. There is\ndiffuse heterogeneous marrow signal intensity consistent with known multiple\nmyeloma. A 2.0 cm STIR hyperintense enhancing lesion in the right vertebral\nbody of L4 and a 2.0 cm lesion in the left vertebral body of T12 with similar\ncharacteristics are unchanged in size. Compared to the most recent prior\nstudy, there is an increase in the STIR signal intensity. The spinal cord\nappears normal in caliber and configuration, with the conus medullaris\nterminating at L1. There is no evidence of spinal canal narrowing. Facet\nosteophytes contribute to mild bilateral neural foraminal narrowing at L4-5\nand L5-S1, unchanged. There is mild posterior disc bulge at L2-3, L3-4, L4-5,\nwhich do not appear to contact the traversing or exiting nerve roots.", "output": "1. Similar heterogeneous marrow signal and unchanged size of focal lesions in\nthe right vertebral body of L4 and left vertebral body of T12, consistent with\nknown multiple myeloma.\n2. Unchanged mild bilateral neural foraminal narrowing at L4-5 and L5-S1." }, { "input": "For the purpose of counting the last well-formed intervertebral disc space is\nconsidered L5-S1 with a partially sacralized lumbar vertebrae\n\nThere is kyphosis of the thoracolumbar junction secondary to the compression\ndeformity of T11 vertebrae. Also seen is minimal retrolisthesis of L3 on L4\nand L5 on S1. There are innumerable osseous lesions involving all the\nvisualized vertebral bodies as well as the sacrum in keeping with osseous\ninvolvement by multiple myeloma.\n\nThere is are multiple stable compression deformities involving the T11\nvertebrae with loss of height by approximately 50%, anterior compression\ndeformity of T10 and superior endplate compression deformity of T12. These\nare likely pathologic fractures given the presence of osseous metastasis.\n\nThe visualized retroperitoneal, paravertebral and paraspinal soft tissues\nappear unremarkable.\n\nThe conus terminates at L2. The visualized portions of the spinal cord appear\nunremarkable. No enhancing abnormal epidural mass is seen.\n\nAt T11-T12, the neural foramina and spinal canal are patent.\n\nAt T12-L1, there is loss of disc signal. The neural foramen and spinal canal\nare patent.\n\nAt L1-L2, the disc signal is preserved. There is a small left foraminal disc\nprotrusion. Neural foramina and spinal canal are patent.\n\nAt L2-L3, there is diffuse broad-based disc bulge with mild bilateral facet\narthropathy causing mild bilateral neural foramen narrowing and narrowing of\nbilateral subarticular recess. Ligamentum flavum thickening with disc bulge\nis causing mild spinal canal narrowing.\n\nAt L3-L4, there is loss of disc height and signal with bilateral foraminal\ndisc protrusion and moderate bilateral facet arthropathy causing mild\nbilateral neural foramen narrowing and narrowing of bilateral subarticular\nrecess. Spinal canal is patent.\n\nAt L4-L5, mild retrolisthesis of L4 on L5 with moderate bilateral facet\narthropathy causing mild bilateral neural foramen narrowing. Spinal canal\npatent.\n\nAt L5-S1, the intervertebral disc height and signal is maintained. Neural\nforamina and spinal canal are patent.", "output": "1. Innumerable osseous lesions, likely from patient's known multiple myeloma.\n2. Stable pathologic compression fractures involving T10- T12 vertebrae with\nkyphosis of the thoracolumbar spine.\n3. No abnormal cord signal or epidural enhancing mass is seen.\n4. Multilevel degenerative disease of the lumbar spine, worst at L3-L4 as\ndescribed above." }, { "input": "There is transitional anatomy at the lumbosacral junction. Assuming the ilial\nlumbar ligaments are at L5, there is partial sacralization of L5. No focal\nsuspicious marrow lesion is identified. Vertebral bodies are maintained in\nheight and alignment. There is diffuse disc desiccation with decrease of\nheight loss most notably at L1-L2. Conus terminates at the L1 level, a normal\nanatomic position.\n\nAt T12-L1 and L1-L2 there are diffuse disc bulges without canal or foraminal\nnarrowing.\n\nAt L2-L3, there is diffuse disc bulge and facet joint hypertrophy which narrow\nthe subarticular recesses without significant canal or foraminal narrowing.\n\nAt L3-4 disc bulge and mild facet joint hypertrophy which narrow the\nsubarticular recesses. There is no significant canal or foraminal narrowing.\n\nAt L4-5, there is a diffuse disc bulge and a central disc protrusion. In\ncombination with facet joint hypertrophy, greater on the left there is\nnarrowing of the subarticular recesses there is minimal left foraminal\nnarrowing.\n\nAt L5-S1 there is no significant canal or foraminal narrowing.\n\nA few small T2 hyperintensities within the kidneys bilaterally are likely\ncysts. The included retroperitoneal paraspinal soft tissues are otherwise\nunremarkable.", "output": "Multilevel degenerative changes as above without significant canal or\nforaminal narrowing." }, { "input": "There is a burst fracture of the L1 vertebral body with moderate anterior and\nposterior height loss and approximately 6 mm bony retropulsion into the spinal\ncanal at this level (08:27). The conus medullaris terminates at the level of\nthe bony retropulsion, which does not touch the conus. There is no cord/conus\nsignal abnormality or significant resultant spinal canal narrowing/mass-effect\non the cauda equina nerve roots due to the retropulsion. Abnormal signal\nwithin the collapsed vertebral body likely represents edema. There is STIR\nhyperintense signal in the surrounding pre vertebral and paraspinal soft\ntissues at this level consistent with edema.\n\nHeterogeneous signal in the T1 vertebral body on sagittal STIR sequence only\nis favored to represent artifact given unremarkable appearance on both axial\nT2 weighted and sagittal T1 and T2 weighted images. Otherwise, thoracic spine\nvertebral bodies demonstrate normal alignment and preserved height. There is\nfocal fat or a small intraosseous hemangioma in the T12 vertebral body. \nOtherwise marrow signal is unremarkable. The thoracic spinal cord is normal\nin caliber and signal intensity. The imaged proximal cauda equina nerve roots\nare unremarkable. There is no evidence of an epidural collection in the\nthoracic spine. Mild signal and height loss of several thoracic spine\nintervertebral discs is consistent with degenerative change. There is no\nsignificant spinal canal or neural foraminal narrowing within the thoracic\nspine. A posterior disc bulge is partially visualized at L2-3 likely causing\nmild canal narrowing at this level.\n\nAside from edema at L1 surrounding the burst fracture, the imaged prevertebral\nand paraspinal soft tissues are unremarkable. There are small bilateral right\nlarger than left pleural effusions which are partially visualized in the\nchest.", "output": "1. L1 burst fracture with moderate height loss and 6 mm posterior midline bony\nretropulsion at the level of the conus medullaris. No bony contact or cord\nsignal abnormality of the conus or significant resultant spinal canal\nnarrowing.\n2. Prevertebral and paraspinal soft tissue edema surrounding the burst\nfracture at L1.\n3. Mild thoracic spine degenerative changes without spinal canal or neural\nforaminal narrowing.\n4. Incidentally noted and partially visualized small bilateral\nright-larger-than-left pleural effusions." }, { "input": "There is scoliosis of lumbar spine convex to the right in the lower lumbar and\nto the left in the upper lumbar region increased from the prior study.\n\nFrom T9-10 through T12-L1 disc degenerative changes are seen.\n\nAt L1-2 level, there is a new right-sided disc herniation seen extending\nsuperiorly behind the L1 vertebral body and indenting the thecal sac. This\ncould affect the right L1 nerve root. There is mild narrowing of the\nforamina.\n\nAt L2-3 anterior disc osteophytes are seen. Mild narrowing of the right\nforamen seen.\n\nAt L3-4 disc and facet degenerative changes with moderate left subarticular\nrecess and foraminal narrowing which is slightly increased from the prior\nstudy.\n\nAt L4-5 level, disc and facet degenerative changes seen with moderate left\nforaminal narrowing and mild to moderate spinal stenosis. There is thickening\nof the ligaments and a small right-sided synovial cyst. There is moderate\nleft and severe right subarticular recess narrowing seen. Increased from the\nprior study.\n\nAt L5-S1 level disc bulging is seen with moderate-to-severe left foraminal\nnarrowing increased from the prior study.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. New right-sided disk herniation at L1-2 level extending superiorly and\nindenting the thecal sac which could affect the right L1 nerve root.\n2. Increased lumbar scoliosis with increased degenerative changes at L3-4 and\nL5-S1 levels as described above most pronounced at L4-5 level where there is a\nsmall right-sided synovial cyst also seen." }, { "input": "There are 7 cervical, 12 rib-bearing vertebrae, and 5 lumbar-type vertebrae\nwith transitional anatomy of bilateral L1 transverse processes, as seen on the\nprior CTs.\n\nCERVICAL:\nThe craniocervical junction is not well assessed as it is located at the\nsuperior margin of the field of view on the sagittal images. Artifacts\nobscure the anterior arch of C1 on sagittal images.\n\nThere is complete fusion of C4 and C5 vertebral bodies. There is mild diffuse\nloss of height involving C6 and C7 vertebral bodies without marrow edema. \nThere is a kyphotic curvature centered at C4-C5. There is mild\nanterolisthesis at C3-C4 and mild retrolisthesis at C6-C7. Evaluation of\nspinal cord signal is limited by motion artifacts. No evidence for pathologic\ncontrast enhancement.\n\nC2-C3: Tiny left paracentral disc protrusion without spinal canal narrowing. \nBilateral facet arthropathy with minimal to no neural foraminal narrowing.\n\nC3-C4: Mild anterolisthesis. Broad-based endplate osteophytes remodel the\nventral spinal cord. Ligamentum flavum infolding contacts the dorsal spinal\ncord. There is overall moderate spinal canal narrowing. Evaluation of spinal\ncord signal is limited by artifacts, as above. Faint T2 hyperintensity in the\ncord at this level cannot be excluded. Neural foraminal narrowing by\nuncovertebral and facet osteophytes appears moderate on the right and severe\non the left on motion limited evaluation.\n\nC4-C5: The vertebral bodies are fused. Right paracentral bony ridge minimally\nremodels the ventral spinal cord. Mild-to-moderate spinal canal narrowing. \nNeural foraminal narrowing by uncovertebral and facet osteophytes appears\nsevere on the right and moderate to severe on the left on motion limited\nevaluation.\n\nC5-C6: Broad-based posterior endplate osteophytes minimally remodel the\nventral spinal cord. Mild spinal canal narrowing. Neural foraminal narrowing\nby uncovertebral and facet osteophytes appears severe bilaterally on motion\nlimited evaluation.\n\nC6-C7: Mild retrolisthesis. Broad-based posterior endplate osteophyte ridge\nwithout spinal cord remodeling. Mild spinal canal narrowing. Neural\nforaminal narrowing by uncovertebral and facet osteophytes appears severe\nbilaterally on motion limited evaluation, worse on the left.\n\nC7-T1: Small disc bulge versus shallow endplate osteophytes. No significant\nspinal canal narrowing. Neural foraminal narrowing by uncovertebral and facet\nosteophytes appears severe bilaterally on motion limited evaluation.\n\nTHORACIC:\nNo evidence for acute compression fracture. There is T9 vertebral body\ndeformity with anterior wedging, severe loss of height anteriorly, and mild\nloss of height posteriorly, as well as a vertical cleft in the center,\nunchanged in configuration dating back to the earliest available comparison CT\nfrom ___. There is fluid signal within the central cleft, without\nevidence for adjacent marrow edema.\n\nThere are small disc protrusions at multiple levels, essentially throughout\nthe thoracic spine, without spinal cord contact or significant spinal canal\nnarrowing. No evidence for spinal cord signal abnormalities. No evidence for\npathologic contrast enhancement.\n\nLUMBAR:\nVertebral body heights are preserved. There is minimal retrolisthesis at\nL1-L2, L2-L3, and L3-L4, as seen on the prior CT. No suspicious bone marrow\nsignal abnormalities are seen. There is loss of disc height throughout the\nlumbar spine and extensive discogenic bone marrow changes in the endplates\nfrom L1-L2 through L5-S1. The conus medullaris terminates at L1 and appears\nunremarkable. No pathologic contrast enhancement.\n\nT12-L1: Disc bulge, larger on the left than right. Central and left\nparacentral disc herniation extending inferiorly. Moderate facet arthropathy.\nMild narrowing of the thecal sac without mass effect on the conus medullaris. \nLeft subarticular zone narrowing without frank impingement of the traversing\nleft L1 nerve root. Mild bilateral neural foraminal narrowing.\n\nL1-L2: Minimal retrolisthesis, disc bulge with endplate osteophytes which are\nlarger on the left than right, mild-to-moderate facet arthropathy. Left\nsubarticular zone narrowing with contact, but no evidence for frank\nimpingement of the traversing left L2 nerve root. The ventral thecal sac is\nmildly indented without intrathecal nerve root crowding. Mild right and\nmoderate left neural foraminal narrowing.\n\nL2-L3: Minimal retrolisthesis, moderate disc bulge with overlying endplate\nosteophytes which are larger on the left than right, infolding of the\nligamentum flavum, and moderate facet arthropathy. Traversing left L3 nerve\nroot is contacted in possibly impinged in the subarticular zone. Traversing\nright L3 nerve root is contacted in the subarticular zone. The thecal sac is\nmildly indented without intrathecal nerve root crowding. Mild right and\nsevere left neural foraminal narrowing with impingement of the exiting left L2\nnerve root.\n\nL3-L4: Minimal retrolisthesis, disc bulge with endplate osteophytes which are\nlarger on the right than left, infolding of the ligamentum flavum, moderate to\nsevere facet arthropathy. Bilateral subarticular zone narrowing with contact\nand possible impingement of traversing L4 nerve roots, left worse than right. \nMild-to-moderate narrowing of the thecal sac without significant intrathecal\nnerve root crowding. Moderate to severe right and severe left neural\nforaminal narrowing with abutment of the exiting right L3 nerve root\nimpingement of the exiting left L3 nerve root.\n\nL4-L5: Disc bulge with endplate osteophytes, larger on the right than left,\nand moderate to severe facet arthropathy. Bilateral L5 nerve roots are\ncontacted in the subarticular zones. The ventral thecal sac is mildly\nindented without intrathecal nerve root crowding. Severe right neural\nforaminal narrowing with impingement of the exiting right L4 nerve root. \nMild-to-moderate left neural foraminal narrowing.\n\nL5-S1: Disc bulge with endplate osteophytes and severe facet arthropathy. \nBilateral traversing S1 nerve roots are contacted in the subarticular zones. \nThe thecal sac is mildly indented without intrathecal nerve root crowding. \nSevere right neural foraminal narrowing with impingement of the exiting right\nL5 nerve root. Moderate left neural foraminal narrowing with contact of the\nexiting left L5 nerve root.\n\nDegenerative changes of the partially imaged sacroiliac joints are noted. \nHypointense bone island is again seen in the left sacral alum on image 14:41,\nsimilar to prior CTs dating back to ___.\n\nOTHER:\nThere is fluid signal within bilateral mastoid tip air cells, which may be\nsecondary to prolonged supine positioning in the inpatient setting. Other\nmastoid air cells are not included on this exam. Bilateral renal cysts are\nagain noted.", "output": "1. Multilevel cervical degenerative disease, as detailed above, with complete\nfusion of C4 and C5 vertebral bodies and kyphotic angulation centered at\nC4-C5. Spinal canal stenosis is moderate at C3-C4 with spinal cord\nremodeling, mild-to-moderate at C4-C5, and mild at C5-C6 and C6-C7. \nEvaluation of cervical cord signal is limited by artifact; mild cord edema or\nmyelomalacia at C3-C4 cannot be excluded.\n2. Chronic T9 vertebral body fracture. Mild multilevel thoracic degenerative\ndisease without significant spinal canal narrowing. No thoracic spinal cord\nsignal abnormalities.\n3. Extensive multilevel lumbar degenerative disease, as detailed above. Mild\nnarrowing of the thecal sac without significant intrathecal nerve root\ncrowding. Mass effect on multiple exiting and traversing nerve roots, as\ndetailed above.\n4. No evidence for pathologic contrast enhancement.\n\nNOTIFICATION: Dr. ___ paged Dr. ___ regarding the\nquestionable cord signal abnormality at C3-C4 on ___ at 11:34 am, 5\nminutes after discovery of the findings." }, { "input": "The study is moderately degraded by motion. The study is overall unchanged\ncompared to ___\n\nThere is complete fusion of the C4 and C5 vertebral bodies with a kyphotic\ncurvature centered at these levels. There is mild anterolisthesis of C3 on C4\nand mild retrolisthesis of C6 on C7. There is mild diffuse loss of height of\nC6 and C7 vertebral bodies without marrow edema.\n\nAt the level of C2-C3, there is a left paracentral disc protrusion without\nevidence of vertebral canal narrowing. There is bilateral facet arthropathy\nwith no neural foraminal narrowing.\n\nAt the level of C3-C4, there is mild anterolisthesis, broad-based endplate\nosteophytes, ligamentum flavum infolding, with mild vertebral canal narrowing.\nThere is uncovertebral and facet arthropathy causing mild bilateral neural\nforaminal narrowing.\n\nAt the level of C4-C5, the vertebral bodies are fused. There is no vertebral\ncanal narrowing. There is uncovertebral and facet arthropathy causing mild\nright and moderate left neural foraminal narrowing.\n\nAt the level of C5-C6, there are broad-based posterior endplate osteophytes\nwith no vertebral canal narrowing. There is uncovertebral and facet\narthropathy causing severe right and moderate left neural foraminal narrowing.\n\nAt the level of C6-C7, there is mild retrolisthesis, broad-based posterior\nendplate osteophytes with mild vertebral canal narrowing. There is\nuncovertebral and facet arthropathy causing moderate bilateral neural\nforaminal narrowing.\n\nAt the level of C7-T1, there is no spinal canal narrowing. There is\nuncovertebral and facet arthropathy causing severe bilateral neural foraminal\nnarrowing.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm.", "output": "1. Evaluation of cervical cord signal is again limited by artifact. However,\nthere is no evidence of abnormal signal in the cord. The study is overall\nunchanged compared to ___.\n2. Multilevel cervical degenerative disease with complete fusion of C4 and C5\nvertebral bodies as described above, with mild vertebral canal narrowing at\nC3-C4 and multilevel neural foraminal narrowing." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nan L2 vertebral body hemangioma and likely L2 superior endplate atypical\nhemangioma (series 7, image 11). There is a 1 cm T12 left pedicle speckled\nlesion, felt to most likely also represent an atypical hemangioma. Sclerotic\nlesion described on CT examination of ___ at the inferior T12\nendplate and right S2 vertebral body demonstrates T1 and T2 hypointense signal\nwithout evidence definitive enhancement, which likely represents bone islands.\nThere is a T1 hypointense sclerotic focus demonstrating enhancement along the\nanterior L5 vertebral body measuring 1.6 cm (series 6, image 12), incompletely\ncharacterized. This could represent an atypical hemangioma but given the\npatient's clinical history more concerning lesion is not entirely excluded.\n\nThe conus medullaris terminates at the L2 level, top limits of normal. There\nis no abnormal signal or enhancement of the terminal cord, conus medullaris or\ncauda equina.\n\nT11-T12 and T12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: A disc bulge and thickening ligamentum flavum results in mild spinal\ncanal narrowing. In conjunction with facet arthropathy there is mild right\nneural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening ligamentum flavum results in mild spinal\ncanal narrowing. A large facet osteophyte results in mild-to-moderate right\nneural foraminal narrowing. There is mild left neural foraminal narrowing.\n\nL3-L4: A disc bulge results in mild spinal canal narrowing. In conjunction\nwith facet arthropathy, there is mild bilateral foraminal narrowing. A right\nneural foraminal synovial cyst or perineural cyst (series 11, image 6) is\nidentified which does not appear to significantly narrow the neural foramina.\n\nL4-L5: A disc bulge eccentric to the right and thickening of ligamentum flavum\nresults in moderate spinal canal narrowing. There is crowding of the right\nsubarticular zone which likely impinges on the traversing right L5 nerve root\n(series 11, image 12). In conjunction with facet arthropathy, there is mild\nto moderate bilateral neural foraminal narrowing, greater on the left.\n\nL5-S1: A disc bulge with annular fissure does not significantly narrow the\nspinal canal. There is crowding of the subarticular zones contacting but not\nposterior displacing the traversing nerve roots. There appears to be a\nsynovial cyst or perineural cyst in the right neural foramina which exerts\nmass effect on the exiting nerve root. There is mild bilateral neural\nforaminal narrowing.\n\nA left renal simple cyst is identified. On scout images and incompletely\ncharacterized the prostate appears enlarged, but overall similar in size to\nexamination of ___. The remainder the visualized prevertebral paraspinal\nsoft tissues are unremarkable.", "output": "1. Sclerotic lesions described along the T12 inferior endplate and right S2\nvertebral body demonstrates no evidence of abnormal marrow edema pattern and\nare felt to likely represent bone islands.\n2. However, there is a 1.6 cm L5 anterior body lesion demonstrating L1\nhypointensity postcontrast enhancement, as well as additional lesions along\nthe L2 superior endplate and T12 left pedicle. These may represent typical\nhemangiomas, however given the patient's clinical history, repeat examination\nin 3 months could be performed to document stability.\n3. Multilevel lumbar spondylosis as described above most prominent at L4-L5\nwhere there is moderate spinal canal narrowing and mild-to-moderate bilateral\nneural foraminal narrowing.\n4. No evidence abnormal signal or enhancement of the terminal cord or cauda\nequina.\n5. Additional findings described above." }, { "input": "This is a limited study. The sagittal T2 and inversion recovery images\ndemonstrate extensive degenerative changes at the craniocervical junction with\npannus formation posterior to the odontoid process and ligamentous thickening\nposteriorly resulting in moderate to severe spinal stenosis at C1 level and\ndeformity of the spinal cord. Although no obvious increased signal is seen\nwithin the spinal cord on sagittal T 2 images, in absence of T2 axial images\nand with motion limited sagittal inversion recovery images the evaluation is\nlimited. Degenerative changes are seen from C4-5 to C6-7 levels with moderate\nspinal stenosis at C4-5 and mild to moderate spinal stenosis at C5-6 and C6-7\nlevels. No abnormal signal is seen within the bony structures or obvious\nsigns of ligamentous disruption are seen.", "output": "1. Limited study with only sagittal T 2 images of diagnostic quality. \nConsider repeat examination if clinically indicated.\n2. Severe spinal stenosis at C1-2 level due to degenerative pannus formation\nwith deformity of the spinal cord. Although no obvious increased signal is\nseen within the spinal cord, evaluation is limited." }, { "input": "There are multilevel severe compression deformities throughout the thoracic\nspine. The most severe loss of height involves the T8 vertebral body, the\nacuity of which is uncertain. There is also a fracture of the superior\nendplate of the T9 vertebral body with associated hyperintense STIR signal\nwhich may suggesting acute/subacute etiology. Anterior and superior superior\nto the T9 vertebral body edema, the anterior longitudinal ligament is not well\nseen -- ligamentous injury cannot be excluded although is felt to be unlikely\ngiven the probable mechanism of injury. There is approximately 6 mm of\nretropulsion of the T8 vertebral body into the spinal canal involve the spinal\ncord does not appear compressed.\n\nThere are additional milder compression deformities of T10, T7, T6, and T5. \nThere are severe compression deformities of T12, L1, and L2. There is\nhyperintense STIR signal within the T10 and L1 vertebral body suggestive of\nacute to subacute etiology. There is also retropulsion measuring 4 mm of the\nT12 vertebral body into the spinal canal although the cord does not appear\ncompressed.\nThere is fluid and mild widening within the right T9-T10 and T10-T11 facet\njoints.\n\nThe thoracic spinal cord is normal in signal and morphology. There is no\nevidence of spinal cord edema. The interspinous and supraspinous ligaments\nappear normal.\n\nAt the T7-T8 level, bony retropulsion contacts the ventral surface of the\nspinal cord. There is no spinal cord signal abnormality.\n\nAt the T12-L1 level, osseous retropulsion of L1 compression deformity causes\nmoderate spinal canal narrowing with effacement of the ventral CSF space.\n\nAt the L2-L3 level, osseous retropulsion of compression deformity, as well as\nintervertebral osteophytes and facet osteophytes, cause moderate spinal canal\nnarrowing with compression of the traversing left L3 nerve root between\nintervertebral osteophytes and superior left facet osteophyte. There is also\nsevere bilateral neural foraminal narrowing at level.\n\nThere are small bilateral pleural effusions. Multiple cystic hepatic lesions\nare seen, could represent hepatic cysts. There are multiple bilateral cystic\nrenal lesions, including cystic parapelvic lesions which may represent cysts.", "output": "1. Multilevel severe compression deformities throughout the thoracic spine,\ngreatest at the T8 level, and acute or subacute at the T9, T10, and L1 levels.\n2. Posterior retropulsion causes effacement of the ventral surface of spinal\ncord at the T7-T8 level and mild spinal canal narrowing at the T12 and L1\nlevels.\n3. No evidence of spinal cord compression or spinal cord edema.\n4. Anterior longitudinal ligament is not well seen at the T9 level although\nthere is no clear evidence of ligamentous disruption or injury." }, { "input": "THORACIC:\nThe thoracic spine alignment is normal. Vertebral body heights are relatively\nmaintained. Marrow signal is normal. The spinal cord is normal in caliber\nand signal intensity. The imaged proximal cauda equina nerve roots are\nunremarkable.\n\nIntervertebral discs demonstrate preserved height and normal signal intensity.\nAt T6-7 and T7-8, there are mild posterior disc bulges cause very mild spinal\ncanal narrowing, slightly contacting and remodeling the ventral aspect of the\nspinal cord, without cord signal abnormality (series 5 image 9, as well as\nseries 9 images 4 and 9). No neural foraminal narrowing in the thoracic\nspine.\n\nPrevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR:\n\nThe lumbar spine alignment is normal. Vertebral body heights are maintained. \nMarrow signal is normal. The distal spinal cord and conus medullaris is\nnormal and terminates at L1. The cauda equina nerve roots are normal. \nIntervertebral discs demonstrate preserved height and signal intensity. At\nL4-5, there is mild posterior disc bulge and mild bilateral articular joint\nfacet hypertrophy, the disc bulge is causing minimal anterior thecal sac\ndeformity apparently is contacting the traversing nerve roots bilaterally\ntowards the subarticular zones (13:29). Overall, no spinal canal or neural\nforaminal narrowing in the lumbar spine.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. No acute findings. No spinal cord or cauda equina compression.\n2. Very mild posterior disc bulges at T6-7 and T7-8 with slight contact and\nremodeling of the ventral thoracic spinal cord. No definite cord signal\nabnormality. Otherwise, unremarkable MRI thoracic spine\n3. Mild posterior disc bulge at L4-5 level, causing mild anterior thecal sac\ndeformity and contacting the traversing nerve roots bilaterally as described\nabove, with no significant spinal canal stenosis. Otherwise, unremarkable MRI\nlumbar spine." }, { "input": "The visualized elements of the posterior fossa and craniocervical junction are\nunremarkable. The cervical spine alignment is normal. Vertebral body heights\nare normal. Marrow signal is normal. The cervical spinal cord is normal in\ncaliber and signal intensity. Intervertebral discs demonstrate normal height\nand signal intensity. No spinal canal or neural foraminal narrowing.\n\nNo cervical adenopathy. Prevertebral and paraspinal soft tissues are\nunremarkable.", "output": "1. Essentially normal cervical spine MRI.\n\n2. No focal or diffuse lesions are visualized throughout the cervical spinal\ncord." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is stable grade 1 L5 on S1 anterolisthesis. Again are noted bilateral\nL5 pars defects (see 03:6, 14). Stable endplate edema is again noted along\nthe L3-4 and L4-5 level intervertebral disc spaces.\n\nVertebral body heights are preserved. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is stable loss of intervertebral disc height and signal at L3-4 L4-5,\nand L5-S1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is no spinal canal or neural foraminal stenosis.\n\nAt L2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt L3-4 there is left paracentral disc protrusion that is increased compared\nto the ___ prior lumbar spine MRI, with ligamentum flavum hypertrophy\nand facet joint arthropathy resulting in new moderate spinal canal, and left\nsubarticular recess stenosis.\n\nAt L4-5 there is a stable right paracentral disc protrusion with ligamentum\nflavum hypertrophy and facet joint arthropathy resulting in mild spinal canal,\nright subarticular recess, and moderate right neural foraminal stenosis.\n\nAt L5-S1 there is stable disc bulge with ligamentum flavum hypertrophy and\nfacet joint arthropathy resulting in severe left neural foraminal stenosis,\nwith disc material contacting exiting left L5 nerve root, mild right neural\nforaminal stenosis andno spinal canal stenosis.", "output": "1. Interval progression of multilevel degenerative changes as described, with\nnew L3-4 left paracentral disc protrusion resulting in moderate spinal canal\nand left subarticular recess stenosis.\n2. Stable L5 bilateral spondylolysis with minimal L5 on S1 anterolisthesis,\nsevere left neural foraminal stenosis with disc contacting exiting left L5\nnerve root, and mild right neural foraminal stenosis.\n3. Stable L4-5 mild spinal canal and moderate right neural foraminal stenosis." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThere are numerous T2/stir hyperintense lesions throughout the cervical and\nupper thoracic spinal cord. There is an 8 mm lesion at the levels C1 (13:10).\nThere is a 6 mm ventral lesion at the level of C2 (13:9). There is a subtle 7\nmm lesion at the right aspect of the cord at the level of C3 (13:8). There is\na 7 mm lesion in the dorsal cord at the level of C4). There is a 9 mm lesion\nat the ventral aspect of the cord at C6 (13:9). There is a subtle 10 mm\nlesion within the central cord at the level of T2-T3 (13:9). None of these\nlesions demonstrate associated enhancement.\n\nThere is loss of T2 signal of multiple intervertebral discs. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nThere is no abnormal focus of post gadolinium enhancement. There is no\nevidence of infection or neoplasm. There is no prevertebral soft tissue\nswelling.. Subtle areas of white matter T2 hyperintensity are noted in the\nvisualized portion of the pons without definite associated enhancement.\n\n At C2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is minimal disc protrusion without significant spinal canal or\nneural foraminal narrowing.\n\nAt C4-5 there is minimal disc protrusion without significant spinal canal\nnarrowing. Facet and uncovertebral arthropathy produces moderate right and\nmild left neural foraminal narrowing.\n\nAt C5-6 there is minimal disc protrusion without significant spinal canal\nnarrowing. Facet and uncovertebral arthropathy produces moderate right and\nmild left neural foraminal narrowing.\n\nAt C6-7 there is minimal disc protrusion without significant spinal canal\nnarrowing. Facet and uncovertebral arthropathy produce moderate right neural\nforaminal narrowing. The left neural foramen is patent..\n\nAt C7-T1 there is no significant spinal canal or neural foraminal narrowing.\n\nAt T1-T2, there is no significant spinal canal or neural foraminal narrowing.\n\nLimited sagittal view of the T2-T3 and T3-T4 levels demonstrate no significant\nspinal canal or neural foraminal narrowing. There is a left paracentral\nosteophyte at the T2-T3 level indenting the ventral thecal sac without\nsignificant spinal canal narrowing..", "output": "1. Demyelinating lesions in the pons, cervical and visualized upper thoracic\nspinal cord, as described. No associated enhancement.\n2. Mild cervical spondylosis, as described, with up to moderate neural\nforaminal narrowing at the right C4-C5, right C5-C6 and right C6-C7 levels.\n3. No significant spinal canal narrowing." }, { "input": "4 mm retrolisthesis of L3 on L5 is overall similar to prior PET-CT examination\nof ___. Otherwise, the remainder of the lumbar alignment is\nanatomic. Vertebral body heights are preserved. Mixed ___ 1 and 2 endplate\nchanges at L1-L2, L2-L3, L4-L5 and L5-S1 as well as ___ type 2 predominant\nendplate changes at L3-L4 is identified. No focal suspicious marrow lesion. \nDegenerative loss of disc height and signal is severe spanning L1-L2 through\nL4-L5. Loss of disc height at L5-S1 is mild. The conus medullaris terminates\nat the T12 level, within expected limits. There is no signal abnormality of\nthe terminal cord. Buckling of the cauda equina superior to the L3-L4 level\nis identified.\n\nT10 T11 through T12-L1: No significant spinal canal or neural foraminal\nnarrowing.\n\nL1-L2: A disc bulge with thickening ligamentum flavum results in mild spinal\ncanal narrowing. There is mild bilateral facet arthropathy with small facet\njoint effusions. The combination of degenerative changes results in moderate\nright and no significant left neural foraminal narrowing.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum and epidural fat\nresults in severe spinal canal narrowing, crowding the cauda equina. There is\nbilateral facet arthropathy which results in moderate to severe right and\nmoderate left neural foraminal narrowing.\n\nL3-L4: A disc bulge with thickening of the ligamentum flavum results in severe\nspinal canal narrowing, crowding the cauda equina. In conjunction with facet\narthropathy, there is severe left and mild right neural foraminal narrowing.\n\nL4-L5: A disc bulge with thickening lymph labrum results in mild spinal canal\nnarrowing. The traversing nerve roots are contacted by the disc in the\nsubarticular zones, with potential impingement against the facet. Bilateral\nfacet arthropathy results in severe left and mild-to-moderate right neural\nforaminal narrowing.\n\nL5-S1: A disc bulge results in mild spinal canal narrowing. In conjunction\nwith facet arthropathy, there is mild bilateral neural foraminal narrowing.\n\nThe visualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Multilevel lumbar spondylosis, most prominent at L2-L3 and L3-L4 where\nthere is severe spinal canal narrowing, crowding/compressing the cauda equina,\nworse at L3-L4.\n2. There is also moderate to severe right L2-L3 and severe left L3-L4 and\nL4-L5 neural foraminal narrowing. Crowding of the bilateral subarticular\nzones at L4-L5 contacts the traversing nerve roots, with potential impingement\nagainst the facets.\n3. No focal suspicious marrow lesion.\n4. Additional findings as described above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 19:06 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Vertebral body heights are grossly maintained. There is minimal grade 1\nretrolisthesis of L 2 on L3, and grade 1 retrolisthesis of L3 on L4. The\nremainder of the sagittal spinal alignment is grossly maintained.\n\nMixed type 1 and type ___ ___ degenerative endplate changes are again noted,\nsimilar to the prior examination, most prevalent at L1-L2, L2-L3, and L3-L4. \nThere is no focal suspicious bone marrow lesion identified. The conus\nmedullaris terminates at the level of T12-L1.\n\nThere is multilevel loss of intervertebral disc height and intrinsic T2\nsignal, compatible with disc desiccation. Multilevel degenerative changes are\nas follows:\n\nT12-L1: Unremarkable.\n\nL1-L2: Mild posterior disc bulging combines with thickening of the ligamentum\nflavum and prominent dorsal epidural fat to result in mild canal stenosis with\nmild right neural foraminal narrowing.\n\nL2-L3: A posterior disc bulge flattens the ventral thecal sac combining with\nprominent dorsal epidural fat and thickening of ligamentum flavum to result in\nmild-to-moderate canal stenosis. There is moderate to severe right and mild\nleft foraminal narrowing.\n\nL3-L4: A posterior disc bulge combines with thickening of the ligamentum\nflavum to result in severe canal stenosis with compression and buckling of the\ncauda equina nerve roots, with severe bilateral subarticular recess narrowing,\nsevere left and mild right neural foraminal narrowing.\n\nL4-L5: Mild posterior disc bulging is noted with facet arthropathy and\nthickening of the ligamentum flavum resulting in mild-to-moderate canal\nstenosis with mild right and moderate severe left neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge indents the ventral thecal sac without\nsignificant canal stenosis. There is mild bilateral subarticular recess\nnarrowing with mild bilateral foraminal narrowing.\nThe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits. There is no evidence for abnormal intramedullary,\nleptomeningeal, or epidural enhancement.", "output": "1. Extensive ___ 1 and 2 degenerative endplate changes. No focal suspicious\nbone marrow lesion is identified.\n2. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most severe at L3-L4 with severe canal stenosis, severe bilateral recess\nnarrowing, severe left and moderate right neural foraminal narrowing. At this\nlevel, there is associated compression and buckling of the cauda equina nerve\nroots.\n3. L2-L3 moderate to severe canal stenosis with moderate to severe bilateral\nneural foraminal narrowing.\n4. Additional degenerative findings, as above.\n5. Overall no significant change since the previous MRI.\n6. No abnormal intraspinal enhancement." }, { "input": "At the craniocervical junction and C2-3 levels mild degenerative changes\nidentified.\n\nAt C3-4 level, disc bulging and a right paracentral disc osteophyte deforms\nthe spinal cord and results in moderate-to-severe spinal stenosis. There is\ndeformity of the spinal cord increased signal within the spinal cord due to\nmyelomalacia.\n\nAt C4-5 level, a disc osteophyte severely narrows the spinal canal and deforms\nthe spinal cord with increased signal within the spinal cord indicating\nmyelomalacia. Severe right-sided and moderate left-sided foraminal narrowing\nis seen.\n\nAt C5-6 mild spinal stenosis due to disc bulging and mild foraminal narrowing\nis seen.\n\nAt C6-7 level, disc and uncovertebral degenerative changes seen with severe\nleft-sided and moderate right-sided foraminal narrowing. There mild spinal\nstenosis.\n\nAt C7-T1, T1-2 and T2-3 mild degenerative changes are seen.", "output": "Moderate-to-severe spinal stenosis at C3-4 and severe spinal stenosis at C4-5\nlevels with deformity of the spinal cord increased signal within the spinal\ncord due to myelomalacia. Degenerative changes at other levels as described\nabove. There has been considerable progression of degenerative changes since\nprevious MRI. No evidence of fracture or ligamentous disruption seen." }, { "input": "Vertebral body height is maintained. No suspect marrow lesions are seen. There\nare ___ type 1 changes seen at C5-C6 and C6-C7 which have progressed\ncompared to prior study. There is loss of normal intervertebral disc height at\nC5-C6 and to a lesser extent at C6-C7.\n\nThe craniovertebral junction is unremarkable.\n\nThe cord is normal in signal intensity and morphology.\n\nAt C2-C3, there is no significant disc herniation, spinal canal stenosis or\nneural foraminal narrowing.\n\nAt C3-C4, there is no significant disc herniation, spinal canal stenosis, or\nneural foraminal narrowing.\n\nAt C4-C5, there is a broad-based posterior disc protrusion which is mildly\nnarrowing the spinal canal. There is bilateral uncovertebral joint and facet\njoint arthropathy resulting in moderate left and mild right neural foraminal\nnarrowing. These findings have progressed compared to prior study.\n\nAt C5-C6, there is a broad-based posterior disc protrusion and bilateral\nuncovertebral joint and facet joint arthropathy. There is resulting moderate\nspinal canal stenosis and remodeling of the cervical spinal cord. There is\nbilateral moderate to severe neural foraminal narrowing. These findings have\nprogressed compared to prior study.\n\nAt C6-C7, there is a central disc protrusion which is effacing the ventral CSF\nand slightly indenting the ventral aspect of the cervical spinal cord. There\nis bilateral uncovertebral joint and facet joint arthropathy with moderate to\nsevere right and moderate left neural foraminal narrowing. These findings have\nprogressed compared to prior study.\n\nAt C7-T1, there is minimal disc bulge eccentric to the left. There is no\nsignificant spinal canal stenosis. There is mild bilateral neural foraminal\nnarrowing.\n\nAt T1-T2, there is mild disc bulge with mild to moderate bilateral neural\nforaminal narrowing.\n\nAt T2-T3, there is a midline disc protrusion indenting the ventral thecal sac.\nThere is severe left and moderate right neural foraminal narrowing.\n\nThe visualized soft tissues of the neck are unremarkable.", "output": "Multilevel degenerative changes most pronounced at C5-C6 and C6-C7 as detailed\nabove. Findings have progressed compared to prior study." }, { "input": "2 mm retrolisthesis of L3 on L4 and L4 on L5 is unchanged since ___. \nRemainder of the lumbar alignment is anatomic. Artifact at the level of the\nT11 vertebral body is identified, similar in position from prior examination\nof ___. Vertebral body heights are preserved. Mixed ___ type 1 and type 2\nendplate changes are identified, most prominent at L3-L4 and L4-L5, progressed\nfrom prior exam. The marrow signal is diffusely T1 hypointense, similar in\nappearance to prior exam, presumably secondary to chronic systemic process. \nLoss of disc height and signal at L3-L4 and L4-L5 is moderate, and mild at\nL5-S1, progressed from prior exam. The conus medullaris terminates at the\nL1-L2 level, unchanged in within expected limits. There is no signal\nabnormality of the visualized cord, or conus.\n\nT12-L1 and L1-L2: On sagittal sequences, disc bulges results in mild spinal\ncanal narrowing without significant neural foraminal narrowing.\n\nL2-L3: Mild degenerative changes do not result in significant spinal canal or\nneural foraminal narrowing.\n\nL3-4: A disc bulge with intervertebral osteophytes results in mild spinal\ncanal narrowing. Facet arthropathy results in moderate bilateral neural\nforaminal narrowing, greater on the right.\n\nL4-L5: A left eccentric disc bulge and osteophytes and thickening of\nligamentum flavum results in moderate spinal canal narrowing with crowding of\nthe bilateral subarticular zones,, left-greater-than-right. In conjunction\nwith facet arthropathy, there is to moderate to severe left neural foraminal\nnarrowing and mild right neural foraminal narrowing.\n\nL5-S1: A small central protrusion with annular fissure does not significantly\nnarrow the spinal canal. Facet arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nThe above degenerative findings have progressed from prior exam ___.\n\nThere is a left 8 mm S2-S3 perineural cyst.\n\nOther: There is a incompletely characterize 6 mm T2 hyperintense cystic\nlesion at the visualized inferior pole of the right kidney, statistically most\nlikely representing simple cysts. Otherwise, the remainder the visualized\nprevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, progressed from examination\nof ___.\n2. The findings are most prominent at L4-L5 where a left eccentric disc bulge\nand intervertebral osteophytes, results in moderate spinal canal narrowing\nwith crowding of the left-greater-than-right subarticular zones. In\nconjunction with facet arthropathy, there is moderate to severe left neural\nforaminal narrowing." }, { "input": "THORACIC:\nAlignment is normal.There is a heterogeneous bone marrow signal. T1\nhyperintense lesions are seen in the T5 and T9 vertebral bodies, consistent\nwith hemangiomas. There is STIR hyperintense signal in the T11 vertebral body\nwith associated T1 hypointense signal and contrast enhancement. Prevertebral\nedema is seen at this level. Mild STIR hyperintense signal is also seen in\nthe T3 and T6 vertebral bodies with associated T1 hypo intense signal and\ncontrast enhancement. There is a well-circumscribed T2/STIR hyperintense, T1\nhypo intense, noncontrast enhancing lesion in the left T4 vertebral body. \nThe spinal cord appears normal in caliber and configuration. There are\nmultilevel disc protrusions, greatest at T11-12, resulting in mild spinal\ncanal stenosis. No significant spinal canal or neural foraminal stenosis are\nseen at the other levels.\n\nLUMBAR:\n\nThere is grade 1 retrolisthesis of L2 on 3. Vertebral body heights are\npreserved. Heterogeneous bone marrow signal is seen with no focal bone marrow\nreplacing lesion. The visualized portion of the spinal cord is preserved in\nsignal and caliber. There is loss of intervertebral disc height and signal at\nmultiple. Within the limits of this noncontrast study there is no\nparavertebral or paraspinal mass identified and there is no evidence of\ninfection or neoplasm. The visualized portion of the sacroiliac joints are\npreserved. Posterior fusion hardware and laminectomies are seen at L3- S1 on\nthe right and L3-L5 on the left.\n\nAt L1-2 there is disc bulge and facet arthropathy resulting in mild spinal\ncanal at moderate to severe bilateral neural foraminal stenosis.\n\nAt L2-3 there is grade 1 retrolisthesis of L2 on L3 with facet arthropathy and\nligamentum flavum thickening resulting in moderate to severe spinal canal and\nbilateral neural foraminal stenosis. Bilateral low-density structures are\nnoted at this level on the T2 sequences with no evidence of significant\nencroachment on the T1 sequences, likely artifactual in nature. This level\ndemonstrated substantial narrowing on the previously performed myelogram.\n\nAt L3-4 there is no spinal canal or neural foraminal stenosis.\n\nAt L4-5 there is facet arthropathy resulting in mild spinal canal and\nbilateral neural foraminal stenosis.\n\nAt L5-S1 there is no significant spinal canal stenosis. Artifact from\nmetallic hardware limits evaluation of the neural foramina at this level.\n\nOTHER: Partially visualized hardware is seen in the lower cervical spine. \nTrace bilateral pleural effusions are seen. There are multiple T2\nhyperintense lesions of the kidneys, likely representing simple cysts. \nMultiple punctate T2 hyperintense lesions are seen in the liver, likely\nrepresenting simple cysts or hemangiomas.", "output": "1. Abnormal bone marrow signal with associated contrast enhancement in the T3,\nT6 and T11 vertebral bodies with prevertebral abnormal signal at the level of\nT11, concerning for underlying osseous metastatic lesions and less likely\ndegenerative changes. No evidence for pathologic compression fracture or\nepidural extension of disease. A bone scan can be performed for further\nevaluation.\n2. Nonenhancing abnormal signal in the T4 vertebral body, likely representing\nan atypical hemangioma.\n3. Mild multilevel degenerative changes throughout the thoracic spine with\nmild multilevel spinal canal stenosis.\n4. Limited evaluation of the spinal canal lumbar spine secondary to artifact\nfrom metallic hardware. Postsurgical changes to the lumbar spine with\ndegenerative changes, worst at L1-2 and L2-3 resulting in mild spinal canal\nstenosis at L1- 2 and moderate to severe spinal canal stenosis at L2-3. \nModerate to severe bilateral neural foraminal stenosis at L1-2 and L2-3. If\nclinically indicated, a CT myelogram can be acquired for further evaluation\nhardware.\n\nRECOMMENDATION(S): Bone scan can be performed for further evaluation.\n\nNOTIFICATION: The results of this study were discussed by Dr. ___ with\nDr. ___ At 12:50 pm via phone." }, { "input": "CERVICAL:\nMultiple T2 hyperintense brain stem and cerebral hemispheric lesions are\nbetter assessed on MRI from ___. A subtle focus of increased T2\nsignal hyperintensity is noted in the anterior spinal cord at the C2 level,\nbest seen on sagittal T2 images (2:9, 3:9). There is no associated\nenhancement of this lesion or elsewhere throughout the cervical spinal cord.\n\nCervical spinal alignment is normal. There is apparent partial osseous fusion\nat the posterior aspect of the C2-3 vertebral level, with truncated\n___ dimension of the C2-3 intervertebral disc, likely congenital.\nOtherwise, vertebral body and intervertebral disc heights are preserved. Disc\ndesiccation is noted at multiple cervical levels.\n\nFrom C2-3 through C4-5, small disc protrusions and thickening of the\nligamentum flavum result in no significant spinal canal or neural foraminal\nnarrowing.\n\nAt C5-6 and C6-7, central disc protrusions and thickening of the ligamentum\nflavum result in mild spinal canal narrowing, unchanged since the prior study.\nUncovertebral joint arthropathy resulting in moderate neural foraminal\nnarrowing at C5-6 and mild narrowing at C6-7.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThoracic spinal alignment is normal. Vertebral body and intervertebral disc\nheights are preserved. The spinal cord appears normal in caliber and\nconfiguration. There no focal enhancing lesions are noted throughout the\nthoracic spinal cord. The conus medullaris terminates at the T12-L1 level.\n\nAt T1-2, there is a mild central disc protrusion and ligamentum flavum\nthickening, with no significant spinal canal or neural foraminal narrowing.\n\nFrom T2-3 through T5-6, there is no significant spinal canal or neural\nforaminal narrowing.\n\nAt T6-7 through T8-9, small central disc protrusions ligamentum flavum\nthickening result in no significant spinal canal or neural foraminal\nnarrowing.\n\nT12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: Mucosal thickening is noted in the bilateral maxillary sinuses. A\npartially visualized enhancing T2 hyperintense lobulated mass in the posterior\nliver is approximately 4.4cm in greatest dimension (17:14)", "output": "1. Small T2 hyperintense lesion in the anterior cervical spinal cord at the C2\nlevel is compatible with demyelination with no associated enhancement, either\nnew or more conspicuous since the prior study.\n2. Other intracranial T2 hyperintense white matter plaques in the pons,\nbrainstem, and cerebellar hemispheres are better assessed on prior MRI/ MRA of\nthe brain from ___.\n3. No thoracic spinal cord lesions or pathologic postcontrast enhancement.\n4. Multilevel cervical and thoracic spondylosis is mild, as described above.\n5. T2 hyperintense enhancing hepatic mass is potentially a hemangioma, but\nincompletely assessed on this exam.\n6. Bilateral maxillary sinus inflammatory disease.\n\nRECOMMENDATION(S): Ultrasound is recommended for further characterization of\npartially visualized hepatic mass described in IMPRESSION #5." }, { "input": "The examination is motion degraded. Within these confines:\n\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc height and signal are maintained. \nMultiple T2 hyperintense lesions of the brainstem is better evaluated on MRI\nhead performed on the same day. There is no signal abnormality of the\nvisualized cord.\n\nC2-C3 through C4-C5: There are small disc protrusions and thickening of the\nligamentum flavum at multiple levels without significant spinal canal or\nneural foraminal narrowing.\n\nC5-C6 and C6-C7: Central disc protrusion and thickening of the ligamentum\nflavum results in mild spinal canal narrowing. There is bilateral\nuncovertebral facet arthropathy resulting in mild bilateral neural foraminal\nnarrowing.\n\nC7-T1 through T4-T5: There is no significant spinal canal or neural foraminal\nnarrowing.\n\nTrace fluid signal seen in the left mastoid tip. Otherwise, prevertebral\nparaspinal soft tissues are unremarkable.", "output": "1. Within the confines of a motion degraded study, there are no T2\nhyperintense or enhancing lesions within the visualized cord.\n2. T2 hyperintense nonenhancing brainstem lesions are better evaluated on MRI\nhead performed on the same day.\n3. Mild cervical spondylosis as described above, not significantly changed\nfrom prior examination of ___." }, { "input": "Patient is noted to be status post C4-C6 discectomy and fusion with anterior\nand posterior hardware.\n\nOn the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen.\n\nThe craniovertebral junction is unremarkable. The cord is normal in signal\nintensity and morphology.\n\nAt C2-C3, there is no significant disc herniation or spinal canal narrowing.\nThere is bilateral uncovertebral joint and facet joint arthropathy resulting\nin bilateral mild to moderate neural foraminal narrowing.\n\nAt C3-C4, there is no significant disc herniation or spinal canal narrowing.\nThere is bilateral uncovertebral and facet joint arthropathy resulting in\nsevere right and moderate to severe left neural foraminal narrowing.\n\nAt C4-C5, patient is status post bilateral laminectomy. There is no\nsignificant disc herniation or spinal canal stenosis. Evaluation of neural\nforamen is limited by artifact from surgical hardware.\n\nAt C5-C6, patient is status post bilateral laminectomy. There is no disk\nherniation or spinal canal stenosis. Evaluation neural foramen is limited by\nartifact from surgical hardware.\n\nAt C6-C7, patient is status post bilateral laminectomy. There is a posterior\ncentral disc osteophyte complex mildly impinging upon the ventral CSF without\ncausing significant stenosis or contacting the cord. Although evaluation of\nthe neural foramen is limited by surgical hardware, there is apparent severe\nbilateral neural foraminal stenosis.\n\nAt C7-T1, there is no significant spinal canal stenosis. There is bilateral\nuncovertebral and facet joint arthropathy resulting in moderate to severe left\nand severe right neural foraminal narrowing. There is a small right perineural\ncyst at this level.\n\nThe visualized soft tissues of the neck are unremarkable.", "output": "Patient is status post discectomy and fusion from C4 through C6. Artifact\nfrom cervical hardware mildly limits evaluation. There is no evidence of\nhigh-grade spinal canal stenosis. There is multilevel neural foraminal\nstenosis which is most pronounced at C3-C4, C6-C7, and C7-T1." }, { "input": "CERVICAL:\nNo cord abnormalities. Specifically no abnormal cord enhancement, expansion\nor T2 signal abnormality.\nNormal alignment. Minimal degenerative changes cervical spine. No\nsignificant central canal narrowing at any level. Patent foramina at all\nlevels in the cervical spine\n\nTHORACIC:\nNo cord abnormalities. Specifically, no cord enhancement, expansion or T2\nsignal abnormality.\nNormal alignment. Spine is otherwise normal. No significant central canal,\nforaminal narrowing at any level.\n\nOTHER: None", "output": "1. Normal cord." }, { "input": "Mild 2 mm retrolisthesis of L3 on L4 is noted. Vertebral body heights are\npreserved. There is a L3 inferior endplate Schmorl's node and vertebral body\nhemangioma. There is no suspicious marrow signal. Mild loss of disc height\nthrough L2-L3 through L5-S1 is identified. The conus medullaris terminates at\nthe T12-L1 level, within expected limits. There is no signal abnormality of\nthe visualized cord, conus medullaris or cauda equina.\n\nT12-L1 through L3-L4: Small disc protrusions are noted without significant\nspinal canal narrowing. There is no significant neural foraminal narrowing.\n\nL4-L5: A disc protrusion and thickening of ligamentum flavum does not result\nin significant spinal canal narrowing. Facet arthropathy results in mild\nright neural foraminal narrowing and moderate left neural foraminal narrowing.\n\nL5-S1: A disc protrusion does not result in significant spinal canal\nnarrowing. Bilateral facet arthropathy results in no significant right neural\nforaminal narrowing and mild left neural foraminal narrowing.\n\nThere is subcutaneous STIR hyperintense signal without enhancement compatible\nwith dependent edema. Otherwise prevertebral and paraspinal soft tissues are\nunremarkable. There is no abnormal enhancement. No prevertebral or epidural\nfluid collections are identified.", "output": "1. Lumbar spondylosis, most prominent at L4-L5 where there is moderate left\nneural foraminal narrowing is identified.\n2. No prevertebral or paraspinal fluid collections to suggest abscess or\nevidence of discitis/osteomyelitis." }, { "input": "There is straightening of the lumbar spine. The vertebral body heights are\npreserved. A small Schmorl's node is present at the posterior inferior aspect\nof the L4 vertebral body. The L4-L5 and L5-S1 intervertebral discs\ndemonstrate decreased height and decreased signal on T2 weighted imaging.\n\nThe visualized spinal cord is normal in signal, caliber and configuration. \nThe conus medullaris terminates at the level of T12.\n\nFrom T11-T12 through L2-L3 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nL4-L5: There is disc desiccation and diffuse disc bulge with a posterior\ncentral and slightly left paracentral disc protrusion, impinging the thecal\nsac as well as the traversing nerve root on the left causing moderate\nleft-sided neural foraminal narrowing, additionally there is mild bilateral\narticular joint facet hypertrophy.\n\nL5-S1: There is disc desiccation and diffuse disc bulge with a posterior and\ncentral disc protrusion, contacting the traversing nerve roots bilaterally,\nslightly more pronounced on the left, there is facet joint arthropathy\nresulting in mild bilateral neural foraminal narrowing.\n\nThe remainder of the levels demonstrate no evidence of spinal canal or neural\nforaminal narrowing. No abnormal enhancement is present on postcontrast\nimages. There is no evidence of infection or neoplasm.", "output": "1. No enhancement concerning for infection is identified.\n2. Disc degenerative changes identified at L4-L5 and L5-S1 levels as described\nabove.\n3. No cord signal abnormalities identified." }, { "input": "Redemonstration of known type 3 dens fracture, better assessed on the CT\ncervical spine performed earlier the same day. There is 3 mm anterior\ndisplacement of the dens relative to the body of C2. There is irregularity of\nthe anterior longitudinal ligament at the level of the C2 fracture, suspicious\nfor injury (6:7 and 2:8). There is high T2 signal in the prevertebral soft\ntissues extending from C2 through C4, with more central areas of high T1\nsignal, consistent with prevertebral edema/hematoma. There is no evidence of\nan epidural hematoma. There is no significant spinal canal narrowing at this\nlevel. The posterior longitudinal ligament is intact. Slightly increased\nsignal is seen in the interspinous ligament between C1 and C2. Otherwise, the\nligamentum flavum, the interspinous ligament and nuchal ligament appear\nintact. Normal craniocervical junction.\n\nThe patient is status post anterior fusion of C4 through C7 with\nintervertebral disc spacers at C4-C5, C5-C6, and C6-C7. There are multilevel\nspinal canal narrowing, most prominent at C5-C6 and C6-C7 where it is moderate\nsecondary to diffuse disc bulges. There is multilevel neural foraminal\nnarrowing, most prominent at C5-C6 on the right where it is moderate. There\nis multilevel facet joint arthropathy.\n\nAlignment is otherwise normal. Vertebral body and intervertebral disc signal\nintensity appear otherwise normal. The spinal cord appears normal in caliber\nand configuration. There is no evidence of infection or neoplasm.", "output": "1. Redemonstration of known type 3 dens fracture, with 3 mm anterior\ndisplacement of the dens relative to the body of C2. There is no significant\nspinal canal narrowing at this level.\n2. Irregularity of the anterior longitudinal ligament at the level of the C2\nfracture, suspicious for injury.\n3. Prevertebral edema/hematoma extending from C2 through C4. There is no\nevidence of an epidural hematoma.\n4. Status post anterior fusion of C4 through C7.\n5. Moderate spinal canal narrowing from C5-C7 levels, secondary to diffuse\ndisc bulges. Moderate right neural foraminal narrowing at C5-C6 level.\n6. Multilevel facet joint arthropathy." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThe alignment of the cervical spine is maintained. There is diffuse marrow\nheterogeneity related to degenerative process with ___ type 2 endplate\ndegenerative changes at C6-C7 and mild loss of vertebral body heights at C4\nand C5.\n\n The visualized portion of the spinal cord is grossly preserved in signal. \nThere is multilevel disc desiccation with loss of intervertebral disc height\nat C6-C7.\n\nThe cervicomedullary junction appears unremarkable. The prevertebral and\nparaspinal soft tissues appear unremarkable.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: There is a central disc protrusion causing deformation of the ventral\nthecal sac and spinal cord, without definite associated cord signal\nabnormality, and mild spinal canal stenosis. There is no neural foraminal\nnarrowing.\n\nC4-C5: There is a central and left paracentral disc protrusion with endplate\nosteophytes causing mild-to-moderate spinal canal stenosis with flattening of\nthe spinal cord without spinal cord edema. There is facet and uncovertebral\njoint arthropathy with mild left and no right neural foraminal narrowing.\n\nC5-C6: There is a central and right paracentral disc protrusion causing\nmild-to-moderate spinal canal stenosis without evidence of cord edema. There\nis facet and uncovertebral joint arthropathy without neural foraminal\nnarrowing.\n\nC6-C7: There is a disc bulge with endplate osteophyte causing mild spinal\ncanal stenosis. There is mild facet and uncovertebral joint arthropathy\nwithout neural foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal stenosis.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical spondylosis as described above, worse at C3-C4 through\nC3-C4 through C5-C6 with mild-to-moderate spinal canal stenosis and no\nsignificant neural foraminal narrowing.\n3. Within limits of study, no evidence of cord compression or cervical spinal\ncord lesion.\n4. Nonspecific marrow heterogeneity, which may be degenerative in nature, with\ndifferential considerations including anemia. If clinically indicated,\nconsider correlation with CBC." }, { "input": "There are five lumbar-type vertebral bodies which are maintained in height and\nalignment. Degenerative bone marrow signal changes seen at the endplates\nadjacent to the L5-S1 disc, predominantly ___ type 2. There is a T1 and T2\nhyperintense partially visualized lesion in the T10 vertebral body compatible\nwith a hemangioma. No suspicious marrow lesion identified. Intervertebral\ndisc desiccation with height loss is noted at L5-S1, similar to prior. Conus\nterminates at the T12-L1 level, in normal anatomic position.\n\nAt T10-T11, there is disc bulge and facet joint hypertrophy contributing to\nmild canal narrowing and moderate right and mild left foraminal narrowing.\n\nAt T11-T12 there is facet joint hypertrophy without significant canal or\nforaminal narrowing.\n\nAt T12-L1, there is no canal or foraminal narrowing.\n\nAt L1-2, there is a small disc bulge and facet joint hypertrophy without\nsignificant canal or foraminal narrowing.\n\nAt L2-3, there is a small disc bulge and facet joint hypertrophy contributing\nto subarticular recess narrowing and mild right greater than left foraminal\nnarrowing. Findings are similar compared to prior.\n\nAt L3-4, there is a disc bulge and facet joint hypertrophy resulting in\nsubarticular recess narrowing and moderate right greater than left foraminal\nnarrowing. These findings are similar compared to prior.\n\nAt L4-5, there is extensive facet joint hypertrophy bilaterally resulting in\nsubarticular recess narrowing. There is apparent contact of a right facet\njoint osteophyte with the traversing right L5 nerve root (300: 59). Overall\nthere is mild canal narrowing. There is moderate bilateral foraminal\nnarrowing, similar compared to prior.\n\nAt L5-S1, prior right-sided hemi laminectomy changes are noted. There are\nendplate osteophytes and extensive facet joint hypertrophy which contribute to\nright subarticular recess narrowing. There is also loss of the normal fat\nsignal around the traversing right S1 nerve root nerve root in the\nsubarticular recess (300:67). It is uncertain how much of this is postop\ngranulation tissue versus recurrent disc or facet joint changes. . No\noverall canal narrowing. There is moderate right worse than left foraminal\nnarrowing, similar to prior.\n\nIncluded paraspinal and retroperitoneal soft tissues are grossly unremarkable.", "output": "1. Degenerative changes most notably in the lower lumbar spine which have not\nchanged since ___.\n2. Similar appearance of the right S1 nerve root in the subarticular recess\nwith loss of the surrounding fat planes in this region, potentially due to\ncombination of facet joint osteophytes, postoperative granulation tissue\nversus recurrent disc material. These findings could be further delineated\nwith contrast enhanced imaging if desired.\n3. Contact of the traversing right L5 nerve root at L4-5 from adjacent facet\njoint hypertrophy.\n4. Remaining details as above." }, { "input": "The alignment is normal. Predominantly ___ type 2 degenerative bone marrow\nchanges at the endplates of L5-S1 is re-demonstrated. No concerning focal\nbone marrow lesions are identified. Intervertebral disc desiccation with\nheight loss is noted at L5-S1 overall unchanged in appearance compared to\nprior exam. The conus terminates at T12-L1. No terminal cord signal\nabnormalities are identified.\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: Disc bulge, ligamentum flavum thickening and facet joint osteophytes\nare seen contributing to mild spinal canal narrowing. Facet joint osteophytes\ncontribute to mild bilateral neural foraminal narrowing. The extent of\ndegenerative changes is unchanged compared to prior exam.\n\nL3-L4: Mild disc bulge, facet joint osteophytes and ligamentum flavum\nthickening is seen resulting in mild spinal canal narrowing. Facet joint\nosteophytes contribute to moderate right and mild-to-moderate left neural\nforaminal narrowing, not significantly progressed compared to the prior exam.\n\nL4-L5: Mild disc bulge is seen however there is no significant spinal canal\nnarrowing. Facet joint osteophytes contribute to subarticular recess\nnarrowing. There is apparent contact of the right facet joint osteophyte with\nthe traversing right L5 nerve root overall similar in appearance compared to\nthe prior exam. Moderate bilateral neural foraminal narrowing is unchanged.\n\nL5-S1: Patient is status post right-sided hemilaminectomy with appropriate\npostoperative changes and enhancing granulation tissue. Endplate osteophytes\nand facet joint osteophytes contribute to right subarticular recess narrowing.\nLoss of the normal fat signal around the traversing right S1 nerve root in the\nsubarticular recess likely reflects combination of granulation tissue and\nfacet joint osteophytes. No significant spinal canal narrowing is seen. \nModerate bilateral neural foraminal narrowing is unchanged.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Overall, no significant interval change in the extent of degenerative\nchanges at L5-S1 with a combination of granulation tissue and facet joint\nosteophytes contacting the right traversing S1 nerve root in the subarticular\nrecess.\n2. Contact of the traversing right L5 nerve root at L4-L5 from adjacent facet\njoint osteophytes is re-demonstrated.\n3. No terminal cord signal abnormalities identified.\n4. No significant spinal canal stenosis." }, { "input": "There is stable grade 1 anterolisthesis of C7 on T1. . There is anterior\nfusion of C5-6 with susceptibility which limits evaluation of the vertebral\nbodies. Vertebral body heights are preserved. There is T2/STIR and T1\nhyperintense signal in the C7 vertebral body, consistent with a hemangioma.\nThere is a focus of T2/STIR hyperintense signal within the spinal cord at the\nlevel of C5-C6, increased in prominence from prior exam but unchanged in\ndistribution. Intervertebral disc signal and heights are preserved. Within\nthe limits of this noncontrast study there is no evidence of infection or\nneoplasm. There is no prevertebral soft tissue swelling.. The visualized\nportion of the posterior fossa, cervicomedullary junction, paranasal sinuses\nand lung apicesare preserved.\n\nThere is baseline mild spinal canal narrowing secondary to congenital\nshortening of the pedicles\n\nAt C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is facet arthropathy and central disc protrusion resulting in\neffacement of the ventral thecal sac and moderate bilateral neural foraminal\nstenosis.\n\nAt C4-5 there is facet arthropathy and central disc protrusion resulting in\neffacement of the ventral thecal sac and mild bilateral neural foraminal\nstenosis.\n\nAt C5-6 there is facet arthropathy resulting in moderate bilateral neural\nforaminal stenosis. Ventral epidural soft tissue is seen which enhances post\ncontrast administration and is most consistent with granulation tissue. There\nis effacement of ventral thecal sac at this level with moderate spinal canal\nstenosis.\n\nAt C6-7 there is facet arthropathy resulting in mild bilateral neural\nforaminal and spinal canal stenosis.\n\nAt C7-T1 there is uncovering of the disc with no significant spinal canal or\nneural foraminal stenosis.", "output": "1. Anterior fusion at C5-6 with ventral anterior granulation tissue and\nmoderate spinal canal stenosis. Unchanged configuration of myelomalacia in\nthe spinal cord at this level, although slightly increased in prominence.\n2. Stable multilevel degenerative changes throughout the remainder of the\nspine, as described above.\n3. Stable C7 hemangioma." }, { "input": "Alignment is normal. Patient is status post removal of L5-S1 fusion with\nL4-L5 laminectomy, diskectomy and posterior spinal fusion at these levels. \nThere is associated postsurgical changes. Within the midline posterior\nsubcutaneous tissues is a a fluid collection that is 1.1 x 0.8 x 6 cm (TV x AP\nx SI) T2 hyperintense, T1 hypo intense and peripherally enhancing . At the\nlevel of the laminectomy within the paraspinal muscles is an 4.8 x 3.2 x 6.9\ncm (TV x AP x SI) (05:26) similar-appearing collection with mild enhancement\nof the adjacent paraspinal muscles. No definite communication between these 2\ncollections identified. Direct comparison is limited due to absence of IV\ncontrast on prior CT, however the fascia planes are unchanged in appearance\nsuggestive of similar fluid volume within these collections. There is\nenhancement and edema within the paraspinal musculature at this level.\n\nMild STIR and T1 hyperintensity along the L4 and L5 endplates are consistent\nwith ___ type 2 degenerative changes. Increased T2/FLAIR hyperintense\nsignal with subtle enhancement of the L5-S1 intervertebral disc with stable\nendplate changes is most consistent with degenerative disc vascularization\nrather than discitis. Vertebral body and intervertebral disc signal intensity\notherwise appear normal. The spinal cord appears normal in caliber and\nconfiguration. No epidural collection. The conus terminates at mid L1 level.\nThere is no evidence of infection or neoplasm. No evidence of arachnoiditis.\n\nT12-L3: No evidence of spinal canal or neural foraminal narrowing.\nL3-L4: Small posterior disc bulge with mild ligamentum flavum thickening and\nfacet hypertrophy is causing mild spinal canal and mild bilateral neural\nforaminal narrowing.\nL4-L5: Small posterior disc bulge with mild bilateral facet hypertrophy\ncausing mild bilateral neural foraminal narrowing and possible contact of\nexiting left L4 nerve root, unchanged since prior examination.\nL5-S1: Small right foraminal disc extrusion with bilateral facet and\nuncovertebral hypertrophy causing mild bilateral neural foraminal narrowing\nand compression of right L5 exiting neve root, unchanged since prior\nexamination. No significant spinal canal narrowing.\nS1-S2: Ghost tracks are seen at the S1 level bilaterally. Just medial to the\nright pedicle is a new 1.1 x 0.8 cm area of susceptibility artifact along the\nright foramina, adjacent to the exiting right S1 nerve root (6:33). This\nlikely represents a small amount of metal remnant from the prior surgery. An\nalternative, less likely, would be a collection of air related to a recent\ninvasive procedure. Unless such a procedure was performed within the past\nseveral days, air would not be expected to persist.\n\nPartially visualized intra-abdominal organs are unremarkable.", "output": "1. Status post L4-L5 laminectomy and discectomy with posterior spinal fusion\nand associated postsurgical changes.\n2. 1.1 and 4.8 cm peripherally enhancing fluid collections within the\nposterior subcutaneous tissue with inflamed, edematous paraspinal musculature\nat the level of L4-L5 likely represents postoperative seromas with adjacent\npostoperative change, however superimposed infection cannot be excluded due to\nenhancement. No significant change in volume of fluid when compared to ___ CT.\n3. Increased signal and enhancement of L5-S1 intervertebral disc is most\nconsistent with vascularization rather than discitis given stable endplate\nchanges.\n4. Mild multilevel degenerative changes with no interval change in possible\ncontact of exiting left L4 nerve root from small posterior disc bulge and\nfacet hypertrophy as well as persistent compression of right L5 exiting nerve\nroot due to right foraminal disc extrusion.\n5. New susceptibility artifact at level of L5 foramina likely represents small\namount of metal however focal air would be similar in appearance if patient\nhas had recent invasive procedure.\n6. No findings to suggest arachnoiditis or epidural collection.\n\nNOTIFICATION: The findings were discussed ___, NP by ___\n___, M.D. on the telephone on ___ at 1:59 ___, 30 minutes after\ndiscovery of the findings." }, { "input": "The vertebral body heights are maintained. There is mild levoscoliosis. There\nare type ___ ___ endplate degenerate changes at L5-S1. There is loss of normal\ndisc signal and height at multiple levels, but most severe at L5-S1.\n\nThe conus medullaris is normal in appearance and terminates at L1-L2.\n\nAt L1-L2, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-L3, there is minimal disc bulge, facet arthropathy and ligamentum flavum\nthickening without significant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in bilateral subarticular zone and mild bilateral neural\nforaminal narrowing. There are also bilateral facet joint effusions. There is\nno significant spinal canal narrowing.\n\nAt L4-L5, there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in bilateral subarticular zone and moderate left neural\nforaminal narrowing. There is no significant spinal canal or right neural\nforaminal narrowing.\n\nAt L5-S1, there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in bilateral subarticular zone narrowing, moderate right\nand severe left neural foraminal narrowing. There is likely encroachment of\nthe exiting left L5 nerve root. The disc contacts the traversing S1 nerve\nroots.", "output": "Stable lumbar spondylosis as detailed above, worst at L5-S1, where there is\nmoderate right and severe left neural foraminal narrowing with encroachment of\nthe exiting left L5 nerve root." }, { "input": "There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of T12-L1. There is no spinal cord signal\nabnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1: There is a mild posterior disc bulge and bilateral facet hypertrophy\nproducing minimal spinal canal stenosis, with no appreciable neural foraminal\nnarrowing.\n\nL1-L2: There is a slightly more pronounced posterior disc bulge combined with\nbilateral facet hypertrophy and ligamentum flavum thickening, resulting in\nmild-to-moderate spinal canal stenosis with moderate left and mild-to-moderate\nright neural foraminal narrowing. The disc bulge at this level flattens the\nventral thecal sac.\n\nL2-L3: There is a significant posterior disc bulge with facet and ligamentum\nflavum hypertrophy resulting in moderate canal stenosis with moderate left and\nmild-to-moderate right neural foraminal narrowing. The disc bulge at this\nlevel contacts the bilateral descending L3 nerve roots.\n\nL3-L4: A posterior disc bulge, ligamentum flavum and facet hypertrophy result\nin moderate canal stenosis with moderate severe left and mild right neural\nforaminal narrowing. The disc bulge at this level contacts the exiting left\nL3 nerve root, in addition to the bilateral descending L4 nerve roots.\n\nL4-L5: A large posterior disc bulge with bilateral facet and ligamentum flavum\nhypertrophy resultant moderate spinal canal stenosis, with moderate to severe\nbilateral neural foraminal narrowing. The disc bulge at this level contacts\nthe bilateral exiting L4 nerve roots, right greater than left.\n\nL5-S1: A posterior disc bulge and bilateral facet hypertrophy results in mild\nspinal canal stenosis with moderate right neural foraminal narrowing. The\ndisc bulge at this level contacts the exiting right L5 and descending right S1\nnerve roots.", "output": "1. Multilevel spondylosis of the lumbar spine appears slightly most pronounced\nsince the prior exam. Findings are most significant from L2-L3 through L4-L5\nlevels, with moderate spinal canal stenosis, and moderate to severe bilateral\nneural foraminal narrowing." }, { "input": "Heterogeneous fat within the bone marrow of the cervical and upper thoracic\nvertebral bodies consistent with changes secondary to multiple myeloma. There\nis no evidence of tumor extension into the spinal canal. Alignment is normal.\nAt C5-C6, there is mild posterior disc protrusion posteriorly with flattening\nof the spinal cord (06:31). At C6-C7, there is posterior disc protrusion in\nthe posterior right aspect with flattening of the spinal cord (06:36). \nMultilevel moderate degenerative changes with narrowing of the intervertebral\ndiscs and facet osteophytes, more since ___. Within the limits of\nthis noncontrast examination, there is no evidence of infection or neoplasm.", "output": "1. Posterior disc protrusion with flattening of the spinal cord at the C5-C6\nand C6-C7 levels.\n2. Multilevel moderate degenerative changes, worse since prior study.\n3. Bony changes within cervical and upper thoracic vertebral bodies consistent\nwith patient's history of multiple myeloma and more pronounced as compared to\nprior study." }, { "input": "At the craniocervical junction and from C2-3 to C4-5 mild degenerative changes\nidentified without spinal stenosis or foraminal narrowing.\n\nAt C5-6 level, disc and uncovertebral degenerative changes seen with\nmoderate-to-severe right-sided and moderate left-sided foraminal narrowing. \nThere is a right-sided disc osteophyte it contacts and slightly deforms the\nright side of the spinal cord. Overall there is no change since the previous\nstudy.\n\nAt C6-7 mild disc bulging identified with a right paracentral disc protrusion\nwhich contacts the spinal cord with mild deformity. Abnormal signal is seen\nwithin the spinal cord.\n\nAt C7-T1 to T2-3 mild degenerative change seen.\n\nMild heterogeneity of the marrow signal within the vertebral bodies could be\ndue to osteopenia of patient's history of myeloma. This has not significantly\nchanged from the prior study.", "output": "Overall no significant change in appearance of the cervical spine degenerative\nchanges which are predominantly seen at C5-6 and C6-7 levels. Mild flattening\nof the right side of the spinal cord is seen at C5-6 and C6-7 levels which has\nnot changed. No abnormal signal within the spinal cord. Foraminal narrowing\nmost pronounced at C5-6 level are as before." }, { "input": "Alignment is anatomic. There are no suspicious osseous lesions. \nDegenerative endplate irregularity is again demonstrated, most prominent at\nC4-5, C5-6 and C6-C7. Multilevel disc desiccation and degenerative facet\ndisease is again demonstrated:\n\nAt C4-5, there is a small broad-based small broad-based central disc\nprotrusion, but no significant spinal canal or foraminal narrowing.\n\nAt C5-C6, there is a left paracentral disc protrusion which causes mild spinal\ncanal narrowing, and mildly deforms the left anterior aspect of the spinal\ncord. Uncovertebral joint osteophytes cause mild right and mild to moderate\nleft neural foraminal narrowing. There is no cord signal abnormality.\n\nAt C6-C7, there is a very small central disc protrusion, but no significant\nspinal canal or foraminal narrowing.\n\nAt C7-T1, there are degenerative osteophytes within the left facet, but no\nsignificant narrowing.\n\nThere is no pathologic enhancement within the spine. Paravertebral soft\ntissues and the partially visualized posterior fossa are unremarkable.", "output": "Left paracentral disc protrusion slightly deforming the left\nventral cord at C5-6, without cord edema or myelomalacia. Milder spondylosis\nat other levels." }, { "input": "CERVICAL:\nAlignment is normal.Vertebral body heights are preserved. There are multilevel\nintervertebral disc degenerative changes, most severe at C5-6. Multilevel\nendplate degenerative changes are noted. The spinal cord is normal in\ncaliber, without definite cord signal abnormality seen.\n\nAt C1-2, there is no significant spinal canal or neural foraminal stenosis.\n\nAt C2-3, there is diffuse disc bulge, bilateral uncovertebral hypertrophy\ncausing moderate left and moderate to severe right-sided neural foraminal\nnarrowing, there is no evidence of central spinal canal stenosis.\n\nAt C3-4, there is diffuse disc bulge causing anterior thecal sac deformity,\nbilateral uncovertebral hypertrophy causes moderate to severe bilateral neural\nforaminal narrowing, there is moderate spinal canal stenosis.\n\nAt C4-5, there is diffuse disc bulge, bilateral uncovertebral hypertrophy\ncausing mild right and moderate to severe left-sided neural foraminal\nnarrowing, additionally there is articular joint facet hypertrophy on the\nleft, there is no evidence of central spinal canal narrowing (series 10, image\n15).\n\nAt C5-6, there is moderate spinal canal stenosis and mild bilateral neural\nforaminal stenosis secondary to disc bulge, posterior osteophytes and\nuncovertebral and facet arthrosis. This is associated with minimal ventral\ncord remodeling changes.\n\nAt C6-7 and C7-T1, there is no moderate or severe spinal canal or neural\nforaminal stenosis.\n\nLUMBAR:\n\nThere is mild leftward convex curvature of the lumbar spine.Vertebral body\nheights are grossly preserved. There are moderate multilevel intervertebral\ndisc degenerative changes, worse at L1-L2. Multilevel endplate degenerative\nchanges are seen, predominantly at the T12-L1 through L2-3 levels.\n\nThe conus medullaris terminates at L1. The imaged lower thoracic spinal cord\nis normal in configuration and signal.\n\nAt T11-12, there is mild spinal canal and bilateral neural foraminal stenosis\nsecondary to disc bulge, ligamentum flavum thickening and bilateral facet\narthrosis.\n\nAt T12-L1, irregular contour of the endplates consistent with Schmorl's node\nand bone marrow replacement for fat ___ type 2 endplate changes. There is\nmild spinal canal stenosis and moderate right and mild left neural foraminal\nstenosis secondary to diffuse disc bulge, ligamentum flavum thickening and\nbilateral facet arthrosis (series 6: Image 9).\n\nAt L1-2, there is mild spinal canal and moderate bilateral neural foraminal\nstenosis secondary to diffuse disc bulge, ligamentum flavum thickening and\nbilateral facet arthrosis. Irregular contour of the endplates is consistent\nwith Schmorl's node.\n\nAt L2-3, there is moderate spinal canal stenosis and moderate bilateral neural\nforaminal stenosis, left greater than right, secondary to diffuse disc bulge,\nligamentum flavum thickening and bilateral facet arthrosis.\n\nAt L3-4, there is moderate to severe spinal canal and moderate bilateral\nneural foraminal stenosis secondary to diffuse disc bulge, ligamentum flavum\nthickening and bilateral facet arthrosis. Disc bulge likely contacts the\nexiting right L3 nerve root in the extraforaminal zone (6:26). Irregular\ncontour of the endplates is consistent with Schmorl's node.\n\nAt L4-5, there is moderate spinal canal stenosis secondary to diffuse disc\nbulge with a more focal right paracentral component, which appears to contact\nthe traversing nerve roots (6:32)., more significant towards the right, there\nis moderate articular joint facet hypertrophy.\n\nAt L5-S1, there is no significant spinal canal or neural foraminal stenosis. \nThere is moderate bilateral articular joint facet hypertrophy.\n\nOTHER: Several simple bilateral renal cysts, partially evaluated this exam, if\nclinically warranted, correlation with renal ultrasound is recommended.", "output": "1. Multilevel degenerative changes of the cervical spine, as detailed above,\nare most notable for severe spinal canal and bilateral neural foraminal\nstenosis at C3-4 associated with ventricle remodeling changes. No definite\ncord signal abnormality seen.\n2. Multilevel degenerative changes of the lumbar spine, as detailed above, are\nmost notable for severe spinal canal stenosis at L3-4 with disc bulge probably\ncontacting the exiting right L3 nerve root in the extraforaminal zone and\nmoderate spinal canal stenosis at L4-5 with disc bulge likely contacting the\ntraversing right L5 and S1 nerve roots.\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): Several simple bilateral renal cysts, partially evaluated\nthis exam, if clinically warranted, correlation with renal ultrasound is\nrecommended." }, { "input": "2 mm retrolisthesis of T12 on L1, 3-4 mm anterolisthesis of L3 on L4 and L4 on\nL5 is identified, are new from examination of ___. Vertebral body heights\nare maintained. ___ type 1 endplate changes at T12-L1, L3-L4 and L4-L5 is\nnoted. Otherwise, there is no suspicious marrow signal. There is disc\ndesiccation and loss of disc height at T12-L1. Severe loss of disc height at\nL3-L4 and L4-L5 is identified with trace STIR hyperintense signal, which is\nlikely degenerative in nature. Additional multilevel mild disc desiccation\ndemonstrates no significant loss of disc height. The conus medullaris\nterminates at the L1 vertebral level, within expected limits. The signal and\nmorphology of the visualized cord, conus medullaris are unremarkable. There\nis multilevel buckling of the cauda equina most prominent inferior to the\nL3-L4 levels.\n\nT9-T10 through T12-L1: There are posterior disk protrusions as well as mild\nthickening of the ligamentum flavum without significant spinal canal or neural\nforaminal narrowing, most prominent at T10 and T11.\n\nL1-L2: There is no significant spinal canal or neural foraminal narrowing.\n\nL2-L3: There is a disc bulge as well as bilateral facet arthropathy and\nthickening of the ligamentum flavum, without significant spinal canal or\nneural foraminal narrowing.\n\nL3-L4: A disc bulge as well as bilateral facet arthropathy and thickening of\nthe ligamentum flavum, results in moderate spinal canal narrowing. There is\nsevere right neural foraminal narrowing and moderate left neural foraminal\nnarrowing. The disc bulge crowds the subarticular recesses, contacting the\ntraversing nerve roots without definitive impingement.\n\nL4-L5: A large disc bulge, bilateral thickening of the ligamentum flavum and\nfacet arthropathy with joint effusions results in moderate to severe spinal\ncanal narrowing. In addition, crowding of the bilateral subarticular recesses\ncontacts the traversing nerve roots and may impinge on the traversing left L5\nnerve root. There is severe left neural foraminal narrowing. The right\nneural foraminal is moderately to severely narrowed, and appears to flatten\nthe exiting right L4 nerve (series 3, image 4).\n\nL5-S1: A disc bulge and bilateral thickening of the ligamentum flavum with\nfacet arthropathy and right-sided facet joint effusion results in mild spinal\ncanal narrowing. There is crowding of the subarticular recesses which\ncontacts but does not impinge on the traversing nerve roots. There is\nmoderate bilateral neural foraminal narrowing.\n\nThe above degenerative changes appear significantly worsened from examination\nof ___.\n\nThe left adrenal gland is diffusely nodular, with dominant 1.6 cm lesion,\npreviously described on CT examination as an adenoma. The right adrenal gland\ndemonstrates a 1 cm medial limb nodule, unchanged from prior examinations,\nwhich may represent an adenoma or nodular hyperplasia.\n\nT2 hypointense 1.4 x 1.2 cm (AP, TRV ; series 7, image 22) right inferior\nrenal pole lesion is incompletely characterize, not seen on prior MRI abdomen\nof ___, but similar in size from prior CT examination of ___\nallowing for technical differences. Additional adjacent 6 mm incompletely\ncharacterized T2 hyperintense cystic lesion is noted.\n\nCystic structure contiguous with the main pancreatic duct measuring up to 4 mm\nin transverse dimension (series 7, image 15) is noted which appears more\nprominent when compared to prior examination of ___, although this may be\nsecondary to technical differences. This may represent an IPMN.\n\nSTIR hyperintense subcutaneous signal is most compatible with dependent edema.\nThere is also STIR hyperintense signal of the right greater than left\nparaspinal muscles, which may represent atrophy versus muscle strain.", "output": "1. Multilevel multifactorial lumbar spondylosis, most prominent at L3-L4 where\nthere is moderate spinal canal narrowing, severe right neural foraminal\nnarrowing and moderate left neural foraminal narrowing and at L4-L5 where\nthere is moderate severe spinal canal narrowing, severe left neural foraminal\nnarrowing and moderate to severe right neural foraminal narrowing. These\nfindings are significant worsened since ___.\n2. 1.4 cm T2 hypointense left inferior renal pole incompletely characterized\nlesion, not definitively seen on prior exams. This may represent a\nhemorrhagic cyst although neoplasm is not excluded.\n3. STIR hyperintense signal of the L3-L4 and L4-L5 discs, most compatible with\ndegenerative changes. However, very early diskitis may appear in this fashion\nand clinical correlation with infectious markers is recommended.\n4. Interval increased prominence of a 4 mm cystic structure contiguous with\nthe pancreatic duct. This may represent a prominent side branch or IPMN.\n5. Unchanged appearance of previously described left adrenal adenoma. Nodular\nfocus of the right adrenal gland is unchanged and likely represents adrenal\nadenoma or nodular hyperplasia.\n\nRECOMMENDATION(S): Regarding point 2: Further evaluation with renal mass mass\nMRI if there no contraindications is recommended if clinically indicated.\nRegarding point 3: STIR hyperintense signal of the L3-L4 and L4-L5 discs, most\ncompatible with degenerative changes. However, very early discitis may appear\nin this fashion and clinical correlation with infectious markers is\nrecommended.\nRegarding Point 4: The apparent increased prominence of the pancreatic cystic\nfocus may be secondary to technical differences, however dedicated examination\nis recommended to exclude interval increase size." }, { "input": "The preceding torso CT demonstrates 12 rib-bearing vertebrae, L1 with\ntransitional anatomy of the left transverse process, L2 through L5 with\nconventional anatomy, and a rudimentary hypoplastic disc at S1-S2. The\nnumbering is documented on sagittal image 2:13 of the present exam.\n\nThe localizer sequence demonstrates a levoconvex scoliosis centered at L3-L4. \nThere is mild retrolisthesis of L3 on L4 and of L4 on L5, as seen on the\npreceding CT.\n\nLumbar vertebral body heights are grossly preserved. There are discogenic\nbone marrow changes in the endplates from L2-3 through L5-S1 associated with\ndisc space narrowing, ___ type 2 at L2-L3 and L5-S1, and ___ type 1 at\nL3-L4 and L4-L5. The ___ type 1 changes limit detection of traumatic marrow\nedema. The preceding CT demonstrates no evidence for vertebral body fracture,\nbut L4-5 anterior osteophytes appear fractured. The present MRI demonstrates\nminimal prevertebral edema at the level of L4 which may involve the anterior\nlongitudinal ligament. Posterior longitudinal ligament appears intact.\n\nThe preceding CT demonstrates a nondisplaced fracture involving the right L4\nposterior elements common specifically the transverse process, pedicle,\nlamina, pars interarticularis and the articular facet, extending into the\nright L3-4 and L4-5 facet joints. A tiny freed cortical fracture fragment is\nseen in the medial aspect of the right L4-5 facet joint on the preceding CT. \nThe present MRI demonstrates edema along the fracture lines, as well as fluid\nsignal in the right L4-5 facet joint. Mild widening of the superior aspect of\nthe right L4-5 facet joint is again seen, similar to the CT.\n\nThere is edema in bilateral posterior paravertebral muscles of the lumbar\nspine.\n\nThe distal spinal cord demonstrates normal signal intensity, with the conus\nmedullaris terminating at the lower aspect of L1.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-2: Mild disc bulge. Moderate facet arthropathy. No significant spinal\ncanal narrowing. No significant neural foraminal narrowing is seen, but\nevaluation is limited by the scoliosis.\n\nL2-3: Mild to moderate disc bulge with endplate osteophytes and moderate\nfacet arthropathy. Right subarticular zone is narrowed with impingement of\nthe traversing right L3 nerve root. Thecal sac is mildly narrowed without\nmass effect on the intrathecal nerve roots. No significant neural foraminal\nnarrowing is seen, but evaluation is limited by the scoliosis.\n\nL3-4: Mild retrolisthesis. Moderate disc bulge and facet arthropathy. Right\ngreater than left subarticular zone narrowing with impingement of the\ntraversing right L4 nerve root and abutment of the traversing left L4 nerve\nroot. The thecal sac is mildly narrowed with mild crowding of the intrathecal\nnerve roots. Mild bilateral neural foraminal narrowing.\n\nL4-5: Mild retrolisthesis with a moderate disc bulge and moderate to severe\nfacet arthropathy, as well as thickening of the ligamentum flavum. Severe,\nleft greater than right subarticular zone narrowing with compression of the\ntraversing left L5 nerve root and impingement of the traversing right L5 nerve\nroot. Moderate thecal sac narrowing with crowding of the intrathecal nerve\nroots. Mild to moderate right and severe left neural foraminal narrowing with\nabutment of the exiting left L4 nerve root.\n\nL5-S1: Disc bulge with endplate osteophytes, larger on the left. Moderate\nfacet arthropathy. Left subarticular zone is narrowed with abutment of the\ntraversing left S1 nerve root. The remainder of the spinal canal is not\nsignificantly narrowed. Moderate right and moderate to severe left neural\nforaminal narrowing with abutment of bilateral exiting L5 nerve roots.\n\nMarrow signal in the visualized upper sacrum and medial iliac bones is\ndiffusely heterogeneous without evidence for concerning focal lesions on STIR\nimages.", "output": "1. L4-5 anterior osteophyte fractures with minimal prevertebral edema, which\nmay involve the anterior longitudinal ligament.\n2. Allowing for ___ type 1 discogenic marrow changes in the endplates at\nL3-4 and L4-5, no vertebral body fracture is seen. Posterior longitudinal\nligament is intact.\n3. Right L4 pedicle, lamina, pars interarticularis and articular facet\nfractures extending into the right L3-4 and L4-5 facet joints. The right L4-5\nfacet joint is slightly widened superiorly, unchanged compared to the\npreceding CT, and it contains fluid.\n4. Bilateral posterior paravertebral muscle edema in the lumbar spine.\n5. Scoliosis and multilevel degenerative disease with mild crowding of the\nintrathecal nerve roots at L3-4 and moderate crowding of the intrathecal nerve\nroots at L4-5, as well as mass effect on multiple traversing and exiting nerve\nroots, as detailed above." }, { "input": "The obtained sagittal images are limited by motion artifacts, particularly the\nfat-suppressed T2 weighted images.\n\n___ neck CTA demonstrates that C4 and C5 vertebral bodies\npreviously demonstrated loss of height, with marked endplate irregularities at\nthe C4-5 interspace suggesting sequela of prior infection, or less likely\nrheumatoid arthritis. The preceding CT from ___ demonstrates\nfurther flattening of C4 and C5 vertebral bodies. The present MRI demonstrates\nbone marrow edema. In the region of the C4-5 disc space, as well as\nprevertebral edema from C2 through C6-7. Anterior and posterior longitudinal\nligaments appear disrupted on image 4:11.\n\nThe preceding ___ CT also demonstrates a nondisplaced fracture\nthrough the posterior superior corner of the C7 vertebral body. The present\nMRI demonstrates only mild bone marrow edema through the fracture line,\nsuggesting that the fracture may not be acute. There is a C7 spinous process\nfracture which demonstrates corticated margins on the preceding CT. However,\nthere is associated soft tissue edema adjacent to the fracture fragments, as\nwell as edema in the adjacent paravertebral muscles.\n\nThere appears to be interspinous and left paravertebral edema at C2-3. ___ CT demonstrates progressive erosive changes in the right\n(contralateral) C2-3 facet joint compared to ___, suggesting\nsequela of rheumatoid arthritis or infection. There is associated high T2\nsignal along the right C2-3 facet joint.\n\nThere is persistent kyphotic angulation at C4-5 as well as multilevel\ndegenerative disease. There is a spinal canal narrowing from C2-3 through\nC6-7, worst at C4-5, with abutment of the spinal cord at C4-5. No definite\ncord edema is detected on motion limited evaluation.\n\nThere is a disc herniation at T2-3 with mild spinal canal narrowing.\n\nCerebellar tonsils are normally positioned.", "output": "1. Incomplete exam with sagittal images only. The obtained sagittal images are\nlimited by motion artifacts.\n2. Compared to ___, there is increased collapse of C4 and C5\nvertebral bodies and persistent kyphotic angulation at C4-5. Preexisting\nirregularity within the C4-5 endplates could be related to prior infection or,\nless likely, rheumatoid arthritis. Currently, there is edema in the C4-5 disk\nspace, likely posttraumatic, given the presence of prevertebral edema and\ndisruption of the anterior and posterior longitudinal ligaments. The spinal\ncanal at C4-5 is moderately narrowed with abutment of the spinal cord, but no\nclear evidence for cord edema on limited assessment.\n3. Nondisplaced fracture through the posterior superior corner of the C7\nvertebral body demonstrates only mild bone marrow edema, suggesting that the\nfracture may not be acute. T7 spinous process fracture demonstrates corticated\nmargins on CT, suggesting that it is not acute, but there is associated soft\ntissue edema.\n4. Apparent interspinous and left paravertebral edema at ___ be\nposttraumatic. CT demonstrates progressive erosive changes in the\ncontralateral right C2-3 facet joint, with associated high T2 signal on the\npresent MRI, which may be related to rheumatoid arthritis or infection." }, { "input": "The conus terminates at the L1-2 level. No intraspinal mass or nerve root\nabnormal enhancement is seen.\n\nPost-surgical changes are seen at L4-5. Mixed signal abnormality is seen at\nthe posterior elements and interspinous region with a mixture of low signal\nintensity areas compatible with susceptibility in addition to a small area of\nfluid signal intensity in the interspinous region (series 2, image 9) with the\nfluid component lessened from the prior exam. There is granulation tissue at\nthe surgical site in the interspinous region which demonstrates enhancement. \nThis has lessened compared to prior examination. Very minimal extension of\nthis granulation tissue to the posterior aspect of the spinal canal is seen \nwith a faint area of enhancement along the left lateral aspect of the\nposterolateral canal close to the posterior aspect of the left L5 nerve root\nbut without any definite encasement or impingement. These findings have\nimproved compared to prior exam. At L4-5, there is disc desiccation and there\nis a small left lateral disc osteophyte complex (series 2, image 6) which\nminimally narrows the neural foramen on the left without any evidence of nerve\nroot impingement. The remainder of the L4-5 disc is desiccated with mild\ndiffuse disc bulge. No central canal stenosis is seen at this level.\n\nMild diffuse disc bulge is unchanged in addition to disc desiccation at L3-4. \nNo central canal or neural foramen stenosis is seen at this level. Remaining\nlevels demonstrate no significant disc protrusion or foraminal stenosis.\n\nMild lumbar spine facet joint degeneration is seen at L4-5.\n\nNo prevertebral soft tissue mass is seen. Incidentally noted is a high signal\ninterpolar region lesion at the posterior aspect of the left kidney measuring\n13 mm, likely reflecting simple cyst, though not completely characterized on\nthis study.", "output": "1. Post-surgical changes at L4-5 where there is granulation tissue in the\nposterior surgical defect with minimal extension into the left posterior\naspect of the spinal canal with enhancement of granulation tissue as described\nabove, but these findings have lessened compared to prior examination and\nthere is no clear evidence of nerve root encasement or impingement.\n\n2. Mild degenerative discogenic change with mild diffuse disc bulge at L3-4\nand L4-5.\n\n3. Small disc osteophyte complex posterolaterally on the left at L4-5 with\nminimal neural foraminal narrowing but no evidence of nerve root impingement.\n\n4. Left renal lesion likely reflects cyst but is not fully characterized on\nthis study." }, { "input": "From T11-T12 through L2-3 new abnormalities identified.\n\nDisc degenerative changes seen. Without spinal stenosis or foraminal\nnarrowing.\n\nAt L4-5 previous postsurgical changes are seen. There is mild disc bulging.\nAlthough contrast enhanced study was not performed, there is no interval\nchange in the appearance of the spinal canal at this level since the previous\nMRI. No spinal stenosis is seen. Mild narrowing of the left foramen is again\nnoted.\n\nAt L5-S1 level no abnormalities are seen. The distal spinal shows normal\nsignal intensity. The paraspinal soft tissues are unremarkable.", "output": "No significant interval change since the previous MRI. Mild degenerative\nchanges seen. No evidence of spinal stenosis or nerve root compression." }, { "input": "Alignment is anatomic. Vertebral body heights are preserved. Bone marrow\ndemonstrates normal signal characteristics. There is minimal degenerative\ndisc signal, most notable at C3-C4. There are no cord signal abnormalities\nwithin the cervical and included upper thoracic spine. The cerebellar tonsils\nare normally positioned, and the visualized posterior fossa appears\nunremarkable. 12 mm oblong T2 hyperintense, T1 iso-to-minimally-hyperintense\nenhancing lesion within the right spinal cord traversing the C3 and C4 levels\n(4:10, 6:11) and 6 mm oblong mildly T2 hyperintense, T1\niso-to-minimally-hyperintense lesion with subtle enhancement within the right\nspinal cord (401:9, 6:5) at the C2 level are compatible with demyelinating\nplaques.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\n\nC3-C4: Mild disc protrusion mildly indents the ventral thecal sac without\nsignificant spinal canal narrowing. There is no neural foraminal stenosis.\n\nC4-C5: Minimal disc protrusion minimally indents the ventral thecal sac\nwithout significant spinal canal narrowing. There is no neural foraminal\nstenosis.\n\nC5-C6: Mild disc protrusion mildly indents the ventral thecal sac without\nsignificant spinal canal narrowing. There is no neural foraminal stenosis.\n\nC5-C6: No significant spinal canal or neural foraminal narrowing.\n\nC6-C7: Minimal disc protrusion minimally indents the ventral thecal sac\nwithout significant spinal canal narrowing. There is no neural foraminal\nstenosis.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nT1-T2: No significant spinal canal or neural foraminal narrowing.\n\nT2-T3: No significant spinal canal or neural foraminal narrowing.\n\nExtravertebral soft tissues are grossly unremarkable. There is no\nparavertebral or paraspinal soft tissue signal abnormality. There is no\ncervical lymphadenopathy by size criteria. Visualized lung apices are\nunremarkable.", "output": "1. Two oblong T2 hyperintense, T1 iso-to-minimally hyperintense enhancing\nlesions within the right spinal cord, the larger measuring 12 mm traversing\nthe C3-C4 levels and the smaller measuring 6 mm at the C2 level, are\ncompatible with demyelinating plaques.\n2. Mild degenerative disc disease, as detailed above. No significant spinal\ncanal narrowing or neural foraminal stenosis." }, { "input": "The numbering of the vertebral bodies is based on prior PET-CT from ___\nand CT abdomen and pelvis from ___. Based on these studies, there\nare 11 rib-bearing vertebral bodies with a rudimentary rib at T12 and 4 lumbar\nvertebrae with sacralized L5 vertebrae.\n\nThere is grade 1 anterolisthesis of L4 on L5. The alignment of the lumbar\nspine is otherwise maintained.\n\nThere is a left para-aortic soft tissue mass involving the left psoas muscle\nmeasuring approximately 3.5 x 4.6 x 7.8 cm on image 5:17 and 2:18. This is\nlikely metastatic from patient's known endometrial cancer. The mass is\nencasing and obstructing the left ureter causing moderate left-sided hydro\nnephrosis. This is relatively unchanged compared to the recent prior CT. \nThis mass is also invading the L2 vertebrae along the left lateral aspect. \nThe soft tissue mass is also extending into the L1-L2 left neural foramen on\nimage 5:13 and L2-L3 left neural foramen on image 6:6. Also seen is enhancing\nsoft tissue mass in the epidural space extending posteriorly from the left\nposterior lateral aspect of L2 vertebrae and the left pedicle indenting the\nventral thecal sac as seen on image 6:4 and 10:4.\n\nThe visualized lower spinal cord appears unremarkable. The conus terminates\nat L1-L2 and is unremarkable.\n\n At T12-L1 there is there is mild loss of disc signal. Disc height is\nmaintained. No spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is there is mild loss of disc signal. Disc height is\nmaintained.No spinal canal or neural foraminal stenosis.\n\nAt L2-3 there is there is mild loss of disc height and signal with broad-based\ndisc bulge with left para-aortic soft tissue mass extending into the left\nneural foramen causing narrowing of the spinal canal posterior to the\nvertebral body and medial to the pedicle and mild narrowing of left neural\nforamen.No spinal canal stenosis..\n\nAt L3-4 there is there is mild loss of disc height and signal with broad-based\ndisc bulge, moderate bilateral facet arthropathy and ligamentum flavum\nthickening with the left para-aortic soft tissue mass extending into left\nsubarticular recess causing impingement of the traversing L4 nerve root.Mild\nspinal canal stenosis with indentation of the ventral thecal sac..\n\nAt L4-5 there is loss of disc height and signal with broad-based disc bulge,\nmoderate bilateral facet arthropathy causing mild left neural foraminal\nnarrowing the combination of subluxation and degenerative changes produces\nsevere spinal stenosis at this level.\n\nAt L5-S1 there is loss of disc height and signal with broad-based disc bulge\ncausing mild bilateral neural foramen narrowing.No spinal canal stenosis.", "output": "1. Left para-aortic soft tissue mass involving the left psoas muscle invading\nthe L2 vertebral body, extending into the left paracentral epidural space at\nthe level of L2 and extending into L1-L2 and L2-L3 left neural foramen causing\nnarrowing of the spinal canal as described above.\n2. Obstructive moderate left hydroureteronephrosis, secondary to the\nencasement of left ureter by the left para-aortic mass.\n3. Mild multi-level multifactorial degenerative disease of the lumbar spine as\ndescribed above. This includes severe spinal stenosis at L4-5." }, { "input": "The study is nearly nondiagnostic due to severe motion artifact. \nAdditionally, postcontrast images were not obtained due to excessive motion.\n\nOn this limited examination, a subcutaneous T2 hyperintense fluid collection\noverlying the surgical site is again seen, measuring 13.2 x 3.2 x 7.4 cm,\npreviously 14.8 x 3.0 x 9.8 cm. As before, this appears to connect\npredominantly inferiorly to a deeper fluid collection surrounding the surgical\nhardware about the posterior elements with multiple T2 hypointense septae the\nthat measures 6.0 x 2.8 x 3.1 cm, previously 11.6 x 4.2 x 8.3 cm. As before,\nthe collection does appear to continue to abut the dura (03:11). The\npreviously noted extruded L5-S1 disc is similar in appearance given the\nlimitations of this examination. As before, this disc extrusion in\ncombination with the overlying fluid collection results in moderate to severe\ncanal narrowing, although complete assessment is limited due to severe motion\ndegradation (03:11).", "output": "1. Severely limited, nearly nondiagnostic examination due to respiratory\nmotion artifact and the absence of intravenous contrast.\n2. Re-demonstrated postoperative fluid collection in the subcutaneous soft\ntissues, but also extending into the laminectomy bed and abutting the dura. \nOverall, the collection is minimally changed, possibly slightly decreased in\nsize although measurement differences could be related to technique. \nInfection or CSF leak is impossible to exclude.\n3. Overall similar appearance of L5-S1 extruded disc resulting in moderate to\nsevere canal narrowing, although the precise degree of narrowing is not\npossible to determine given the severe motion degradation." }, { "input": "Study is severely degraded by motion and spinal fusion hardware artifact.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis lumbar spine. There is approximately 2 mm L3 on L4\nanterolisthesis.\n\nPatient is status post lumbar fusion and decompression with laminectomy,\nintervertebral spacers, and posterior spinal fusion hardware with extensive\nassociated artifact noted. Chronic compression deformity of L1 is unchanged. \nSchmorl's nodes are again seen at multiple levels throughout the thoracic and\nlumbar spine. L4 vertebral body probable hemangioma is noted.\n\nAgain seen is a large subcutaneous T2 hyperintense fluid collection with\nnumerous internal septa, overall measuring 14.8 x 3.0 x 7.7 cm, previously\nmeasuring 13.2 x 3.2 x 7.4 cm on ___, and 14.8 x 3.0 x 9.8 cm on ___. The collection appears to connect inferiorly with a deeper T2\nhyperintense fluid collection within the surgical bed surrounding the surgical\nhardware (series 6, image 34) however the connection is not well appreciated\non this exam. The deeper collection within the surgical bed has decreased in\nsize compared to prior and measures approximately 7.7 x 2.4 x 5.1 cm,\npreviously measuring 11.6 x 4.2 x 8.3 cm in ___. This collection extends to\nand abuts the dura inferiorly (series 6, image 29), improved compared to\nprior.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Findings suggestive of nonspecific lumbar nerve root thickening is\nagain seen. Within limits of study could no definite focal enhancement of\nlumbar nerve roots is seen.\n\nThere is loss of intervertebral disc height and signal at T12-L1 and L1-2.\n\nAt the L5-S1 intervertebral disc space there is again noted nonspecific fluid\ncollection with minimal prevertebral extension (see 04:14 on current study and\n3:9 on ___ prior exam). Postcontrast imaging, this fluid collection\ndemonstrates peripheral enhancement (see 3, 4, 5, 10:10; 6, 7, 9: 33-38).\n\nAt L5-S1 again is noted soft tissue density at posterior margin, abutting the\nventral thecal sac, with peripheral enhancement suggested on postcontrast\nimaging (see 3, 4, 5, 10:10 on current study and 2, 3, 4:9 on ___\nprior exam). This structure again cause moderate to severe spinal narrowing\nat this level with suggested contact of the nerve roots posteriorly (series 3,\nimage 11). Question additional approximately 8 mm peripherally enhancing\nepidural collection contiguous with the structure (see 4, 5, 10:13).\n\n Artifacts limit evaluation for lumbar spine neural foraminal evaluation.\n\n Limited imaging the kidneys demonstrate bilateral at least partially T2\nhyperintense structures, incompletely characterized. Extensive edema is noted\nthroughout the lumbar paraspinal muscles. Question minimal nonspecific\nenhancement of the right psoas muscles at the L3-4 level (see, 7, 09:22).", "output": "1. Study is severely degraded by motion and spinal fusion hardware artifact.\n2. Previously described large loculated fluid collection in the subcutaneous\ntissue and laminectomy bed appears to have decreased in size and may represent\nresolving postoperative seroma, although CSF leak or superinfection cannot be\nexcluded on the basis of this examination.\n3. L5-S1 intervertebral disc space soft tissue density with peripheral\nenhancement abutting ventral thecal sac in two locations, as described. While\nfinding may represent disc extrusion with disc sequestration and adjacent\ngranulation tissue, abscesses are not excluded on the basis of this\nexamination.\n4. Peripherally enhancing collection at L5-S1 intervertebral disc space with\nprevertebral extension as described. Question corresponding fluid collection\nto be present on ___ prior exam, though comparison is limited due to\nlack of prior contrast lumbar spine MRI. Findings concerning for abscess,\nwith differential consideration of degenerative or postoperative changes.\n5. Nonspecific lumbar nerve root thickening without definite focal enhancement\nas described. Please note that arachnoiditis is not excluded on the basis\nexamination.\n6. Question minimal nonspecific enhancement of the right psoas muscles at the\nL3-4 level.\n7. Grossly stable chronic L1 compression deformity.\n8. Limited imaging the kidneys demonstrate bilateral at least partially\ncystic structures, incompletely characterized." }, { "input": "Study is severely degraded by motion and metallic fusion hardware artifact. \nWithin these confines:\n\nFor the purposes of numbering, the lowest rib-bearing vertebral body with\ndescending to the T12 level.\n\nThe patient is status post lumbar fusion with laminectomy, intervertebral disc\nspacers, and posterior spinal fusion hardware with extensive associated\nartifact again noted. There is redemonstration of known chronic compression\ndeformity of the L1 vertebral body, unchanged. Multilevel Schmorl's nodes are\nagain noted.\n\nThere is interval decrease in the size of the previously seen large\nsubcutaneous T2 hyperintense fluid collection containing multiple septation\nwithin the soft tissues overlying the lumbar spine measuring 11.3 x 2.0 x 4.3\ncm, previously measuring 14.8 x 3.0 x 7.7 cm (4:10, 6:25). There is also\ninterval decrease in the previously seen T2 hyperintense fluid collection\nwithin the surgical bed surrounding the surgical hardware measuring 5.1 x 2.3\nx 3.9 cm, previously measuring 7.7 x 2.4 x 5.1 cm (4:10, 6:32). The\ncollection again extends anteriorly and inferiorly abutting the dura at the\nlevel of L5-S1. No new fluid collections are identified.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. There is no definite evidence of lumbar nerve root enhancement.\n\nThere is redemonstration loss of intervertebral disc height and signal at\nT12-L1 and L1-L2, unchanged.\n\nFrom T12-L1 to L4-L5 there is no definite evidence of vertebral canal\nnarrowing.\n\nAt L5-S1 there is redemonstration of a nonspecific fluid collection with\nminimal prevertebral extension, not significantly changed compared to prior\nstudy (04:10). Additionally, there is a peripherally enhancing, soft tissue\ndensity along the posterior margin of L5-S1, which abuts the ventral thecal\nsac causing moderate to severe vertebral canal narrowing at this level with\nlikely contact of the nerve roots posteriorly (8:9). This is not\nsignificantly changed compared to prior study. With no vertebral canal and no\nneural foraminal narrowing.\n\nHardware artifact limits evaluation for neural foraminal narrowing at all\nlevels.\n\nThere are bilateral T2 hyperintense cystic lesions in the bilateral kidneys,\nincompletely characterized. Edema is again noted in the paraspinal muscles in\nthe lumbar spine.\n\nOn limited imaging the pelvis, question 2.4 cm right adnexal T2 hyperintense\nstructure versus artifact (see 06:43).", "output": "1. Study is severely limited by motion and spinal hardware artifact.\n2. Compared to ___ prior exam, grossly stable large loculated fluid\ncollections in the subcutaneous tissue overlying the lumbar spine and within\nthe lumbar spine laminectomy bed, decreased in size from prior study,\ncompatible with resolving postoperative seroma. However, CSF leak or\nsuperinfection cannot be excluded.\n3. Grossly stable appearance of the L5-S1 intervertebral disc space\nperipherally enhancing soft tissue density abutting the ventral thecal sac,\nwhich may represent a disc extrusion with adjacent granulation tissue. \nHowever, abscess cannot be definitively excluded.\n4. Peripherally enhancing collection at the L5-S1 intervertebral disc space\nwith prevertebral extension is again seen and unchanged from prior study. \nFindings again may represent abscess or postoperative change.\n5. No new focal fluid collections identified.\n6. Stable L1 compression deformity.\n7. T2 hyperintense cystic lesions in the kidneys, incompletely characterized.\n8. On limited imaging the pelvis, question 2.4 cm right adnexal cystic\nstructure versus artifact. If clinically indicated, consider dedicated pelvis\nMRI or ultrasound for further evaluation." }, { "input": "THORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There are multilevel disc protrusions and facet arthropathy\nthroughout the thoracic spine with no evidence of significant spinal canal or\nneural foraminal stenosis. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nThere is anterolisthesis of L3 on L4 with partial osseous fusion at this level\nand disc space height loss. Posterior fusion is seen from L1 - 5 on the right\nand L1-L4 on the left. Laminectomy changes at these levels are also seen. \nInterbody spacers are seen at L4- L5. Fractured pedicular screws are seen at\nright L5 and left L3 levels. There is a linear defect in the superior\nendplate of the L1 vertebral body containing T2 hyperintense fluid with\nperipheral T1 hypo intense signal and contrast enhancement of the adjacent\nbone marrow but not within this fluid. There is a 1.6 cm AP x 2 cm TR x 5.6\ncm SI peripherally enhancing collection in the posterior subcutaneous soft\ntissues. This area directly communicates with a second deeper 5.1 cm AP x 8.6\ncm TR x 10.7 cm SI T2 hyperintense peripherally enhancing collection in the\nparaspinal spaces which extends around the hardware and adjacent to the dorsal\nepidural space, however there appears to be well demarcated fat plane between\nthe epidural space and the collection. The paraspinal collection results in\nmass effect and distortion of the thecal sac and moderate to severe spinal\ncanal stenosis at the level of L1-L2. No abnormal contrast enhancement is\nnoted extending into the thecal sac or within the spinal cord. No abnormal\nsignal seen in the psoas muscles.\n\nThere is a heterogeneous mildly T2 hyperintense lesion with a ramp of T2/T1\nhypo intense signal in the right ilium which likely represents a benign\nosseous lesion such is an enchondroma.\n\nOther: Multiple T2 hyperintense lesions are noted in the right kidney, likely\nrepresenting cysts.", "output": "1. Mild multilevel degenerative changes throughout the thoracic spine.\n2. Postsurgical changes in the lumbar spine, as described above, with\nfractured screws seen at the right L5 and left L3 levels.\n3. Directly communicating subcutaneous and paraspinal fluid collections at the\nsurgical site around the hardware which comes in close proximity and distorts\nbut does not appear to extend into the thecal sac resulting in moderate to\nsevere spinal canal stenosis at L1-2. These fluid collections may represent\ninfection versus complicated seromas.\n4. Linear defect in the superior endplate of the L1 vertebral body containing\nfluid and abnormal surrounding bone marrow signal which is consistent with a\nsubacute/chronic fracture. Superimposed infection cannot be excluded given\nthe surrounding abnormal bone marrow signal." }, { "input": "Moderately motion and metal artifact degraded exam. Posterior fusion T10-L4,\nmultilevel disc spacers. L4-5 disc spacer.. Lower thoracic-L5 laminectomy.. \nNo vertebral body or paraspinal edema. No worrisome osseous lesions. Minimal\nanterolisthesis L2-L3, L3-L4, stable since ___. Multilevel\ndegenerative changes, mild diffuse disc bulges, lumbar facet arthritis. Small\nfluid collection at the laminectomy bed at L1-L3, similar to prior, likely\npostsurgical. Normal visualized cord. Stable mild L1 vertebral body height\nloss, no associated edema.\n\nAt L1-L2, patent central canal. Mild-to-moderate bilateral foraminal\nnarrowing, similar.\n\nAt L2-L3, patent central canal. Probably mild bilateral foraminal narrowing.\n\nAt L3-L4,, patent central canal. Mild-to-moderate bilateral foraminal\nnarrowing, similar.\n\nAt L4-5, patent central canal. Mild-to-moderate right foraminal narrowing,\npatent left foramina, similar.\n\nAt L5-S1, there is new large right paramedian, superior disc extrusion, it\nmeasures 1.5 cm in AP diameter. Mass effect on traversing right L5, S1\nnerves. Mild central canal narrowing. Severe bilateral foraminal narrowing,\nadvanced facet arthritis, similar. New bright T2 signal within L5-S1 disc\nspace, likely degenerative/reactive, no endplate edema, no paraspinal edema.\n\nParaspinal muscle atrophy. Tiny benign simple cyst right kidney, no further\nfollow-up is indicated. No arachnoiditis.", "output": "1. New large right paramedian, superior disc extrusion L5-S1 level, mass\neffect on traversing right L5, S1 nerves, mild central canal narrowing.\n2. Postoperative, degenerative changes lumbar spine.\n3. Severe bilateral L5-S1 foraminal narrowing, similar.\n4. Remainder as above." }, { "input": "Sagittal T1 weighted and STIR images of the lumbar spine were performed. \nImages are degraded by motion and metal artifact.\n\nPostsurgical changes of posterior spinal fusion from T10 through S1 with\nmultilevel disc spacers. There are new posterior spinal fusion changes at\nL5-S1 compared to the prior exam.\n\nWithin the dorsal subcutaneous tissues, there is a STIR hyperintense, T1\nhypointense fluid collection measuring 17.6 cm SI x 3.9 cm AP, which is\nincreased compared to prior exam where it measured 7.4 SI x 2 cm AP.\n\nAdditionally, a deeper fluid collection in continuity with the thecal sac is\nalso increased from prior exam. There is suggestion of communication of the\nsuperficial and deeper fluid collections at the level of S1-S2 (image 15 of\nseries 2).", "output": "1. Limited imaging of the lumbar spine due to patient's inability to continue\nwith the exam. Recommend further evaluation with and without contrast when\nthe patient is amenable.\n2. Interval increase in size of the superficial and deeper fluid collections\nwith suggestion of communication at the level of S1-S2. While a CSF leak is a\nconsideration, a postoperative seroma is also in the differential. A\nsuperimposed infectious process cannot be excluded." }, { "input": "Examination is extremely limited secondary to motion, despite patient\nsedation.\n\nSince prior MRI on ___, interval postop changes now seen extending\ninferiorly to the S1 level.\n\nThere is a large T2 hyperintense fluid collection within the subcutaneous\ntissues measuring 17 cm cc x 3.7 cm AP x up to 15 cm TRV. Additionally, the\ndeeper soft tissues in the laminectomy bed is an additional T2 hyperintense\ncollection measuring approximately 12.5 cm cc by up to 6.1 cm TRV and 3.1 cm\nAP at the laminectomy site at the L5-S1 level. There is T2 hyperintensity\nnoted within the L5-S1 disc.\n\nThere is a 1.2 x 2.0 cm T2 hypointense lesion in the ventral epidural region\nposterior to L5 vertebral body,. This corresponds with disc extrusion seen on\nMRI dated ___. In combination with the fluid collection in the\npostoperative bed, there is moderate secondary canal narrowing. Elsewhere, no\nevidence of critical canal narrowing. Cannot assess the neural foramen\nsecondary to image quality and artifact.", "output": "Limited exam secondary to significant motion, obscuring details.\nThere is a large T2 hyperintense collection in the posterior subcutaneous\ntissues as well as in the post laminectomy bed.\nPersistent right central L5-S1 disc extrusion." }, { "input": "Moderate to severely motion limited exam. Post lumbar fusion and decompression\nwith laminectomy, intervertebral spacers, and posterior spinal fusion hardware\nwith extensive associated artifact noted. Chronic compression deformity of L1\nappears unchanged. No evidence of new malalignment.\n\nAgain seen is a large subcutaneous T2 hyperintense fluid collection with\nnumerous septa soft loculations which measures approximately 14.8 x 3.0 x 9.8\ncm (previously 17 x 3.7 x 15 cm). This connects both superiorly and\ninferiorly (series 5, image 13; 31) with a deeper T2 hyperintense fluid\ncollection within the surgical bed surrounding the surgical hardware which\nmeasures approximately 11.6 x 4.2 x 8.3 cm (previously 12.5 x 3.2 x 6.1 cm). \nAs seen previously, this collection extends to and abuts the dura inferiorly\nas well as superiorly on the left (series 5, image 16; 27).\n\nDisc extrusion (best delineated on lumbar spine MRI performed on ___ and\npostoperative fluid collection posterior to L5 and at L5-S1 appears to cause\nat least moderate to severe spinal canal narrowing (series 2, image 8)\nalthough axial images are severely degraded. Assessment for infection is\nlimited without intravenous contrast.", "output": "1. Extremely limited exam due to motion and lack of intravenous contrast.\n2. Redemonstrated large loculated postoperative fluid collection in the\nsubcutaneous tissue and laminectomy bed which may represent a postoperative\nseroma although CSF leak or superinfection cannot be excluded by this\nexamination.\n3. At least moderate to severe spinal canal narrowing due to disc extrusion\nand postoperative fluid collection at L5-S1." }, { "input": "Alignment is normal. Intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof infection or neoplasm.\nThere are degenerative changes in the lumbar spine, with multilevel diffuse\ndisc bulges, lumbar facet arthritis. There is fluid within bilateral L4-5\nfacet joints, more prominent on the left. Reactive degenerative type\nposterior element mild edema at L5 level, more prominent compared with prior\nexam. There are mild endplate reactive degenerative changes at L5-S1 level. \nL4-5 disc space narrowing is more prominent today compared with prior exam. \nL5-S1 disc space narrowing is similar. There are few benign small perineural\ncysts at S2 level, largest measures 1.2 cm. There is minimal grade 1 L4-5\nanterolisthesis, new since prior exam, degenerative in etiology. There is\nsmall benign cyst along the posterior margin between L4 and L5 spinous\nprocesses, degenerative in etiology. There is small benign simple cyst in\nleft kidney, similar compared with CT thoracic spine ___.\nAt L1-L2, L2-L3 levels central canal and foramina are patent.\nL3-L4 level: There is mild central canal narrowing, stable. Bilateral\nforamina are patent.\nL4-5 level: There is tiny broad-based central disc protrusion, new. There is\nmild central canal narrowing, with partial encroachment on intrathecal\nsegments bilateral traversing L5 nerves, more prominent compared the prior\nexam. There is moderate left foraminal narrowing sagittal image 15 series 2,\nmore prominent. There is mild right foraminal narrowing, stable.\nL5-S1 level: There is diffuse disc bulge with endplate hypertrophic changes\nwith mild central canal narrowing, and mild encroachment on traversing left S1\nnerve root sleeve, minimally more prominent. There is moderate bilateral\nforaminal narrowing, stable.", "output": "1. There are degenerative changes in the lumbar spine, which have mildly\nworsened.\n2. There is mild central canal narrowing at L3-L4, L4-5, L4-5, L5-S1 levels.\n3. There is moderate left L4-5, moderate bilateral L5-S1 foraminal narrowing." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. Intervertebral disc signal and\nheights are preserved. Within the limits of this noncontrast study there is\nno evidence of infection or neoplasm. There is no prevertebral soft tissue\nswelling.. The visualized portion of the posterior fossa, cervicomedullary\njunction, paranasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is no spinal canal or neural foraminal stenosis.\n\nAt C4-5 there is disc protrusion withno spinal canal or neural foraminal\nstenosis.\n\nAt C5-6 there is disc protrusion withno spinal canal or neural foraminal\nstenosis.\n\nAt C6-7 there is no spinal canal or neural foraminal stenosis.\n\nAt C7-T1 there is disc protrusion withno spinal canal or neural foraminal\nstenosis. Small left perineural cyst is seen at this level.\n\nAt T1-T2 level, bilateral perineural cysts are visualized, there is no\nevidence of spinal canal stenosis.", "output": "1. Minimal degenerative changes in the cervical spine with no significant\nspinal canal or neural foraminal stenosis.\n2. No evidence for ligamentous or cord injury." }, { "input": "Thoracic vertebral bodies are maintained in height and alignment. There is\ndiffuse heterogeneity of the bone marrow signal. Discrete T1 and T2\nhypointense lesions are seen in multiple vertebral bodies with the largest in\nthe T8 vertebral body, measuring 1.2 cm. Additional discrete lesions\nidentified within T9, T11, and L1. Degenerative bone marrow signal changes\nseen at the endplates adjacent to the T11-T12 intervertebral disc which\ndemonstrates desiccation and height loss, most significantly at its anterior\nmargin. There is associated focal accentuated thoracic kyphosis at this\nlevel. Intervertebral disc height loss is also noted T7-T8 and T8-T9.\n\nThe visualized spinal cord is preserved in signal and caliber.\n\nAt T11-T12, there is a small disc bulge which partially effaces the ventral\nCSF and causes overall mild canal narrowing. There is also mild to moderate\nleft foraminal narrowing and minimal right foraminal narrowing.\n\nOtherwise, there is no significant canal or foraminal narrowing. There is T1\nand T2 hypointense signal just posteromedial to the T5-T6 left facet which\ncould be due to focal ligamentum flavum thickening/calcification. At T7-T8\nand T8-T9 there are small disc bulges without significant canal narrowing. \nPerineural cysts seen bilaterally at T1-T2 and C7-T1.\n\nA subcentimeter T2 hyperintense focus at the dome of the liver on the right\nmay represent a cyst or hemangioma. Included paraspinal soft tissues are\nunremarkable.", "output": "Degenerative changes most notably at T11-T12 where there is mild canal\nnarrowing and moderate left foraminal narrowing. Otherwise, no significant\ncanal or foraminal narrowing.\nHeterogeneous bone marrow signal with focal lesions as described above, most\nconspicuous in the T8 vertebral body. Underlying infiltrative process such as\nmultiple myeloma or metastatic disease would be of concern. Consider\ncorrelation with SPEP/UPEP and CT of the thoracic spine for further\ncharacterization." }, { "input": "Vertebral body heights and alignment are preserved. Diffuse heterogeneity of\nthe bone marrow likely represents a combination of degenerative change and\nfatty marrow conversion, as there is no definitive abnormal STIR hyperintense\nsignal. Otherwise no suspicious focal bone marrow lesion is identified.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease. There is moderate to severe disc height loss at\nthe T11-T12 level, as seen previously. The remainder the intervertebral disc\nheights are relatively well preserved.\n\nThe visualized distal spinal cord is preserved in signal and caliber. The\nconus medullaris terminates at the L1-L2 level.\n\nMultilevel facet joint degenerative changes are seen, with trace effusions at\nmultiple levels.\n\nSagittal view of T11-T12 demonstrates disc bulge mildly narrowing the spinal\ncanal with mild remodeling of the ventral cord, unchanged. Foraminal\ncomponent of disc and facet osteophytes produce mild right neural foraminal\nnarrowing. The left neural foramen is patent.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L 2, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-L3, disc bulge indents the ventral thecal sac without significant spinal\ncanal narrowing. The neural foramina are patent.\n\nAt L3-L4, disc bulge indents the ventral thecal sac without significant spinal\ncanal narrowing. Facet and endplate osteophytes produce minimal bilateral\nneural foraminal narrowing.\n\nAt L4-L5, disc bulge indents the ventral thecal sac without significant spinal\ncanal narrowing. Facet and endplate osteophytes produce mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is trace central disc protrusion without significant spinal\ncanal narrowing. The neural foramina are patent.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Overall mild lumbar spondylosis, as described, without significant spinal\ncanal narrowing, and only up to mild neural foraminal narrowing at the\nbilateral L4-L5 level.\n2. Moderate to severe disc height loss at T11-T12 with disc bulge mildly\nnarrowing the spinal canal, unchanged compared to the dedicated thoracic MR\nexamination from ___.\n3. The marrow signal is diffusely T1 heterogeneous, without definitive STIR\nsignal abnormality. This may be seen in the setting of reconversion and\nclinical correlation is recommended. Please refer to earlier MRI thoracic\nspine for additional details and recommendations." }, { "input": "Vertebral body heights are preserved. Alignment is normal. No suspicious\nbone marrow signal abnormalities are seen. The cerebellar tonsils are\nnormally positioned. Visualized portion of the posterior fossa appears\nunremarkable. No spinal cord signal abnormalities are seen.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: No spinal canal narrowing. Unchanged mild left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Unchanged small central disc protrusion without spinal canal narrowing.\nNo neural foraminal narrowing.\n\nC5-C6: Unchanged shallow central broad-based disc protrusion without spinal\ncanal narrowing. Unchanged moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nC6-C7: Unchanged small central disc protrusion without spinal canal narrowing.\nUnchanged mild left neural foraminal narrowing by primarily uncovertebral\nosteophytes.\n\nC7-T1: Unchanged small central disc protrusion without spinal canal narrowing.\nNo neural foraminal narrowing. Perineural cysts are again seen in the left\nneural foramen.\n\nT1-T2: Sagittal images and partial axial images through this level again\ndemonstrate perineural cysts within bilateral neural foramina. No spinal\ncanal or neural foraminal narrowing.\n\nSubcentimeter nodule in the lower pole of the right thyroid lobe is again\npartially visualized, image 8:38. No sonographic follow-up is warranted for\nnodules smaller than 15 mm in this age group, according to the ACR guidelines.", "output": "1. No significant change compared to ___.\n2. Small central disc protrusions without spinal canal narrowing.\n3. Unchanged moderate left C5-C6, mild left C3-C4, and mild left C6-C7 neural\nforaminal narrowing." }, { "input": "There has been no significant interval change since the previous study. At\nT11-12 level disc bulging mildly indents the thecal sac and results in minimal\nto mild spinal canal narrowing as before.\n\nFrom T12-L1 to L5-S1 levels mild disc bulging seen. At L3-4 and L4-5 levels\nmild narrowing of both foramina seen without compression of exiting nerve\nroots. At other levels no foraminal narrowing is seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "No significant interval change in mild degenerative changes compared with the\nMRI of ___. No evidence of high-grade spinal stenosis or foraminal\nnarrowing. No evidence of nerve root displacement or focal disc herniation." }, { "input": "THORACIC:\nA mild levoconvex curvature of the thoracic spine is seen. The bone marrow\nsignal is slightly heterogeneous on T1 and T2 suggesting a combination of bone\nmarrow replacement for fat and degenerative changes which appears grossly\nunchanged in the lumbar region since the prior exam in ___, with no\nevidence of suspicious bone lesions on the STIR sequences. The spinal cord is\nnormal in caliber and signal intensity. There is mild loss intervertebral\ndisc height and signal intensity in the midthoracic spine, and a small\nSchmorl's node at the inferior endplate of T7.\n\nT11-T12: A disc bulge is seen, effacing the ventral thecal sac and causing\nmild spinal canal narrowing. There is no foraminal narrowing.\n\nOtherwise, there is no evidence of spinal canal or neural foraminal narrowing.\nThere is no evidence of infection or neoplasm. There is no evidence of\nabnormal enhancement after contrast administration.\n\nLUMBAR:\nThe lower spine alignment is normal. Vertebral body heights are normal, the \nbone marrow signal is slightly heterogeneous on T1 and T2 suggesting a\ncombination of bone marrow replacement for fat and degenerative changes,\ngrossly unchanged in the lumbar region since the prior exam in ___,\nwith no suspicious bone lesions on the STIR sequences. the lower aspect\nspinal cord appears normal in caliber and configuration, the conus medullaris\nterminates at the level of L1 and is unremarkable.\nThere is mild loss of signal intensity involving L3-4 and L4-5 disc with small\ndisc bulges. However, there is no evidence of significant spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm. \nAn unchanged subcentimeter perineural cyst is again seen at S2-S3 level. The\nvisualized paravertebral structures are grossly unremarkable.", "output": "1. Mild degenerative changes of the thoracic and lumbar spine, worst at\nT11-T12.\n2. Multilevel degenerative changes throughout the lumbar spine remain\nrelatively stable since the prior exam, including disc degenerative changes at\nL3-L4 and L4-5 levels.\n3. There is no evidence of abnormal enhancement after contrast administration." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nTHORACIC AND LUMBAR SPINE:\n\nLevels were established by counting down from the C2 level using series 15,\nimage 8.\n\nThere is levoscoliosis of the thoracic and dextroscoliosis of lumbar spine. \nGrossly stable anterior angulation at T11-12 is again seen. There is again\nnoted transitional anatomy with partial sacralization of L5. Schmorl's nodes\nare again seen at multiple levels throughout the thoracolumbar spine. T8\nminimal chronic anterior compression deformities again noted. Otherwise,\nvertebral body heights are grossly preserved.\n\nVertebral body marrow signal is diffusely heterogeneous, as seen previously. \nMore focal 1.2 cm region within the T8 vertebral body demonstrating relatively\nhypointense signal on T1 (although still hyperintense relative to muscle and\ndisc) and T2 weighted sequences appears relatively hyperintense on STIR images\nappears and unchanged, without significant enhancement compatible with red\nmarrow as seen elsewhere (series ___, image 11).\n\nT11-12 mixed type 1 and type ___ ___ changes are again seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal. \nDeformation of the ventral thecal sac and spinal cord without definite\nassociated cord signal abnormalityis again noted at T7-8, T8-9, and T11-12\nlevels, grossly unchanged.\n\nIntervertebral disc heights and signalare decreased from T7-T8, T8-T9, and\nnotably anteriorly at T11 T12 compatible with degenerative changes.\n\nAt C7-T1, disc protrusion causes minimal spinal canal narrowing. No\nneuroforaminal narrowing.\n\nAt T7-T8 and T8-T9, disc protrusions causes minimal spinal canal and no\ndefinite neural foraminal narrowing.\n\nAt T11-T12, disc bulge and central protrusion cause mild spinal canal and\nbilateral neuroforaminal narrowing.\n\nOtherwise, there is no definite evidence of thoracic spine vertebral canal or\nneural foraminal narrowing.\n\nAt L2-L3, disc bulge and posterior ligamentous thickening cause mild spinal\ncanal and mild bilateral neuroforaminal narrowing.\n\nAt L3-L4, disc bulge and central protrusion in conjunction with posterior\nligamentous thickening cause mild spinal canal and moderate bilateral\nneuroforaminal narrowing.\n\nAt L4-L5, disc bulge causes minimal spinal canal and mild bilateral\nneuroforaminal narrowing.\n\nAt L5-S1, there is no neuroforaminal or spinal canal narrowing.\n\n OTHER:\nWithin limits of study, there is no definite evidence of new paravertebral or\nparaspinal mass.\n\nLimited imaging the pelvis again demonstrates nonspecific heterogeneous marrow\nsignal in the sacrum, grossly similar compared to significantly ___\npelvic MRI, better evaluated on prior pelvic MRI. Sacral probable Tarlov\ncysts are again noted.", "output": "1. Study is moderately degraded by motion.\n2. No evidence of fracture or definite new focal lesions.\n3. Diffuse heterogeneous marrow signal as seen previously, some of which may\nagain represent red marrow.\n4. Grossly stable multilevel thoracic and lumbar spondylosis compared to ___ thoracic and lumbar spine MRI as described, again resulting in up\nto moderate neuroforaminal narrowing without definite evidence of moderate or\nsevere vertebral canal or neural foraminal narrowing." }, { "input": "Alignment is normal. Diffuse fatty signal noted throughout the vertebral\nbodies. The intervertebral disc signal intensity appears normal. The spinal\ncord appears normal in caliber and configuration.\n\nC2-C3: Mild diffuse disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nC3-C4: Mild diffuse disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nC4-C5: Mild diffuse disc bulge and uncovertebral hypertrophy causing mild\nspinal canal narrowing. No significant neural foraminal narrowing.\n\nC5-C6: Mild diffuse disc bulge and uncovertebral hypertrophy causing mild\nspinal canal narrowing. Moderate left neural foraminal narrowing, slightly\nmore progressive in nature in comparison to the study of ___. No significant\nright neural foraminal narrowing.\n\nC6-C7: Centrally protruding disc bulge with central protrusion causing mild\nspinal canal narrowing. Minimal left neural foraminal narrowing.\n\nC7-T1: Mild diffuse disc bulge with left central predominance causing minimal\ncanal narrowing. No significant neural foraminal narrowing.\n\nOther: Within the limits of this noncontrast study there is no paravertebral\nor paraspinal mass identified.", "output": "1. Moderate left neural foraminal narrowing at C5-C6.\n2. Mild spinal canal narrowing noted at C4-C5, C5-C6, C6-C7.\n3. Otherwise, more mild, multilevel degenerative changes as described above." }, { "input": "12 rib-bearing vertebrae are again demonstrated. There is unchanged mild\nanterior wedging of T11 vertebral body and minimal anterior wedging of T11\nvertebral body, with unchanged associated loss of disc height and kyphotic\nangulation at T11-T12. Lumbar vertebral body heights are preserved. Lumbar\nalignment is normal. No evidence for suspicious bone marrow signal\nabnormalities.\n\nThe distal spinal cord appears unremarkable. The conus medullaris terminates\nat L1.\n\nAt T11-T12, there is a disc bulge and bilateral paracentral disc protrusions,\nas well as facet arthropathy. There is mild narrowing of the thecal sac\nwithout spinal cord contact. There is moderate right and mild left neural\nforaminal narrowing. No change since the prior MRI.\n\nT12-L1: No spinal canal or neural foraminal narrowing. Minimal facet\narthropathy.\n\nL1-L2: Minimal disc bulge and facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Mild disc bulge, larger on the right than left, and moderate facet\narthropathy. No mass effect on the intrathecal nerve roots. Subarticular\nzones are narrowed, right greater than left, with probable abutment of the\ntraversing right L3 nerve root. Minimal, right greater than left neural\nforaminal narrowing. No change since the prior MRI.\n\nL3-L4: Disc bulge and mild-to-moderate facet arthropathy. No mass effect on\nthe intrathecal nerve roots. Bilateral traversing L4 nerve roots are abutted\nin the subarticular zones. Mild-to-moderate bilateral neural foraminal\nnarrowing with contact of the exiting L3 nerve roots. No change since the\nprior MRI.\n\nL4-L5: Disc bulge and moderate facet arthropathy, as well as thickening of the\nligamentum flavum. No mass effect on the intrathecal nerve roots. Bilateral\ntraversing L5 nerve roots are contacted in the subarticular zones. Moderate\nbilateral neural foraminal narrowing with abutment of the exiting L4 nerve\nroots.\n\nL5-S1: Minimal disc bulge and mild-to-moderate facet arthropathy. No spinal\ncanal narrowing or significant neural foraminal narrowing.\n\nTarlov cysts are again seen in the sacrum.", "output": "1. Multilevel lumbar and lower thoracic degenerative disease appears unchanged\ncompared to ___.\n2. No significant mass effect on the thecal sac. Subarticular zones are\nnarrowed from L2-L3 through L4-L5 with varying degrees of contact of the\ntraversing nerve roots.\n3. Neural foraminal narrowing is moderate bilaterally at L4-L5, and\nmild-to-moderate bilaterally at L3-L4 and L5-S1, unchanged.\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 straightening of the normal cervical lordosis. Vertebral body height\nand alignment are preserved. There is generalized intervertebral disc\ndesiccation with intervertebral disc space height loss particularly at C5-C6\nand C6-C7. Bone marrow signal is unremarkable, except for endplate\ndegenerative changes. The visualized posterior cranial fossa and\ncraniocervical junction are unremarkable. The prevertebral and paraspinal soft\ntissues are unremarkable.\n\nC2-C3: No significant disc herniation, spinal canal or neural foraminal\nnarrowing. Note is made of uncovertebral osteophytes and mild ligamentum\nflavum thickening.\n\nC3-C4: There is no significant disc herniation. There are uncovertebral\nosteophytes, facet arthropathy and ligamentum flavum thickening without spinal\ncanal narrowing. There is no significant neural foraminal narrowing.\n\nC4-C5: There is a moderate diffuse disc bulge which is asymmetric to the left\nlateral recess and foramina, as well as uncovertebral osteophytes and facet\narthropathy with mild ligamentum flavum thickening, resulting in partial\neffacement of the CSF spaces and mild spinal canal narrowing with flattening\nand deformity of the cord. There is apparent intramedullary T2 signal\nhyperintensity at this level. There is moderate left and mild right neural\nforaminal narrowing.\n\nC5-C6: There is a moderate to severe diffuse disc bulge with superimposed\ncentral to left paracentral disc protrusion which results in near complete\neffacement of the surrounding CSF spaces, cord deformity and apparent cord\nsignal abnormality. There are also uncovertebral osteophytes, facet\narthropathy and mild ligamentum flavum thickening, findings which contribute\nto moderate spinal canal stenosis. There is mild bilateral neural foraminal\nnarrowing. The appears the left paracentral protrusion is atypical and other\nless likely considerations include epidural mass.\n\nC6-C7: There is a moderate to severe diffuse disc bulge which is asymmetric to\nthe left lateral recess and foraminal, as well as uncovertebral osteophytes,\nfacet arthropathy and mild ligamentum flavum thickening, resulting in\nflattening and deformity of the ventral cord with mild to moderate spinal\ncanal narrowing. No definite cord signal abnormality is identified. There is\nno significant neural foraminal narrowing.\n\nC7-T1: There is minimal diffuse disc bulge and uncovertebral osteophytes,\nwithout spinal canal or neural foraminal narrowing.", "output": "1. Moderate to severe multilevel spondylosis, particularly at C4-C5 and C5-C6,\nresulting in mild to moderate spinal canal narrowing with cord deformity and\napparent cord signal abnormality, which may represent a degree of\nmyelomalacia. There is also mild to moderate neural foraminal narrowing at\nthese levels, as described above.\n\n2. Central to left paracentral disc protrusion at C5-C6 is somewhat atypical\nand other less likely considerations include epidural mass at this level.\nFurther evaluation with MRI of the cervical spine with and without contrast.\n\n3. Mild to moderate spinal canal narrowing is also seen at C6-C7 without\nhigh-grade neural foraminal narrowing." }, { "input": "There is 2 mm anterolisthesis of L4 on 5, degenerative in nature without\nevidence of spondylolysis. There is moderate to severe loss of disc height at\nL4-5 and L5-S1. Remainder of the disc heights are preserved. Vertebral body\nheights are maintained. The conus terminates at the superior endplate of L1,\nwithin expected limits. There is no signal abnormalities of the visualized\ncord. There is no suspicious marrow signal. There is a 9 mm perineural cyst\ncentered in the left L5-S1 neural foramen. Additional the large perineural\ncysts involving the bilateral S1-2 through S3-4 neural foramen are noted\n(measuring up to 2.8 cm) resulting in scalloping of the posterior cortex of\nthe sacral vertebral bodies. In addition, there is suggestion of mild\nscalloping of the L4-L5 vertebral bodies, suggestive of dural ectasia.\n\nT10-11 through T12-L1: Unremarkable.\n\nL1-2: There is a very small disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nL2-3: There is a small posterior disc bulge without significant spinal canal\nor neural foraminal narrowing.\n\nL3-4: There is a small concentric disc bulge as well as mild bilateral facet\narthropathy. There is no significant spinal canal or neural foraminal\nnarrowing.\n\nL4-5: There is mild uncovering of the disc and small posterior disc protrusion\neccentric to the right as well as mild bilateral facet arthropathy and\ninfolding of ligamentum flavum. There is no significant spinal canal\nnarrowing. There is mild left neural foraminal narrowing where the disc\napparently contacts the exiting left L4. The right neural foramen is widely\npatent. In addition, the left-sided facet arthropathy contacts and displaces\nthe traversing left L5 nerve root. (Series 5, image 11).\nL5-S1: There is a small posterior disc bulge, mild bilateral facet arthropathy\nwithout significant spinal canal or neural foraminal narrowing. However, the\ndisc contacts the right exiting nerve root (series 4, image 15).\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes as described above, most severe at L4-5\nwhere there is mild left neural foraminal narrowing, disc protrusion contacts\nand mildly effaces the exiting left L4 nerve root. In addition, there is\nleft-sided facet arthropathy which contacts and displaces the traversing left\nL5 nerve root.\n2. Multiple perineural cysts as described above, which results cortical\nscalloping of the sacrum.\n3. Degenerative 2 mm anterolisthesis of L4 on 5, unchanged from prior exam." }, { "input": "NUMBERING USED FOR THE PRESENT STUDY SHOWN ON SERIES 3, IMAGE 7.\n\nOn the count series, reversal of cervical lordosis. No disc herniation, no\nsignificant canal narrowing.\n\nTHORACIC SPINE:\n\nThe thoracic spine has normal curvature vertebral body height, bone marrow\nsignal and alignment. The intervertebral disc have normal height and signal\nintensities. There is no disc herniation, or spinal canal or neural foraminal\nstenosis. Minimal protrusions are noted in the mid thoracic spine.\nThe thoracic spinal cord and conus medullaris have normal morphology and\nsignal intensities. The posterior elements and paraspinal soft tissues are\nnormal.\n\nThere is no abnormal enhancement on post-contrast images.\n\nThere is a 14x16 mm slightly lobulated T2 hyperintense focus without abnormal\nenhancement representing a paravertebral cystic structure adjacent to and\nmildly indenting the left anterior aspect of the T4 vertebral body. Series 7,\nimage 16; series 4, image 6 .\n\nLUMBAR SPINE:\n\nThe vertebral body height and alignment is maintained. The bone marrow has a\nnormal signal intensity. There is mild loss of normal intervertebral disc\nsignal at L4-L5.\n\nThere is mild disc bulge at L4-L5 without significant spinal canal stenosis or\nneural foraminal narrowing at any level.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensity. The conus medullaris terminates at L1-L2 level.\n\nThe posterior elements and paraspinal soft tissues are normal.\nMinimal increased signal noted in the posterior spinous soft tissues at L3\nlevel, may relate to approach for the recent epidural anesthesia, based on the\nhistory.\nNo obvious fluid collections or hematomas noted in the posterior spinous soft\ntissues or in the epidural space.\nProminent epidural fat noted at L5 and at S1 levels.\nThere is no abnormal enhancement on post-contrast images.\n\nThe uterus is noted to be enlarged consistent with postpartum state.", "output": "No evidence of epidural abscess or hematoma. No cord signal abnormalities.\n\n14 mm cystic structure adjacent to the left side of T4 vertebral body which\nmay represent an esophageal duplication cyst, neurenteric cyst, cystic tumor\nless likely versus a pleural abnormality. Further evaluation with a CT scan of\nthe chest could be performed on a non-urgent basis." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. No\nmarrow lesion on STIR sequences. Disc heights are preserved. The visualized\nposterior fossa is unremarkable. There is no cord signal abnormality. There\nis no significant spinal canal or neural foraminal narrowing. No abnormal\npostcontrast enhancement. The visualized prevertebral and paraspinal soft\ntissues are unremarkable.", "output": "1. Unremarkable cervical spine MRI. Specifically, no evidence of a\ndemyelinating lesion.\n2. Additional findings described above." }, { "input": "There is minimal retrolisthesis of 5 on C6. Vertebral body heights are\npreserved. Signal abnormality along the inferior endplate of C5 is consistent\nwith ___ type degenerative change. There is up to moderate loss of disc\nheight involving the C4-T1 this, worst at the C5-6 level. The visualized\nportion of the spinal cord is preserved in signal and caliber.\n\nC2-3: There is no spinal canal stenosis. There is no neural foraminal\nnarrowing.\nC3-4: There is no spinal canal stenosis. There is no neural foraminal\nnarrowing.\nC4-5: There is no spinal canal stenosis. There is no neural foraminal\nnarrowing.\nC5-6: There is a disc bulge with moderate spinal canal stenosis. There is\nmoderate to severe right and mild left neural foraminal narrowing.\nC6-7: There is a disc bulge with mild spinal canal stenosis. There is\nmoderate to severe left and moderate right neural foraminal narrowing.\nC7-T1: There is no spinal canal stenosis. There is no neural foraminal\nnarrowing.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.", "output": "1. No evidence of cervical spinal cord lesion.\n2. Multilevel degenerative changes as described above. There is up to\nmoderate spinal canal stenosis, worst at the C5-6 level. There is moderate to\nsevere neural foraminal narrowing on the right at C5-6 and on the left at C6-7\nlevels." }, { "input": "CERVICAL:\nThere is inferior descent of the cerebellar tonsils measuring 17 mm on the\nright and 13 mm on the left with effacement of the CSF spaces in the posterior\nfossa. The cerebellar tonsils demonstrate a pointed morphology. The odontoid\nprocess is retroflexed. There is slight flattening of the skullbase. There\nis mild mass effect on the posterior cervicomedullary junction.\n\nCSF phase flow images demonstrate pulsatile bidirectional flow along the\nanterior cervicomedullary junction and throughout the cervical spinal canal.\n\nEvaluation of the cervical spinal cord demonstrates prominence of the central\ncanal measuring 2 x 2 mm at the level of C5-C6. There is prominence of the\ncentral canal from C5 through T1.\n\nThe cervical vertebral body heights and alignment are maintained. There ___\ntype 2 endplate changes at C5-C6 and along the inferior endplates of C2, C3,\nand C4.\n\nThere is no significant spinal canal narrowing from C2-C3 through C4-C5. \nModerate right and mild left neural foraminal narrowing at C3-C4 and\nmild-to-moderate bilateral neural foraminal narrowing at C4-C5.\n\nAt C5-C6, there is moderate intervertebral disc height loss with posterior\ndisc osteophyte complex resulting in mild spinal canal narrowing. There is\nsevere right and moderate to severe left neural foraminal narrowing due to\nfacet and uncovertebral joint osteophytes.\n\nAt C6-C7, there is mild-to-moderate intervertebral disc height loss with a\nposterior disc osteophyte complex resulting in no significant spinal canal\nnarrowing. Mild right neural foraminal narrowing.\n\nAt C7-T1, there is prominent disc osteophyte complex resulting in mild spinal\ncanal narrowing. No significant neural foraminal narrowing.\n\nThere is no abnormal enhancement.\n\nTHORACIC:\nThe thoracic vertebral body heights and alignment are maintained. Hemangioma\nin the T12 vertebral body. There is a 9 mm cyst in the T6 vertebral body.\n\nAside from the prominent central canal extending to T1, the thoracic spinal\ncord is normal in signal intensity.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: There is a lobular T2 hyperintense 2.6 cm AP x 3.5 cm TV mass in the\nposterior right hepatic lobe, possibly a cyst.", "output": "1. Chiari 1 malformation with bony changes at the skullbase as described.\n2. Prominent central canal from C5 through T1 measuring up to 2 x 2 mm\naxially. Given the size to be smaller than 2 mm, this is by definition a\nsyrinx\n3. Pulsatile bidirectional CSF flow with in the cervical spine. No evidence\nof significant CSF flow obstruction at the foramen magnum.\n4. Multilevel cervical spondylosis as described above, most pronounced at\nC5-C6 with severe right and moderate to severe left neural foraminal\nnarrowing.\n5. Incompletely characterized lobular T2 hyperintense mass in the posterior\nright hepatic lobe, possibly a cyst.\n6. Please see the separate concurrent MRI head report for additional details." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno focal suspicious marrow lesion. The conus medullaris terminates at T12-L1\nlevel, within expected limits. There is no signal abnormality of the terminal\ncord.\n\nMinimal disc protrusions at L4-L5 and L5-S1 does not narrow the spinal canal. \nThere is no significant neural foraminal narrowing.\n\nVisualize prevertebral and paraspinal soft tissues are unremarkable.", "output": "There is no spinal canal or neural foraminal narrowing." }, { "input": "Grade 1 anterolisthesis of L4-5 is seen. Mild retrolisthesis of L5-S1 is\nseen. The bone marrow signal is within normal limits. The cord terminates at\nT12-L1. Possible increased cord signal abnormality is seen at T10-T11. Disc\ndesiccation and loss of disc height are seen involving the lower thoracic and\nlower lumbar spine.\n\nT10-T11: Disc bulge, posterior osteophytes, moderate to severe spinal canal\nnarrowing, mild bilateral foraminal narrowing.\n\nT11-T12: Mild disc bulge, bilateral facet osteophytes, no spinal canal or\nforaminal narrowing.\n\nT12-L1: Disc bulge, central disc protrusion, thickening of the ligamentum\nflavum, bilateral facet osteophytes, mild spinal canal narrowing, no foraminal\nnarrowing.\n\nL1-L2: No spinal canal or foraminal narrowing.\n\nL2-L3: No spinal canal or foraminal narrowing.\n\nL3-L4: Disc bulge, thickening of the ligamentum flavum, bilateral facet\nosteophytes, moderate spinal canal narrowing, mild to moderate bilateral\nforaminal narrowing.\n\nL4-L5: Anterolisthesis, disc bulge, thickening of the ligamentum flavum,\nbilateral facet osteophytes, epidural lipomatosis, mild-to-moderate spinal\ncanal narrowing, moderate bilateral foraminal narrowing.\n\nL5-S1: Central disc extrusion extending behind S1, posterior and bilateral\nfacet osteophytes, thickening of the ligamentum flavum, mild spinal canal\nnarrowing, moderate to severe bilateral foraminal narrowing.\n\nThere is no abnormal enhancement.\n\nA subcentimeter T2 hyperintense lesion is seen in the right kidney (6:7).", "output": "1. Moderate to severe spinal canal narrowing at T10-11 with possible cord\nsignal abnormality at this level, incompletely evaluated on the current exam.\n2. Moderate spinal canal narrowing at L3-4.\n3. Mild-to-moderate spinal canal narrowing at L4-5.\n4. Moderate to severe bilateral foraminal narrowing at L4-5 and L5-S1.\n\nRECOMMENDATION(S): MRI of the thoracic spine is recommended for further\nevaluation.\n\nNOTIFICATION: Updated findings were submitted to the EDQA nurse group by Dr.\n___ on ___." }, { "input": "From T1-2 to T7-8 level disc degenerative changes and mild bulging seen. A\nsmall disc protrusion in the midline is seen at T5-6 level contacting the\nspinal cord without deformity.\n\nAt T8-9 level disc bulging and a small protrusion seen with mild spinal\nstenosis contacting the spinal cord without deformity or compression.\n\nAt T9-10 level right-sided disc herniation is identified which displaces the\nspinal cord and results in severe spinal stenosis and compression of the\nspinal cord. There is subtle increased signal within the spinal cord at T10\nlevel (05:11)..\n\nFrom T11-12 to L1-2 levels no abnormalities are seen.\n\nFollowing contrast administration no abnormal enhancement is seen. No\nevidence of discitis or osteomyelitis. No paraspinal abscess is seen.", "output": "1. A right paracentral disc herniation at T9-10 level displacing the spinal\ncord to the left side and compressing the spinal cord.\n2. Subtle increased signal within the spinal cord at T10 level indicative of\nmyelomalacia/cord edema.\n3. Degenerative changes at other levels as above." }, { "input": "There are 5 non rib-bearing lumbar type vertebral bodies. There is grade 1\nanterolisthesis of L3 on L4 and L4 on L5. Vertebral body heights are\npreserved.\n\nThe terminal spinal cord appears normal in caliber and configuration. Conus\nmedullaris terminates at the L1 level. There is no epidural collection.\n\n1.8 cm area of focal fat is seen within the L3 vertebral body. A Schmorl's\nnode is noted in the L3 superior endplate. Bone marrow signal is otherwise\nnormal. There is no evidence of infection or neoplasm.\n\nT12-L1: The intervertebral disc spaces relatively well preserved. There is a\ntrace posterior disc bulge without significant spinal canal narrowing. The\nneural foramina are patent.\n\nL1-L2: The intervertebral disc spaces relatively well preserved. There is a\ntrace posterior disc bulge without significant spinal canal stenosis. There\nis minimal facet hypertrophy with minimal narrowing of the left neural\nforamen. The right neural foramen is patent.\n\nL2-L3: There is minimal narrowing of the intervertebral disc space. There is\na small posterior disc bulge in conjunction with ligamentum flavum hypertrophy\nand facet osteophytes producing mild spinal canal narrowing. In conjunction\nwith facet hypertrophy, there is mild left-greater-than-right neural foraminal\nnarrowing.\n\nL3-L4: There is a mild posterior disc bulge in conjunction with facet\nosteophytes and ligamentum flavum hypertrophy producing severe spinal canal\nnarrowing (09:17). In conjunction with facet hypertrophy, there is moderate\nleft and mild right neural foraminal narrowing.\n\nL4-L5: There is a mild posterior disc bulge and a small midline protrusion\nwith a fragment extending inferiorly along the upper posterior margin of the\nL5 body in conjunction with facet hypertrophy producing mild spinal canal\nnarrowing. In conjunction with facet hypertrophy, there is severe left neural\nforaminal narrowing with probable compression of the exiting L4 nerve root. \nThere is mild narrowing of the right neural foramen.\n\nL5-S1: The intervertebral disc space is preserved. There is no significant\nspinal canal or neural foraminal narrowing.\n\nSmall perineural cysts are noted at S1-S2.\n\nThe visualized portion of the retroperitoneum is grossly unremarkable.", "output": "1. Multilevel degenerative changes, as described above, most notable for\nsevere spinal canal narrowing at L3-L4 and severe left neural foraminal\nnarrowing at L4-L5 with probable compression of the exiting left L4 nerve\nroot.\n2. No fracture, epidural collection or evidence of discitis or osteomyelitis." }, { "input": "There is endplate irregularity at L5-S1 disc space involving inferior L5 and\nsuperior S1 endplates best seen on sagittal T1 images, and there is mildly\nincreased disc space signal, and adjacent vertebral body edema. Appearance of\nendplates is similar compared to ___ CT exam. There is mild disc\nspace, and moderate L5, S1 vertebral body enhancement following contrast\nadministration. There is mild edema and enhancement involving bilateral\nsacral ala, likely reactive, without marrow replacement on T1 images. There\nis mild anterior paravertebral soft tissue stranding and enhancement, without\nlocal fluid collection. There is no ventral epidural abscess or phlegmon. \nThere is not much lateral paravertebral edema.\nThere are bilateral L4-5, L5-S1 facet joint degenerative changes, with mild\nadjacent posterior element reactive edema, without much paravertebral fluid or\nedema to suggest septic arthritis.\n\nAlignment is normal. Spinal cord appears normal in caliber and configuration.\nThere are degenerative changes in the lower lumbar facet joints.\nAt T12-L1, L1-L2, L2-L3 levels there is no significant central canal or\nforaminal narrowing.\nAt L3-L4 level central canal is patent and there is mild bilateral foraminal\nnarrowing.\nAt L4-5 level there is mild diffuse disc bulge and ligamentum flavum\nhypertrophy causing mild central canal narrowing. There is mild bilateral\nforaminal narrowing.\nL5-S1 level: Please see first paragraph for non mechanical findings. Central\ncanal is patent. There is moderate left, and severe right foraminal\nnarrowing.\n\nThere are varices in the left upper quadrant.", "output": "1. There is abnormal L5-S1 disc space with endplate irregularity and vertebral\nbody enhancement, consistent with disc space infection in the appropriate\nclinical setting. There is no epidural or paravertebral phlegmon or abscess.\n2. There are degenerative changes in the lumbar spine with advanced lower\nlumbar facet arthritis resulting in significant bilateral L5-S1 foraminal\nnarrowing." }, { "input": "Mild leftward curve of the lumbar spine is seen. Subtle retrolisthesis of L2\non L3 has progressed. Grade 1 (approximately 5 mm) anterolisthesis of L4 on\nL5 have developed over the interval.\n\nVertebral body marrow signal intensity is diffusely heterogenous with probable\nmultilevel endplate degenerative change, most marked at L2-L3 and L5-S1. \nThere is reduced intervertebral disc height, most marked at L2-L3 and L5-S1,\nbut also present at L1-L2 and L4-L5. There is diffuse disc desiccation.\n\nVisualized distal cord is normal in signal and terminates at the inferior L1\nlevel.\n\nT11-T12: An approximately 4 mm right paracentral disc extrusion has developed\nover the interval that appears to contact the right ventral aspect of the cord\nwith mild spinal canal narrowing. There is no neural foraminal narrowing. No\nassociated intramedullary signal abnormality is evident.\n\nT12-L1: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nL1-L2: Disc desiccation, mild disc bulge and small central disc protrusion\nhave progressed over the interval without significant spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Subtle retrolisthesis of L2 on L3 is now noted. Disc desiccation has\nprogressed. Mild diffuse disc bulge has decreased. No significant central\nstenosis is demonstrated. Mild bilateral foraminal narrowing has increased.\n\nL3-L4: There is a minimal disc bulge. Mild central stenosis and inferior\nright foraminal narrowing have developed.\n\nL4-L5: There grade 1 anterolisthesis of L4 on L5 with disc desiccation and\nunroofing of the disc. Facet degenerative changes and mild ligamentous\nhypertrophy are noted. Disc encroaches on the left neural foramen and may\ncontact the exiting left L4 nerve root. Moderate to severe spinal canal\nstenosis, moderate right and severe left foraminal narrowing have progressed.\n\nL5-S1: Disc desiccation has progressed. Small amount disc encroaches on the\nneural foramina. There is no significant spinal canal. Mild approaching\nmoderate bilateral neural foraminal narrowing has progressed.\n\nThere is no evidence of infection or neoplasm. Colonic diverticular are\nnoted.", "output": "1. Minimal leftward curve lumbar spine.\n2. Retrolisthesis of L2 on L3 and anterolisthesis of L4 on L5.\n3. Interval progression in multilevel lumbar spondylosis with mild to severe\ncentral stenosis most pronounced at L4-5 as detailed 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": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Degenerative changes are seen\nparticularly at the L5-S1 vertebral level where there are ___ type 1 signal\nintensity changes. Otherwise, vertebral body heights are preserved. The\nvisualized portion of the spinal cord is preserved in signal and caliber. The\nconus is seen terminating at the L1-L2.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\n\nAt T12-L1 there is minimal posterior disc bulge. However, there is no\nvertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is also minimal posterior disc bulge and mild ligamentum flavum\nhypertrophy without evidence of vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is minimal posterior disc bulge and mild ligamentum flavum\nhypertrophy.No vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is minimal posterior disc bulge, mild ligamentum flavum\nhypertrophy, tiny facet joint effusions.No vertebral canal or neural foraminal\nstenosis.\n\nAt L4-5 there is mild posterior disc bulge, mild facet joint arthropathy, mild\nligamentum flavum hypertrophy, and small bilateral facet joint effusions which\nmildly narrows the vertebral canal.No evidence of neural foraminal stenosis\nbilaterally.\n\nAt L5-S1 note is made of mild-to-moderate degenerative changes with endplate\nsclerosis of the L5-S1. Additionally, there is a moderate posterior disc\nbulge, mild facet joint arthropathy, and small bilateral facet effusions. \nThere is a midline and left-sided disc protrusion causing narrowing of the\nvertebral canal as well as narrowing of the left neural foramina with probable\ncontact on the left L5 exiting nerve root and the left S1 traversing nerve\nroot.", "output": "1. Degenerative changes seen at the L5-S1 with moderate posterior disc bulge\nand a midline and left-sided disc protrusion resulting in mild narrowing of\nthe vertebral canal and left neural foramina narrowing with probable contact\nof the left exiting nerve root and possibly the left traversing nerve root." }, { "input": "Advanced degenerative changes cervical spine. Minimal anterolisthesis C3-C4,\nC4-C5, C7-T1, likely degenerative. Disc osteophyte complex C3-C4 through\nC7-T1 levels. Disc space narrowing C3-C4, C5-C6, C6-C7 levels. Posterior\nelement hypertrophic changes. No cord T2 signal abnormality. No worrisome\nlesions.\n\nAt C2-C3 level there is mild central canal narrowing. Mild bilateral\nforaminal narrowing, left greater than right.\n\nAt C3-C4 level there is moderate central canal narrowing, minimal cord\nflattening, incompletely face CSF, no cord edema. Moderate bilateral\nforaminal narrowing, right greater than left.\n\nAt C4-C5 level there is mild central canal narrowing. Moderate to severe\nleft, mild right foraminal narrowing.\n\nAt C5-C6 level there is mild-to-moderate central canal narrowing, preserved\nCSF. Moderate to severe bilateral foraminal narrowing.\n\nAt C6-C7 level there is mild-to-moderate central canal narrowing, preserved\nCSF about cord. Moderate to severe left, moderate right foraminal narrowing.\n\nAt C7-T1 level there is minimal central canal narrowing. Mild-to-moderate\nbilateral foraminal narrowing.\n\nProminent soft tissue posterior nasopharynx, may represent reactive adenoids,\ndirect visualization recommended. Normal underlying clivus.", "output": "1. Advanced degenerative changes cervical spine.\n2. Moderate central canal narrowing C3-C4 level, and mild-to-moderate at\nC5-C6, C6-C7 levels.\n3. Multilevel significant foraminal narrowing.\n4. Prominent soft tissue posterior nasopharynx, may represent reactive\nadenoids, direct visualization recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:27 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of the lumbar spine. There is approximately 3 mm L4 on\nL5 anterolisthesis. T11 and T12 minimal chronic anterior compression\ndeformities are seen. Schmorl's nodes are seen at multiple levels with lumbar\nspine. Chest, vertebral body heights are preserved. L4-5 probable type 1\n___ changes are seen. T10-11, T11-12, L1 superior endplate, L 2, L3, L4\ninferior endplate and L4-5 endplate type ___ ___ changes are seen. S1\nvertebral body probable hemangioma is noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nThere is loss of intervertebral disc height and signal at T9-10 through T11-12\nand L2-3 through L5-S1. Nonspecific facet joint fluid is noted at multiple\nlevels of the lumbar spine.\n\nAt T9-10 there is disc bulge and epidural fat with mild vertebral canal\nnarrowing, with neural foramina incompletely evaluated.\n\nAt T10-11 there is disc bulge, epidural fat, facet joint hypertrophy with mild\nvertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt T11-12 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild vertebral canal and mild bilateral neural\nforaminal narrowing.\n\nAt T12-L1 there is facet joint hypertrophy, epidural fat, ligamentum flavum\nthickening, with no vertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is facet hypertrophy, ligamentum flavum thickening, dural fat,\nwith mild vertebral canal and no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with moderate vertebral canal and moderate bilateral\nneural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with moderate vertebral canal and moderate bilateral neural\nforaminal narrowing.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, L4 on L5 anterolisthesis, with moderate to severevertebral canal\nand moderate bilateral neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge with question contact the bilateral descending S1\nnerve roots, facet joint hypertrophy, ligamentum flavum thickening, with\nmild-to-moderatevertebral canal and severe bilateral neural foraminal\nnarrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Nonspecific probable dependent edema is noted in\nthe dorsal lumbar soft tissues.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel lumbar spondylosis and epidural fat as described, most\npronounced at L4-5, where there is moderate to severe vertebral canal and\nmoderate bilateral neural foraminal narrowing.\n3. L5-S1 mild-to-moderate vertebral canal and severe bilateral neural\nforaminal narrowing.\n4. L2-3 and L3-4 moderate vertebral canal and moderate bilateral neural\nforaminal narrowing.\n5. Limited imaging of thoracic spine demonstrates multilevel thoracic\nspondylosis with suggested moderate bilateral neural foraminal narrowing at\nT10-11. If clinically indicated, consider dedicated thoracic spine MRI for\nfurther evaluation." }, { "input": "Study is mildly degraded by motion.\n\nThe localizer images through the cervical spine demonstrate multilevel\ndegenerative changes, with no spinal cord compression. Precise degree of\nspinal canal or neural foraminal stenosis cannot be assessed on these limited\nimages. There is prominence of the soft tissues in the nasopharynx, also seen\non the previous examination which may reflect reactive change in the adenoids.\n\nTHORACIC:\nAlignment is normal.The vertebral bodies are normal in height. There are\nmultilevel degenerative endplate marrow signal changes and endplate\nosteophytes as well as scattered fatty rests. There is diffuse disc\ndesiccation, with mild loss of intervertebral disc height noted most\nprominently at the T7-T8 and T8-T9 levels.The spinal cord appears normal in\ncaliber and configuration. There are small disc protrusions throughout the\nthoracic spine, there is mild multilevel facet arthropathy. There is mild\nnarrowing of the spinal canal at T11-T12 and T12-L1 levels, due to prominent\nposterior epidural fat in combination with the mild degenerative changes. \nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno spinal cord compression. There is no evidence of infection or neoplasm.\n\nLUMBAR:\nThere is mild grade 1 anterolisthesis of L4 on L5, similar to the previous\nexam. Alignment is otherwise normal.The vertebral bodies are normal in\nheight. There are degenerative endplate marrow signal changes and endplate\nosteophytes as well as multiple small Schmorl's nodes. There is a hemangioma\nat S1. Diffuse disc desiccation loss of intervertebral disc height. The\ndistal spinal cord is normal in caliber and signal. The conus medullaris is\nnormal and terminates at L1-L2.\n\n\nAt T12-L1, there is facet arthropathy with prominent epidural fat and\nligamentum flavum infolding causing no significant narrowing of spinal canal\nor neural foramina.\n\nAt L1-L2, there is facet arthropathy with ligamentum flavum infolding mildly\nprominent epidural fat causing mild narrowing of the spinal canal. There is\nno neural foraminal narrowing.\n\nAt L2-L3, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy in combination with prominent epidural fat which causes\nmild-to-moderate spinal canal narrowing and bilateral moderate neural\nforaminal narrowing.\n\nAt L3-L4, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy causing mild-to-moderate narrowing of spinal canal and\nbilateral moderate neural foraminal narrowing.\n\nAt L4-L5, there is a diffuse disc bulge with ligamentum flavum infolding and\nprominent facet arthropathy which again results in moderate spinal canal\nnarrowing and bilateral moderate neural foraminal narrowing.\n\nAt L5-S1, there is a diffuse disc bulge with small central protrusion\ncomponent, ligamentum flavum infolding, and facet arthropathy causing mild\nnarrowing of the spinal canal, and narrowing of the lateral recesses with disc\nmaterial abutting the bilateral S1 nerve roots although without compression. \nThere is bilateral moderate to severe neural foraminal stenosis.\n\nThere is no evidence of infection or neoplasm.\n\nOTHER: The paraspinal and prevertebral soft tissues are unremarkable. 6 mm T2\nhyperintensity in the left kidney is noted, probably a renal cyst.", "output": "1. No evidence of spinal cord compression or cauda equina compression.\n2. Multilevel degenerative changes of the lumbar spine with prominent epidural\nfat. There is again multilevel spinal canal or neural foraminal stenosis in\nthe lumbar spine, with findings similar to the previous examination. The\nfindings are most pronounced at the L4-L5 level." }, { "input": "There is soft tissue edema in the right lateral aspect of the neck extending\nfrom the skull base at the level of C1 vertebrae up to the level of the\nsupraclavicular fossa. There is soft tissue edema and swelling extends into\nthe right paravertebral space along the cervical spine and also involves the\nright paraspinal musculature which appear edematous and enlarged as seen on\nimage 11:26. Also seen is a 2.1 x 3.4 cm abscess collection in the right lung\napex, better evaluated on recent prior chest CT. There is associated\nsurrounding bronchiectasis and infiltration in the lung parenchyma. These\nfindings are incompletely evaluated in the absence of intravenous contrast.\n\nCERVICAL SPINE:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized cervical spinal cord appears\nunremarkable without focal cord signal abnormality or cord expansion. The\nmarrow signal appears unremarkable.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt C2-C3, the intervertebral disc height is maintained. No neural foramina or\nspinal canal stenosis.\n\nAt C3-C4, there is central disc osteophyte complex indenting the ventral\nthecal sac. Uncovertebral and facet arthropathy results in mild right neural\nforamen narrowing. No left neural foramen or spinal canal stenosis is seen.\n\nAt C4-C5, there is central disc osteophyte complex indenting the ventral\nthecal sac. No neural foramina or spinal canal stenosis is seen.\n\nAt C5-C6, There is central disc osteophyte complex with bilateral\nuncovertebral and facet arthropathy resulting in mild spinal canal stenosis\nindenting the ventral aspect of the cord, moderate right and mild left neural\nforamen stenosis.\n\nAt C6-C7, there is central disc osteophyte complex indenting the ventral\naspect of the cord resulting in mild spinal canal stenosis. No neural foramen\nstenosis is seen.\n\nAt C7-T1, bilateral neural foramen the disc height is maintained. No neural\nforamina or spinal canal stenosis is seen.\n\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized thoracic spinal cord appears\nunremarkable without focal cord signal abnormality or cord expansion. There\nis mild loss of intervertebral disc height and signal at T12-L1. The disc\nheight and signal is maintained at all other levels.\n\nThe neural foramen and spinal canal are patent at all levels. No epidural\nabscess is seen. Induration of the right paraspinal musculature extending\ninferiorly to at least T6 level is noted.\n\nLUMBAR:\nThe lumbar spine is imaged only on sagittal images. No axial images could be\nacquired because of patient discomfort and study had to be aborted in between.\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. No abnormal marrow signal is seen. The conus\nterminates at L1-L2. There is mild loss of intervertebral disc signal at\nL4-L5 and L5-S1. The intervertebral disc height is maintained at all levels.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nEvaluation for neural foramen and spinal canal stenosis is somewhat limited in\nthe absence of axial images. There is mild-to-moderate bilateral neural\nforamen stenosis at L5-S1. The neural foramen and spinal canal are patent at\nall other levels.", "output": "1. Please note that the study had to be aborted because of patient discomfort\nand no lumbar spine axial images or postcontrast images were acquired.\n2. Right apical lung abscess with surrounding pulmonary parenchymal opacity,\nbetter evaluated on recent prior outside CT chest.\n3. Extensive soft tissue swelling in edema in the right lateral neck extending\nfrom C1 inferiorly to supraclavicular fossa and posteriorly along right\nparaspinal musculature to at least T6 level, with associated edema involving\nthe right paraspinal musculature. Findings are incompletely evaluated in the\nabsence of intravenous contrast, and are concerning for infectious etiology,\ngiven presence of right upper lobe pulmonary abscess.\n4. Mild degenerative disease involving the visualized cervical, thoracic and\nlumbar spine without high-grade neural foramina or spinal canal stenosis at\nany level, as described above." }, { "input": "From T10-T11 to L3-4 level, mild disc degenerative changes identified. No\nspinal stenosis or foraminal narrowing seen.\n\nAt L4-5 disk and facet degenerative change is seen. There is a small central\ndisc protrusion which extends superiorly to the right side and mildly indents\nthe thecal sac. There is mild-to-moderate narrowing of the right and mild\nnarrowing of the left foramen. There is no spinal canal sparing\n\nTitle findings S1 level disk degenerative changes and mild bulging seen. There\nis mild narrowing of the foramina without compression of exiting nerve roots.\n\nThe distal spinal cord. Paraspinal soft tissues are unremarkable.\n\nNote is made of increased signal within the left pedicles of L4 and L5\nvertebral bodies on inversion recovery images subarticular edema from facet\ndegenerative changes.", "output": "Multilevel disk and facet degenerative changes are seen predominantly\naffecting the L4-5 level with a small protrusion at this level extending\nsuperiorly to the right side mildly indenting the thecal sac." }, { "input": "The has been no significant interval change since the previous MRI\nexamination. Spinal fusion identified from L1--3 level. The spinal canal is\npatent at these levels. There is mild scoliosis of the lumbar spine. From T11-\n2 to L2-3 disc degenerative changes are identified without spinal stenosis.\nMild retrolisthesis is seen at L2-3 level. There is mild-to-moderate bilateral\nforaminal narrowing at L2-3 level.\n\nAt L3-4 level, disc bulging and a small protrusion extending slightly\nsuperiorly to right side of the midline. There is moderate right subarticular\nrecess and moderate to severe right foraminal narrowing seen. There is mild\nnarrowing of the left foramen.\n\nAt L4-5 and L5-S1 levels disc and facet degenerative change is seen. At L4-5\nlevel mild to moderate foraminal narrowing seen.\n\nThe distal spinal cord. Paraspinal soft tissues are unremarkable except for\nmild prominence of right renal collecting system. There is also a clumping of\nnerve roots to the thecal sac indicating post- operative arachnoiditis.", "output": "No significant change since the previous MRI examination. Scoliosis of the\nlumbar spine and moderate-to-severe right foraminal narrowing at L3-4 level\nwith moderate right subarticular recess narrowing at this level again noted.\nOther findings as described above." }, { "input": "The patient is status post L1-L3 posterior fusion and L1-L5 laminectomy with\npostoperative changes and hardware artifact that limits assessment of the\ncorresponding regions.\n\nThere is interval development of posterior paraspinal multilocular collections\nat laminectomy sites; the largest opposing level of L3 measuring 1.7 x 2.5 x\n2.8 cm (AP,TV,SI directions; respectively) as well as smaller collection\nopposing the inferior aspect of L2 vertebral region measuring 0.6 x 1.4 x 0.9\ncm (AP,TV,SI directions; respectively). Aforementioned collections are in\nclose proximity to posterior epidural space with no thecal sac compression. \nThere is surrounding T2 STIR hyperintense signal intensity likely representing\nedematous changes that are new when compared to previous examination dated\n___. There is increased epidural enhancement at L3-4.\n\nThere is interval development L3-L4 endplate T2 STIR hyperintense signal\nintensity with corresponding T1 hypointensity and enhancement. The disc is\nhyperintense on the STIR images. Overall, these findings are worrisome for\ndisc and adjacent endplate infection.\n\nThe lumbar spinal canal is capacious with no epidural encroachment. However;\nthere is interval worsening of intrathecal septations and posterior and\nperipheral clumping of cauda equina nerve roots through L3-S1 level. These\nare due to arachnoiditis. There is no intradural abnormal enhancement. \nIncluded spinal cord and conus medullaris show normal signal intensity and\nvolume with no abnormal enhancement. Conus medullaris ends at the level of\nL1-L2.\n\nThere is has been an increase in lumbar lordosis since the study of ___. The\nsagittal alignment is relatively maintained apart from mild retrolisthesis of\nL1 over L2 and L2 over L3. Mild degree levocurvature of the lumbar spine\ncentered at L2-L3 level.\n\nThere are multilevel moderate to severe disc degenerative disease evidenced by\ndisc desiccation, disc height loss more pronounced at the middle lumbar levels\nand disc osteophyte complexes formation.\n\nT12-L1: No disc bulge, spinal canal stenosis or neural foraminal narrowing.\n\nL1-L2: There is no disc bulge or spinal canal stenosis. There are moderate\nbilateral neural foraminal narrowing.\n\nL2-L3: There is no disc bulge or spinal canal stenosis. There is severe right\nand moderate left neural foraminal narrowing.\n\nL3-L4: There is small disc bulge without spinal canal stenosis. There is\nsevere right and moderate left neural foraminal narrowing.\n\nL4-L5: There is small disc bulge without spinal canal stenosis. There is\nmild-to-moderate bilateral neural foraminal narrowing; more on the left side.\n\nL5-S1: There is no disc bulge or spinal canal stenosis. There are bilateral\nmild neural foraminal narrowing.\n\nDilatation of the right renal pelvocaliceal system.", "output": "1. Status post L1-L3 posterior fusion and L1-L5 laminectomies with newly\ndeveloped laminectomy site multilocular collections largest at the levels of\nL2 and L3.\n2. Interval development of endplate signal abnormality with intradiscal T2\nhyperintensity at the level of L3-L4; appearance concerning for early\ninfection.\n3. Redemonstration of clumping and peripheral distribution of cauda equina\nfibers through L3-S1 level as well as interval worsening of intrathecal\nseptations likely related to arachnoiditis.\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 12:15 pm, 45 minutes\nafter discovery of the findings." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level.\n\nVertebral body alignment is preserved. There are ___ type 1 degenerative\nchanges at L5-S1 without prevertebral soft tissue edema or fluid collection.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus terminates at L2.\n\nThere is loss of intervertebral disc height with disc desiccation at L5-S1.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints 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 no vertebral canal or neural foraminal narrowing.\n\nAt L3-4 there is no vertebral canal or neural foraminal narrowing.\n\nAt L4-5 there is mild central posterior disc bulge with narrowing of the\nsubarticular zone, left greater than right, with contact of the traversing\nnerve roots. There is bilateral facet joint hypertrophy. There is no neural\nforaminal narrowing.\n\nAt L5-S1 there is grossly stable left paracentral disc protrusion with\ndecreased left S1 nerve root compression. There is a disc bulge narrowing the\nsubarticular zone and contacting the bilateral traversing nerve roots, left\ngreater than right. There is bilateral facet hypertrophy and ligamentum\nflavum thickening resulting in moderate bilateral neural foraminal narrowing\nwith contact of the bilateral exiting nerve roots.", "output": "1. Study is mildly degraded by motion.\n2. Multilevel degenerative changes as described, most pronounced at L5-S1,\nwhere there is grossly stable left paracentral disc protrusion and left S1\nnerve root compression. Disc bulge at L5-S1 again results in moderate\nbilateral neural foraminal narrowing with contact of bilateral exiting nerve\nroots." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Mild multilevel cervical degenerative disease are most\npronounced at C3-C4 where there is a small disc protrusion. No severe spinal\ncanal and neural foraminal narrowing is identified.There is no evidence of\ninfection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nLigamentum flavum hypertrophy and facet osteophytes at T10-T11 encroaches upon\nthe spinal canal, but is not pressed upon the cord. Otherwise, no severe\nspinal canal or neural foraminal stenosis is demonstrated.There is no evidence\nof infection or neoplasm. There is no abnormal enhancement after contrast\nadministration.\n\nLUMBAR:\nAlignment is normal. Focal fat within the posterior aspect of the L2\nvertebral body is seen. There are mild degenerative signal loss of the L5-S1\ndisc associated with a small posterior disc bulge with no underlying mass\neffect on the underlying nerve roots. Otherwise, mild multilevel degenerative\nchanges of the lumbar spine do not result in significant spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm.\nThere is no abnormal enhancement after contrast administration.", "output": "1. No evidence of cord compression or cord signal abnormality.\n2. Mild multilevel degenerative changes of the cervical and lumbar spine do\nnot result in severe spinal canal or neural foraminal narrowing." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. The conus medullaris terminates at\nthe mid L1 level.\n\nThere is mild loss of T2 signal of the intervertebral discs, particularly at\nthe L4-L5 and L5-S1 levels, a manifestation of degenerative disc disease. \nThere is minimal disc height loss at L5-S1. The remainder of the\nintervertebral disc heights are relatively well preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nSagittal view at T10-T11 and T11-T12 demonstrate no significant spinal canal\nor neural foraminal narrowing\n\nAt T12-L1 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-2 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-3 there is minimal central disc protrusion without significant spinal\ncanal or neural foraminal narrowing.\n\nAt L3-4 there is minimal disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L4-5 there is minimal disc bulge without significant spinal canal\nnarrowing. There is mild effacement of the subarticular zones with contact of\nthe traversing L5 nerve roots with possible compression on the left (09:18). \nFacet arthropathy and endplate osteophytes produce mild left neural foraminal\nnarrowing. The right neural foramen is patent.\n\nAt L5-S1 there is no significant spinal canal or neural foraminal narrowing.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Mild lumbar spondylosis, as described, with possible compression of the\ntraversing left L5 nerve root, without significant spinal canal narrowing and\nonly up to mild neural foraminal narrowing at the left L4-L5 level.\n2. No terminal cord signal abnormality." }, { "input": "Sagittal IDEAL and axial postcontrast T1 weighted images are limited by motion\nartifact.\n\nThere are 12 rib-bearing vertebrae. Vertebral body heights are preserved. \nAlignment is normal. No evidence for suspicious bone marrow lesions. There is\na subcentimeter T1 hyperintense hemangioma in the T6 vertebral body, image\n6:11. No evidence for an epidural or intrathecal mass. No evidence for\npathologic leptomeningeal contrast enhancement.\n\nNo evidence for spinal cord signal abnormalities. The cord demonstrates\nnormal morphology. The conus medullaris is not fully included on the sagittal\nimages, but tapers at L1, with the prior lumbar spine MRI confirming that the\nconus medullaris terminates at L1-L2.\n\nNo significant spinal canal narrowing. Mild neural foraminal narrowing by\nfacet osteophytes is seen at T8-T9 and T9-T10 on the left, T10-T11 on the\nright.", "output": "1. No evidence for metastatic disease in the thoracic spine.\n2. No evidence for thoracic spinal canal narrowing or spinal cord signal\nabnormalities.\n3. Mild neural foraminal narrowing at several lower thoracic levels, as\ndetailed above." }, { "input": "Essentially nondisplaced acute type 2 odontoid fracture. Fracture of the\nright lateral mass, right anterior arch of C1. Acute/subacute superior\nendplate fracture deformity of the T2 vertebral body with approximately 50%\nloss of height anteriorly and vertebral body edema. T2 vertebral body edema\nextends into the right pedicle and right superior articular facet. No\nretropulsion.\n\nNo definite anterior longitudinal ligament disruption. Intact transverse\nligament, posterior longitudinal ligament, tectorial membrane, ligament\nflavum. Mild edema between C1-C2 spinous process, suggestive of posterior\nligamentous complex injury. Paraspinal edema.\n\nTrace volume fluid, without diastasis lateral mass occiput C1 articulation.\n\nFluid without significant distraction at lateral C1-C2 mass articulation, may\nrepresent acute atlantooccipital injury. Normal pre dentate interval.\n\nRemaining cervical vertebral body heights are preserved.\n\nDegenerative changes cervical spine. Multilevel disc osteophyte complexes,\nposterior element hypertrophic changes. Minimal anterolisthesis C6-C7, C7-T1,\nsimilar, likely degenerative, no paravertebral edema at this level.\n\nMild-to-moderate central canal narrowing C3-C4, C4-C5 levels, moderate central\ncanal narrowing C5-C6 level, with preserved CSF about cord, no cord\nflattening. No cord signal abnormality.\n\nEvaluation of foramina is difficult secondary to patient motion. \nMild-to-moderate bilateral C2-C3, moderate bilateral C3-C4, moderate bilateral\nC4-C5, moderate bilateral C5-C6, mild-to-moderate right and mild left C6-C7,\nmild-to-moderate bilateral C7-T1 foraminal narrowing.\n\nMild prevertebral soft tissue swelling at C2. STIR and T2 hyperintense signal\nwithin the paraspinal soft tissues from skullbase to C3, likely ligamentous\ninjury and/or partial tearing.\n\nNo definite focal cord signal abnormalities.\n\nMultilevel degenerative changes of the cervical spine with prominent disc\nosteophyte complex at C5-C6. Mild spinal canal narrowing and C3-C4 and C5-C6.\nModerate spinal canal narrowing at C4-C5.\n\nMild left foraminal narrowing at C2-C3, moderate bilateral foraminal narrowing\nat C3-C4, moderate to severe left greater than right foraminal narrowing at\nC4-C5, severe left and mild right foraminal narrowing at C5-C6, and mild left\nforaminal narrowing at C7-T1.", "output": "1. Type 2 odontoid fracture.\n2. Fracture right lateral mass, right anterior arch C1\n3. T2 superior endplate fracture with 50% loss of height.\n4. Fluid bilateral atlantoaxial joints, suggestive of mild subluxation.\n5. Probable posterior ligamentous complex injury C1-C2.\n6. Moderate central canal narrowing C5-C6 level.\n7. Multilevel significant foraminal narrowing.\n8. No cord signal abnormality." }, { "input": "Acute superior endplate fracture deformity of the T2 vertebral body with\napproximately 50% loss of height. Edema extends into the right greater than\nleft pedicles, right superior articular facet T2.\nNo retropulsion.\n\nChronic appearing anterior wedge compression deformity of T9. Multilevel\nSchmorl's nodes. Normal spinal cord. No epidural hematoma.\n\nMild multilevel degenerative changes. Spinal canal is patent. No significant\nneural foraminal narrowing.\n\nModerate right hydronephrosis, partially seen, better seen on ___.\n\nIrregular parenchymal band like signal alterations in the dependent portions\nof the lungs,, with very bright nodular and branching opacities suggestive of\nmucous plugging, aspiration or infection.", "output": "1. Acute T2 vertebral body fracture, 50% height loss, extends to posterior\nelements.\n2. No cord signal abnormalities.\n3. Patent central canal, foramina.\n4. Right hydronephrosis, partially seen, similar.\n5. Nodular opacities posterior dependent lungs bilaterally, suggestive of\naspiration, mucous plugging or infection." }, { "input": "The vertebral body height and alignment within the lumbar spine are normal. \nThere are multilevel degenerative endplate changes, greatest within the\nsuperior endplate of L5.\n\nThe conus medullaris is normal in position and morphology in terminates at the\nT12-L1 level.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the T12-L1 level, the spinal canal and neural foramina appear normal.\n\nAt the L1-L2 level, there is bilateral facet arthropathy. The spinal canal\nand neural foramina appear normal.\n\nAt the L2-L3 level, there is bilateral facet arthropathy, diffuse disc bulge,\nand superimposed posterior disc extrusion, migrating inferiorly, causing mild\nto moderate spinal canal narrowing, left-sided subarticular zone narrowing\nwith displacement of the traversing left L3 nerve root, as well as mild left\nneural foraminal narrowing.\n\nAt the L3-L4 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge, and superimposed posterior disc protrusion and\nannular fissure causing mild spinal canal narrowing, bilateral subarticular\nzone narrowing with contact of the traversing bilateral L4 nerve roots, as\nwell as mild bilateral neural foraminal narrowing.\n\nAt the L4-L5 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge, and left paracentral/foraminal disc protrusion\ncausing moderate spinal canal narrowing, bilateral subarticular zone narrowing\nwith contact of the traversing right L5 nerve root and compression of the\ntraversing left L5 nerve root, as well as moderate bilateral neural foraminal\nnarrowing, slightly greater on the right side.\n\nAt the L5-S1 level, there is bilateral facet arthropathy, ligamentum flavum\nthickening, diffuse disc bulge and small posterior disc protrusion causing\nvery mild spinal canal narrowing and mild left neural foraminal narrowing.", "output": "Multilevel lumbar spondylosis including a disc extrusion at L2-L3 level as\nwell as disc protrusions at the L3-L4 and L4-L5 levels likely affecting\nmultiple associated traversing nerve roots within the subarticular zones, most\nprominently the left L5 nerve root at the L4-L5 level." }, { "input": "THORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere are disc bulges at T8-T9 and T9-T10, mildly effacing the ventral thecal\nsac with no significant spinal canal or neural foraminal stenosis. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal. ___ type 2 end plate changes are noted at the superior\nendplate of L5. Otherwise, vertebral body signal intensity appears normal. \nThere is disc desiccation at L3- S1. There is stable appearance of the disc\nprotrusion at L2-L3 with effacement of the ventral thecal sac and resulting in\nmild spinal canal and left subarticular zone narrowing. The protruded disc\ncontinues to extend inferiorly and abuts the transiting left L3 nerve root. \nThere is a stable disc protrusion at L3-L4 with facet arthropathy resulting in\nmild bilateral neural foraminal narrowing and no significant spinal canal\nnarrowing. Stable disk bulge with superimposed central disc protrusion and\nfacet arthropathy at L4-L5 resulting in moderate spinal canal and bilateral\nneural foraminal stenosis. Facet arthropathy at L5-S1 with no significant\nspinal canal or neural foraminal stenosis. There is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.\n\nOTHER: There is a 0.6 cm T2 hyperintense lesion in the right lobe hepatic\nlobe, likely representing a simple hepatic cyst or hemangioma.", "output": "1. No evidence for epidural hematoma or abscess.\n2. Mild degenerative changes in the thoracic spine with no significant spinal\ncanal or neuroforaminal stenosis.\n3. Stable appearance of the disc protrusions at L2-L3, L3-L4 and at L4-L5, as\ndescribed above." }, { "input": "There has been no significant interval change compared to the recent MRI dated\n___.\n\nThoracic spine:\nNumbering of the thoracic spine is provided on series 4, image 7.\nAlignment is normal. There is a 10 mm focus of T1 and T2 hyperintensity along\nthe superior aspect of the T12 vertebral body that is isointense on STIR\nsequence, likely representing focal fat. Marrow signal is otherwise normal. \nIntervertebral disc signal intensity appears normal. The spinal cord appears\nnormal in caliber and configuration. Conus medullaris terminates at T12. A\nsmall perineural cyst is noted at T1-T2 on the right. Disc bulges are again\nnoted at T9-T10 and T10-T11 which mildly effaces the ventral thecal sac,\nwithout significant spinal canal or neural foraminal narrowing. There is no\nevidence of infection or neoplasm.\n\nLumbar spine:\nNumbering of the lumbar spine is provided on series 10, image 10.\nAlignment of the lumbar spine is normal. Bone marrow signal is normal. There\nis no evidence of infection or neoplasm. There is loss of T2 signal in the\nintervertebral discs at L2-L3, L3-L4, L4-L5 and L5-S1, suggestive of\ndegenerative disc disease. Multilevel degenerative changes throughout the\nlumbar spine are as follows:\n\nAt T12-L1 and L1-L2, there is no significant spinal canal or neural foraminal\nnarrowing.\n\nAt L2-L3, there is a broad-based disc bulge with a small left paracentral\nprotrusion that compresses the thecal sac at this level. There is also\ncrowding of the left subarticular zone with disc material contacting the\ntraversing L3 nerve root (14:4).\n\nAt L3-L4, there is a disc bulge and bilateral facet joint arthropathy that\nresults in mild bilateral neuroforaminal narrowing. No significant spinal\ncanal stenosis at this level.\n\nAt L4-L5, there is disc bulging with superimposed left paracentral protrusion,\nand bilateral facet joint arthropathy that results in moderate spinal canal\nstenosis. There is compression of the left L5 in nerve root, in addition to\ncontact of the right L5 nerve root (14:19).\n\nAt L5-S1, there is no significant spinal canal or neuroforaminal narrowing.\n\nLimited images of the abdomen demonstrate a 7 x 7 mm T2 hyperintensity in the\nright hepatic lobe (8: 8), similar to the prior study in ___ and most\nlikely represents a cyst.", "output": "1. No epidural collections, discitis/osteomyelitis or cord signal\nabnormalities.\n2. Multilevel degenerative changes in the lumbar spine as described above.\nNotable levels include L2-L3 where there is mild spinal canal narrowing and\ncrowding of left subarticular zone due to disc bulge with superimposed central\nprotrusion that abuts left L3 traversing nerve root. At L4-L5, there is\nmoderate spinal canal stenosis, compression of the left L5 nerve root, and\ncontact of the right L5 nerve root." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nQuestion minimal edema and C6 vertebral body versus artifact. Otherwise,\nthere is no marrow signal abnormality. The visualized portion of the spinal\ncord is grossly preserved.\n\nThere is loss of intervertebral disc height and signal at C6-7. Otherwise,\nintervertebral disc heights and signal are preserved.\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.\n\n At C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is disc bulge withno spinal canal or neural foraminal stenosis.\n\nAt C4-5 there is a disc bulge with right-sided facet joint arthropathy and\nuncovertebral hypertrophy resulting in moderate right neural foraminal\nstenosis andno spinal canal stenosis.\n\nAt C5-6 there is no spinal canal or neural foraminal stenosis.\n\nAt C6-7 there is disc bulge with right greater than left uncovertebral\nhypertrophy and facet joint arthropathy resulting in moderate spinal canal and\nmoderate to severe bilateral neural foraminal stenosis.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no evidence of cord signal abnormality or\nligamentous injury.\n3. Multilevel degenerative changes as described, most pronounced at C6-7,\nwhere there is moderate spinal canal and moderate to severe bilateral neural\nforaminal stenosis.\n4. Question minimal edema versus artifact in C6 vertebral body without\ndefinite loss of vertebral body height." }, { "input": "Incomplete segmentation C2-C3 vertebral bodies. 3 mm anterolisthesis C4-C5,\nminimal anterolisthesis C7-T1, likely degenerative. Multilevel degenerative\nchanges, disc space narrowing, disc osteophyte complexes, posterior element\nhypertrophic changes. No cord signal abnormality. No worrisome osseous\nlesions.\n\nAt C2-C3, patent central canal, patent foramina.\n\nAt C3-C4, moderate to severe central canal narrowing, completely effaced CSF\nabout cord, mild cord flattening, no cord signal abnormality. Moderate to\nsevere right, severe left foraminal narrowing.\n\nAt C4-C5, mild-to-moderate central canal narrowing, preserved CSF. Moderate\nright, mild left foraminal narrowing.\n\nAt C5-C6, moderate central canal narrowing, minimal flattening ventral cord,\nnearly completely efface CSF. Severe right, moderate left foraminal\nnarrowing.\n\nAt C6-C7, moderate central canal narrowing, minimal flattening of the ventral\ncord, nearly completely efface CSF. Moderate bilateral foraminal narrowing.\n\nAt C7-T1 patent central canal. Patent foramina.", "output": "1. Advanced degenerative changes cervical spine.\n2. Incomplete segmentation C2-C3 vertebral bodies.\n3. Moderate to severe central canal narrowing C3-C4 level, mild cord\nflattening.\n4. Moderate central canal narrowing C5-C6, C6-C7 levels.\n5. Multilevel significant foraminal narrowing, as above." }, { "input": "Vertebrae are normal in stature and alignment. There is no suspicious marrow\nsignal abnormality. Intervertebral discs are preserved in height and signal.\n\nThe spinal cord is normal in course and caliber. There is questionable\nincreased STIR signal within the spinal cord at C6 (series 5, image 5). This\nmay also be present on axial T2 sequences (series 6, image 23), although\nevaluation is limited due to motion and pulsation artifact. No additional\npossible cord lesions are identified.\n\nC2-3: There is no significant spinal canal or neural foraminal stenosis.\n\nC3-4: There is no significant spinal canal or neural foraminal stenosis.\n\nC4-5: There is no significant spinal canal or neural foraminal stenosis. Mild\nright foraminal narrowing possible\n\nC5-6 There are uncovertebral and facet osteophytes but no significant spinal\ncanal or neural foraminal stenosis.\n\nC6-7: There uncovertebral and facet osteophytes causing mild right and no\nsignificant left neural foraminal stenosis. There is no significant spinal\ncanal stenosis.\n\nC7-T1: There is no significant spinal canal or neural foraminal stenosis.\n\nPulsation artifacts at T4 indenting the posterior cord partly imaged.\nThe prevertebral and paraspinal soft tissues are normal.\nThe visualized posterior fossa is normal in morphology and signal.", "output": "1. Questionable increased STIR signal within the spinal cord at C6 (series 5,\nimage 5). This may be faintly present on the axial T2 sequence (series 6,\nimage 23), although confirmation that this is a true lesion is limited due to\nmotion and pulsation artifact. There is no enhancement of this possible lesion\nand no expansion of the spinal cord. Correlate clinically and consider close\nfollow up on 1.5T scanner if needed.\n2. Very minimal degenerative disease with no significant spinal canal or\nneural foraminal stenosis.\n\nNOTIFICATION: Findings were discussed by Dr. ___ of radiology by\nphone with Dr. ___ at 09:10 ___." }, { "input": "MRI of the cervical spine was performed with sagittal T2, sagittal IDEAL, and\naxial T2 sequences to evaluate for a possible abnormality seen on MRI cervical\nspine from ___.\n\nThe cervical and visualized upper thoracic spinal cord are normal in course,\ncaliber, and signal. The cord signal abnormality at C6 postulated at MRI from\n___ is not reproduced on sagittal T2, sagittal IDEAL (which\ncontains a fluid-sensitive sequence equivalent to STIR), or axial T2\nsequences. The visualized posterior fossa is normal.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. There is no spinal canal or neural foraminal narrowing.", "output": "Normal cervical and visualized upper thoracic spinal cord. The abnormality\npostulated at C6 on recent MRI from ___ is not reproduced on the\ncurrent study, indicating that it was artifactual." }, { "input": "Vertebral body heights and alignment are preserved. There is a small\nSchmorl's node at the superior endplate of L2. There is mild type ___ ___\nendplate degenerative change at L3-L4. There is no prevertebral soft tissue\nedema. There is otherwise no suspicious focal bone marrow lesion.\n\nThere is loss of T2 signal of the intervertebral discs from the L3-L4 through\nL5-S1 levels also including the L1-L2 level, a manifestation of degenerative\ndisc disease. There is mild intervertebral disc height loss at the L3-L4,\nL4-L5 and L5-S1 levels.\n\nThe visualized distal spinal cord is preserved in signal and caliber. The\nconus medullaris terminates at the L1-L2 level. There is no epidural\ncollection or abnormal focus of post contrast enhancement.\n\nMultilevel facet degenerative changes most prominent at the L4-L5 and L5-S1\nlevels.\n\nSagittal view of T11-T12 demonstrates no significant spinal canal or neural\nforaminal narrowing.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is trace disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L2-L3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-L4, disc bulge indents the ventral thecal sac without significant spinal\ncanal or neural foraminal narrowing.\n\nAt L4-L5, disc bulge and ligamentum flavum thickening mildly narrows the\nspinal canal. There is contact of the traversing L5 nerve roots without\ndisplacement. Facet and endplate osteophytes produce mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is small disc bulge with tiny superimposed central protrusion\nwithout significant spinal canal or neural foraminal narrowing.\n\nThe bladder appears prominently distended, partially visualized. The\nvisualized retroperitoneum is otherwise grossly unremarkable.", "output": "1. Mild multilevel lumbar spondylosis, as described, with only up to mild\nspinal canal narrowing at L4-L5 and mild neural foraminal narrowing at the\nbilateral L4-L5 level. No significant spinal canal or neural foraminal\nnarrowing at other levels. No nerve root compression.\n2. No abnormal focus of post contrast enhancement.\n3. Distended bladder." }, { "input": "There are 5 lumbar-type vertebrae. The localizer sequence demonstrates a\nlevoconvex scoliosis centered at T12-L1 and a dextroconvex scoliosis centered\nat L3-L4, with left lateral subluxation of L2 on L3 and right lateral\nsubluxation of L4 on L5 better demonstrated on the ___ CT. There is\nminimal retrolisthesis of T12 on L1, L2 on L3 and of L3 on L4, unchanged since\nthe ___ MRI. There is also grade 1 anterolisthesis of L4 on L5 and minimal\nretrolisthesis of L5 on S1, new compared to the ___ MRI but seen on the ___ CT. Vertebral body heights are within normal limits.\n\nThere is no evidence for osseous, epidural, or leptomeningeal metastatic\ndisease. The distal spinal cord demonstrates normal morphology and signal\nintensity, with the conus medullaris terminating at L1.\n\nThere is loss of disc height from L2-L3 through L5-S1, and discogenic bone\nmarrow changes at multiple lumbar and visualized lower thoracic levels.\n\nSagittal images through the T11-12 level demonstrate a disc bulge which\nindents the ventral thecal sac but does not contact the spinal cord. It was\npartially visualized at the edge of the field of view of the sagittal images\non the prior MRI. There are no axial images through this level on the present\nMRI.\n\nT12-L1: Minimal retrolisthesis and a mild disc bulge without significant\nspinal canal or neural foraminal narrowing, similar to the prior MRI.\n\nL1-L2: Mild disc bulge and mild facet arthropathy without significant spinal\ncanal narrowing. Small right foraminal disc protrusion, which in combination\nwith facet arthropathy results in only minimal right neural foraminal\nnarrowing, without nerve root impingement. No change since the prior MRI.\n\nL2-L3: Minimal retrolisthesis, mild disc bulge, left greater than right facet\narthropathy, and thickening of the ligamentum flavum are present. Previously\nnoted right foraminal disc protrusion has decreased in size since ___. The\nleft subarticular zone is narrowed but the traversing left L3 nerve root is\nnot appear compressed. The spinal canal is mildly narrowed without\nsignificant mass effect on the intrathecal nerve roots. There is minimal\nright and mild to moderate left neural foraminal narrowing without evidence\nfor nerve root impingement.\n\nL3-L4: Previously noted left paracentral and foraminal disc protrusion has\ndecreased, and left paracentral, foraminal, and extra foraminal osteophytes\nhave increased. There is mild thickening of the ligamentum flavum, and left\ngreater than right moderate facet arthropathy. The left subarticular zone is\nnarrowed, but the traversing left L4 nerve root does not appear compressed. \nThere is no mass effect on the intrathecal nerve roots. There is moderate\nleft neural foraminal narrowing with abutment of the exiting left L3 nerve\nroot by the disc material and endplate osteophytes, overall similar to the\nprior MRI a. There is no right neural foraminal narrowing.\n\nL4-L5: Grade 1 anterolisthesis, thickening of the ligamentum flavum, moderate\nright and severe left facet arthropathy are present. The traversing left L5\nnerve root appears impinged in the subarticular zone. Right subarticular zone\nis also narrowed with abutment of the traversing right L5 nerve root. The\nspinal canal is severely narrowed with crowding of the intrathecal nerve\nroots. These findings have all progressed since ___. In addition, there is\nmoderate left neural foraminal narrowing, progressed since ___. The right\nneural foramen is foreshortened due to the anterolisthesis.\n\nL5-S1: Minimal retrolisthesis, moderate right and mild to moderate left facet\narthropathy are present. There is no spinal canal narrowing. There is mild\nright and minimal left neural foraminal narrowing, which are new.\n\nThere is a cortical defect in the posterior interpolar left kidney, where\nsmall cystic lesion was seen on the ___ MRI.", "output": "1. No evidence for osseous, epidural, or leptomeningeal metastatic disease.\n2. Overall progression of multilevel degenerative disease, as detailed above,\nwith severe spinal canal stenosis at L4-L5, and mass effect on several\ntraversing and exiting nerve roots.\n3. Thoracolumbar scoliosis." }, { "input": "The lumbar spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal. The visualized aspect of the lower thoracic\nspinal cord appears normal in caliber and configuration, conus medullaris\nterminates at the level of T12-L1 and is unremarkable.\n\nAt the different intervertebral disc spaces, there is no evidence of neural\nforaminal narrowing or spinal canal stenosis.\n\nAt L5-S1 level, there is mild bilateral articular joint facet hypertrophy,\nwith no evidence of spinal canal narrowing (series 5, images 34 and 35).\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable.", "output": "1. There is no evidence of spinal canal stenosis or neural foraminal\nnarrowing throughout the lumbar spine.\n\n2. Mild articular facet joints degenerative changes are visualized at L5-S1\nlevel." }, { "input": "CERVICAL SPINE: Alignment is anatomic. There is no suspicious osseous\nabnormality. At C5-C6, a broad-based disc protrusion with a central focal\ncomponent and an underlying annular tear mildly narrows the spinal canal with\nremodeling of the ventral spinal cord. The spinal cord has normal signal and\nthere is no abnormal intradural enhancement. Other smaller, very mild disc\nprotrusions and osteophytes are seen, but there is no other significant spinal\ncanal or foraminal narrowing. There is no abnormal intradural enhancement. \nProminent tonsillar tissue and cervical lymph nodes are likely physiologic in\na patient of this age.\n\nTHORACIC SPINE: Alignment is anatomic. There are no suspicious osseous\nlesions. There is no abnormal intradural enhancement. The spinal cord has\nnormal signal. Scattered very mild disc protrusions are present without\nsignificant spinal canal or foraminal narrowing.\n\nLUMBAR SPINE: There is transitional anatomy with marked sacralization of L5,\nwhen numbered by counting down from C2. By the numbering system outlined\nabove, the thecal sac terminates at the level of the S1-S2 border, and the\nconus medullaris terminates at the level of the mid L1 vertebral body and has\nnormal contour and signal.\n\nAlignment is unremarkable. There are no suspicious osseous lesions. There is\nno abnormal dural enhancement. There is no abnormal intradural enhancement.\n\nThe scout sequences reveal abnormal increased signal in the left greater than\nright lung base, partially visualized. In addition, there is a small amount\nof free fluid in the pelvis.", "output": "1. No evidence of osteomyelitis, discitis, epidural abscess or other\ninfectious pathology of the spine.\n2. Very mild degenerative changes, most prominent at C5-6 where a disc\nprotrusion mildly narrows the spinal canal.\n3. Transitional anatomy with marked sacralization of L5.\n4. Marked signal abnormality in lung bases. This could represent atelectasis\nor pneumonia.\n5. A small amount of free fluid in the pelvis, which can be physiologic in a\nfemale patient of this age." }, { "input": "There is grade 1 L5 on S1 anterolisthesis with bilateral L5 pars\ninterarticularis defect. There is mild edema about posterior elements at L5\nlevel, inferior articular facets at L4 level, with mild adjacent paravertebral\nsoft tissue edema and mild edema of the adjoining L4, L5 spinous processes,\nlikely reactive and degenerative. There multilevel degenerative changes with\nmultilevel disc space narrowing, endplate hypertrophic changes, diffuse disc\nbulges and facet arthritis. There is no evidence of bone marrow replacement\nprocess. There are no acute compression fractures. There is minimal\nvertebral body height loss at L3, L4 levels, which is likely degenerative,\nwith few adjacent Schmorl's nodes, or less likely sequela of chronic\ncompression fractures. Conus terminates at upper L2 endplate. The spinal\ncord appears normal in caliber and configuration. There is no definite\nevidence of infection. There few small T2 hyperintense renal lesions on the\nleft side, statistically likely benign cysts. Few left renal parapelvic cysts\nare seen.\n\nAt L1-L2 level there is mild central canal narrowing. Bilateral foramina are\npatent.\nAt L2-L3 level there is tiny, central, inferior disc protrusion. There is\nmild central canal narrowing. There is mild effacement of the right thecal\nsac from diffuse disc bulge, without effacement of CSF about traversing\nnerves. The bilateral foramina are patent.\nAt L3-L4 level there is mild central canal narrowing. Bilateral foramina are\npatent.\nAt L4-5 level there minimal L4 on L5 retrolisthesis. There is small\nbroad-based, central inferior disc protrusion. Both lateral recesses are\nnarrowed, more prominent on the left. There is mild central canal narrowing\nthere is mild bilateral foraminal narrowing.\nAt L5-S1 level central canal is decompressed secondary to grade 1\nanterolisthesis and bilateral L5 pars defects. Mild effacement of both\nlateral thecal sacs from prominent facet arthritis, encroaching on bilateral\nintrathecal S1 nerves, without effacement of CSF about the nerves. There is\nsmall inferior left foraminal disc protrusion, of intermediate T2 signal\ncentrally, and dark T2 signal peripherally. There is severe left, and\nmoderate to severe right foraminal narrowing.", "output": "1. There is grade 1 anterolisthesis of L5 on S1, with bilateral L5 pars\ninterarticularis defect, and reactive edema, degenerative changes of the\nposterior elements at this level. There is small inferior left foraminal disc\nprotrusion at L5-S1 level, with severe left, and moderate to severe right\nforaminal narrowing.\n2. Degenerative changes in the remainder of the lumbar spine, as above\n3. There are no acute or subacute compression fractures." }, { "input": "Alignment is within normal limits. Vertebral body heights are preserved. \nMarrow signal is unremarkable. The cervical spinal cord is normal in caliber.\nThere is possible patchy hyperintense T2/stir signal in the cervical spinal\ncord involving areas of the central cord as well as the right lateral cord,\nspanning an approximately 2.4 cm length of cord posterior to C5 and C6.\n\nThe remainder of the cervical spinal cord is normal in caliber and signal\nintensity.\n\nSignal and height loss of cervical spine intervertebral discs is consistent\nwith degenerative change. There multilevel disc bulges and endplate\nosteophytes as well as uncovertebral and facet osteophytes, causing areas of\nspinal canal and neural foraminal narrowing, to varying degrees. \nSpecifically:\n\nC2-3: Unremarkable.\nC3-4: Mild spinal canal narrowing. Moderate left and mild right neural\nforaminal narrowing.\nC4-5: Mild spinal narrowing, slight cord remodeling with right ventral spinal\ncord contact by disc osteophyte complex. Mild bilateral neural foraminal\nnarrowing.\nC5-6: Mild spinal canal narrowing. Moderate right and mild left neural\nforaminal narrowing.\nC6-7: Mild-to-moderate spinal narrowing. Moderate left and mild right neural\nforaminal narrowing.\nC7-T1: Unremarkable.\n\n\nPartial right mastoid effusion is noted. Imaged cerebellum and base of the\nbrain are unremarkable. The prevertebral and paraspinal soft tissues are\nunremarkable.", "output": "1. Subtle patchy T2/STIR hyperintense cord signal involving 2.4 cm length of\ncord posterior to C5 and C6. This is nonspecific although this could be\nartifactual in etiology, differential considerations include could represent\nchronic myelomalacia (for example as sequelae of prior injury). Other\nentities such as demyelination, or underlying lesion considered less likely\ndue to absence of cord expansion. Recommend post-contrast MR cervical spine\nimaging, if/when if clinically appropriate.\n2. Moderate cervical spondylosis. Spinal canal narrowing is worst\n(mild-to-moderate) at C6-7. Neural foraminal narrowing is worst (moderate) on\nthe left at C3-4, right at C5-6, and left C6-7.\n\nRECOMMENDATION(S): Postcontrast cervical spine MRI imaging, if/when\nclinically appropriate." }, { "input": "Compared with prior studies, the patient is status post interval bilateral\nL3-4 laminectomies. There are expected postoperative findings including\nenhancing epidural fibrosis at the site of the laminectomies and along the\nposterior midline surgical approach. There is no focal fluid collection. \nThere is trace dependent subcutaneous edema within the soft tissues overlying\nthe mid lumbar spine. Previously demonstrated spinal cord stimulator device\nhas been removed.\n\nThere is minimal, approximately 3 mm of L5-S1 retrolisthesis, unchanged. 3 mm\nL1-2 retrolisthesis is also unchanged. Alignment is otherwise normal.\n\nVertebral body heights are preserved. There are ___ type 1 degenerative\nendplate changes seen at L5-S1. There are multilevel Schmorl's nodes. There\nis an intraosseous hemangioma in the L3 vertebral body. There is no\nsuspicious focal marrow signal abnormality.\n\nThe distal spinal cord and conus medullaris is within normal limits in\nterminates at L1-2. The cauda equina nerve roots are unremarkable.\n\nThere is no abnormal intraspinal enhancement or epidural collection.\n\nSignal and height loss of lumbar spine intervertebral discs is consistent with\ndegenerative change, worst at L4-5 and L5-S1. Multilevel mild posterior disc\nbulges, ligamentum flavum thickening, facet osteophytes, and small\ndegenerative facet joint effusions causing varying degrees of spinal canal and\nneural foraminal narrowing. More specifically:\n\n T12-L1: Unremarkable.\nL1-2: No spinal canal narrowing. Mild bilateral neural foraminal narrowing.\nL2-3: Unremarkable.\nL3-4: Expected postoperative findings from interval L3-4 laminectomies\nincluding posterior epidural fibrosis. No spinal canal narrowing. Moderate\nbilateral neural foraminal narrowing.\nL4-5: No spinal canal narrowing. Moderate right neural foraminal narrowing.\nL5-S1: No spinal canal narrowing. Severe left and moderate right neural\nforaminal narrowing, with probable impingement of the exiting left L5 nerve\nroot.\n\nThere are T2 hyperintense foci seen in the kidneys bilaterally, only partially\nvisualized, without suspicious features. The remaining imaged portions of the\nabdomen and pelvis are unremarkable.", "output": "1. Moderate lumbar spondylosis. No spinal canal narrowing. Multilevel neural\nforaminal narrowing is worst (severe) on the left at L5-S1, likely with\nimpingement of the exiting left L5 nerve root.\n2. Status post interval L3-4 laminectomies with expected postoperative\nfindings including posterior epidural fibrosis. No focal fluid collection. \nNo abnormal enhancement.\n3. T2 hyperintensities in the kidneys are partially visualized bilaterally,\nnot fully evaluated, without suspicious features. Other incidental findings,\nas above.\n\nRECOMMENDATION(S): Management of Incidental Renal Cyst Completely\nCharacterized on CT or MRIBosniak I or II- No further workup\n\nReference:\n\nHerts BR, ___ SG, ___ NM, et. Al. Management of the Incidental Renal\nMass on CT: A White Paper of the ACR Incidental Findings Committee. J ___\n___ ___" }, { "input": "At the craniocervical junction and C2-3 mild degenerative change seen.\n\nAt C3-4 level, posterior disc osteophyte is seen with severe spinal stenosis\nand compression of the spinal cord. There is moderate-to-severe left and\nmoderate right foraminal narrowing.\n\nAt C4-5 level, disc bulging is seen with mild-to-moderate spinal stenosis and\nminimal indentation on the spinal cord. There is mild narrowing of the\nforamina.\n\nAt C5-6 posterior disc osteophyte results in moderate spinal stenosis with\nmoderate-to-severe bilateral foraminal narrowing.\n\nAt C6-7 disc bulging and uncovertebral degenerative changes result in mild\nspinal stenosis and severe left foraminal narrowing.\n\nAt C7-T1 to T3-4 mild degenerative change seen.\n\nIncreased signal is seen within the spinal cord from C3-4 to C5 level\nindicative of myelomalacia and cord edema. There is no evidence of hemorrhage\nwithin the spinal cord.", "output": "1. Severe spinal stenosis at C3-4 moderate spinal stenosis at C5-6 and mild\nspinal stenosis at C4-5 and C6-7 levels as described.\n2. Increased signal within the spinal cord which appears diffuse and is likely\nsecondary to cord edema with some combination of myelomalacia. Cord edema is\nunchanged since ___.\n3. Multilevel foraminal changes as described above." }, { "input": "CERVICAL SPINE:\nThe patient is status post posterior spinal fusion. Multilevel laminectomies\nfrom the levels of C3 through the C7, with orthopedic hardware seen extending\nfrom the level of C3 through T1. The hardware itself is better assessed on\nrecent CT cervical spine examination performed on ___.\n\nSusceptibility artifact emanating from this hardware limits evaluation of the\nadjacent tissues. The examination is also mildly limited secondary to patient\nmotion. Within these limitations:\n\nExtensive postoperative changes are noted, including subcutaneous soft tissue\nswelling, edema, and diffuse enhancement compatible with granulation tissue. \nThese findings are most notable in the posterior soft tissues noted along the\ndorsal aspects of the C3 through T1 vertebral body levels. Small fluid\ncollection along the incision site, likely postoperative. There is linear\ndural thickening, enhancement with mild probably subdural component extending\nfrom C3 through T4 level contributing mild-to-moderately 2 central canal\nnarrowing,, most prominently at cervicothoracic junction at C7-T2 likely\npostoperative in may represent subacute contracting enhancing blood products.\n\nThere is no evidence for abnormal enhancement seen within the spinal canal\nitself. However, the cervical spinal cord again demonstrates increased and\nabnormal T2 signal at the levels of C3 and C4 as seen on the preoperative\ncervical spine MRI, with mildly more prominent small area of mild cord\nexpansion at C4 level. Previously seen small area of linear T2 signal\nabnormality there was involving posterior cord at C5 level is not present\ntoday. Suggestion of mild associated enhancement versus metal artifact which\nmight be accentuated on post gadolinium images on sagittal series 21, image 9.\nOverall, findings may represent postsurgical changes, or sequela of\nspondylotic myelomalacia. Focal area of ischemia is less likely unless\nclinically suspected.\nThere is moderate central canal narrowing at the level of C3 vertebral body,\nmore prominent since prior.\nThere is no definite evidence for acute compression deformity. Minimal\nanterolisthesis of C7 on T1 is unchanged from the preoperative examination. \nOtherwise, the spinal alignment is essentially anatomic.\n\n___ type 2 endplate changes are noted at the level of C3-4. Otherwise, bone\nmarrow signal is mildly heterogeneous but without focal suspicious lesion.\n\n\nMultilevel degenerative changes are as follows:\n\nC1-C2: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nC2-C3: A posterior disc bulge flattens the ventral thecal sac and results in\nmild canal stenosis. No appreciable neural foraminal narrowing.\n\nC3-C4: A posterior disc bulge flattens the thecal sac, contacts the spinal\ncord, and results in moderate canal stenosis just above level of the disc\nspace with moderate bilateral neural foraminal narrowing, similar.\n\nC4-C5: A posterior bulge indents the ventral thecal sac results in mild canal\nstenosis, and mild right neural foraminal narrowing.\n\nC5-C6: There is no significant canal stenosis. However, bilateral facet and\nuncovertebral joint hypertrophy results in moderate severe bilateral neural\nforaminal narrowing, greater on the right.\n\nC6-C7: A mild posterior disc bulge results in flattening of the ventral thecal\nsac and mild canal stenosis. Additionally, bilateral uncovertebral and facet\njoint hypertrophy results in moderate severe left, knee and mild-to-moderate\nright foraminal narrowing, similar to prior.\n\nC7-T1: There is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\n\nTHORACIC SPINE:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is mild central canal narrowing at T2-T3, T3-T4 levels from mild diffuse\ndisc bulges and endplate hypertrophic changes. Otherwise, there is no\nevidence of spinal canal or neural foraminal narrowing.", "output": "1. Postoperative changes. Small fluid collection along the incision site in\nthe posterior paraspinal soft tissues, likely postoperative.\n2. Dural thickening, enhancement is small probably subdural component,\npossibly from late subacute blood products, extends from C3 through T4,\ncontributes to mild to moderate central canal narrowing, likely postoperative;\ninfection is unlikely given lack of adjacent edema, clinically correlate\n3. Cord edema at C3-C4, with mildly more prominent cord expansion at C4 may be\nfrom decompression, equal coal enhancement versus artifact from adjacent\nmiddle hardware it with linear configuration at C4, findings may be from\npreviously seen myelomalacia or edema. Cord ischemia is unlikely unless\nclinically suspected. Previously seen mild cord edema at C5 has resolved.\n4. Normal thoracic cord.\n5. Multilevel spondylosis of the cervical spine, with significant multilevel\nforaminal narrowing, as detailed above." }, { "input": "Vertebral body and intervertebral disc signal intensity appear normal.\nReversal of cervical lordosis with mild kyphosis.\nMild anterolisthesis of C4 over C5 is unchanged.\n\nNo suspicious mass like lesions are noted in the cervical vertebral bodies.\nMinimal type ___ ___ changes are noted at C4 vertebral body anterosuperiorly\nand inferiorly at C5 level.\nDisc desiccation noted at all levels. Prominent anterior osteophytes are noted\nat C5, C6 and C7 levels.\nUncovertebral and facet degenerative changes and ligamentum flavum thickening\nare noted at multiple levels.\nMild degenerative changes are noted at the atlantoaxial joints with small\namount of fluid on the right side.\n\nC2-C3: Shallow central protrusion, no canal or foraminal narrowing.\nC3-4: Mild diffuse bulge, with shallow central component, no disc herniation,\nno canal or significant foraminal narrowing. Mild progression of ligamentum\nflavum thickening at C3-C4.\nC4-5: Mild diffuse bulge with shallow central protrusion, mild foraminal\nnarrowing by disc, uncovertebral changes.\nC5-6: Disc space narrowing, diffuse disc bulge with central protrusion\nindenting the thecal sac outline and bilateral uncovertebral and facet\nchanges, mild canal narrowing and mild foraminal narrowing on both sides.\nC6-7: Mild diffuse bulge, no disc herniation.\nPossible mild foraminal narrowing by disc and uncovertebral changes.\nC7-T1: No disc herniation, no canal or foraminal narrowing.\n\nT1-T2: Minimal bulge.\nT2-T3, T3-T4: Mild bulge/small protrusion/ extrusion, better assessed on the\nprior MR thoracic spine study of ___, performed at Outside facility\n(report not available for perusal.)\n\nNo pre or paravertebral swelling noted.\nThe included spinal cord appears normal in size and signal intensity.\nNo suspicious focal lesions are noted.\nThe craniocervical junction region is unremarkable.\nThe vertebral arterial flow voids are noted.", "output": "MR OF THE CERVICAL SPINE WITHOUT IV CONTRAST:\nMultilevel, multifactorial degenerative changes in the cervical and upper\nthoracic spine included as described above.\nMost prominent changes are noted at C5-6 and C6-7 levels with mild canal and\nforaminal narrowing at C5-6 level.\nMild progression of ligamentum flavum thickening at C3-C4.\nNo significant change compared to the prior study of ___.\nSmall protrusions in the upper thoracic spine T2-T3 and T3-T4 levels, better\nassessed on the prior MR thoracic spine study at outside facility.\nOther details as above.\nOsseous details can be better assessed with CT if needed." }, { "input": "No suspicious bone marrow signal abnormalities are seen. Vertebral body\nheights are preserved. Minimal anterolisthesis of C4 on C5 is unchanged.\nEvaluation for a minimal spondylolisthesis at C5-C6 is limited by disc and\nendplate abnormalities, as described below, similar to prior.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa\nand lower cerebrum appear unremarkable. The cervical and included upper\nthoracic spinal cord to the T2-T3 level demonstrates normal signal intensity.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4. Tiny central disc protrusion, tiny bilateral uncovertebral\nosteophytes, and minimal infolding of the ligamentum flavum are again seen,\nwithout significant spinal canal or significant neural foraminal narrowing.\n\nC4-C5: There is a minimal anterolisthesis without significant spinal canal\nnarrowing. There are small right uncovertebral osteophytes with mild right\nneural foraminal narrowing, unchanged.\n\nC5-C6: Small central disc herniation indents the ventral thecal sac. While\nit does not contact the spinal cord, the ventral surface of the cord is\nremodeled. The spinal canal is mildly narrowed. There is also mild to\nmoderate right and moderate left neural foraminal narrowing by uncovertebral\nosteophytes. There is no significant interval change.\n\nLinear low signal posterior to the C6 vertebral body is again seen, suggesting\npossible ossification of the posterior longitudinal ligament, mildly indenting\nthe ventral thecal sac without mass effect on the spinal cord.\n\nC6-C7: There is moderate right and moderate to severe left neural foraminal\nnarrowing by uncovertebral osteophytes, unchanged. No significant spinal\ncanal narrowing.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nSagittal images through the T2-T3 level again demonstrate a small disc\nprotrusion without significant spinal canal narrowing as well as bilateral\nfacet arthropathy with mild bilateral neural foraminal narrowing. There are\nno axial images through this level.", "output": "1. Unchanged appearance of multilevel cervical degenerative disease compared\nto ___.\n2. While a small central disc herniation at C5-C6 causes mild remodeling of\nthe ventral spinal cord, it does not appear to contact the spinal cord. Cord\nsignal is normal." }, { "input": "Thoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Scattered endplate Schmorl's nodes,\nmost prominent at T8 and T9 are noted. Degenerative loss of disc height and\nsignal is mild diffusely. There is no cord signal abnormality.\n\nThere are small right eccentric central protrusions at T3-T4, through T6-T7\nwith small left eccentric central protrusions at T7-T8 and T9-T10, which do\nnot result in significant spinal canal narrowing. There is no significant\nneural foraminal narrowing.\n\nThere are T2 hyperintense cystic foci of the left kidney measuring up to 7 mm,\nstatistically most likely representing simple cysts. Otherwise, the remainder\nthe visualized prevertebral paraspinal soft tissues are unremarkable..", "output": "1. Multilevel small protrusions are identified, without significant spinal\ncanal narrowing. There is no neural foraminal narrowing.\n2. There is no cord signal abnormality.\n3. No abnormality is identified at the T8 level. Vertically no signal\nabnormality of the T8 spinous process or adjacent paraspinal muscles.\n4. Additional findings as described above." }, { "input": "The imaged posterior fossa appears normal. The craniocervical junction\nappears normal. The cervical cord appears normal in morphology and signal\nintensity.\n\nNo acute vertebral body fractures. No paraspinal collections.\n\nMultilevel cervical degenerative changes in the form of disc desiccation,\nbroad-based disc bulge, facet joint osteophytosis and ligamentum flavum\nhypertrophy as described below:\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: No cord or nerve root compromise.\n\nC4-5: No cord compromise. Mild narrowing of the right neural foramina.\n\nC5-6: Broad-based disc bulge partially effaces the CSF space anterior to the\ncord and mildly deforms the ventral cord, but there is no abnormal cord signal\nintensity and there is ample CSF present in the thecal sac posterior to the\ncord. Mild to moderate neural foraminal narrowing bilateral.\n\nC6-7: No cord compromise. Mild to moderate left and mild right neural\nforaminal narrowing.\n\nC7-T1: No cord compromise. Prominent uncovertebral osteophyte results in\nmoderate severe left neural foraminal narrowing. The right neural foramina is\npatent.\n\nExtra-spinal: No extra-spinal findings of note.", "output": "1. Moderate cervical spondylosis as described above.\n2. There is mild ventral deformation of the spinal cord at the C5-6 level, but\nthere is no abnormal cord signal intensity and still ample CSF present\nposterior to the cord, thus no findings to suggest cord compromise. This\nappears similar compared to prior.\n3. Multilevel neural foraminal narrowing as described above which also appears\nfairly similar compared to prior imaging." }, { "input": "There is slight anterior subluxation of T2 upon T3. Otherwise, alignment is\nnormal. Vertebral body signal intensity appears normal. There is loss of\nsignal of the intervertebral discs on the T2 weighted images, loss of height\nof the discs, multiple bulging discs and multiple Schmorl's nodes. These are\nmanifestations of degenerative disease.\nThere are Schmorl's nodes in the superior endplate of T5, the superior and\ninferior endplates of T7, the inferior endplates of T8, T9 and T10 as well as\nin the superior endplate of T10. There are Schmorl's nodes in the inferior\nendplates of T12 and L1.\nThere are mild disc bulges at T2-3, T7-8, T8-9, T9-10 and T11-12. These do\nnot encroach on the spinal cord. The neural foramina appear normal.\nThere is a small right-sided disc protrusion at T5-6 that flattens the right\nanterior surface of the spinal cord.\nOther than the Schmorl's node in the anterior inferior endplate, the T 10\nvertebral body appears normal. The Schmorl's node appears unchanged since ___.\nThere is no evidence of infection or neoplasm.", "output": "1. Degenerative disease throughout the thoracic spine.\n2. Disc protrusion at T5-6 flattening the right anterior aspect of the spinal\ncord.\n3. Multiple Schmorl's nodes, unchanged since ___." }, { "input": "The patient refused intravenous contrast which renders the evaluation for\nintraspinal metastasis suboptimal.\n\nLumbar spine alignment is maintained. There is mild loss of disc space height\nand signal at L4-L5 and L5-S1; otherwise, disc spaces and vertebral body\nheights are preserved.\n\nBone marrow signal is heterogeneous with confluent areas of low signal\nintensity which are likely due to red marrow reconversion the given the\npatient's history.\n\nThe the conus medullaris demonstrates normal morphology and signal intensity\nand terminates at the level of L1-L2. The cauda equina demonstrates normal\nmorphology is well.\n\nT12-L1, L1-L2, L2-L3 and L3-L4: There are mild facet degenerative changes\nwithout significant spinal canal or neural foraminal narrowing.\n\nL4-L5: There is a diffuse disc bulge and facet degenerative changes which\nresult in mild narrowing of the subarticular recesses. There is mild bilateral\nneural foraminal narrowing.\n\nL5-S1: A disc bulge is eccentric to the left and has a left foraminal\ncomponent. There is narrowing of the left subarticular recess without evidence\nof impingement of the descending left S1 nerve root. There is moderate left\nneural foraminal narrowing, in the disc bulge contacts the exiting left L5\nnerve root. The right neural foramen is mildly narrowed.\n\nThe infrarenal abdominal aorta is ectatic, measuring up to 3.0 cm in AP\ndimension. Several small retroperitoneal lymph nodes are noted.", "output": "1. No evidence for compression of the cauda equina or conus medullaris.\n2. Mild lumbar spine degenerative changes without high-grade spinal canal or\nneural foraminal narrowing.\n3. Borderline aneurysmal infrarenal abdominal aorta. Given differences in\ntechnique, this is similar to the abdominal CT dated ___." }, { "input": "There is a focus of increased signal at the posterior left aspect of the\ncervicomedullary junction (2:8 and 3:8) with subtle enhancement (4:8 and 6:6).\nThe findings in correlation with the periventricular signal abnormalities on\nthe brain images are suggestive of demyelinating disease.\n\nThere are no other foci of signal abnormalities within the cervical spinal\ncord up to T3 level. No spinal cord compression seen. No significant\ndegenerative changes are identified.", "output": "1. Focus of signal abnormality within the posterior left aspect of the spinal\ncord at the cervicomedullary junction with subtle enhancement suggestive of\ndemyelinating disease.\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": "Study is degraded by motion. Within these confines:\n\nLevels were established by counting down from the C2 level using series 3,\nimage 2.\n\nThere is dextroscoliosis of the thoracic spine.Vertebral body heights are\npreserved. There is no marrow signal abnormality.\n\nQuestion central mid through lower T11 thoracic spinal cord nonenhancing\nlesion versus artifact, seen only definitely on sagittal STIR imaging, not\ndefinitely seen on corresponding axial imaging (see 4, 5, 6, 9:9). The conus\nis noted T12-L1. Otherwise, the visualized portion of the spinal cord is\ngrossly preserved in signal and caliber.\n\nIntervertebral discheightsandsignalare preserved.\n\nMultilevel degenerative changes of the thoracic spine is seen, including disc\nbulges, facet joint hypertrophy, ligamentum flavum thickening, without\ndefinite evidence of moderate or severe vertebral canal or neural foraminal\nnarrowing.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified.", "output": "1. Study is degraded by motion.\n2. Question central mid through lower T11 thoracic spinal cord nonenhancing\nlesion versus artifact, as described.\n3. Multilevel thoracic spondylosis as described, without definite evidence of\nmoderate or severe vertebral canal or 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%\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": "Multiple images are limited by motion artifact. The localizer sequence,\nseries 4, demonstrates 7 cervical, 12 rib-bearing, and 5 lumbar-type\nvertebrae.\n\nCERVICAL:\nVertebral body heights are preserved. No suspicious bone marrow signal\nabnormalities are seen. No significant spondylolisthesis is seen allowing for\nmotion artifact.\n\nThe cerebellar tonsils extend into the foramen magnum by approximately 3 mm,\nas seen on the preceding brain MRI, congruent with the other stigmata\nintracranial hypotension.\n\nThere is a thin dorsal epidural collection from C3-C4 through C5-C6 levels,\ncausing minimal anterior displacement of the thecal sac without significant\neffacement of CSF around the cord. There is a focus of high T2 signal in the\nmidline interspinous space at C4-C5 measuring 6 x 5 mm, images 11:19 and 5:11,\nwith an apparent discontinuity in the ligamentum flavum at this level, see\nimage 11:18. There are small nerve root sleeve diverticula\n\nThere is linear and curvilinear high T2 signal surrounding the right first\nposterior rib (images ___, 12:4, 5:1, 6:1). It is not clear whether this\nextends to the distal right T1-T2 neural foramen.\n\nNo spinal cord signal abnormalities are seen allowing for motion artifact.\n\nC2-C3: No spinal canal or neural foraminal narrowing. Left facet arthropathy\nis present.\n\nC3-C4: Mild right neural foraminal narrowing by facet osteophytes. No spinal\ncanal narrowing.\n\nC4-C5: Mild right neural foraminal narrowing by facet osteophytes. No spinal\ncanal narrowing.\n\nC5-C6: Broad-based central disc protrusion indents the ventral thecal sac but\ndoes not contact the spinal cord. Mild right neural foraminal narrowing by\nuncovertebral osteophytes.\n\nC6-C7: No significant spinal canal or neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nVertebral body heights are preserved. No suspicious bone marrow signal\nabnormalities are seen. There is a dorsal epidural collection from T1-T2 to\nT7-T8 with prominence of the dorsal epidural veins. The thecal sac is\ndisplaced anteriorly and narrowed, with greatest degree of narrowing from T3\nthrough T8 where there is paucity of CSF around the cord. Cord signal is\nnormal. No significant disc disease is seen from T1-T2 through T11-T12.\n\nLUMBAR:\nVertebral body heights are preserved. Alignment is normal. No suspicious\nbone marrow signal abnormalities are seen. The conus medullaris terminates at\nL1 and appears unremarkable.\n\nT12-L1: A central disc herniation extending superiorly indents the ventral\nthecal sac without significant spinal canal narrowing or mass effect on the\nconus medullaris. No neural foraminal narrowing.\n\nL1-L2, L2-L3: No spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild disc bulge and facet arthropathy without significant spinal canal\nnarrowing. Mild right neural foraminal narrowing.\n\nL4-L5: Disc bulge, central disc protrusion, and facet arthropathy cause mild\nspinal canal narrowing with mild crowding of the intrathecal nerve roots, as\nwell as mild narrowing of the subarticular zones without frank compression of\nthe traversing L5 nerve roots. Minimal left neural foraminal narrowing.\n\nL5-S1: Mild disc bulge and facet arthropathy. Traversing left S1 nerve root\nis contacted by a facet osteophyte without evidence for compression. Mild\nright neural foraminal narrowing.", "output": "1. 3 mm descent of the cerebellar tonsils into the foramen magnum is again\ndemonstrated, congruent with the other stigmata of intracranial hypotension\nseen on the preceding brain MRI.\n2. Thin dorsal epidural collection from C3-C4 through C5-C6, mildly displacing\nthe thecal sac anteriorly without significant effacement of CSF around the\nspinal cord. Apparent discontinuity in the ligamentum flavum at C4-C5 in the\nmidline with a 6 x 5 mm apparent fluid collection in the C4-C5 interspinous\nspace. Dorsal epidural collection from T1-T2 through T7-T8 with prominence of\ndorsal epidural veins, displacing the thecal sac anteriorly with effacement of\nCSF around the cord from T3 through T8. These findings are congruent with the\npresence of a CSF leak.\n3. There is linear and curvilinear T2 signal surrounding the right posterior\nfirst rib. It is not clear whether this extends to the distal margin of the\nright T1-T2 neural foramen. This may represent a potential site of CSF leak. \nNo other site of CSF leak is identified.\n4. No evidence for spinal cord signal abnormalities.\n5. Lower lumbar degenerative disease and mild cervical degenerative disease,\nas detailed above." }, { "input": "The prior CT torso demonstrates that there 12 rib-bearing and 5 lumbar-type\nvertebrae. The numbering is documented on images 3:9 and 9:9.\n\nTHORACIC SPINE:\n\nMild anterior wedging of T6 and T7 vertebral bodies is unchanged compared to\n___. Other thoracic vertebral body heights are within normal\nlimits. Alignment is normal. There is no evidence for bone marrow or\nligamentous edema. The visualized lower cervical and thoracic spinal cord\ndemonstrates normal signal intensity.\n\nSagittal images through the C5-C6 level demonstrate a disc protrusion plus/\nminus endplate osteophytes mildly indenting the ventral spinal cord. No axial\nimages through this level.\n\nC6-C7: Central disc protrusion indents the ventral thecal sac but does not\ncontact the spinal cord. The neural foramina are not fully assessed as they\nare not fully included on the axial images.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nT1-T2: No spinal canal or neural foraminal narrowing.\n\nT2-T3: Small left paracentral disc protrusion approaches the ventral spinal\ncord without cord deformity. No neural foraminal narrowing.\n\nT3-T4: Mild disc bulge without significant spinal canal narrowing. No neural\nforaminal narrowing.\n\nT4-T5: Tiny central disk protrusion without spinal canal narrowing. No\nneural foraminal narrowing.\n\nT5-T6: Tiny disc bulge versus central disc protrusion without spinal canal\nnarrowing. No neural foraminal narrowing.\n\nT6-T7, T7-T8, T8-T9: Small disc bulges without spinal canal narrowing. Facet\narthropathy at T8-T9 without neural foraminal narrowing.\n\nT9-T10: Small disc bulge and a possible small superimposed right paracentral\ndisc protrusion, without spinal canal narrowing. Mild facet arthropathy with\nmild right neural foraminal narrowing.\n\nT10-T11: No spinal canal or neural foraminal narrowing.\n\nT11-T12: Tiny disc bulge without spinal canal narrowing. Left facet\narthropathy without significant neural foraminal narrowing.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nLUMBAR SPINE:\n\nVertebral body heights and alignment are normal. There is no evidence for\nbone marrow edema or ligamentous edema. The conus medullaris appears\nunremarkable, terminating at L1.\n\nL1-L2: No spinal canal or neural foraminal narrowing.\n\nL2-L3: Small right foraminal/extra foraminal disc protrusion without\nsignificant neural foraminal narrowing. No spinal canal narrowing.\n\nL3-L4: No spinal canal or neural foraminal narrowing.\n\nL4-L5: No spinal canal or neural foraminal narrowing.\n\nL5-S1: No spinal canal or neural foraminal narrowing.\n\nOTHER:\n\nCircumscribed T2 hyperintense right hepatic lesion image 7:15 was\ncharacterized as a cyst on the ___ liver MRI. Subcentimeter T2\nhyperintense foci in both kidneys were also characterized as cysts on the\nliver MRI.", "output": "1. Chronic mild anterior wedging of T6 and T7 vertebral bodies without marrow\nedema. No evidence for bone marrow or ligamentous edema in the thoracic or\nlumbar spine.\n2. At C5-C6, the ventral spinal cord is mildly indented by a central disc\nprotrusion plus/minus endplate osteophytes, incompletely evaluated in the\nabsence of axial images through this level.\n3. Multiple small disc bulges and protrusions at C6-C7 and in the thoracic\nspine, approaching the ventral spinal cord at T2-T3 on the left without cord\ndeformity, and without cord contact or significant spinal canal narrowing at\nother levels. No significant thoracic neural foraminal narrowing.\n4. No spinal canal or neural foraminal narrowing in the lumbar spine.\n5. Visualized distal cervical and thoracic spinal cord demonstrates no signal\nabnormalities. The conus medullaris appears normal." }, { "input": "Lumbar spine:\nAgain seen is a Chance fracture of the L1 vertebral body with superior\ndisplacement of the superior endplate. The defect runs through the pedicles\nand pars interarticularis bilaterally. There is a suggestion of disruption of\nthe ligamentum flavum at this level as well as through and through tear of the\ninterspinous ligaments.\nThere is extensive soft tissue edema involving the subcutaneous tissues of the\nspine at this level and extending inferiorly to L3-4.\n\nThere is a large posterior subdural hematoma encroaching on the spinal canal\nextending from the and 12 level to L1-2. This is at the level of the conus\nand it appears not to compress the conus medullaris, although a largely fills\nremaining space within the lumbar canal.\n\nThere is a large prevertebral hematoma surrounding the aorta and displacing\nthe crura of the diaphragm. There is a small subarachnoid hemorrhage in the\ndependently portion of the distal thecal sac.\n\nThere is loss of signal of the intervertebral discs on the T2 weighted images\nat L4-5 and L5-S1 with a focal annular fissure in the posterior portion of the\nL4-5 intervertebral disc. There is no other spinal canal or neural foraminal\nnarrowing.\n\nCervical spine:\nNo fractures are identified. Alignment is normal. There are changes of\ndegenerative disc disease with loss of signal of the intervertebral discs on\nthe T2 weighted images. The disc abnormalities are poorly characterized on\nthis study due to the patient's thoracic kyphosis as well as motion artifact. \nWithin these limitations, there appears to be disc protrusions at C2-3, C3-4,\nC5-6 and C6-7 with contact on the spinal cord. Motion limited axial images\nsuggest deformity of the spinal cord at each of these levels. However, the\nsagittal images do not confirm this. If cervical spine degenerative disease\nis an ongoing concern, repeat imaging may be attempted when the patient can\nhold still.\n\nThoracic spine:\nThere is prominent thoracic kyphosis. There is a fracture of the inferior\nendplate of the T12 vertebral body anteriorly. There is no retropulsed bone\nor canal encroachment. Again seen is a paravertebral hematoma and intraspinal\nsubdural hematoma associated with the fracture and posterior ligamentous\ncomplex injury.\nThere are changes of degenerative disc disease at the other thoracic levels\nwith loss of signal of the intervertebral discs on the T2 weighted images but\nno encroachment on the spinal canal. There is ___ type 1 signal change at\nT6-7 associated with small Schmorl's nodes.", "output": "1. L1 Chance fracture with large intraspinal subdural hematoma encroaching on\nthe thecal sac. There does not appear to be compression of the conus\nmedullaris at this time.\n2. Fractures of the anterior and posterior cortex of L1, the pars\ninterarticularis and pedicles bilaterally as well as disruption of the\nligamentum flavum and interspinous ligaments.\n3. Fracture of the anterior inferior margin of the T12 vertebral body.\n4. Extensive cervical degenerative disease, incompletely evaluated due to\nkyphosis and patient motion. The axial images suggest canal narrowing caused\nby multiple disc protrusions in the cervical spine. However, this is not\nconfirmed on axial images. If there is ongoing concern repeat cervical spine\nMR may be attempted when the patient can hold still.\n\nNOTIFICATION: The findings of a subdural hematoma encroaching on the spinal\ncanal as well as extensive posterior ligamentous complex injury were discussed\nby telephone by Dr. ___ with Dr. ___ at 15:20, immediately upon\nreviewing the images." }, { "input": "Study is mildly degraded by motion.\n\nThere is straightening of the cervical lordosis. Vertebral body heights are\npreserved. There is no definite bone marrow signal abnormality. There is no\nprevertebral or paraspinal soft tissue edema. The anterior and posterior\nlongitudinal ligaments are grossly intact. Degenerative changes are most\nsevere at the C5-6 level with moderate loss of disc height and posterior disc\nprotrusion resulting in minimal narrowing of the spinal canal. There is no\nadditional definite vertebral canal or neural foraminal narrowing noted.\n\nThe cervicomedullary junction and partially imaged posterior fossa are\npreserved. The visualized portion of the spinal cord is preserved in signal\nand caliber. There is no abnormality on diffusion-weighted images.", "output": "1. Study is mildly degraded by motion.\n2. Mild degenerative changes as described.\n3. Within limits of study, no definite cervical spinal cord lesion identified.\n4. Within limits of study, no definite evidence of ligamentous injury or acute\ncervical spine fracture." }, { "input": "Study is mildly degraded by motion.\n\n There is straightening of cervical lordosis. Vertebral body heights are\npreserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc height at C5-6.\n\nThere is no prevertebral soft tissue swelling.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is central disc protrusion, novertebral canal and no neural\nforaminal narrowing.\n\nAt C4-5 there is central disc protrusion, novertebral canal and no neural\nforaminal narrowing.\n\nAt C5-6 there is disc bulge, uncovertebral hypertrophy, mildvertebral canaland\nmild rightneural foraminal narrowing.\n\nAt C6-7 there is left paracentral disc extrusion with superior migration,\ndeformation of the ventral thecal sac and spinal cord without definite\nassociated cord signal abnormality, mild-to-moderatevertebral canaland\nmoderate leftneural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nOTHER:\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Interval progression of multilevel cervical spondylosis as described, most\npronounced at C6-7, where there is left paracentral disc extrusion with\nsuperior migration, deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality, mild-to-moderate\nvertebral canal and moderate left neural foraminal narrowing." }, { "input": "Alignment is normal. There are scattered areas of focal fat deposition in\nmultiple lumbar vertebral bodies. Otherwise, vertebral body signal intensity\nappears normal. There is loss of signal of the intervertebral disc at L5-S1,\na manifestation of degenerative disease. Otherwise disc signal intensity\nappears normal. The spinal cord appears normal in caliber and configuration.\nAxial imaging from T11-___-L4 demonstrates no significant abnormalities.\nAt L4-5, prominent facet osteophytes encroach on the spinal canal. On the\nleft, the osteophyte compresses the traversing L5 nerve roots against the\nintervertebral disc. The neural foramina appear normal. There is a small\nsynovial cyst associated with the left the L4-5 facet joint.\nAt L5-S1 there is a midline protrusion of the intervertebral disc that\nmigrates superiorly along the posterior margin of the L5 vertebral body. This\nencroaches on the thecal sac but does not appear to produce nerve root\ncompression. Bulging of the disc compresses the right S1 nerve root against\nthe facet joint.\nThere is no evidence of infection or neoplasm.", "output": "1. L5-S1 midline disc protrusion without nerve root compression.\n2. L5-S1 disc bulge compressing the right S1 nerve root against the facet\njoint." }, { "input": "Please note that patient refused contrast for this examination. Evaluation of\nmetastatic disease is thus limited. There are 5 non rib bearing lumbar\nvertebral bodies. There is no acute fracture or subluxation. Vertebral body\nheights are maintained. Heterogeneous signal is again noted within the\nvertebral bodies with degenerative endplate changes at L4/L5 and L5/S1. The\nconus terminates at the L1/L2 disc space, within normal limits.\n\nAt T12/L1, there is a mild posterior disc bulge without canal stenosis or\nneural foraminal narrowing.\n\nAt L1/L2, there is mild disc bulge without spinal canal stenosis or neural\nforaminal narrowing.\n\nAt L2/L3, there is no significant spinal canal stenosis or neural foraminal\nnarrowing.\n\nAt L3/L4, there is a posterior broad-based disc protrusion as well as\nbilateral facet hypertrophy and ligamentum flavum thickening leading to mild\nbilateral neural foraminal narrowing. There is mild spinal canal stenosis at\nthis level.\n\nAt L4/L5, there is a posterior disc bulge with facet hypertrophy and\nligamentum flavum thickening leading to moderate right subarticular recess\nnarrowing with impingement of the descending L4 nerve root. There is also\nbilateral moderate neural foraminal narrowing at this level.\n\nAt L5/S1, there is a broad-based disc protrusion as well as bilateral facet\nhypertrophy leading to severe bilateral neural foraminal narrowing and mild\ncanal stenosis.\n\nMultiple bilateral T2 hyperintense lesions are seen within the kidneys with\nthe largest at the upper pole of the right kidney. The remaining paraspinal\nsoft tissues are unremarkable.", "output": "1. Please note study is limited due to lack of administration of intravenous\ncontrast. Please note contrast was not administered due to patient refusal for\ncontrast.\n2. No significant interval change to lumbar spine spondylosis, most pronounced\nat L4/L5 level, where there is moderate right subarticular recess narrowing\nand moderate bilateral neural foraminal narrowing.\n3. Stable L5/S1 level severe bilateral neural foraminal narrowing.\n4. Limited imaging of kidneys demonstrate multiple bilateral at least\npartially cystic lesions as described. While this finding may represent renal\ncysts, other etiologies cannot be excluded on the basis of this examination.\nRecommend clinical correlation. If clinically indicated, further evaluation\nmay be obtained via renal ultrasound." }, { "input": "There is increased signal within the mid thoracic vertebral bodies on T1 and\nT2 weighted images with low signal on inversion recovery images indicative of\npostradiation therapy changes within the marrow. There are no focal bony\nabnormalities suspicious for metastatic disease seen and there is no evidence\nof pathologic fracture. Multilevel degenerative changes are identified with a\nsmall disc protrusion at T7-T8 level in the right paracentral region indenting\nthe thecal sac. There is no spinal stenosis seen.", "output": "No evidence of bony metastatic disease or pathologic fracture. No epidural\nlesion identified. Multilevel degenerative changes seen. No spinal stenosis.\nNo abnormal signal within the spinal cord or extrinsic spinal cord\ncompression. Postradiation therapy changes seen within the mid thoracic\nvertebral bodies." }, { "input": "Alignment is normal. Vertebral body signal intensity appears normal. There\nis loss of signal of the intervertebral discs on the T2 weighted images, a\nmanifestation of degenerative disc disease. There is loss of height of the\ndiscs, also due to disk degeneration.\n\nAt C2-3 there is a tiny midline disc protrusion that slightly encroaches on\nthe spinal canal but does not contact the spinal cord. The neural foramina\nappear normal.\n\nAt C3-4 osteophytes narrow the AP diameter of the spinal canal and resolved\nand slight flattening of the cord. Uncovertebral osteophytes produce severe\nbilateral neural foraminal narrowing.\n\nAt C4-5 osteophytes narrow the spinal canal, flatten the spinal cord, and\nindent the spinal cord in the midline. Uncovertebral and facet osteophytes\nproduce severe bilateral foraminal narrowing.\n\nAt C5-6, intervertebral osteophytes narrow the spinal canal but do not contact\nthe spinal cord. Uncovertebral and facet osteophytes produce severe neural\nforaminal narrowing bilaterally.\n\nAt C6-7 a broad bulge of the intervertebral disc encroaches on the spinal\ncanal and slightly flattens the anterior surface of the spinal cord.\nUncovertebral osteophytes produce severe bilateral foraminal narrowing.\n\nDisc bulges C7-T1 encroaches on the spinal canal but does not contact the\nspinal cord. The spinal cord appears normal in caliber and configuration.\n\nThere is no evidence of infection or neoplasm.", "output": "Degenerative disc disease unchanged since ___. No evidence of\nmetastatic disease." }, { "input": "The alignment of the lumbar spine is maintained. The vertebral body height is\nmaintained at all levels. Again seen is minimal anterior wedging of T11 and\nT12 vertebral bodies. The lumbar vertebral body heights are maintained. There\nis a hemangioma in the body of L2.\n\nThe distal spinal cord appears unremarkable. The conus is unremarkable and\nterminates at L1. No pathologic intrathecal contrast enhancement is seen.\n\nThere are ___ type 1 and type 2 changes at T12-L1 and L4-L5. The marrow\nsignal is otherwise unremarkable. No focal marrow lesion is seen.\n\nNo areas of abnormal enhancement to suggest diskitis osteomyelitis or insert\ninfections. The visualized paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nT11-T12, there is loss of disc height and signal with diffuse broad-based disc\nbulge indenting the ventral thecal sac and causing mild bilateral neural\nforamen narrowing.\n\nAt T12-L1 the disc height and signal is maintained. Neural foramen and spinal\ncanal are patent.\n\nAt L1-L2, the disc height and signal is maintained. Neural foramen spinal\ncanal are patent.\n\nAt L2-L3, the disc height and signal is maintained. Neural foramina and\nspinal canal are patent.\n\nAt L3-L4, there is a loss of disc height and signal with left foraminal and\nlateral and right foraminal disc protrusions causing mild right and moderate\nleft neural foraminal narrowing. The spinal canal is patent.\n\nAt L4-L5, there is diffuse broad-based disc bulge asymmetric towards the left\nwith moderate bilateral facet arthropathy causing mild right and moderate left\nneural foramen narrowing. The spinal canal is patent.\n\nAt L5-S1, postsurgical changes related to prior laminectomy with stable mild\nenhancing granulation tissue in the spinal canal without any mass effect on\nthe thecal sac. There is a diffuse disc bulge with superimposed central disc\nprotrusion with enhancement along the caudal aspect of the protrusion,\nunchanged compared to the prior study, likely postsurgical in nature is\nrelated to prior discectomy. Moderate bilateral facet arthropathy. There is\nmoderate left and severe right neural foramen narrowing. Spinal canal is\npatent.", "output": "1. Unchanged appearance of the lumbar spine with stable postoperative changes\nrelated to prior laminectomy/discectomy at L5 with minimal enhancing\ngranulation tissue in the spinal canal and enhancement in the disc at that\nlevel, likely postoperative in nature.\n2. No evidence of discitis osteomyelitis.\n3. Multilevel degenerative disease of the lumbar spine as described above,\nworst at L5-S1 with moderate to severe bilateral neural foramen narrowing." }, { "input": "There is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. ___ type 1 endplate changes are noted in the\nlower thoracic spine at T9-10, ___ type 3 endplate changes at T11-12 and\nL4-5 levels. A venous malformation (also known as a hemangioma) is seen in\nthe L2 vertebral body. There is multilevel disc space height loss and\ndecreased signal. The intervertebral discs are normal in height and signal\ncharacteristics. The conus medullaris terminates at the level of L1-L2. There\nis no spinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1: There is no significant spinal canal or neural foraminal stenosis.\n\nL1-L2: Facet arthropathy with no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: Disc bulge and mild facet arthropathy with no significant spinal canal\nor neural foraminal stenosis\n\nL3-L4: Disc bulge, facet arthropathy and ligamentum flavum thickening\nresulting in mild spinal canal and bilateral neural foraminal stenosis.\n\nL4-L5: Disc bulge, slightly progressed in comparison to the prior MRI, facet\narthropathy and ligamentum flavum thickening resulting in mild spinal canal\nand bilateral neural foraminal stenosis.\n\nL5-S1: Stable disc bulge with superimposed central disc protrusion resulting\nin mild spinal canal stenosis and mild left, and severe right neural foraminal\nstenosis. The extra foraminal portion of the disc abuts the exiting right L5\nnerve root. Degenerative changes are noted in the lower thoracic spine", "output": "1. Active endplate changes at T9-10, with multilevel disc protrusions with no\naxial imaging acquired at this levels.\n2. Slightly progressed multilevel degenerative changes throughout the lumbar\nspine, as described above, worse at L5-S1 with mild spinal canal, mild left\nand severe right neural foraminal stenosis. The extra foraminal portion of\nthe disc bulge at L5-S1 abuts the exiting right L5 nerve root. Recommend\ncorrelation with right L5 radiculopathy." }, { "input": "Study is degraded by motion.\n\n There is straightening of cervical lordosis and there is minimal C7 on T1\nanterolisthesis.. Vertebral body heights are preserved. There is no definite\nfocal marrow signal abnormality. Multiple Schmorl's nodes are noted\nthroughout the cervical spine.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc height and signal throughout cervical\nspine.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa, cervicomedullary junction,\nparanasal sinuses and lung apicesare preserved.\n\nAt C2-3 there is disc bulge, mildvertebral canal and no neural foraminal\nnarrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, deformation of the thecal sac and spinal cord without definite\nassociated cord signal abnormality, severevertebral canal and severe\nbilateral neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, left paracentral disc extrusion, uncovertebral\nhypertrophy, facet joint hypertrophy, deformation of the thecal sac and spinal\ncord without definite associated cord signal abnormality, novertebral canal or\nneural foraminal narrowing.\n\nAt C5-6 there is left paracentral disc protrusion, uncovertebral hypertrophy,\ndisc bulge with deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, moderatevertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy with deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, mildvertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.", "output": "1. Study is degraded by motion and limited by patient inability to tolerate\nexam, resulting in axial T2 imaging not being obtained.\n2. Multilevel cervical spondylosis as described, most pronounced at C4-5,\nwhere there is left paracentral disc extrusion, severe vertebral canal\nnarrowing with deformation of the ventral thecal sac and spinal cord and\nwithout definite associated cord signal abnormality.\n3. C3-4 severe vertebral canal narrowing with deformation of the ventral\nthecal sac and spinal cord and without definite associated cord signal\nabnormality.\n4. C5-6 moderate vertebral canal and mild bilateral neural foraminal narrowing\nwith deformation of ventral thecal sac and spinal cord without definite\nassociated cord signal abnormality.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. Vertebral body heights and marrow signal are normal.\nThere is diffuse desiccation of the intervertebral discs at L4-5 and L5-S1\nwith mild disc height loss. The distal thoracic spinal cord is normal in\ncourse, caliber, and signal. The conus medullaris is normal in appearance and\nposition, terminating at L1. There is no evidence of infection or neoplasm.\n\nThere is mild diffuse disc bulge at L1-2 that does not cause significant\nspinal canal or neural foraminal stenosis. There is a mild diffuse disc bulge\nwith a shallow central protrusion at L4-5, unchanged from MRI on ___ and not causing significant spinal canal stenosis. There is\nmild-to-moderate bilateral foraminal narrowing.\n\nThere is a mild diffuse disc bulge with a broad-based protrusion at L5-S1,\nresulting in moderate to severe left-sided and moderate right-sided foraminal\nstenosis that is unchanged from prior MRI. There is facet arthropathy at\nmultiple levels.", "output": "1. Mild diffuse disc bulge with a superimposed small disc protrusions at\nL5-S1. This results in moderate right-sided and moderately severe left-sided\nneural foraminal stenosis at L5-S1, unchanged from prior MRI on ___. No significant spinal canal stenosis.\n2. Mild diffuse disc bulge and small central disc protrusion at L4-5 but\nwithout significant spinal canal , also unchanged from prior MRI.\n\n***********reviewed with Dr. ___" }, { "input": "The examination is mildly motion degraded. Within these confines:\n\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Disc height and signal are also preserved. \nThe visualized posterior fossa is unremarkable. There is no definitive\nevidence for cord signal abnormality.\n\nC2-C3: Unremarkable.\n\nC3-C4 through C5-C6: Small central protrusions result in mild spinal without\neffacement of the cord. There is no significant neural foraminal narrowing.\n\nC6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Within the confines of a slightly motion degraded study, no definitive cord\nsignal abnormality.\n2. Mild degenerative changes without significant spinal canal or neural\nforaminal narrowing." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration. Mild, broad-based disc bulge at C5-C6 and C6-C7\nindent the thecal sac but do not touch the spinal cord.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal.Vertebral body heights and intervertebral disc spaces are\ngrossly preserved. Slight heterogeneous signal intensity lingular flexed\ncomponent of degenerative change. No suspicious osseous lesion or enhancing\nlesion after contrast in the vertebral bodies. There is a Schmorl's node at\nthe inferior endplate of L1. The spinal cord ends at the L1 vertebral level. \nNo spinal cord signal abnormality or abnormal enhancement after contrast.\n\nThe patient is status-post bilateral laminectomy at 1 and L2 for excision of a\nmass. A large 4.6 x 2.2 x 6.5 cm epidural fluid collection centered at L2 but\nextending superiorly and inferiorly to the L3 and L1 vertebral body levels\nappears early postoperative given the dependent fluid-fluid levels reflecting\nhemorrhage as well as air (e.g. Series 15, image 10, 14). This fluid\ncollection displaces the thecal sac anteriorly and to the right resulting in\nsevere cauda equina compression that is most prominent at L1-L2 (e.g., series\n15, image ___. The left neural foramen is narrowed and may touch the\nexiting nerve root.\n\nAt L1-L2, mild broad-based disc bulge narrows the neural foraminal bilaterally\nand may touch the exiting left nerve root. However, the most significant\nfinding is severe canal stenosis secondary to mass effect from the extradural\nfluid collection.\n\nAt L2-L3, mild disc bulge results in bilateral neural foraminal narrowing. \nThere is severe spinal canal stenosis secondary to the disc bulge and the mass\neffect of the postoperative, extradural fluid collection.\n\nAt L3-L4, there is crowding of the posterior spinal canal secondary to\nligamentum flavum hypertrophy. Mild broad-based disc bulge mildly narrows the\nbilateral neural foramina but does not clearly touches the exiting nerve\nroots.\n\nAt L4- L5, a mild broad-based disc bulge mildly narrows the bilateral neural\nforamina without touching the exiting nerve roots. The disc bulge, along with\nligamentum flavum hypertrophy, results in moderate to severe narrowing of the\nspinal canal touching the nerve roots (series 15, image 27).\n\nAt L5-S1, a mild central disc bulge indents the thecal sac but does not\nsignificantly narrow the spinal canal. Bilateral mild neural foraminal\nnarrowing from facet hypertrophy and disc bulge is noted but the exiting nerve\nroots appear intact.\n\nNo abnormal enhancement after contrast administration to suggest local\nrecurrence of ependymoma or tumor, although it would be helpful to of the\nprior exams to compare what to the original tumor looked like.", "output": "1. Large extra-dural fluid collection that appears early post-operative given\nthe presence of hemorrhage and air. The collection exerts mass effect on the\nspinal canal causing severe stenosis and compression of the cauda equina at L1\nthrough L3 and moderate narrowing of the L1-L2 left neural foramina. No\nabnormal enhancement of the cauda equina.\n\n2. Multilevel degenerative changes in the lumbar spine as above.\n\n3. No evidence to suggest local recurrence of the presumed ependymoma,\nalthough it would be helpful to review the prior exams.\n\n4. Bilateral small pleural effusions with adjacent atelectasis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:29 ___, 15 minutes after\ndiscovery of the findings." }, { "input": "There is grade 1, 2 mm, anterolisthesis of L4 on L5. There is grade 1, 1 mm\nretrolisthesis of L1 on L2. The vertebral body heights are preserved. There\nis a chronic Schmorl's node at the inferior L1 endplate. There is diffuse low\nintervertebral disc signal, consistent with degeneration. The conus\ndemonstrates normal signal morphology, terminating appropriately at the mid L1\nlevel. There is no abnormal enhancement involving the conus or nerve roots. \nThere is laminectomy decompression anatomy at L1 and L2 with enhancing\ngranulation/scar tissue within the laminectomy bed. There is a small fluid\ncollection just superficial to the dorsal thecal sac measuring 0.8 cm AP x 0.9\ncm TV x 4.6 cm SI (02:10), which is significantly decreased in size as\ncompared to prior study when it measured 5.9 cm AP x 6.1 cm AP x 2.4 cm TV.\n\nAt T12-L1 there is no spinal canal neural foraminal stenosis.\n\nAt L1-L2 there is disc bulge causing mild spinal canal narrowing and mild\nbilateral neural foraminal stenosis.\n\nAt L2-L3 there is disc bulge without spinal canal narrowing. There is mild\nbilateral neural foraminal stenosis.\n\nAt L3-L4 there is disc bulge, facet and endplate osteophytes, and ligamentum\nflavum thickening causing mild spinal canal narrowing which contacts with the\ntraversing L4 nerve roots in the subarticular zones at the disc level, without\ncompression (07:22). There is mild bilateral neural foraminal stenosis.\n\nAt L4-L5 there is disc bulge, facet and endplate osteophytes, and ligamentum\nflavum thickening causing mild spinal canal narrowing with more significant\nsubarticular zone stenosis which contacts the traversing L5 nerve roots in the\nsubarticular zones at the disc level, left greater than right (09:10). There\nis mild bilateral neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge, facet and endplate osteophytes, ligamentum\nflavum thickening causing mild spinal canal narrowing and contacting the\ntraversing left S1 nerve root in the subarticular zone at the disc level\n(09:15). There is mild bilateral neural foraminal stenosis.\n\nThere is lipoatrophy of the paraspinal musculature. Otherwise the paraspinal\nsoft tissues are unremarkable.", "output": "1. L1 and L2 laminectomy anatomy with progressive enhancing granulation/scar\ntissue within the laminectomy bed.\n2. Small residual fluid collection within the laminectomy bed, just\nsuperficial to the dorsal thecal sac, which is significantly decreased in size\nas compared to prior study, likely representing an involuting hematoma/seroma.\n3. No evidence of residual enhancing disease within the thecal sac.\n4. Multilevel degenerate changes of the lumbar spine, as described, most\nadvanced at L4-L5 where there is subarticular zone stenosis which contacts the\ntraversing L5 nerve roots, left greater than right." }, { "input": "There are 7 cervical, 12 rib-bearing, and 6 lumbar-type vertebrae. The 6\nlumbar-type vertebrae is labeled a lumbarized S1 for the purposes of this\nreport. The numbering is documented on images 4:9, 4:10, and 5:10.\n\nCERVICAL:\nNo concerning bone marrow signal abnormalities are seen. Vertebral body\nheights are preserved. There is no subluxation. No spinal cord signal\nabnormalities seen. There is no abnormal contrast enhancement.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\nunremarkable.\n\nThe craniocervical junction and C1-C2 level appear unremarkable.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: Small central disc protrusion indents the ventral thecal sac and\nmildly remodels the ventral spinal cord without cord signal abnormality,\nunchanged compared to the ___ cervical spine MRI. Mild spinal canal\nnarrowing. No significant neural foraminal narrowing.\n\nC4-C5: Small central disc protrusion indents the ventral thecal sac but does\nnot contact the spinal cord, unchanged since the ___ MRI. No significant\nneural foraminal narrowing.\n\nC5-C6: Central/right paracentral broad-based disc protrusion with endplate\nosteophytes indent the ventral thecal sac and mildly remodel the ventral\nspinal cord, without cord signal abnormality. There is mild to moderate\nspinal canal narrowing. There is also mild to moderate right neural foraminal\nnarrowing by uncovertebral osteophytes. These findings are unchanged since\nthe ___ MRI.\n\nC6-C7: Central disc protrusion indents the ventral thecal sac and remodels\nthe ventral spinal cord with moderate to severe spinal canal narrowing, but no\nevidence for cord signal abnormalities. There is moderate right and severe\nleft neural foraminal narrowing by uncovertebral osteophytes. These findings\nare unchanged since the ___ MRI.\n\nC7-T1: There is a broad-based right paracentral and foraminal disc protrusion\nwhich moderately narrows the right neural foramen but causes no significant\nspinal canal narrowing, unchanged since the ___ MRI.\n\nTHORACIC:\nNo concerning bone marrow signal abnormalities are seen. Vertebral body\nheights are preserved. There is no subluxation. No spinal cord signal\nabnormalities seen. There is no abnormal contrast enhancement. At T11-T12,\nligamentum flavum thickening and/or facet arthropathy, right greater than\nleft, mildly indents the right posterior thecal sac without mass effect on the\nspinal cord, and also cause mild to moderate right neural foraminal narrowing.\nNo significant spinal canal or neural foraminal narrowing is seen at other\nlevels.\n\nLUMBAR:\nNo concerning bone marrow signal abnormalities are seen. Vertebral body\nheights are preserved. There is no subluxation. The conus medullaris appears\nunremarkable, terminating at L2. There is no abnormal contrast enhancement.\n\nT12-L1: Mild bilateral facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Mild bilateral facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Mild disc bulge and minimal bilateral facet arthropathy without spinal\ncanal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge and mild bilateral facet arthropathy without spinal\ncanal narrowing or significant neural foraminal narrowing.\n\nL4-L5: Mild disc bulge and facet arthropathy. Mild bilateral neural\nforaminal narrowing without evidence for neural impingement.\n\nL5-S1: Mild disc bulge, mild right and mild-to-moderate left facet\narthropathy. The traversing left S1 nerve root appears contacted in the\nsubarticular zone, image 9:34. No mass effect on the intrathecal nerve roots.\nMild bilateral neural foraminal narrowing without evidence for exiting L5\nnerve root impingement. Findings are unchanged compared to the ___\nlumbar spine MRI.\n\nS1-S2: Mild bilateral facet arthropathy, causing mild bilateral neural\nforaminal narrowing without evidence for exiting S1 nerve root impingement. \nNo spinal canal narrowing.", "output": "1. There are 7 cervical, 12 rib-bearing, it and 6 lumbar-type vertebrae. For\nthe purposes of this report, the 6 lumbar-type vertebrae is labeled a\nlumbarized S1.\n2. Multilevel cervical degenerative disease is unchanged compared to the ___ cervical spine MRI, worst at C6-C7, where there is moderate to\nsevere spinal canal narrowing with spinal cord remodeling, but no evidence for\ncord signal abnormalities. Moderate right and severe left neural foraminal\nnarrowing is also present at C6-C7.\n3. No evidence for mass effect on the spinal cord in the thoracic or upper\nlumbar spine. Normal spinal cord signal.\n4. At L5-S1, there is a disc bulge and left greater than right facet\narthropathy, contacting the traversing left S1 nerve root in the subarticular\nzone, unchanged compared to the ___ lumbar spine MRI." }, { "input": "The alignment of the lumbar spine is normal. The patient is status post\nvertebroplasty at the T12 and L4 vertebral bodies. The chronic compression\nfractures and loss of height of the T12 and L4 vertebral bodies are unchanged.\nThe bone marrow is heterogeneous in signal, related to degenerative endplate\nchanges. The intervertebral disc spaces of L1-L2, L2-L3, and L5-S1 are\nnarrowed. The intervertebral discs are diffusely desiccated. The conus\nmedullaris terminates at L1-2 L2. The spinal cord and nerve roots of the\ncauda equina are normal in signal. Tarlov cysts are noted in the sacrum.\n\nAt T12-L1, left central disc protrusion and bilateral facet arthropathy mildly\nindents the anterior thecal sac without spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L1-L2, diffuse disc bulge with superimposed central disc protrusion,\nligamentum flavum thickening, and bilateral facet arthropathy cause mild\nspinal canal and moderate right neural foraminal stenosis, unchanged from the\nprior examination.\n\nAt L2-L3, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet hypertrophy cause mild spinal canal stenosis and no neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L3-L4, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet arthropathy cause mild-to-moderate spinal canal status and no neural\nforaminal stenosis, unchanged from the prior exam.\n\nAt L4-5, diffuse disc bulge, ligamentum flavum thickening and bilateral facet\narthropathy cause moderate spinal canal stenosis and no neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L5-S1, diffuse disc bulge ligamentum flavum thickening, and bilateral facet\narthropathy cause moderate spinal canal stenosis, mild right, and moderate\nleft neural foraminal stenosis, unchanged from the prior examination.", "output": "1. Unchanged, chronic compression fractures status post vertebroplasty of T12\nand L4.\n2. Stable, multilevel degenerative changes of the lumbar spine, most advanced\nat L5-S1 with moderate spinal canal, mild right, and moderate left neural\nforaminal stenosis." }, { "input": "There is no evidence of focal bony abnormality suspicious for metastatic\ndisease. Incidental hemangioma is seen in the L1 vertebral body. There is mild\nscoliosis of the lumbar spine. The T11-12 and T12-L1 disk bulging identified.\nAt L1-2 disc bulging is seen indenting the thecal sac without spinal stenosis.\n\nFrom L2-3 to L5-S1 level disk bulging is identified without spinal stenosis.\nMild narrowing of the foramina seen in the lower lumbar region. There is no\nfocal disk herniation. There is no evidence of nerve root displacement. CV and\nfacet degenerative changes are seen at L4-5 level with mild narrowing of both\nsubarticular recesses.\n\nThe conus and paraspinal soft tissues are unremarkable.", "output": "Overall no significant interval change since the previous MRI of ___. Mild multilevel disc degenerative changes including severe facet\ndegenerative changes at L4-5 level again noted. There is no spinal stenosis or\nhigh-grade foraminal narrowing. No evidence of nerve root compression. Mild\nscoliosis of the lumbar spine ." }, { "input": "The alignment of the lumbar vertebral bodies appears maintained, the conus\nmedullaris terminates at the level of L1-L2 level and is unremarkable. The\nsignal intensity in the bone marrow is heterogeneous with areas of high-signal\nintensity in the lower thoracic and lumbar regions consistent with bone marrow\nreplacement for fat. Non expansile hemangiomas are identified at T11 and L5\nvertebral bodies.\n\nIrregular contour at the level of T11-T12 is consistent with Schmorl's node,\nadditionally there is diffuse disc bulge causing moderate bilateral neural\nforaminal narrowing, contacting the traversing nerve roots bilaterally, there\nis bilateral articular joint facet hypertrophy ligamentum flavum thickening\nresulting in moderate spinal canal stenosis (5:8).\n\nAt T12-L1 level, there is bilateral articular joint facet hypertrophy and mild\nligamentum flavum thickening causing mild bilateral neural foraminal\nnarrowing, however, there is no evidence of central spinal canals stenosis.\n\nAt L1-L2 level, there is irregular contour at the endplates consistent with\nSchmorl's node, mild disc bulging causing mild bilateral neural foraminal\nnarrowing, there is moderate articular joint facet hypertrophy and ligamentum\nflavum thickening, with no evidence of central spinal canal stenosis or nerve\nroot compression.\n\nAt L2-L3 level, there is disc bulge causing mild bilateral neural foraminal\nnarrowing, with no frank evidence of nerve root compression, there is mild\narticular joint facet hypertrophy and ligamentum flavum thickening.\n\nAt L3-L4 level, there is diffuse disc bulge causing bilateral neural foraminal\nnarrowing, contacting the traversing and exiting nerve roots bilaterally,\nadditionally there is articular joint facet hypertrophy ligamentum flavum\nthickening resulting in moderate to severe spinal canal narrowing with\ncrowding of the nerve roots within thecal sac (05:32).\n\nAt L4-5 level, there is diffuse disc bulge with underlying posterior central\ndisc protrusion, causing anterior thecal sac deformity and bilateral neural\nforaminal narrowing, contacting the traversing and exiting nerve roots of L4\nbilaterally. There is bilateral articular joint facet hypertrophy ligamentum\nflavum thickening resulting in severe spinal canal stenosis (05:38). There is\nvacuum disc phenomenon.\n\nAt L5-S1 level, there is disc bulge causing anterior thecal sac deformity and\nbilateral neural foraminal narrowing with small posterior central disc\nprotrusion, there is bilateral articular joint facet hypertrophy ligamentum\nflavum thickening causing moderate to severe spinal canal narrowing. There is\nvacuum disc phenomenon.\n\nThe sacroiliac joints adjacent vacuum phenomena and apparently sclerotic\nchanges on the right (5, 48). 3 by 4 cm renal cystic formation is identified\non the left kidney, partially evaluated this exam (05:16). There is mild\nposterior soft tissue edema towards the midline noted on the sagittal STIR\nsequence (03:11).", "output": "1. Multilevel, multifactorial degenerative changes throughout lower thoracic\nand lumbar spine, more significant at T11-T12, and from L2-L3 through L5-S1\nlevels.\n\n2. Moderate to severe spinal canal stenosis at L3-L4, L4-5, and L5-S1 levels,\nproducing crowding of the nerve roots within the thecal sac and bilateral\nneural foraminal narrowing as described above.\n\n3. 3 x 4 cm renal cystic formation identified in the left kidney, partially\nevaluated in this exam, if clinically warranted, correlation with abdominal CT\nor abdominal MRI are recommended.\n\nRECOMMENDATION(S):\n3 x 4 cm renal cystic formation identified in the kidney is partially\nevaluated, if clinically warranted, correlation with abdominal CT or MR are\nrecommended.\nManagement of Incidental Renal Cyst Completely Characterized on CT or MRI.\nReference:\nHerts BR, ___ SG, ___ NM, et. Al. Management of the Incidental Renal\nMass on CT: A White Paper of the ACR Incidental Findings Committee. J ___\n___ ___" }, { "input": "CERVICAL:\nAlignment is normal.There is loss of signal of the intervertebral discs on the\nT2 weighted images, a manifestation of degenerative disease. There are ___\ntype 2 signal intensity changes of the vertebral endplates at C6-7. There are\ndisc bulges at C4-5, C5-6 and C6-7 that encroach on the spinal canal but do\nnot contact the spinal cord. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.\n\nTHORACIC:\nAlignment is normal.There is loss of signal of the intervertebral discs on the\nT2 weighted images due to degenerative disease. There are ___ type 2\nchanges of the vertebral endplates at T11-12. Mild disc bulges slightly\nencroach on the spinal canal at several levels without contacting the spinal\ncord. The spinal cord appears normal in caliber and configuration.There is no\nevidence of infection or neoplasm.\nLUMBAR:\nAlignment is normal.There are ___ type 2 signal intensity changes of the\nvertebral endplates at L4-5, a manifestation of degenerative disease. There\nis no spinal canal or neural foraminal compromise. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.\n\nOTHER:", "output": "1. No evidence of syrinx.\n2. Mild degenerative disease at multiple levels." }, { "input": "Previously described comminuted fracture of the posterior arch of C1 is better\ndepicted on prior CT; however, there is associated increased T2/STIR signal\nwithin the left lateral mass of C1. Additionally, there is fluid between the\nlateral masses of C1 and C2 bilaterally, and also between the occiput and C1.\nThere is additional fluid seen within the atlantodental joint, in the region\nof the atlantoaxial ligament. The apical ligament is not seen, which can be\nnormal; however, given increased fluid in this area, disruption is not\nexcluded. There is a possible defect in the superior extension of the anterior\nlongitudinal ligament, the atlanto-occipital membrane, and the anterior arch\nof C1 may be lower than the expected position in relation to C2.\n\nThere is no clear evidence of transverse ligamentous disruption, though when\ncompared to prior CT, it appears that a portion of the bony insertion point of\nthe left aspect of the transverse ligament is attached to the anterior arch,\nwhile an additional portion of the insertion site displaced to the left with\nthe fracture fracture, thus the mechanical stability of C1/C2 at this site is\nuncertain. Comparison with outside hospital CT may would be useful for further\nassessment.\n\nThere is a prominent prevertebral soft tissue hematoma, extending from the\nclivus inferiorly to the C4 level. The hematoma measures 0.6 cm in maximal\nthickness. There is no evidence of anterior longitudinal ligamentous\ndisruption below the inferior level of the hematoma although given the\npresence of a hematoma, anterior longitudinal ligamentous injury cannot be\nentirely excluded.\n\nThe remaining vertebral body heights and alignment within the cervical spine\nappear normal.\n\nThe cervical spinal cord is normal in signal morphology. There is no evidence\nof cord contusion or edema. There is no evidence of epidural hematoma.\n\nThere is no evidence of significant spinal canal or neural foraminal\nnarrowing.", "output": "1. Comminuted fracture of the posterior arch of C1 is better depicted on prior\nCT; however, there is associated increased T2/STIR signal within the left\nlateral mass of C1.\n2. Large prevertebral soft tissue hematoma extending from the clivus to the\ninferior aspect of the C4 vertebral body.\n3. Abnormal fluid signal between the lateral masses of C1 and C2, between the\nocciput and C1, and within the atlantodental joint -- given the apical\nligament is not seen, apical ligament injury is not excluded.\n4. There is an additional defect in the atlanto-occipital membrane and the\nanterior arch of C1 appears lower than its expected position in relation to\nC2.\n5. No clear transverse ligamentous disruption although given prior CT\nfindings, including the fracture traversing the insertion site of the\ntransverse ligament, the mechanical stability of C1 and C2 is uncertain (see\nabove).\n6. No evidence of spinal cord compression, cord contusion, or cord edema.\n\nNOTIFICATION: These findings were discussed with neurosurgery nurse\n___, at 1400, ___, by Dr. ___\ntelephone." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nLevoscoliosis of the lumbar spine is again noted. There is transitional\nanatomy with partial sacralization of L5. Vertebral body heights are\npreserved. L1-2, L2-3 and L4-5 endplate probable type ___ ___ changes without\ndefinite epidural collection is noted. Multiple Schmorl's nodes are noted\nthroughout the lumbar spine.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal throughout the lumbar\nspine, with near complete loss of intervertebral disc height at L4-5.\n\nAt T12-L1 there is disc bulge, mildvertebral canal and no neural foraminal\nnarrowing.\n\nAt L1-2 there is disc bulge, prominent epidural fat, ligamentum flavum\nhypertrophy, facet joint hypertrophy, mildvertebral canal and no neural\nforaminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal and mild bilateral neural foraminal\nnarrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, novertebral canaland mild rightneural foraminal\nnarrowing.Left-sided nonspecific facet edema is noted.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canalmild rightneural foraminal narrowing. \nLeft-sided nonspecific facet edema is noted.\n\nAt L5-S1 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, novertebral canal and no neural foraminal narrowing. Nonspecific\nbilateral facet edema is noted. Bilateral facet joint probable synovial cysts\nare noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm. \nMultiple sacral probable perineural cysts are noted. Limited imaging of the\nkidneys suggest bilateral extrarenal pelvises (see 07: ___.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel lumbar spondylosis as described, without definite moderate or\nsevere vertebral canal or neural foraminal narrowing.\n3. Limited imaging of the kidneys suggest bilateral extrarenal pelvises. If\nconcern for hydro ureter, consider renal ultrasound for further evaluation.\n\nNOTIFICATION: Insert-" }, { "input": "The imaged posterior fossa appears normal. The craniocervical junction\nappears normal. The cervical cord is normal in volume, morphology and signal\nintensity. No cord lesions.\n\nIncreased cervical lordosis. No acute vertebral body fractures. No\ndislocations.\n\nThere is multilevel degenerative changes of the cervical spine in the form of\ndisc desiccation, disc osteophyte complexes, facet joint osteophytosis and\nligamentum flavum hypertrophy as described below:\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: Partial effacement of the CSF space anterior to the cord, but there is\nno cord compromise. Moderate severe right and mild moderate left neural\nforaminal narrowing.\n\nC4-5: Partially effacement of the CSF space surrounding the cord, but no\nabnormal cord signal to suggest cord compromise. Moderate neural foraminal\nnarrowing bilateral.\n\nC5-6: Partially effacement of the CSF space anterior to the cord, but no cord\ncompromise. Moderate neural foraminal narrowing bilateral.\n\nC6-7: No cord compromise. Severe left and moderate right neural foraminal\nnarrowing\n\nC7-T1: No cord compromise. The neural foramina are patent bilateral.\n\nExtra-spinal: Bilateral parotid dilated ductules or cysts are nonspecific\n(right more than left) and reference is made to MR head done on the same day\nfor a for description.", "output": "No evidence of compromise of the cervical cord in the spinal canal. No\nabnormal cord signal intensity.\n\nNo acute vertebral body fractures or dislocations.\n\nDegenerative changes result in multilevel neural foraminal narrowing most\nmarked on the right at the C3-4 and left C6-7 levels as described above." }, { "input": "MRI OF THE THORACIC SPINE:\nThe study is markedly degraded by motion limiting the evaluation. For the\npurposes of numbering, a count-down was performed from the level of C2\nvertebrae based on the localizer images.\n\nThe alignment of the thoracic spine is maintained.\n\nAgain seen is a burst fracture involving T9 vertebral body with loss of height\nby approximately 50% and mild retropulsion of the fractured fragments into the\nspinal canal posteriorly causing mild spinal canal stenosis at that level. \nAlso seen is compression deformity along the superior endplate of T4 and T5\nvertebrae with approximately 10% loss of height at both these levels. No\nretropulsion of osseous fragments seen. No epidural hematoma is seen.\n\nThere is marrow edema involving T9 vertebrae. The marrow signal is otherwise\nunremarkable.\n\nThe visualized thoracic spinal cord appears unremarkable without focal cord\nsignal abnormality or cord expansion.\n\nThe there large layering right-sided pleural effusion and trace left-sided\npleural effusion. The remaining visualized retroperitoneal, paraspinal and\nparavertebral soft tissues appear unremarkable.\n\nThere is a right central disc protrusion at T1-T2, T3-T4 and T4-T5 indenting\nthe ventral thecal sac. Also seen is diffuse broad-based disc bulge at T6-T7,\nT7-T8, T10-T11 and T2-11-T12 indenting the ventral thecal sac. No neural\nforamen narrowing is seen at any level.\n\nLUMBAR SPINE:\n The alignment of the lumbar spine is maintained. There is compression\ndeformity along the superior endplate of L3 vertebrae with loss of height by\napproximately 50%. There is no associated marrow edema. There are ___ type\n2 changes at L2-L3, L3-L4 and L4-L5. The visualized lower spinal cord appears\nunremarkable with the conus terminating at L1.\n\nThe visualized retroperitoneal, paraspinal and paravertebral soft tissues\nappear unremarkable. No definite abnormal enhancement is seen on postcontrast\nimages though evaluation is markedly limited given the motion artifact.\n\nAt L1-L2, the intervertebral disc height and signal is maintained. The spinal\ncanal and bilateral neural foramina patent.\n\nAt L2-L3, there is loss of disc height and signal with broad-based disc bulge\nand mild bilateral facet arthropathy with ligamentum flavum thickening and\nprominent epidural fat causing mild bilateral neural foramen narrowing and\nmoderate spinal canal narrowing.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc bulge\nand a small annular fissure with mild ligamentum flavum thickening and\nprominent epidural fat causing mild spinal canal stenosis. Bilateral neural\nforamen are patent.\n\nAt L4-L5, there is loss of disc height and signal with broad-based disc bulge\nand small annular fissure with bilateral facet arthropathy and mild ligamentum\nflavum thickening with prominent epidural fat causing severe spinal canal\nstenosis and mild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is loss of disc height and signal with broad-based disc bulge\nbilateral facet arthropathy and prominent epidural fat causing severe spinal\ncanal stenosis and moderate bilateral neural foramen narrowing, left greater\nthan right.", "output": "1. Markedly motion degraded study, especially in the postcontrast images\nlimiting the evaluation.\n2. Multiple benign-appearing vertebral body fractures, especially at T9 with\nloss of height by approximately 50%. Also seen is compression deformity along\nthe superior endplates of T4, T5 and L3 vertebrae as described above.\n3. Mild multilevel degenerative disease of the thoracic spine without neural\nforamina or spinal canal stenosis at any level.\n4. Multilevel multifactorial degenerative disease of the lumbar spine,\nespecially at L4-L5 and L5-S1 with severe spinal canal stenosis secondary to\nepidural lipomatosis with ligamentum flavum thickening and disc bulge. Also\nseen is moderate bilateral neural foramen narrowing at L5-S1." }, { "input": "The patient is status post left L5 hemilaminectomy. The alignment of the\nlumbar spine is normal. The bone marrow of the endplates of L5-S1 are\nheterogeneous, related to degenerative endplate changes. There is focal fatty\ndeposition within the anterior and inferior corner of the T12 vertebral body. \nThe conus medullaris terminates at T12-L1. The spinal cord and nerve roots of\nthe cauda equina are normal in signal. The height of the vertebral bodies are\nmaintained. The intervertebral disc spaces of L4-L5 are moderately narrowed,\nprogressed from the prior examination. The intervertebral discs are diffusely\ndesiccated.\n\nAt T11-T12 and T12-L1, there is no spinal canal or neural foraminal stenosis,\nunchanged from the prior examination.\n\nAt L1-L2, asymmetric disc bulge, eccentric to the left, causes mild left\nneural foraminal stenosis, progressed from the prior examination. There is no\nspinal canal stenosis.\n\nAt L2-L3, symmetric disc bulge and bilateral facet arthropathy cause moderate\nbilateral neural foraminal stenosis, left greater than right, progressed from\nthe prior examination. There is no spinal canal stenosis.\n\nAt L3-L4, symmetric disc bulge and bilateral facet arthropathy cause moderate\nleft neural foraminal and mild-to-moderate right neural foraminal stenosis,\nprogressed from the prior examination. There is no spinal canal stenosis.\n\nAt L4-5, diffuse disc bulge with new, superimposed left neural foraminal disc\nprotrusion and bilateral facet arthropathy cause severe left neural foraminal\nand moderate right neural foraminal stenosis, progressed from the prior\nexamination. There is no spinal canal stenosis.\n\nAt L5-S1, the asymmetric disc bulge, eccentric to the left and bilateral facet\narthropathy cause moderate left neural foraminal and mild right neural\nforaminal stenosis, progressed from the prior examination. There is no spinal\ncanal stenosis.\n\nBoth kidneys contain multiple well-circumscribed T2 hyperintense lesions, the\nlargest measuring 3.5 cm in the right upper pole, unchanged from the prior\nexamination and representing renal cysts. The nonobstructing calculi, seen on\nthe prior CT urogram, in the left kidney, are not well visualized on this\nexamination.", "output": "Status post left L5 hemilaminectomy with progressive, multilevel degenerative\nchanges of the lumbar spine, most advanced at L4-L5 with a new left neural\nforaminal disc protrusion, causing severe left neural foraminal stenosis." }, { "input": "Mild retrolisthesis is seen involving L5 on S1. The marrow signal is\nheterogeneous throughout the lumbosacral spine with areas of punctate STIR\nhyperintense lesions seen within the iliac bone. Incidental note is made of\nfatty conversion of marrow within the coccyx. No cord signal abnormalities\nare identified, with the conus terminating at L1/L2.\n\nL3-L4: Facet joint arthropathy and ligamentum flavum hypertrophy contributes\nto moderate canal narrowing at this level. Facet joint osteophytes contribute\nto moderate left and mild right neural foraminal narrowing.\n\nL4-5: Central disc bulge, facet joint osteophytes and ligamentum flavum\nhypertrophy contributes to severe canal narrowing at this level. Facet joint\nosteophytes also contribute to severe bilateral neural foraminal narrowing.\n\nL5-S1: Central disc bulge is seen, which in combination with facet joint\nosteophytes and ligamentum flavum hypertrophy contributes to mild canal\nnarrowing. Severe right and moderate left neural foraminal narrowing is seen.\n\nIncidental note is made of a cystic lesion within the midpole of the left\nkidney, measuring 2.2 cm. Otherwise, no paraspinal or paravertebral soft\ntissue abnormalities are identified.", "output": "1. Severe canal stenosis at L4-5 secondary to central disc bulge, facet joint\nosteophytes and ligamentum flavum hypertrophy. Bilateral severe neural\nforaminal narrowing is seen.\n2. Heterogeneous bone marrow with multiple STIR hyperintense lesions, although\nincompletely evaluated on this noncontrast study, is concerning for\nmyelomatous involvement as seen on the prior CT." }, { "input": "The alignment is normal. Diffuse loss of the normal T2 signal is seen within\nthe intervertebral discs of the lower lumbar spine. Vertebral body focus of\nfat versus hemangioma within the L3 level measures 1.8 cm, unchanged compared\nto the prior exam. No other bone marrow signal abnormalities are identified. \nThe cord terminates at T12. No terminal cord signal abnormalities are seen.\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: There is no spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild disc bulge is seen resulting in bilateral subarticular zone\nnarrowing. There is contact with the traversing bilateral L4 nerve roots,\noverall similar to the prior exam. Facet joint arthropathy results in mild\nbilateral neural foraminal narrowing, unchanged compared to the prior exam.\n\nL4-L5: Disc bulge, and posterior epidural lipomatosis results in mild spinal\ncanal narrowing. Facet joint arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nL5-S1: Mild disc bulge results in moderate bilateral subarticular zone\nnarrowing. There is no significant spinal canal narrowing. Facet joint\narthropathy results in moderate bilateral neural foraminal narrowing, left\ngreater than right. This appears slightly progressed compared to the prior\nexam.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Overall, slight interval progression of lumbar spondylosis compared to the\nprior exam from ___ with moderate bilateral neural foraminal\nnarrowing, left greater than right at L5-S1 and mild spinal canal narrowing at\nL4-L5 secondary to disc bulge, and posterior epidural lipomatosis.\n2. No terminal cord signal abnormalities identified.\n3. Unchanged L3 vertebral hemangioma versus fat deposit." }, { "input": "Precise vertebral numbering cannot be established as the most caudal\nrib-bearing vertebra is not included on the images. The vertebra above the\nmost caudal fully formed disc attaches the iliolumbar ligament, as expected,\nand is labeled L5. The numbering is documented on image 2:10.\n\nVertebral body heights are preserved. There is no subluxation. Bone marrow\nsignal is diffusely low. No focal bone marrow signal abnormalities are\ndetected on STIR images.\n\nThe conus medullaris terminates at L1. The included distal spinal cord\nappears morphologically normal, but evaluation of its signal is limited by\nmotion artifact on the sagittal T2 weighted and STIR images.\n\nSagittal images through the T11-12, T12-L1, and L1-L2 levels demonstrate no\nspinal canal or neural foraminal narrowing. No axial images through these\nlevels.\n\nSagittal images through the L1-L2 level demonstrate a mild disc bulge without\nsignificant spinal canal or neural foraminal narrowing. No axial images\nthrough this level.\n\nL2-L3: Prominent posterior epidural fat mildly narrows the spinal canal\nwithout mass effect on the intrathecal nerve roots. Minimal disc bulge does\nnot significantly contribute to spinal canal narrowing. No significant neural\nforaminal narrowing.\n\nL3-L4: The disc is desiccated with a mild bulge. There is mild bilateral\nfacet arthropathy. In combination with prominent posterior epidural fat, this\ncauses mild spinal canal narrowing without mass effect on the intrathecal\nnerve roots. Subarticular zones are narrowed. Traversing L4 nerve roots may\nbe contacted but do not appear compressed. Small right foraminal disc\nprotrusion causes mild right neural foraminal narrowing and may contact the\nexiting right L3 nerve root. No significant left neural foraminal narrowing.\n\nL4-L5: Mild disc bulge and facet arthropathy. No significant spinal canal or\nneural foraminal narrowing.\n\nL5-S1: Minimal bilateral facet arthropathy. No significant disc abnormality.\nNo significant spinal canal or neural foraminal narrowing.", "output": "1. Prominent posterior epidural fat mildly narrows the spinal canal at L2-L3\nand at L3-L4, with slight contribution from a disc bulge at L3-L4. However,\nthere is no mass effect on the intrathecal nerve roots.\n2. At L3-L4, mild disc bulge and mild facet arthropathy narrow the\nsubarticular zones with abutment, but no evidence for compression, of the\ntraversing L4 nerve roots. There is also a small right foraminal disc\nprotrusion mildly narrowing the right neural foramen and contacting the\nexiting right L3 nerve root.\n3. Diffusely abnormal bone marrow signal. While some residual red marrow may\nbe seen at the age of ___, the diffuse nature of the abnormal signal suggests\nred marrow reconversion, which may be seen in the setting of anemia, smoking,\nor chronic systemic illness. More rarely, this is secondary to an\ninfiltrative process. Recommend correlation with clinical history and\nlaboratory data." }, { "input": "Cervical:\nThere is normal cervical alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. There is T2 hyperintensity at the mid to\nanterior aspect of the C6-C7 disc without associated loss of height adjacent\nvertebral or paraspinal abnormality (06:10). At C4-C5 there is a central disc\nbulge causing mild spinal canal narrowing without neural foraminal stenosis. \nThe remaining levels are unremarkable. The cord demonstrates normal signal\nand morphology. The paraspinal soft tissues are unremarkable.\n\nThoracic:\nThere is normal thoracic alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. The intervertebral disc spaces demonstrate\nnormal signal and height. The thoracic cord demonstrates normal signal and\nmorphology. There is no evidence of epidural abscess. There is no\nsignificant neural foraminal or spinal canal stenosis. The paraspinal soft\ntissues are unremarkable.\n\nLumbar:\nThere is normal lumbar alignment. There is mild central compression of the L5\nvertebral body without correlate marrow abnormality, consistent with\nchronicity. Remainder the vertebral body heights are preserved with\nunremarkable marrow signal. The intervertebral disc spaces demonstrate normal\nsignal and height. There is no significant neural foraminal or spinal canal\nstenosis. There is no evidence of epidural abscess.\n\nAt L4-L5 there is disc bulge and facet osteophytes causing subarticular zone\nand lateral recess stenosis which contacts the traversing L5 nerve roots\n(14:30)\nAt L5-S1 there is disc bulge and facet osteophytes causing subarticular zone\nstenosis which contacts the traversing L5 nerve roots (14:36).\n\nThe perispinal soft tissues are unremarkable.", "output": "1. Nonspecific T2 hyperintensity at the mid the anterior C6-C7 disc space\nwithout associated abnormality within the vertebral bodies, epidural space, or\nparaspinal soft tissue to suggest an infectious process.\n2. Mild degenerative changes of the lumbar spine, as described.\n3. No evidence of epidural abscess." }, { "input": "There has been continued anterior vertebral body height loss of the T11 and to\na lesser degree of the T12 vertebral bodies. There is no bone marrow edema. \nVertebral body heights are otherwise preserved.\nThere is progression of the L5-S1 anterolisthesis now measuring 12 mm from\npreviously 9 mm. Vertebral body alignment is otherwise maintained. There is\nunchanged multilevel degenerative disc disease, most pronounced at L4-L5 and\nL5-S1 with moderate to severe disc space height loss.\nBone marrow signal intensity is within normal limits.\n\nAt T10-T11, there is a right paracentral disc protrusion and facet joint\narthropathy which results in mild right neural foraminal narrowing but no\nspinal canal stenosis or significant left neural foraminal narrowing.\n\nAt T11-T12, there is facet joint arthropathy and ligamentum flavum thickening\nwhich results in moderate left and mild right neural foraminal narrowing but\nno spinal canal stenosis.\n\nAt T12-L1, there is facet joint arthropathy which result in mild left neural\nforaminal narrowing but no spinal canal stenosis or right neural foraminal\nnarrowing.\n\nAt L1-L 2, there is facet joint hypertrophy and ligamentum flavum thickening\nbut no spinal canal stenosis or neural foraminal narrowing.\n\nAt L2-L3, there is a disc bulge with facet joint hypertrophy and small\nbilateral facet joint effusions as well as ligamentum flavum thickening. \nPostsurgical changes after left L3 hemilaminectomy are again noted. There is\nmild spinal canal stenosis and moderate bilateral neural foraminal narrowing.\n\nAt L3-L4, previously seen left-sided disc protrusion is again identified along\nwith a left-sided hemilaminectomy. Mild indentation on the thecal sac is\nseen. There is now a new right-sided disc herniation identified within the\nright lateral recess of L4 (06:14) right L4 nerve root.\n\nAt L4-L5, there is disc bulging resulting in moderate bilateral foraminal\nnarrowing.\n\nAt L5-S1, there is severe facet joint arthropathy and ligamentum flavum\nthickening. There is spondylolisthesis. Uncovering and bulging of the disc\nand spondylolisthesis result in severe bilateral foraminal narrowing and\ncompression of exiting L5 nerve roots in the neuroforamen (series 201, image\n33 and image 15). There is no spinal canal stenosis.", "output": "1. No evidence of high-grade spinal stenosis or thecal sac compression. There\nis no MRI evidence of cauda equina compression (defined as severe spinal\nstenosis with crowding of the cauda equina nerve roots and lack of CSF within\nthe thecal sac).\n2. New right-sided disc herniation at L3-4 level which could affect the right\nL4 nerve root.\n3. Worsening multilevel degenerative changes of the lumbar spine with slightly\nincreased L5-S1 anterolisthesis now measuring 12 mm from previously 9 mm.\n4. Multilevel disc protrusions and bulges which have mostly progressed from\n___.\n5. Multilevel severe and moderate neural foraminal narrowing, as detailed\nabove, which appears grossly stable from ___, including compression of the\nbilateral L5 nerve roots." }, { "input": "There is scoliosis of the lumbar spine convex to the right in the lower lumbar\nand to the left in the lumbar region.\n\nFrom T10-11 through L3-4 disc degenerative changes identified with mild\nbulging. Minimal narrowing of the foramina seen at L2-3 and L3-4 levels.\n\nThere is mild chronic compression of the superior endplate of L4 identified. \nAt L4-5 level diffuse disk bulge and facet degenerative changes and mild\nnarrowing of the foramina seen without spinal stenosis.\n\nAt L5-S1 level bilateral spondylolysis of L5 seen with grade 1\nspondylolisthesis of L5 over S1. There is severe left-sided and moderate\nsevere right-sided foraminal narrowing with compression of the exiting L5\nnerve root within the foramina.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Bilateral spondylolysis of L5 with grade 1 spondylolisthesis of L5 on S1 with\nsevere left-sided and moderately severe right-sided foraminal narrowing and\ncompression of exiting L5 nerve roots within the foramina. Mild scoliosis of\nthe lumbar spine and multilevel mild degenerative changes at other levels as\ndescribed above." }, { "input": "There have been no significant changes since the prior study. Again seen is\nanterior subluxation of L5 upon S1 with apparent fusion across the interspace.\nThere is scoliosis with its apex to the left at L1. There are marked changes\nof degenerative disc disease at every image level with loss of signal of the\nintervertebral discs on the T2 weighted images and loss of height. These are\nmanifestations of degenerative disc disease.\n\nAxial images at T12-L1 demonstrate mild facet osteophyte formation and\nligamentum flavum thickening along with mild disc bulging. There is no\nencroachment on the neural foramina and only mild encroachment on the spinal\ncanal with no evidence of conus or cauda equina compression.\nAt L1-2, L2-3 there are facet osteophytes and ligamentum flavum thickening but\nno canal or foraminal compromise.\nAt L2-3, disc bulges and ligamentum flavum thickening mildly narrows the\nspinal canal without evidence of nerve root compression. There is no neural\nforaminal narrowing.\nAt L4-5, a bulging disc, facet osteophytes, and ligamentum flavum thickening\nproduce mild spinal canal narrowing. There is a small midline protrusion of\nthe disc that minimally indents the thecal sac. This and facet osteophyte\nproduce narrowing and compromise of the traversing left L5 nerve root. On the\nleft, disc bulging and facet osteophyte somewhat narrow the neural foramen\nwithout contact the nerve root.\n\nAt L5-S1 the combination of facet osteophyte formation, spondylolisthesis and\nloss of disc height produces moderate -severe neural foraminal narrowing\nbilaterally. This is more severe on the left than right.", "output": "Year changes of degenerative disc disease, stable since the prior study. This\nincludes osteophyte formation and disc protrusions with compression of nerve\nroots in the spinal canal and neural foramina as discussed above." }, { "input": "There is grade 1 anterolisthesis of C3 on C4 with moderate spinal stenosis and\ncompression of the cord without abnormal signal within the cord at this level\n(4:11). There is no evidence of acute compression fracture. No infiltrative\nprocess or abnormal enhancement is identified.\n\nThere is left convex scoliosis in the lumbar spine. There is L5 on S1\nspondylolisthesis with severe left-sided neuroforaminal stenosis and moderate\nright neuroforaminal stenosis at this level which is unchanged since previous\nexamination. There is chronic compression of the anterior endplate of C4\nlikely secondary to degenerative change. Multilevel degenerative changes are\npresent including loss of signal of the intervertebral disc spaces, joint\nspace narrowing, osteophytosis, facet arthropathy, and subchondral cystic\nchange worst at C3-C4 and L5-S1. Mild multilevel disc bulging is present\nwithout cord compression.", "output": "1. Grade 1 anterolisthesis of C3 on C4 with moderate spinal stenosis and\ncompression of the cord without abnormal signal within the cord at this level.\n2. No evidence of acute fracture or infiltrative process.\n3. L5 on S1 spondylolisthesis with severe left-sided neuroforaminal stenosis\nand moderate right neuroforaminal stenosis unchanged from previous\nexamination.\n4. Extensive multilevel degenerative changes, detailed above." }, { "input": "There is new kyphotic angulation of the previously seen sacral fracture (4:13,\n5:3). This angulation was not seen on the prior study dated ___ or\non the scout images of pelvic MRI dated ___. This results in mild\nnarrowing of the spinal canal at the termination of the thecal sac, and\nperhaps contributing to patient's worsening neurologic symptoms. There is a\nfracture of the S1 segment and S2 segment, which is new from ___,\nbut limited in evaluation comparing only to the provided scout of that study. \nThe left L5 pedicle demonstrates hyperintense STIR signal, likely due to a\nfracture given the corresponding hypointense T1 signal, which is new from\n___.\n\nThere is dextroscoliosis of the lumbar spine with 4 mm L4-L5 anterolisthesis\nand 1 cm L5-S1 anterolisthesis, similar to the prior study. There is a\nmoderate L4 superior endplate chronic compression fracture. There is loss of\nintervertebral disc space and T2 signal on the basis of degenerative process,\nwith complete obliteration of L5-S1 disc space, similar to the prior study. \nThe conus terminates at L1.\n\nT12-L1: There is a disc bulge with ligamentum flavum thickening causing stable\nmild spinal canal stenosis. Combined with bilateral facet osteophytes, there\nis stable moderate right and mild left neural foraminal narrowing.\n\nL1-L2: There is no spinal canal stenosis. There is bilateral facet\nosteophytes and lig ligamentum flavum thickening. There is stable mild\nbilateral neural foraminal narrowing.\n\nL2-L3: There is disc bulge with ligamentum flavum thickening, with stable\nmoderate spinal canal stenosis and deformity of the thecal sac. The disc\nbulge causes posterior displacement of bilateral traversing nerve roots in\nconjunction with bilateral facet osteophytes, there is stable moderate right\nand mild left neural foraminal narrowing.\n\nL3-L4: There is a disc bulge with ligamentum flavum thickening causing stable\nmild spinal canal stenosis with deformity of the thecal sac. The disc bulge\nand facet osteophytes cause posterior displacement of the left L4 traversing\nnerve root. In conjunction with bilateral facet osteophytes, there is\nmoderate left and no right neural foraminal narrowing.\n\nL4-L5: There is a disc bulge with asymmetric left foraminal component with\nligamentum flavum thickening causing stable mild spinal canal stenosis. The\ndisc bulge and facet osteophytes contacting the left L5 traversing nerve root\nwith posterior displacement. In conjunction with bilateral facet osteophytes,\nthere is severe left and no right neural foraminal narrowing, with the disc\nbulge and facet osteophytes compressing the left exiting L4 nerve root,\nsimilar to the prior study.\n\nL5-S1: There is no neural foraminal narrowing. Grade 2 spondylolisthesis with\nbilateral facet arthropathy cause severe left and moderate right neural\nforaminal narrowing, similar to the prior study, with endplate osteophyte\ncontacting the undersurface of the right L5 exiting nerve root and facet\nosteophytes combined with spondylolisthesis compressing the left L5 nerve\nroot, similar to the prior study.", "output": "1. New kyphotic angulation of the sacrum, which was not seen on the prior\nstudy dated ___ or on the scout images from recent pelvic MRI\ndated ___. There is resulting mild spinal canal stenosis at the\ntermination of the thecal sac, perhaps contributing to patient's progression\nof neurologic symptoms.\n2. New fractures of the S1 and S2 segments and left L5 pedicle, which were not\nseen on the most recent MRI from ___, although comparison is made\nonly to the provided scout images of that study.\n3. L4-L5 and L5-S1 spondylolisthesis with unchanged moderate to severe lumbar\nspondylosis with multilevel neural foraminal narrowing compressing the nerve\nroots, as detailed above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:01 pm, 2\nminutes after discovery of the findings." }, { "input": "Dextroconvex curvature of the thoracic spine with apex at T8 and compensatory\nlevoconvex curvature of the thoracolumbar spine with apex at T12 is unchanged\nfrom prior examination. The remainder of the thoracic alignment is anatomic. \nNew from examination of ___ is superior endplate compression fractures\nof T9, T10 and T12 as well as an inferior endplate fracture of L1,\ncharacterized by linear STIR hyperintense signal. There is no retropulsion of\nthe T9 and T10 superior endplate fractures. 3 mm retropulsion of the T12\nsuperior endplate fracture is identified. No retropulsion of the L1 inferior\nendplate fracture is noted.\n\nNo loss of vertebral body height at T9 and T10. There is mildly greater than\n25% loss of the T12 vertebral body height and less than 25% loss of the L1\nvertebral body height. The remainder the vertebral bodies are unremarkable\nwithout definitive evidence for prominent marrow replacing lesions.\n\nThere is no abnormal cord signal or enhancement. Allowing for expected mild\nenhancement of the above-described endplate compression fractures, no\nsuspicious enhancement is noted.\n\nMultilevel degenerative changes including disc protrusions and bulges do not\nsignificantly narrow the spinal canal. There is no significant neural\nforaminal narrowing. The T12 superior endplate retropulsion results in mild\nspinal canal narrowing and there appears to be moderate left and no\nsignificant right neural foraminal narrowing.\n\nA hiatal hernia and left lung base rounded atelectasis are re-identified. \nThere are very small bilateral pleural effusions. T2 hyperintense signal of\nthe right lower lobe (series 7, image 32) is not definitively seen on prior CT\nchest and may represent a new focus of infection or atelectasis. Clinical\ncorrelation is recommended with repeat CT chest as indicated. Incidentally\nnoted 1.3 x 0.9 cm (AP, TRV) ovoid T1 and T2 subpleural hyperintense focus at\nthe left T3 costovertebral junction is compatible with a small lipoma,\ndemonstrating signal dropout on water sensitive sequence.", "output": "1. Findings most compatible with acute compression fractures of the superior\nT9, T10 and T12 endplates as well as of the L1 inferior endplate. There is\nslightly greater than 25% loss of the T12 vertebral body height and less than\n25% loss of the L1 vertebral body height. No T9 or T10 vertebral body height\nloss is noted.\n2. 3 mm retropulsion of the T12 superior endplate fracture results in mild\nspinal canal narrowing and there appears to be moderate left T11-T12 neural\nforaminal narrowing.\n3. Multilevel degenerative changes as described above without high-grade\nspinal canal or neural foraminal narrowing. There is no abnormal signal or\nenhancement of the cord.\n4. No definite underlying lesions are associated with the compression\nfractures.\n5. There is T2 hyperintense rounded focus in the right lung base, not seen on\nCT chest of ___. This could represent infectious etiology or\natelectasis. Clinical correlation is recommended with CT chest as indicated.\n6. Additional findings described above.\n\nRECOMMENDATION(S): Clinical correlation is recommended with CT chest as\nindicated for impression number 5.\n\nNOTIFICATION: The findings of acute compression fractures of T9, T10, T12 and\nL1 Dr. ___. by ___, M.D. on the telephone on ___ at\n8:48 am, 10 minutes after discovery of the findings." }, { "input": "CERVICAL:\nAgain seen is anterior subluxation of C3 on C4, C6 on C7 and C7 on T1. These\nare unchanged since the prior study and appear related to degenerative disc\ndisease. Degenerative changes include loss of signal of the intervertebral\ndiscs on the T2 weighted images, loss of height of the intervertebral discs,\nthickening of the posterior longitudinal ligament and disc bulges encroaching\non the spinal canal. These changes produce canal narrowing with flattening of\nthe spinal cord at C 3 4, 4 5 and C6-7..\n\nTHORACIC:\nThere is further collapse of the T7 vertebral body with hyperintensity on the\nwater ideal and hypointensity on the T1 weighted images indicating a recent\nfracture. There is a fracture of the superior endplate of T10 with\nhyperintensity on the water ideal images, indicating recent fracture. There\nare changes of degenerative disc disease throughout the thoracic spine with\nloss of height of the intervertebral discs and loss of signal on the T2\nweighted images. There is no compression of the spinal cord.\n\nLUMBAR:\nAgain seen is anterior subluxation of L5 on S1 with essentially complete loss\nof the intervertebral disc and apparent fusion at this level. This is\nunchanged since the pelvic CT of ___. There is a fracture of the\nsuperior endplate of the L3 vertebral body, new since the spine MR of ___. It is difficult to compare this to the spine CT of ___, but\nthe duration of the vertebral bodies suggests that this is also new since\n___. This area was not included in the ___ spine MR. ___ are\ndegenerative changes throughout the lumbar spine including loss of signal of\nthe intervertebral discs on the T2 weighted images and loss of height of the\ndiscs. There is a broad bulge of the L4-5 disc with mild narrowing of the\nspinal canal but compression of the traversing left L5 nerve root in the canal\nand of the left L4 nerve root in the neural foramen. Again seen is deformity\nof the sacrum due to an insufficiency fracture, incompletely characterized on\nthe prior study.\n\nOTHER:", "output": "1. T7, T10 and L3 vertebral fractures that appear new since prior studies.\n2. Sacral insufficiency fracture with limited evaluation.\n3. Degenerative subluxations in the cervical spine with spinal cord optimize\ndue to osteophytes and disc bulges.\n4. L4-5 disc bulge compressing L4 and L5 nerve roots" }, { "input": "The exam is moderately degraded due to motion artifact.\n\nCERVICAL:\nThere is advanced degenerative change at the atlanto occipital joint with\npannus formation, without spinal canal narrowing. Cervical vertebral body\nheight and alignment appears stable with minimal spondylolisthesis at multiple\nlevels, unchanged.\n\nThe cervical spinal cord appears stable in morphology. There is no definite\ncord signal abnormality.\n\nAt C3-4, degenerative spondylolisthesis, a disc protrusion, and thickening of\nthe ligamentum flavum result in moderate spinal canal narrowing. \nUncovertebral and facet joint hypertrophy result in severe left neural\nforaminal narrowing. There is mild right neural foraminal narrowing.\n\nAt C4-5, there is a disc protrusion without spinal canal narrowing. \nUncovertebral and facet joint hypertrophy result in moderate bilateral neural\nforaminal narrowing.\n\nAt C5-6, there is a disc protrusion without spinal canal narrowing. \nUncovertebral and facet joint hypertrophy result in moderate right and mild\nleft neural foraminal narrowing.\n\nAt C6-7 a disc protrusion and ligamentum flavum thickening result in mild\nspinal canal narrowing. Uncovertebral and facet joint hypertrophy result in\nmild left neural foraminal narrowing. There is no right neural foraminal\nnarrowing.\n\nAt C7-T1, there is a disc protrusion without spinal canal or neural foraminal\nnarrowing.\n\nTHORACIC:\nS shaped scoliosis of the thoracic spine is noted.\n\nThere is marrow reactive change within the T5 vertebral body with mild loss of\nheight, consistent with an acute to subacute compression fracture. There is no\nbone retropulsion or epidural hematoma.\n\nThere is progressive interval collapse of the T7 vertebral body from the ___ MRI. There is approximately 50% loss of height of T7. There\nare no marrow reactive changes to suggest an acute change.\n\nThoracic vertebral body height and alignment are otherwise stable with mild\nloss of height of several thoracic vertebral bodies.\n\nThere is moderate degenerative disc disease within the thoracic spine, without\nhigh-grade spinal canal or neural foraminal narrowing.\n\nThere is no signal abnormality within the thoracic cord. The conus medullaris\nterminates at the T12-L1 level appears stable in morphology.\n\n\nThere is a moderate size hiatal hernia. Fluid within the distal esophagus\nlikely reflects gastroesophageal reflux. Linear band like areas of signal\nintensity within the left lower lobe likely reflects atelectasis. There may\nbe tiny bilateral pleural effusions.\n\nOTHER:\nHyperintense signal on T2 weighted images within the central pons is likely\nsecondary to chronic small vessel disease, unchanged.\n\nThere is no paravertebral or paraspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. Progressive interval collapse of the T7 vertebral body from the ___ MRI, without acute bone marrow reactive change.\n3. Mild acute to subacute T5 vertebral body compression fracture.\n4. Grossly stable multilevel cervical degenerative changes detailed above.\n5. Grossly stable additional chronic compression fractures within the thoracic\nspine and moderate degenerative disc disease, without high-grade spinal canal\nnarrowing or abnormal cord signal.\n6. Moderate hiatal hernia and gastroesophageal reflux." }, { "input": "There is normal cervical alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. There is diffuse low signal within the\nintervertebral disc spaces without significant loss of height.\n\nAt C2-C3 there is central disc protrusion and uncovertebral and facet\nosteophytes causing mild spinal canal narrowing and mild left neural foraminal\nstenosis.\nAt C3-C4 there are uncovertebral and facet osteophytes causing mild spinal\ncanal narrowing and moderate right and severe left neural foraminal stenosis.\nAt C4-C5 there are uncovertebral facet osteophytes causing moderate right and\nsevere left neural foraminal stenosis. There is no significant spinal canal\nstenosis.\nAt C5-C6 there are uncovertebral, intervertebral, and facet osteophytes with a\nsmall central protrusion causing mild spinal canal narrowing and severe\nbilateral neural foraminal stenosis.\nAt C6-C7 there is central disc protrusion and uncovertebral and facet\nosteophytes causing mild spinal canal narrowing and mild bilateral neural\nforaminal stenosis.\nAt C7-T1 there is no significant neural foraminal or spinal canal stenosis.\n\nThere is mild mucosal thickening within the sphenoid sinus. There is no\nprevertebral edema or evidence of ligamentous injury. The paravertebral soft\ntissues are unremarkable. The vascular flow voids are preserved. There is a\nretropharyngeal course of the left carotid artery. The cervical cord\ndemonstrates normal signal and morphology. Incidental note is made of a\nretropharyngeal course of the left cervical internal carotid artery.", "output": "1. Multilevel degenerative changes of the lumbar spine, as described, without\nMR evidence of ligamentous or soft tissue injury. Please refer to dedicated\nCT of the cervical spine for the evaluation of osseous fractures.\n2. Multilevel neural foraminal stenosis greatest at left C3-C4, left C4-C5,\nand bilateral C5-C6, where there is severe neural foraminal stenosis.\n3. No evidence of cord compression or contusion." }, { "input": "There is no evidence of acute bony or ligamentous injury identified. No\nevidence of ligamentous disruption seen. No evidence of spinal cord\ncompression or intraspinal hematoma. No abnormal signal seen within the spinal\ncord. Mild degenerative disc disease is seen from C3-4 through the C5-6\nlevels. Linear hyperintensity adjacent to the left upper esophagus appears to\nbe slightly prominent lymphatic duct, an incidental finding.", "output": "Mild degenerative changes. No evidence of bony or ligamentous injury." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is mildly heterogeneous but unchanged from prior examination,\nwhich may be seen in setting of marrow reconversion. No focal suspicious\nmarrow lesion is identified. There is unchanged mild loss of disc height and\nsignal at L4-L5 with moderate to severe loss of disc height and signal at\nL5-S1. The conus medullaris terminates at the T12 vertebral level, within\nexpected limits.\n\nT12-L1 through L3-L4: There is no significant spinal canal or neural\nforaminal narrowing.\n\nL4-L5: A left lateral disc protrusion crowds the left-greater-than-right\nsubarticular zones contacting the left traversing L5 nerve root. This results\nin moderate left neural foraminal narrowing and no significant right neural\nforaminal narrowing. These findings are unchanged from prior exam.\n\nL5-S1: There is interval near-complete resolution of previously described\nleft disc extrusion. There is now a new right disc extrusion which impinges\non the traversing right S1 nerve root (series 2, image 12 and series 5, image\n21). The disc also crowds the thecal sac. There is unchanged moderate\nbilateral neural foraminal narrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. There is a new right L5-S1 disc extrusion which impinges on the traversing\nright S1 nerve root.\n2. Interval resolution of previously noted left L5-S1 disc extrusion.\n3. Additional mild L4-L5 spondylosis as described above." }, { "input": "Study is moderately degraded by motion, especially limiting evaluation for\nspinal cord lesion. Within these confines:\n\nCERVICAL:\nThere is minimal C4 on C5, C6 on C7, and C7 on T1 anterolisthesis. There is\nmild loss of C6 and C7 vertebral body heights. There is ___ type 2 endplate\ndegenerative changes of anterior inferior C4 vertebral body.\n\nThere is loss of intervertebral disc spaces C5-C6 and C6-C7 related to\ndegenerative process.\n\nWithin the confines of the study, there is no definite cord edema or\nenhancement.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: There is a disc protrusion with facet and uncovertebral joint\narthropathy resulting in mild spinal canal stenosis with severe right and\nmoderate left neural foraminal narrowing.\n\nC4-C5: There is a disc protrusion with facet and uncovertebral joint\narthropathy resulting in mild-to-moderate spinal canal stenosis with severe\nright and mild left neural foraminal narrowing.\n\nC5-C6: There is a disc protrusion with endplate osteophytes, facet and\nuncovertebral joint arthropathy and ligamentum flavum thickening causing\nmoderate spinal canal stenosis with CSF effacement, cord flattening and\ndeformity (11:21) without definite evidence of cord edema within the confines\nof the study. There is moderate left and mild right neural foraminal\nnarrowing.\n\nC6-C7: There is disc bulge with facet and uncovertebral joint arthropathy and\nendplate osteophytes resulting in moderate-to-severe spinal canal stenosis\nwith CSF effacement and spinal cord deformity and flattening. There is severe\nleft and mild right neural foraminal narrowing.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The inferior endplates of\nT3 and T4 vertebral bodies demonstrate hyperintense STIR and hypointense T1\nsignal with enhancement. There is cortical irregularity of T4 inferior\nendplate. Findings may be related to ___ type 1 endplate degenerative\nchanges or edema surrounding Schmorl's node at T4. There are ___ type 2\nendplate degenerative changes at T7-T8 level. There is a T1 and T2\nhyperintense T8 vertebral body lesion, likely hemangioma.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThere is mild dependent atelectasis within the lungs. There are small disc\nprotrusions with indentation of the ventral thecal sac without spinal canal or\nneural foraminal stenosis. There is no abnormal enhancement or enhancing\nmass.\n\nLUMBAR:\nThere is mild dextroscoliosis of the lumbar spine. There is 3 mm\nretrolisthesis of L3 on L4. There are ___ type 2 endplate degenerative\nchanges at L1-L2 through L4-L5 levels with inferior endplate Schmorl's node at\nL1 superior endplate Schmorl's node at L3 and L4. The conus medullaris\nterminates at L1-L2. There is normal caliber and morphology of the conus\nmedullaris and the cauda equina nerve roots. There is loss of intervertebral\ndisc space at L2-L3 through L5-S1 levels with disc desiccation.\n\nThere is an exophytic T2 hypointense left interpolar kidney 2.1 x 2.2 cm\nlesion seen on localizer image, and not visualized on other sequences, and\nincompletely characterized on this study. There is a probable subcentimeter\nleft lower pole renal cysts.\n\nL2: There is a disc bulge with endplate osteophyte causing mild spinal canal\nstenosis and mild left and no right neural foraminal narrowing.\n\nL2-L3: There is a disc bulge with ligamentum flavum thickening and bilateral\nfacet arthropathy resulting in mild spinal canal stenosis with narrowing of\nbilateral subarticular zones, mild bilateral neural foraminal narrowing.\n\nL3-L4: There is a disc bulge with endplate osteophyte, ligamentum flavum\nthickening, bilateral facet arthropathy resulting in mild spinal canal\nstenosis with narrowing of bilateral subarticular zones, and mild bilateral\nneural foraminal narrowing.\n\nL4-L5: There is a disc bulge with endplate osteophyte, ligamentum flavum\nthickening and bilateral facet arthropathy resulting in mild spinal canal\nstenosis with narrowing of bilateral subarticular zone compressing the\nbilateral L5 exiting nerve roots, with mild bilateral neural foraminal\nnarrowing.\n\nL5-S1: There is a disc bulge with ligamentum flavum thickening bilateral facet\narthropathy resulting in mild spinal canal stenosis, moderate-to-severe left\nand mild right neural foraminal narrowing.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical spondylosis with moderate spinal canal stenosis at\nC5-C6 and C6-C7 causing cord deformity and flattening, with moderate to severe\nmultilevel neural foraminal narrowing, as above.\n3. Multilevel lumbar spondylosis worse at L4-L5 with a disc bulge compressing\nbilateral L5 exiting nerve roots.\n4. Exophytic T2 hypointense left interpolar kidney lesion seen on localizer\nimages only and not visualized on other sequences. This is incompletely\ncharacterized on this study, and was not seen on prior study dated ___. Possibility of underlying malignancy is not excluded. Recommend\ndedicated contrast enhanced MRI for further assessment.\n5. T3 and T4 inferior endplate areas of edema with enhancement. While\nfindings may be degenerative in nature, metastatic lesions are not excluded on\nthe basis of this examination. If clinically indicated, consider correlation\nwith bone scan.\n6. Mild probable chronic C6 and C7 vertebral body height loss.\n\nRECOMMENDATION(S): Exophytic T2 hypointense left interpolar kidney lesion\nseen on localizer images only and not visualized on other sequences. This is\nincompletely characterized on this study, and was not seen on prior study\ndated ___. Possibility of underlying malignancy is not excluded.\nRecommend dedicated contrast enhanced MRI for further assessment.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:04 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "The vertebral body height and alignment within the cervical spine are normal.\nThe bone marrow signal is unremarkable.\n\nThe cervical spinal cord is normal in signal and morphology. There is no\ncerebellar tonsillar ectopia.\n\nThe paraspinal and prevertebral soft tissues appear unremarkable.\n\nIn the C2-C3 level, there is a posterior disc protrusion without significant\nspinal canal narrowing. The neural foramina appear normal.\n\nAt the C3-C4 level, there is a posterior disc protrusion which approaches the\nventral surface of the spinal cord. The neural foramina appear normal.\n\nAt the C4-C5 level, there is an marked right facet hypertrophy, bilateral\nuncovertebral hypertrophy, and a small posterior disc protrusion which cause\nmoderate right and mild left neural foraminal narrowing.\n\nAt the C5-C6 level, there is bilateral facet hypertrophy, right greater than\nleft, and small posterior disc protrusion which causes mild bilateral neural\nforaminal narrowing.\n\nAt the C7-T1 level, there is bilateral facet hypertrophy and a small posterior\ndisc protrusion which cause moderate right and mild left neural foraminal\nnarrowing. The spinal canal appears normal.", "output": "1. Multilevel cervical spondylosis, greatest at the C4-C5 and C5-C6 levels, as\ndescribed.\n2. Reviewed with Dr. ___." }, { "input": "Thoracic spine:\n\nThere is no evidence of spinal stenosis or extrinsic spinal cord compression.\nNo evidence of intrinsic spinal cord signal abnormalities. Mild degenerative\ndisc disease seen without significant bulge or herniation. There is no\ncompression fracture or marrow edema.\n\nLumbar spine: At T12-L1, L1-2 and L2-3 disc degenerative changes are\nidentified. Mild bulging is seen. At L3-4 mild bulging and mild foraminal\nnarrowing identified without spinal stenosis.\n\nAt L4-5 there is a diffuse disc bulge and a broad-based central disc\nprotrusion that extends more to the right side with moderate narrowing of the\nright subarticular recess and mild narrowing the left subarticular recess and\nspinal canal. There is mild narrowing of the foramina.\n\nAt L5-S1 level there is broad-based central protrusion which extends to the\nright-sided contacting the right S1 nerve root without significant\ndisplacement. Minimal narrowing of both foramina is seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild multilevel degenerative changes in the thoracic region without spinal\nstenosis intrinsic spinal cord signal abnormalities or extrinsic spinal cord\ncompression.\n2. Multilevel degenerative changes in the lumbar region. There is a mild\nspinal stenosis at L4-5 level with moderate right-sided and mild left-sided\nsubarticular recess narrowing secondary to disk protrusion. Small disk\nprotrusion contacting the right S1 nerve root at L5-S1 level." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno suspicious marrow lesion. Degenerative loss of disc height and signal at\nL5-S1 is moderate. The conus medullaris terminates at the inferior aspect of\nL1, within expected limits. There is no signal abnormality of the visualized\nterminal cord.\n\nT11-T12 through L4-L5: There are mild degenerative changes without\nsignificant spinal canal or neural foraminal narrowing.\n\nL5-S1: A left central to foraminal zone disc protrusion with annular fissure\ndoes not significantly narrow the spinal canal. There is effacement of the\nleft subarticular zone, posteriorly displacing the traversing nerve root\n(series 5, image 31 ; series 2, image 12). In combination with facet\narthropathy, there is mild to moderate left and mild right neural foraminal\nnarrowing.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. A left central to foraminal zone disc protrusion crowds the left\nsubarticular zone posterior displacing (presumably impinging) the traversing\nnerve root (series 5, image 31). In combination with facet arthropathy there\nis also mild to moderate left neural foraminal narrowing." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc heights are maintained. The\nvisualized posterior fossa is unremarkable. There is no definitive cord\nsignal abnormality.\n\nC2-C3 and C3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: Uncovertebral and facet arthropathy results in mild to moderate left\nand mild right neural foraminal narrowing. There is no spinal canal\nnarrowing.\n\nC5-C6: A central protrusion results in mild spinal canal narrowing, minimally\nremodeling the ventral aspect of the cord (series 7b, image 27). \nUncovertebral facet arthropathy results in mild to moderate right and mild\nleft neural foraminal narrowing.\n\nC6-C7: No significant spinal canal or neural foraminal narrowing. .\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. There is no cord signal abnormality. \nThere are mild degenerative changes in the thoracic spine, most prominent at\nT8-T9 where a small left central protrusion minimally effaces the left ventral\naspect of the thecal sac. There is no significant spinal canal or neural\nforaminal narrowing.\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative finding of the cervical spine, most prominent at C5-C6\nwhere it a central protrusion results in mild spinal canal narrowing minimally\nremodeling the ventral aspect of the cord without underlying cord signal\nchange. Mild to moderate right neural foraminal narrowing is noted at this\nlevel.\n2. No significant spinal canal or neural foraminal narrowing in the thoracic\nspine.\n3. No cord signal abnormality." }, { "input": "Cervical, thoracic and lumbar alignment is anatomic. Vertebral body heights\nare preserved. There is no focal suspicious marrow signal. Disc heights are\npreserved. There is no abnormal cord enhancement. No evidence of abnormal\nenhancement of the nerve roots.\n\nRe-identified is mild degenerative change at C5-C6, with mild spinal canal\nnarrowing and degenerative changes at L5-S1 where a left central to foraminal\nzone protrusion displaces and likely impinges on the traversing left S1 nerve\nroot (series 10, image 40), with mild to moderate left and mild right neural\nforaminal narrowing.", "output": "1. No abnormal enhancement.\n2. Please refer to MRI cervical and thoracic spine of ___ and MRI\nlumbar spine of ___ for further details." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. The conus medullaris terminates at\nthe L1 level.\n\nThere is loss of T2 signal and moderate height loss of the L5-S1 disc. There\nis minimal loss of T2 signal within the L1-L2 disc. The remainder of the\nintervertebral disc signal and heights are relatively well preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nThe visualized portion of the spinal canal is diffusely congenitally narrowed\nby short pedicles.\n\nSagittal views of the T11-T12 and T12-L1 levels demonstrate no significant\nspinal canal or neural foraminal narrowing.\n\nSagittal view of the L1-L2 level demonstrates trace disc protrusion without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L3-4 there is no significant spinal canal narrowing. Facet arthropathy\nproduces mild bilateral neural foraminal narrowing, minimally greater on the\nleft.\n\nAt L4-5 there is no significant spinal canal narrowing. Facet arthropathy\nproduces mild bilateral neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge with left paracentral protrusion and left\nparacentral annular fissure (02:12), unchanged compared the prior examination,\neffacing the left subarticular recess with posterior displacement of the\ntraversing left S1 nerve root with a foraminal component contacting the\nexiting left L5 nerve root. This does not produce significant spinal canal\nnarrowing. In combination with facet arthropathy, there is production of mild\nbilateral neural foraminal narrowing.\n\nOverall degenerative changes are unchanged compared the ___\nexamination.\n\nThe visualized retroperitoneum is grossly unremarkable.", "output": "1. Unchanged disc bulge with left paracentral protrusion and annular fissure\nat the L5-S1 level effacing the left subarticular recess and displacing the\ntraversing left S1 nerve root.\n2. Mild bilateral neural foraminal narrowing at the L3-L4 through L5-S1\nlevels.\n3. Congenitally narrow spinal canal, though there is no significant spinal\ncanal narrowing at any level.\n4. No terminal cord signal abnormality." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in signal, caliber and\nconfiguration.There is no evidence of infection or neoplasm.\n\nMultilevel diffuse disc bulging and uncovertebral degenerative changes result\nin varying degrees of spinal canal and neural foraminal narrowing as detailed\nbelow:\nC1-2: Mild right neural foraminal narrowing without significant canal\nstenosis.\nC2-3: Mild to moderate canal stenosis secondary to disc protrusion and\nmoderate left neural foraminal narrowing.\nC3-4: Mild-to-moderate canal stenosis and moderate bilateral neural foraminal\nnarrowing.\nC4-5: Mild to moderate canal stenosis, moderate to severe right and moderate\nleft neural foraminal narrowing. There is contact of the cord by the disc.\nC5-6: Disc bulge with a focal central disc protrusion results in mild to\nmoderate canal stenosis and mild left neural foraminal narrowing.\nC6-7: Mild to moderate canal stenosis and moderate bilateral neural foraminal\nnarrowing, secondary to disc bulge with a focal central disc protrusion.\nC7-T1: Mild canal stenosis without neural foraminal narrowing.\n\nTHORACIC:\nStatus post T10 and T11 laminectomies. Disc bulge with a focal disc\nprotrusion is seen at T2-T3. Alignment is normal. Vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in signal, caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing. There is no evidence of infection or\nneoplasm.\n\nLUMBAR:\nAlignment is normal. There are small multilevel marginal osteophytes. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in signal, caliber and configuration.There is no\nevidence of infection or neoplasm.\n\nFrom T12-L1 through L2-L3 and at L5-S1 the spinal canal and neural foramina\nare patent.\nL2-L3: Small diffuse disc bulge and facet arthropathy result in mild spinal\ncanal stenosis and mild-to-moderate bilateral neural foraminal narrowing (left\ngreater than right).\nL3-L4: Slight diffuse disc bulging and facet arthropathy results in mild to\nmoderate narrowing of the right neuroforamen and mild spinal canal stenosis.\nL4-L5: Diffuse disc bulging, ligamentum flavum thickening and facet\narthropathy result in mild bilateral neural foraminal narrowing and moderate\nspinal canal stenosis.\n\nOTHER: There are a few bilateral renal cysts measuring up to 3.4 cm on the\nleft.", "output": "1. No evidence of cord compression.\n2. Spondylotic changes of the cervical and lumbar spine with multiple levels\nof mild to moderate canal stenosis as detailed above.\n3. Mild thoracic spondylosis." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\nThere is slight reversal of the normal cervical lordosis. There is mild height\nloss of the C3 through C6 cervical vertebral bodies, likely degenerative. \nMild multilevel intervertebral disc height loss. There are ___ type 1\ndegenerative endplate changes at C6-C7.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nThere is mild STIR hyperintense signal abnormality along the rightward aspect\nof the C4-C5 vertebral bodies and facet joints, which likely relates to\nligamentous strain/partial tearing.\n\nAt C3-C4, there is mild disc bulge and ligamentum flavum thickening resulting\nin flattening of the ventral spinal cord without signal abnormalities and mild\nspinal canal narrowing. There is moderate right and mild-to-moderate left\nneural foraminal narrowing due to osteophytes.\n\nAt C4-C5, there is left central disc protrusion resulting in effacement of the\nventral CSF space and mild spinal canal narrowing. Moderate to severe left\nand moderate right neural foraminal narrowing due to osteophytes.\n\nAt C5-C6, there is disc bulge with flattening of the ventral cord without\nsignal abnormalities. Mild spinal canal narrowing. Moderate left and mild\nright neural foraminal narrowing.\n\nAt C6-C7, there is disc bulge resulting in mild spinal canal narrowing. \nModerate right and mild-to-moderate left neural foraminal narrowing due to\nosteophytes.\n\nThe paraspinal muscles are unremarkable.", "output": "1. Examination is moderately degraded by motion.\n2. Mild STIR hyperintense signal abnormality along the rightward aspect of the\nC4-C5 vertebral bodies and facet joints, which likely relates degenerative\nchanges and less to ligamentous strain/partial tearing.\n3. Mild multilevel degenerative disc disease as described above, most\npronounced at C4-C5 with moderate to severe left and moderate right neural\nforaminal narrowing.\n4. Mild degenerative height loss of the cervical vertebral bodies and\nintervertebral disc as described above." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Mild degenerative\n___ type 2 changes are seen at the C6-C7 vertebral level. Otherwise, the\nvertebral body and intervertebral disk signal intensity appear normal. The\nvisualized portion of the spinal cord appears normal. Note is again made of\nnarrowing of the posterior fossa.\n\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.", "output": "1. Mild degenerative changes seen at the C6-C7 vertebral level. No spinal\ncord signal abnormality." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Vertebral body\nand intervertebral disk signal intensity appear normal.\nMild narrowing of the posterior fossa is again noted. The craniocervical\njunction appears normal.\nThe cervical cord is normal in volume, signal intensity and morphology. No\nabnormal enhancing lesions. No epidural or paraspinal collections.\nMild degenerative changes of the cervical spine, but no high-grade spinal\ncanal or neural foraminal stenosis. ___ type 2 endplate changes are again\nnote that the C6-7 vertebral body endplates.", "output": "1. No findings to suggest cord demyelination. No cord masses. No abnormal\nenhancement.\n2. No high-grade spinal canal or neural foraminal narrowing.\n3. Additional findings as described above." }, { "input": "CERVICAL:\nThere is a enhancing soft tissue mass in the C6 vertebral body with a large\nprevertebral component which centered more on the right prevertebral area. \nThe prevertebral component measures approximately 4.2 x 2.5 x 4.6 cm (TV by AP\nby CC). At the level C6, there appears to be epidural enhancement, concerning\nfor epidural involvement of the tumor. The mass involves the C6-7\nintervertebral disc (there is a small 0.4 x 0.5 x 0.4 cm (TV by AP by CC) T2\nhyperintense and T1 hypointense nonenhancing area in the left posterior aspect\nof the vertebral body component of the mass (series 17, image 26 and series\n15, image 8) which likely represent a small areas intra tumoral necrosis. \nModerate to severe narrowing of the spinal canal is seen at the level of C6,\nwith possible subtle increased cord signal at this level. Increased T2/STIR\nsignal intensity and decreased T1 signal intensity in the inferior aspect of\nC5 and right central aspect of C7 vertebral body with enhancement is also\nconcerning for metastatic disease. Tumoral involvement also is seen involving\nthe spinous processes C5, and C6. There is extensive prevertebral edema\nthroughout the entire cervical spine extending to T3 level. The alignment of\nthe cervical spine is otherwise anatomic. Disc bulge at C4-5 and C6-7 do not\ncause substantial spinal canal stenosis. No high-grade neural foraminal\nstenosis.\n\nTHORACIC:\nT1 hypointensity T2/STIR hyperintensity in T1 vertebral body with enhancement\nis concerning metastasis. Anterior wedging at the same level is consistent\nwith pathologic compression fracture. No epidural or prevertebral soft tissue\ncomponent is identified. Enhancing soft tissue mass centered at T11 spinous\nprocess, left lamina and pedicle with extension of disease to the right\npedicle encroaches the spinal canal causing severe stenosis and compression of\nthe spinal cord at the same level with subtle increased cord signal, worse\ncompared to PET-CT from ___.. The mass measures approximately 3.3\nx 2.3 x 5.4 cm (AP by TV by CC). There also appears to be involvement of\ndisease with the spinous process and left pedicle of T12. The alignment of\nthe thoracic spine is otherwise anatomic. The remaining vertebral body and\ndisc heights are preserved in the thoracic spine. No cord signal abnormality.\nNo spinal canal stenosis or neural foraminal narrowing in the remaining\nthoracic spine.\n\nLUMBAR:\nAlignment of the lumbar spine is anatomic. The vertebral body and\nintervertebral disc demonstrate normal signal intensity. The conus terminates\nat L2. No terminal cord signal abnormality.\n\nAt T12-L1, there is ligamentum flavum thickening without spinal canal stenosis\nor neural foraminal narrowing.\n\nAt L1-2, there is ligamentum flavum thickening without spinal canal stenosis\nor neural foraminal narrowing.\n\nAt L2-3 there is ligamentum flavum thickening without spinal canal stenosis or\nneural foraminal narrowing.\n\nAt L3-4, there is ligamentum flavum without spinal canal stenosis or neural\nforaminal narrowing.\n\nAt L4-5, there are disc bulge, ligamentum flavum thickening, and facet\nosteophytes without spinal canal stenosis or neural foraminal narrowing.\n\nAt L5-S1, there are disc bulge, ligamentum flavum thickening, and facet\nosteophytes without spinal canal stenosis and with mild bilateral neural\nforaminal narrowing.\n\n\nOTHER: 3.5 x 3.2 cm left lower lobe enhancing mass is noted. There is small\nleft pleural effusion with atelectasis. No right pleural effusion. Multiple\nrenal cysts are noted", "output": "1. Enhancing soft tissue mass centered at C6 with a prevertebral soft tissue\ncomponent measuring 4.2 x 2.5 x 4.6 cm and a tiny intratumoral necrotic\ncomponent in the left posterolateral vertebral body, consistent with\nmetastasis. At the level of C6, moderate to severe spinal canal stenosis is\nseen with possible subtle increased T2/stir signal abnormality of the cord\nwhich may be secondary to artifact however cord edema cannot be excluded at\nthis level.\n2. Additional tumoral involvement is seen involving C5 and C7 vertebral bodies\nas well as spinous processes of C5 and C6.\n3. Additional metastatic involvement is seen involving the T1 vertebral body\nwith anterior wedging of T1 consistent with metastases and an associated\npathologic compression fracture.\n4. 3.3 x 2.3 x 5.4 cm enhancing mass centered at the left T11 spinous process,\nlamina and pedicle consistent with metastasis extending into the epidural\nspace causing severe compression of the spinal cord at the same level with\nsubtle increased cord signal abnormality concerning for cord edema, worse\ncompared to PET-CT from ___.\n5. There is additional tumoral involvement of the spinous process and left\npedicle of T12.\n6. 3.5 x 3.2 cm left lower lobe enhancing mass. Small left pleural effusion\nwith atelectasis.\n7. Additional mild degenerative changes as described in the body of the\nreport.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:29 pm, 2 minutes after\ndiscovery of the findings.\n\nUpdated findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 5:20 pm, 30 minutes after discovery of\nthe findings." }, { "input": "Alignment is normal. There are extensive ___ type 2 signal intensity\nchanges of the vertebral endplates from L3 through S1. There is loss of\nsignal of the intervertebral discs on the T2 weighted images involving all of\nthe imaged discs. These are manifestations of degenerative disc disease.\nThere is a hemangioma in the L2 vertebral body. The conus medullaris ends at\nT12-L1.\nAxial images at T12-L1 demonstrate no spinal canal or neural foraminal\nnarrowing.\nAt L1-2, there is a mild bulge of the intervertebral disc with no significant\nencroachment on the spinal canal. There are bilateral facet osteophytes with\nnormal caliber of the neural foramina.\nAt L2-3, bulging of the intervertebral disc and a midline protrusion combine\nwith ligamentum flavum thickening and facet osteophytes to produce\nmoderate-severe spinal canal narrowing. The neural foramina are mildly\nnarrowed.\nAt L3-4, bulging of the disc and a midline protrusion combine with thickening\nof the ligamentum flavum produce moderate spinal canal narrowing. Disc\nbulging and facet osteophytes produce moderate neural foraminal narrowing\nbilaterally.\nAt L4-5, disc bulging and a prominent midline disc protrusion narrow the\nspinal canal. The disc protrusion contacts and compresses the traversing L5\nnerve roots bilaterally. The protrusion extends inferiorly along the\nposterior margin of the L5 vertebral body.\nAt L5-S1, bulging of the disc mildly encroaches on the spinal canal and\ncontacts the traversing S1 nerve roots bilaterally. Disc bulging and facet\nosteophytes produces bilateral neural foraminal narrowing.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Extensive changes of degenerative disc disease with spinal canal and neural\nforaminal narrowing.\n2. Disc bulging and multiple disc protrusions.\n3. No evidence of neoplasm or infection." }, { "input": "CERVICAL:\nThere is moderate artifact in the cervical spine which compromises evaluation\nof the cord. There are no definite T2 signal abnormalities involving cord.\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no abnormal enhancement after contrast administration. \nThere are no worrisome lesions or evidence of infection.\nMultilevel degenerative changes in the cervical spine. Mild disc osteophyte\ncomplexes. Posterior element degenerative changes, more prominent in the\nupper cervical spine.\nAt C2-C3 level central canal is patent, mild right foraminal narrowing, left\nforamen is patent.\nAt C3-C4 level there is moderate central canal narrowing, no cord deformity,\npreserved CSF about cord. Moderate bilateral foraminal narrowing.\nAt C4-C5 level there is mild central canal narrowing. Mild right and moderate\nleft foraminal narrowing.\nAt C5-C6 level there is mild central canal narrowing. Moderate right, mild\nleft foraminal narrowing.\nAt C6-C7 level, there is no central canal narrowing. Mild bilateral foraminal\nnarrowing. There is artifact on sagittal T2 weighted images at the level of\nthe cord, without any STIR or axial T2 correlate.\nAt C7-T1 level there is probable tiny central disc protrusion, causing mild\ncentral canal narrowing. Minimal bilateral foraminal narrowing.\n\nTHORACIC:\nThere is epidural lipomatosis in the upper and mid thoracic spine from T2\nthrough T9 levels contributing to moderate central canal narrowing, with\npreserved CSF no cord flattening.\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\nMultilevel mild degenerative changes. There is no significant contribution to\ncentral canal narrowing from degenerative changes. Foramina are patent.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.L2\nvertebral body lesion is stable since ___, and is indeterminate,\nmay represent hemangioma as there is some internal fat, and osseous\narchitecture has been stable between CT appearance on ___ and ___.\nMultilevel degenerative changes in the lumbar spine is stable since ___ and unchanged. There is multilevel central canal narrowing most\nprominent and moderate at L2-L3, L3-L4, L4-5 levels. Stable multilevel\nforaminal narrowing, as described on ___, most prominent and\nmoderate at L3-L4, L4-5, L5-S1 levels..\nBenign simple cyst right kidney.\nThere is linear enhancement of the roots of the cauda equina, best seen from\nT12 through L5 level on axial post gadolinium images, more apparent compared\nwith ___, most consistent with known tumor involvement. \nInflammatory or infectious process could have similar appearance, clinically\ncorrelate.\n\nOTHER:", "output": "1. There is no cord or cauda equina compression. No cord signal abnormality.\n2. Diffuse mild linear enhancement of the cauda equina, consistent with\nneoplastic involvement given patient history. Inflammatory or infectious\nprocess could have similar appearance, clinically correlate.\n3. Degenerative changes in the cervical spine, with moderate central canal\nnarrowing, multilevel foraminal narrowing, as above.\n4. Epidural lipomatosis in the thoracic spine, contributing to moderate\ncentral canal narrowing.\n5. Degenerative changes in the lumbar spine, unchanged since recent exam, with\nmultilevel moderate central canal and moderate foraminal narrowing." }, { "input": "CERVICAL:\nAlignment is anatomic.Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no abnormal enhancement after contrast administration.\n\nAt C3-C4, there is a mild disc protrusion without significant spinal canal\nstenosis. Facet arthropathy and uncovertebral hypertrophy cause mild right\nand moderate left neural foraminal stenosis.\n\nAt C4-C5, there is a disc protrusion without significant spinal canal\nstenosis. Facet arthropathy and uncovertebral hypertrophy cause mild\nbilateral neural foraminal stenosis.\n\nAt C5-C6 to the there is a disc protrusion eccentric to the right causing mild\nspinal canal stenosis and effacement of the ventral CSF space without cord\nsignal abnormality. The disc, uncovertebral hypertrophy, and facet\narthropathy cause moderate to severe right neural foraminal stenosis. There\nis mild-to-moderate left neural foraminal stenosis.\n\nAt C6-C7, there is a central disc protrusion without significant spinal canal\nstenosis. There is no neural foraminal stenosis.\n\nAt C7-T1, there is a prominent focal central disc protrusion causing mild\nspinal canal stenosis without cord signal abnormality. There is no neural\nforaminal stenosis.\n\nTHORACIC:\nAlignment is anatomic.Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nEpidural lipomatosis of the upper and mid thoracic spine contributes to\nmoderate central canal narrowing without cord flattening or effacement of the\nCSF spaces. There is no neural foraminal stenosis. There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nLumbar alignment is anatomic.Vertebral body and intervertebral disc signal\nintensity appear normal.The cord terminates at the T12-L1 level, within\nexpected limits.A lesion within the L2 vertebral body is stable from prior\nstudies, possibly a hemangioma given the presence of fat, fluid, and\nenhancement, grossly stable from ___. Diffuse enhancement of the distal\nspinal cord from the T12 level, involving the cauda equina nerve roots appears\nslightly increased in extent compared with the immediate prior study.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal stenosis.\n\nAt L1-L2, a concentric disc bulge and thickening of the ligamentum flavum with\nfacet arthropathy causes mild spinal canal and mild subarticular recess\nstenosis. There is no neural foraminal stenosis.\n\nAt L2-L3, a concentric disc bulge, thickening of the ligamentum flavum, and\nfacet arthropathy combine to cause moderate spinal canal stenosis with likely\nimpingement of the traversing L3 nerve root on the left and associated\nmoderate to severe subarticular recess stenosis (21:16). The neural foramina\nappear patent.\n\nAt L3-L4, a concentric disc bulge with a superimposed central component,\nthickening of the ligamentum flavum, and facet arthropathy combine to cause\nmoderate spinal canal stenosis, severe bilateral subarticular recess stenosis,\nand moderate bilateral neural foraminal narrowing.\n\nAt L4-L5, a large concentric disc bulge with a central disc protrusion and\npossible inferiorly directed extrusion versus posterior osteophyte combined\nwith facet arthropathy and thickening of the ligamentum flavum cause moderate\nspinal canal stenosis and severe subarticular recess stenosis with associated\nmoderate bilateral neural foraminal stenosis. There is likely impingement on\nthe traversing left L4 nerve root (series 22, image 10).\n\nAt L5-S1, a concentric disc bulge with central annular fissure and thickening\nof the ligamentum flavum cause mild spinal canal stenosis. Loss of disc\nheight and facet arthropathy results in moderate to severe right and moderate\nleft neural foraminal narrowing.\n\nOTHER: An eccentric rounded T2 hyperintense filling defect within the right\ninternal jugular vein extending from the C3-C4 level through the C6-C7 level\nraises concern for nonocclusive internal jugular vein thrombus (18:13). A\nsimple 7 mm right inferior renal pole cyst is noted.", "output": "1. Slight interval increased conspicuity and thickness of surface enhancement\nof the distal spinal cord and cauda equina consistent with leptomeningeal\ncarcinomatosis, which may represent mild progression versus artifactual\nsecondary to differences in technique.\n2. Possible right internal jugular vein nonocclusive thrombus, further\nevaluation with ultrasound is recommended.\n3. Moderate to severe multilevel degenerative changes as described above.\n\nRECOMMENDATION(S): Right upper extremity ultrasound for DVT, specifically of\nthe right internal jugular vein is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:44 pm, 2 minutes\nafter discovery of the findings." }, { "input": "Study is moderately degraded by motion. Additionally, please note that axial\nimaging was not obtained at the L1 through L1-2 levels. Within these\nconfines:\n\n For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level..\n\nTHORACIC:\nThere is levoscoliosis of the thoracic spine.\n\nVertebral body heights are preserved. T8 vertebral body probable hemangioma is\nnoted.\n\nQuestion cord signal abnormality extending from T9-10 through mid T10 (see 10:\n___. Question T10-11 level minimal cord signal abnormality (see 10:23). \nT11-12 central cord signal abnormality is seen (see 10:28). The conus is\napproximately at the mid L1 level.\n\nThere is multilevel loss of disc height involving the mid and lower thoracic\nintervertebral discs.\n\nNonspecific facet joint fluid is noted at multiple levels of the thoracic\nspine.\n\nC7-T1 through T5-6: There is multilevel facet joint hypertrophy with no\ndefinite evidence of vertebral canal or neural foraminal narrowing.\n\nT6-T7: Central disc protrusion abutting the ventral cord, deformation of the\nventral thecal sac and spinal cord without definite associated cord signal\nabnormality, with mild spinal canal and no foraminal narrowing.\n\nT7-T8: Disc bulge, effacement of the ventral thecal sac, remodeling of the\nventral cord, mild spinal canal and no foraminal narrowing.\n\nT8-T9: Disc bulge, bilateral facet osteophytes, with mild spinal canal and\nmild bilateral foraminal narrowing.\n\nT9-T10: Disc bulge, bilateral facet osteophytes, mild spinal canal narrowing,\nmoderate bilateral foraminal narrowing.\n\nT10-T11: Disc bulge, question minimal cord signal abnormality (see 10:23)\nbilateral facet osteophytes, cord compression without cord signal abnormality,\nmoderate to severe spinal canal narrowing, and moderate bilateral foraminal\nnarrowing.\n\nT11-T12: Disc bulge, bilateral facet osteophytes, cord compression with T2\nhyperintense signal within the cord, moderate to severe spinal canal\nnarrowing, moderate bilateral foraminal narrowing. Nonspecific bilateral\nfacet joint fluid is noted.\n\nLUMBAR:\nThe alignment is normal. The bone marrow signal is within normal limits. The\ncord terminates at L1 and is unremarkable. There is loss of disc height\ninvolving L4-5 and L5-S1.\n\nT12-L1 through L3-4: There is multilevel facet joint hypertrophy and epidural\nfat with no definite evidence of vertebral canal or neural foraminal\nnarrowing.\n\n\nL4-L5: Disc bulge with central disc protrusion, disc annular fissure,\nbilateral facet osteophytes, mild-to-moderate spinal canal narrowing, mild\nbilateral foraminal narrowing. Nonspecific bilateral facet joint fluid is\nnoted.\n\nL5-S1: Asymmetric right disc bulge which contacts descending right S1 nerve\nroot, bilateral facet osteophytes, no spinal canal narrowing, moderate right\nand mild left foraminal narrowing. Nonspecific bilateral facet joint fluid is\nnoted.\n\nOTHER:\nA subcentimeter T2 hyperintense lesion is partially visualized in the right\nkidney, incompletely characterized.\n\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.", "output": "1. Study is moderately degraded by motion. Additionally, please note that\naxial imaging was not obtained at the L1 through L1-2 levels.\n2. Degenerative changes of the thoracic and lumbar spine, worst at T10-11 and\nT11-12 with cord compression and moderate to severe spinal canal narrowing,\nmoderate bilateral neural foraminal narrowing and abnormal cord signal at\nT11-12, with additional question signal abnormality T10-11.\n3. Additional multilevel thoracic and lumbar spondylosis as described.\n4. Right renal at least partially cystic incompletely characterized lesion." }, { "input": "Study is severely degraded by motion. Within these confines:\n\nThere is straightening of the cervical lordosis.\n\n Vertebral body heights are preserved. There is no definite focal marrow\nsignal abnormality. Schmorl's nodes are seen at multiple levels throughout\nthe cervical spine.\n\n There is mild multilevel loss of disc height.\n\nC2-C3: Uncovertebral hypertrophy, disc bulge, facet hypertrophy, with no\nvertebral canal and mild left neural foraminal narrowing.\n\nC3-C4: There is no definite spinal canal or foraminal narrowing.\n\nC4-C5: Uncovertebral hypertrophy, disc bulge, facet hypertrophy, with no\nvertebral canal and mild left neural foraminal narrowing.\n\nC5-C6: Disc bulge, deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality, with mild spinal canal\nand no definite foraminal narrowing.\n\nC6-C7: Disc bulge, mild spinal canal and no definite foraminal narrowing.\n\nC7-T1: Uncovertebral hypertrophy, facet joint hypertrophy, ligamentum flavum\nthickening, central disc protrusion, with no spinal canal and mild left\nforaminal narrowing.\n\nThere is no spinal canal or foraminal narrowing involving the visualized upper\nthoracic spine.\n\n OTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.\n\nOn limited imaging of posterior fossa, question pons and brainstem T2\nhyperintensity versus artifact (see 3:8).", "output": "1. Study is severely degraded by motion.\n2. Mild cervical spondylosis as above.\n3. Please see concurrently obtained thoracic and lumbar spine MRI for\ndescription of thoracic spine findings.\n4. On limited imaging of posterior fossa, question pons and brainstem T2\nhyperintensity versus artifact. If concern for intracranial lesion, consider\nbrain MRI for further evaluation." }, { "input": "THORACIC:\nThe patient is status post laminectomy spanning from T10-T12.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nRedemonstration of cord signal abnormality at T11-T12\n\nAt C7-T1 through T5-T6, there is multilevel facet joint arthropathy without\nevidence of significant disc disease, spinal canal stenosis, or neural\nforaminal narrowing.\n\nAt T6-T7, there is unchanged central disc protrusion, effacing the ventral\nthecal sac and deforming the spinal cord, without evidence of cord signal\nabnormality. There is associated mild spinal canal stenosis. There is no\nbilateral neural foraminal narrowing.\n\nAt T7-T8, there is unchanged diffuse disc bulge with central disc protrusion,\neffacing the ventral thecal sac and deforming the spinal cord, without\nevidence of cord signal abnormality. There is associated mild spinal canal\nstenosis and mild bilateral neural foraminal narrowing.\n\nAt T8-T9, there is mild disc bulge, bilateral facet arthropathy, ligamentum\nflavum thickening without significant spinal canal stenosis or neural\nforaminal narrowing.\n\nAt T9-T10, there is mild disc bulge, bilateral facet arthropathy, ligamentum\nflavum thickening resulting in mild spinal canal narrowing and mild bilateral\nneural foraminal narrowing.\n\nAt T10-T11, there is unchanged disc bulge, ligamentum flavum thickening,\nbilateral facet arthropathy resulting in moderate spinal canal stenosis. \nThere is severe right and moderate left neural foraminal narrowing, unchanged\ncompared to prior exam. Additional, there is subtle abnormal T2\nhyperintensity involving the spinal cord at T10-T11.\n\nAt T11-T12, there is disc bulge, bilateral facet arthropathy resulting in mild\nspinal canal stenosis moderate right and mild left neural foraminal narrowing.\nThere is stable redemonstration of T2 hyperintensity involving the cord at\nT11-T12.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThe conus medullaris terminates at L1. There is loss of disc height at L4-L5\nand L5-S1. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration.\n\nAt T12-L1 through L3-L4, there is multilevel facet joint arthropathy and\nepidural fat without significant spinal canal stenosis and neural foraminal\nnarrowing.\n\nAt L4-5, there is unchanged diffuse disc bulge with central disc protrusion,\nbilateral facet arthropathy, resulting in mild spinal canal narrowing, and\nmild bilateral neural foraminal narrowing. Bilateral joint effusion are again\nnoted.\n\nAt L5-S1, there is unchanged diffuse disc bulge, bilateral facet arthropathy,\nwithout significant spinal canal stenosis. There is mild bilateral neural\nforaminal narrowing, unchanged compared to prior exam.\n\nOTHER: Probable right renal cyst again noted.", "output": "1. Interval postsurgical changes of T10-T12 laminectomy and decompression with\nmultilevel degenerative changes of the lower thoracic spine and lower lumbar\nspine as described above, worst at T10-T11 and T11-T12.\n2. Unchanged cord signal abnormality again noted at T11-T12 and T10-T11." }, { "input": "The minimal, 1 mm retrolisthesis of C4 on C5, 1 mm retrolisthesis of C5 on C6,\nand 1 mm anterolisthesis of C7 on T1 are unchanged from the prior examination.\nThe bone marrow is heterogeneous, related to degenerative endplate changes. \nThe height of the vertebral bodies are preserved. The intervertebral disc\nspaces of C4-C5, C5-C6, and C6-C7 are narrowed. The intervertebral discs are\ndiffusely desiccated. The spinal cord is normal in signal. There is no\nevidence of discontinuity or abnormal signal in the anterior or posterior\nlongitudinal ligaments. There is no edema in the region of the interspinous\nligaments. The paraspinal soft tissues are normal.\n\nAt C2-C3, there is no spinal canal or neural foraminal stenosis.\n\nAt C3-C4, bilateral facet arthropathy causes mild to moderate left neural\nforaminal stenosis. There is a right paracentral disc protrusion without\nspinal canal stenosis.\n\nAt C4-C5, right paracentral disc protrusion and bilateral facet arthropathy\nindents and deforms the right anterolateral thecal sac and causes mild spinal\ncanal, severe right and moderate to severe left neural foraminal stenosis.\n\nAt C5-C6, right paracentral disc protrusion and bilateral facet arthropathy\ncause mild spinal canal, severe right and moderate left neural foraminal\nstenosis. There is no spinal canal stenosis.\n\nAt C6-C7, central disc protrusion bilateral facet arthropathy cause\nmild-to-moderate right neural foraminal and mild left neural foraminal\nstenosis. There is no spinal canal stenosis.\n\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.\n\nThe left inferior thyroid lobe demonstrates a 7 mm T2 hyperintense nodule.", "output": "1. No evidence of traumatic injury.\n2. Unchanged retrolisthesis of C4 on C5 and C5 on C6 as well as\nanterolisthesis of C7 on T1, likely degenerative.\n3. Multilevel degenerative changes of the cervical spine, most advanced at\nC4-C5 where there is mild spinal canal, severe right neural foraminal and\nmoderate-to-severe left neural foraminal stenosis.\n4. 7 mm left inferior thyroid lobe nodule. This could be further evaluated\nwith ultrasound as clinically indicated." }, { "input": "Limited examination due to patient motion, within this limitation, grossly the\nlumbar spine alignment appears maintained, the conus medullaris terminates at\nthe level of L1 and appears unremarkable.\n\nAt T11/T12 level, there is desiccation and mild disc bulge, causing mild\nleft-sided neural foraminal narrowing (images 2, 3, series 5).\n\nAt T12/L1 level, both neural foramina are patent, there is no evidence of\nspinal canal stenosis.\n\nAt L1/L2 level, there is mild diffuse disc bulge and disc desiccation with no\nevidence of neural foraminal narrowing or spinal canal stenosis.\n\nAt L2/L3 level, both neural foramina are patent, there is no evidence of\nspinal canal stenosis or nerve compression.\n\nAt L3/L4 level, there is disc desiccation and diffuse disc bulge, causing\nbilateral neural foraminal narrowing with moderate spinal canal stenosis and\ncrowding of the nerve roots within the thecal sac (image 29, series 5), mild\narticular joint facet hypertrophy is present.\n\nAt L4/L5 level, there is diffuse disc bulge with posterior disc protrusion,\ncausing anterior thecal sac deformity and bilateral neural foraminal\nnarrowing, contacting the exiting nerve roots bilaterally, moderate articular\njoint facet hypertrophy present with joint effusion on the right (images 17\nthrough 18, series a 6).\n\nAt L5/S1 level, there is disc desiccation and mild diffuse disc bulge with no\nevidence of neural foraminal narrowing or spinal canal stenosis, mild\narticular joint facet hypertrophy is present, the sacroiliac joints and the\nvisualized paravertebral structures are grossly unremarkable.", "output": "1. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, worse from L3-4 through L5-S1 levels." }, { "input": "The vertebral body heights are preserved. The marrow signal is unremarkable. \nThere is mild low intervertebral disc signal, consistent with degeneration,\nwithout significant loss of height.\n\nThe C2-C3 level appears normal.\n\nThe C3-C4 level appears normal.\n\nAt C4-C5 there is a central to right foraminal disc protrusion causing mild\nspinal canal narrowing which effaces the thecal sac and contacts the cord\nwithout cord deformity or cord signal abnormality (05:20). There is moderate\nto severe right neural foraminal stenosis secondary to the disc protrusion.\n\nAt C5-C6 there is a broad central disc protrusion and uncovertebral\nosteophytes causing that touches and slightly indents the anterior surface of\nthe spinal cord. Uncovertebral osteophytes produce mild left neural foraminal\nstenosis.\n\nAt C6-C7 there is a minimal disk bulge without spinal canal or neural\nforaminal stenosis.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.\n\nThe paravertebral soft tissues are unremarkable. The ligamentous structures\nare intact, without disruption, thickening, or edema. There is normal\ncervical cord signal morphology. There is questionable STIR signal\nhyperintensity within the cervical cord, however the cord signal is normal on\nthe sagittal and axial T2 and the axial gradient echo sequences, therefore\nthis is likely artifact rather then cord edema.", "output": "1. Multilevel cervical spondylosis, as described, most advanced at C4-C5 where\nthere is a disc protrusion causing mild spinal canal narrowing which contacts\nthe cord without cord deformity or cord signal abnormality. Associated right\nC4-C5 moderate to severe neural foraminal stenosis.\n2. No MR evidence of ligamentous injury.\n3. No evidence of cord edema.\n\nNOTIFICATION: The preliminary findings were discussed via telephone by Dr.\n___ to Dr. ___ at 22:58 on ___, 5 min after discovery." }, { "input": "No suspicious bone marrow signal abnormalities seen. Vertebral body heights\nare normal. Alignment is normal. The cerebellar tonsils are normally\npositioned, and ___ cisterna magna is again noted. No signal abnormalities\nseen in the cervical or included upper thoracic cord to the level of T4-T5.\n\nC2-C3: No spinal canal narrowing. Tiny left uncovertebral and facet\nosteophytes with minimal left neural foraminal narrowing, unchanged.\n\nC3-C4: No spinal canal narrowing. Mild bilateral neural foraminal narrowing\nby uncovertebral and facet osteophytes, unchanged.\n\nC4-C5: Central/right paracentral disc protrusion may have slightly decreased\nin size since ___. It mildly narrows the spinal canal. It no longer\ndefinitively contacts the ventral spinal cord, though the ventral surface of\nthe cord remains slightly remodeled. Moderate to severe bilateral neural\nforaminal narrowing by uncovertebral and facet osteophytes is unchanged.\n\nC5-C6: Right paracentral endplate osteophytes indent the ventral thecal sac\nbut do not contact the spinal cord. There is mild right and moderate to\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\nThese findings are unchanged.\n\nC6-C7: Shallow posterior endplate osteophytes without significant spinal canal\nnarrowing. Minimal left uncovertebral osteophytes without significant neural\nforaminal narrowing. No interval change.\n\nC7-T1: No spinal canal or neural foraminal narrowing.", "output": "1. At C4-C5, the previously noted central/right paracentral disc protrusion\nmay have slightly decreased in size since ___. It mildly narrows the\nspinal canal but no longer definitively contacts the ventral spinal cord,\nthough the ventral surface of the cord remains slightly remodeled. Moderate\nto severe bilateral neural foraminal narrowing is unchanged.\n2. At C5-C6, right paracentral endplate osteophytes indent the ventral thecal\nsac but do not contact the spinal cord, unchanged. Mild right and moderate to\nsevere left neural foraminal narrowing is also unchanged.\n3. Spinal cord signal remains within normal limits." }, { "input": "There is no evidence for fracture. Alignment is normal. Vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm.", "output": "No evidence for fracture or subluxation within the thoracic spine." }, { "input": "Study is mildly degraded by motion.\n\nThe numbering of the cervical, thoracic and lumbar spine is based on the\ncount-down from the level of C2 vertebrae.\n\nCERVICAL:\nThe alignment of the cervical spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized spinal cord appears unremarkable\nwithout focal cord signal abnormality, cord expansion or abnormal enhancement.\n\nThere is loss of intervertebral disc height and signal at multiple levels in\nkeeping with disc degeneration.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nThe marrow signal is markedly heterogeneous with focal areas of enhancement in\nthe cervical spine in keeping with patient's known history of multiple myeloma\n\nAt C2-C3, no neural foramina or spinal canal stenosis is seen.\n\nAt C3-C4, central disc protrusion indents the ventral thecal sac. No neural\nforamina or spinal canal stenosis is seen.\n\nAt C4-C5, central disc protrusion indents the ventral thecal sac. Bilateral\nuncovertebral and facet arthropathy results in mild bilateral neural foramen\nnarrowing.\n\nAt C5-C6, central disc protrusion indents the ventral thecal sac. Bilateral\nuncovertebral and facet arthropathy results in severe bilateral neural foramen\nnarrowing.\n\nAt C6-C7, central disc protrusion indents the ventral thecal sac. Bilateral\nuncovertebral and facet arthropathy results in moderate bilateral neural\nforamen narrowing.\n\nAt C7-T1, no neural foramina or spinal canal stenosis is seen.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. There is pathologic\nfracture involving the T4 vertebrae with soft tissue mass bulging posteriorly\ninto the spinal canal by approximately 5 mm resulting in a least moderate\nspinal canal stenosis at that level causing remodeling of the ventral aspect\nof spinal cord without definite cord signal abnormality and. There is\nextension of the soft tissue mass inferiorly into the T4-T5 neural foramen\nbilaterally resulting in mild-to-moderate neural foramen narrowing.\n\nAlso seen is heterogeneous marrow at multiple other levels with multiple\nlesions in keeping with patient's known multiple sclerosis. No other\npathologic fractures are however seen.\n\nThe visualized spinal cord appears unremarkable without focal marrow signal\nabnormality, marrow expansion or abnormal enhancement. The visualized\nprevertebral, paravertebral and paraspinal soft tissues appear unremarkable. \nThe visualized lung parenchyma appears clear.\n\nThere is loss of intervertebral disc height and signal at multiple levels in\nkeeping with disc degeneration.\n\nThere is focal central disc protrusion indenting the ventral thecal sac at\nT1-T2 indenting the ventral thecal sac. No neural foramina or spinal canal\nstenosis is seen at any other level.\n\nLUMBAR:\nThere is 2 mm anterolisthesis of L5 on S1. The alignment of the lumbar spine\nis otherwise maintained. The superior endplate of L3, along the superior and\ninferior endplates of L2 and inferior endplate of L1. The vertebral body\nheights at the remaining levels are maintained.\n\nThe visualized lower spinal cord appears unremarkable with the conus\nterminating at L1-L2. No focal cord signal abnormality, cord expansion or\nabnormal enhancement is seen.\n\nThere is loss of intervertebral disc height and signal at all levels in\nkeeping with disc degeneration.\n\nThe marrow signal is markedly heterogeneous with multiple focal areas of\nenhancement in keeping with patient's known history of multiple myeloma. No\ncortical breakthrough or epidural mass is however seen.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nAt T12-L1, there is mild loss of disc height and signal. Bilateral neural\nforamen and spinal canal are patent.\n\nAt L1-L2, there is loss of intervertebral disc height and signal. No neural\nforamina or spinal canal stenosis is seen.\n\nAt L2-L3, there is mild loss of disc height and signal. Mild bilateral facet\narthropathy. No neural foramina or spinal canal stenosis is seen.\n\nAt L3-L4, there is mild loss of disc height and signal with mild bilateral\nfacet arthropathy resulting in mild bilateral neural foramen narrowing and\nmild spinal canal narrowing.\n\nAt L4-L5, there is loss of disc height and signal with diffuse disc bulge,\nbilateral facet arthropathy, prominent epidural fat and ligamentum flavum\nthickening resulting in mild bilateral neural foramen narrowing, right greater\nthan left and moderate spinal canal stenosis.\n\nAt L5-S1, there is loss of disc height and signal with diffuse disc bulge and\nbilateral facet arthropathy resulting in moderate bilateral neural foramen\nnarrowing. No spinal canal stenosis is seen.", "output": "1. Study is mildly degraded by motion.\n2. Diffusely heterogeneous marrow with multiple areas of enhancement\ncompatible with patient's known history of multiple myeloma.\n3. T4 probable pathologic fracture with soft tissue mass extending posteriorly\ninto the epidural space exerting mass effect on the spinal cord displacing it\nposteriorly resulting in moderate spinal canal stenosis, without definite cord\nsignal abnormality. The soft tissue mass extends into the neural foramen at\nT4-T5 resulting in mild-to-moderate neural foramen narrowing.\n4. Multilevel multifactorial degenerative disease of the cervical spine, worst\nat C5-C6 with severe bilateral neural foramen narrowing.\n5. Multilevel multifactorial degenerative disease of the lumbar spine, worst\nat L4-L5 with moderate spinal canal and mild bilateral neural foramen\nnarrowing.\n6. Moderate bilateral neural foramen narrowing at L5-S1." }, { "input": "There are 5 lumbar-type vertebrae. Mild anterior wedging of T12 and minimal\nanterior wedging of L1 vertebral bodies is unchanged. L2 through L5 vertebral\nbody heights are preserved. There is straightening of lumbar lordosis,\nsimilar to ___ radiographs, without spondylolisthesis. The localizer\nsequence again demonstrates a mild levoconvex curvature centered at L3-L4. No\nsuspicious bone marrow signal abnormalities are seen. There is a hemangioma\nwithin the L2 vertebral body.\n\nThe distal spinal cord demonstrates normal signal intensity, with the conus\nmedullaris terminating near the L2 upper endplate.\n\nSagittal images through the T10-T11 level demonstrate a disc bulge mildly\nnarrowing the spinal canal. The disc bulge with superimposed lateral endplate\nosteophytes, as well as facet osteophytes, also causes moderate neural\nforaminal narrowing. There are no axial images through this level.\n\nT11-T12: Sagittal images demonstrate no evidence for spinal canal or neural\nforaminal narrowing. No axial images through this level.\n\nT12-L1: Minimal disc bulge and mild facet arthropathy. No significant spinal\ncanal narrowing or neural foraminal narrowing.\n\nL1-L2: Minimal disc bulge and mild facet arthropathy. No significant spinal\ncanal narrowing or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge and facet arthropathy. The ventral thecal sac is\nmildly indented without mass effect on the intrathecal nerve roots. No\nsignificant neural foraminal narrowing.\n\nL3-L4: There is a disc bulge, mild to moderate right and mild left facet\narthropathy. Posterior epidural fat is mildly prominent. The thecal sac is\nmildly narrowed without crowding of the intrathecal nerve roots. Traversing\nright L4 nerve root is contacted and may be impinged in the subarticular zone.\nThere is mild-to-moderate right and mild left neural foraminal narrowing.\n\nL4-L5: There is a mild disc bulge and facet arthropathy. There is a small\ncentral annular tear. The thecal sac is mildly indented without mass effect\non the intrathecal nerve roots. Subarticular zones are mildly narrowed\nwithout frank compression of the traversing L5 nerve roots. The neural\nforamina are mildly narrowed.\n\nL5-S1: There is a disc bulge and a broad-based central disc protrusion the\nventral thecal sac is mildly indented without significant narrowing. There is\nno compression of the traversing S1 nerve roots. There is moderate to severe\nbilateral neural foraminal narrowing with abutment of the exiting L5 nerve\nroots.\n\nVague subcentimeter T2 hyperintensities projecting over right greater than\nleft kidney on axial T2 weighted images may represent pulsation artifacts, but\nsuperimposed cystic lesions, not well characterized, cannot be excluded.", "output": "1. Mild spinal canal narrowing at L3-L4 and L4-L5 without mass effect on the\nintrathecal nerve roots. However, traversing right L4 nerve root at L3-L4 is\ncontacted and may be impinged in the subarticular zone.\n2. Moderate to severe bilateral neural foraminal narrowing at L5-S1 with\nabutment of the exiting L5 nerve roots. Also mild to moderate right L3-L4\nneural foraminal narrowing.\n3. Sagittal images through T10-T11 demonstrate mild spinal canal narrowing and\nmoderate bilateral neural foraminal narrowing, without axial images through\nthis level.\n4. Questionable subcentimeter bilateral renal lesions, versus pulsation\nartifacts.\n\nRECOMMENDATION(S): Consider renal ultrasound.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 11:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The study is degraded by motion artifact.\n\nCervical spine:\n\nVertebral body height and alignment is maintained. Multilevel degenerative\ndisc disease. The spinal cord is normal in signal intensity and caliber. \nVisualized structures of the posterior fossa are unremarkable.\n\nAt C2-C3 level, there is no evidence of neural foraminal narrowing or spinal\ncanal stenosis.\n\nAt C3-C4, there is bilateral uncovertebral hypertrophy causing mild to\nmoderate right and moderate to severe left neural foraminal narrowing, there\nis mild spinal canal stenosis.\n\nAt C4-C5 level, there is bilateral uncovertebral hypertrophy and disc bulging\ncausing moderate to severe bilateral neural foraminal narrowing and mild left\nparacentral spinal canal narrowing (image 14, series 6).\n\nAt C5-C6 level, there is spondylosis and mild disc bulge, bilateral\nuncovertebral hypertrophy resulting in moderate bilateral neural foraminal\nnarrowing.\n\nAt C6-C7 level, there is diffuse disc bulge and bilateral uncovertebral\nhypertrophy causing moderate bilateral neural foraminal narrowing.\n\nAt C7-T1 level, there is bilateral uncovertebral hypertrophy causing moderate\nbilateral neural foraminal narrowing..\n\n\nThoracic spine:\n\nVertebral body height and alignment is maintained. Note is made of a small\nSchmorl's node in the superior endplate of T12. Intervertebral disc spaces\nare grossly preserved. The spinal cord is normal in signal intensity and\ncaliber.\n\nAt T2-T3, there is a small posterior disc bulge with mild indentation of the\nthecal sac. No neural foraminal narrowing.\nAt T5-T6, there is a small left paramedian disc bulge with mild indentation of\nthe thecal sac. No neural foraminal narrowing.\nAt T6-T7, there is a small right paramedian disc osteophyte complex with\nindentation of the thecal sac. No neural foraminal narrowing.\n\nNo significant disc bulge or neural foraminal narrowing at the remaining\nlevels.\n\n\nLumbar spine:\n\nVertebral body height and alignment is maintained. Degenerative disc disease\nis seen at L5-S1.\nAbnormal signal intensity is seen within the L4-L5 intervertebral disc\nextending through the inferior endplate of L4 into the vertebral body with\nevidence of osseous edema. No definitive osseous destruction.\n\nThere is a small vertebral body hemangioma in the posterior aspect of the L1\nvertebral body.\nSmall Schmorl's node involving the L5 superior endplate.\n\nAt L3-L4, there is a left paracentral disc bulge with disc osteophyte complex,\nfacet joint hypertrophy, no spinal canal stenosis, moderate left and mild\nright neural foraminal narrowing.\nAt L4-L5, there is a left paracentral disc bulge with disc osteophyte complex,\nfacet joint hypertrophy, mild spinal canal narrowing, moderate bilateral\nneural foraminal narrowing.\nAt L5-S1, there is a left paracentral disc bulge with disc osteophyte complex,\nfacet joint hypertrophy, no spinal canal stenosis, moderate left and mild\nright neural foraminal narrowing.\n\nNo significant disc bulge or neural foraminal narrowing at the remaining\nlevels.", "output": "1. Findings suggestive of L4-L5 osteomyelitis/discitis, however, given the\nclinical history osseous lymphoma cannot be completely excluded. No\ndefinitive osseous destruction. Vertebral body height is maintained.\n2. No cord compression, epidural hematoma or compression fracture.\n3. Multilevel degenerative changes throughout the spine with disc bulges at\nC5-C6, T2-T3, T5-T6, T6-T7, L3-L4, L4-L5 and L5-S1.\n4. Moderate left neural foraminal narrowing is seen at L4-3 L4 L4-L5 and\nL5-S1.\n5. Moderate right neural foraminal narrowing is seen at C5-C6 and L4-L5.\n\nRECOMMENDATION(S): If clinically warranted, correlation with MRI of the\nlumbar spine with and without contrast is recommended for further\ncharacterization at L4-5 level." }, { "input": "Cervical spine:\n\nAt the craniocervical junction and C2-3 no abnormality is seen. At C3-4 and\nC4-5 mild disc bulging identified slightly indenting the thecal sac without\nspinal stenosis. At C4-5 is central disc protrusion contacts the anterior\naspect of the spinal cord without deformity. Coronal foraminal narrowing seen.\n\n. C5-6 there is disk and uncovertebral degenerative changes with right-sided\ndisc osteophyte with moderate to severe right foraminal narrowing and\nmild-to-moderate left foraminal narrowing. Disc osteophyte indents the slight\nside of the spinal cord.\n\nAt C6-7 mild disk bulging seen without foraminal narrowing.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression. \nAt C7-T1 T1-2 and T2-3 no abnormality is seen.\n\nLumbar spine:\n\nFrom T11-12 to L4-5 levels, vertebral bodies and discs demonstrate normal\nsignal without significant disk bulge or disk herniation. At L5-S1 level\nreduced degenerative changes are seen without bulging or focal disk\nherniation. There is no foraminal narrowing or spinal stenosis. There is no\nevidence of spondylolysis or listhesis. The distal spinal cord and paraspinal\nsoft tissues are unremarkable.", "output": "1. Changes of cervical spondylosis from C3-4 through the C6-7 with most\npronounced changes at C5-6 level with moderate to severe right foraminal\nnarrowing is identified. There is mild indentation on the spinal cord seen on\nthe right side at C5-6 level. No intrinsic spinal cord signal abnormalities\n2. Minimal degenerative changes in the lumbar region at L5-S1 level, otherwise\nunremarkable MRI of lumbar spine." }, { "input": "Mild levoscoliosis centered at L3-L4 is seen. There is grade 1 retrolisthesis\nof L3 on L4, progressed compared to the prior exam from ___. ___ type 2\nendplate changes are seen along the endplates of L2-L3. Diffuse loss of the\nnormal T2 signal and intervertebral disc height is seen within the lumbar\nspine, including vacuum disc phenomenon from L2 through L4-L5 levels. The\ncord terminates at T12-L1. No terminal cord signal abnormalities are seen.\n\nT12-L1: Moderate spinal canal narrowing has progressed compared to the prior\nexam secondary to intervertebral disc bulge, ligamentum flavum thickening,\ndorsal epidural lipomatosis and facet joint arthropathy. Facet joint\nosteophytes contribute to mild bilateral neural foraminal narrowing.\n\nL1-L2: Mild disc bulge, facet joint osteophytes and dorsal epidural\nlipomatosis results in moderate spinal canal narrowing, progressed compared to\nthe prior exam. Facet joint osteophytes further contribute to moderate right\nand mild left neural foraminal narrowing, also progressed.\n\nL2-L3: Mild disc bulge, facet joint osteophytes ligamentum flavum thickening\nand dorsal lipomatosis results in at least moderate spinal canal narrowing at\nthis level. Facet joint osteophytes contribute to moderate to severe\nbilateral neural foraminal narrowing, progressed compared to the prior exam.\n\nL3-L4: Disc bulge, facet joint arthropathy and ligamentum flavum thickening\nresults in severe spinal canal narrowing at this level, progressed compared to\nthe prior exam. There is buckling of the nerve roots cranial to this level of\nsevere spinal canal stenosis. Facet joint osteophytes contribute to severe\nleft and moderate right neural foraminal narrowing, progressed compared to the\nprior exam.\n\nL4-L5: Disc bulge, facet joint osteophytes and ligamentum flavum thickening as\nwell as dorsal epidural lipomatosis contributes to moderate spinal canal\nnarrowing, mildly progressed compared to the prior exam. Facet joint\nosteophytes contribute to severe left and moderate right neural foraminal\nnarrowing.\n\nL5-S1: Mild disc bulge is seen, which in conjunction with ligamentum flavum\nthickening results in mild spinal canal narrowing. Facet joint osteophytes\ncontribute to severe left and moderate to severe right neural foraminal\nnarrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Interval progression of severe lumbar spondylosis compared to the prior\nexam from ___, now with severe spinal canal stenosis at L3-L4, and moderate\nspinal canal stenosis at L2-L3 and L4-L5. There is buckling and crowding of\nthe nerve roots in the area of severe canal stenosis at L3-L4. Given the\npatient's symptoms and imaging findings, the possibility of cauda equina\nsyndrome cannot be completely excluded, and correlation in the appropriate\nclinical setting is advised.\n2. Moderate to severe bilateral neural foraminal narrowing is seen spanning\nfrom L2-L3 through L5-S1 secondary to facet joint osteophytes, as described\nabove.\n3. No terminal cord signal abnormalities identified.\n\nRECOMMENDATION(S): Neurology/neurosurgical consultation is recommended for\nfurther evaluation.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 4:45 pm, 2 minutes after\ndiscovery of the findings." }, { "input": "CERVICAL:\nAlignment is normal.The vertebral body heights are preserved. There is\nmultilevel disc degeneration and varying degrees of disc height loss.The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof infection or neoplasm.There is no abnormal enhancement after contrast\nadministration.\n\nMultilevel degenerative changes are detailed below. These have overall mildly\nprogressed from the prior study from ___.\n\nC2-C3: There is a mild posterior disc bulge resulting in mild indentation of\nthe ventral thecal sac without significant central canal or foraminal\nnarrowing.\n\nC3-C4: There is a diffuse disc bulge with a right paracentral component\nresulting in mild central canal narrowing. This in addition to uncovertebral\njoint hypertrophy and degenerative facet hypertrophy results in mild left and\nmoderate right foraminal narrowing.\n\nC4-C5: There is a broad posterior disc bulge with a left paracentral\ncomponent, uncovertebral joint hypertrophy, and degenerative facet hypertrophy\nresulting in at least moderate moderate central canal narrowing with\nflattening of the cord ventrally and along its right posterior aspect related\nto hypertrophy of the ligamentum flavum, severe left foraminal narrowing, and\nmoderate right foraminal narrowing.\n\nC5-C6: There is a broad-based posterior disc bulge, uncovertebral joint\nhypertrophy, and degenerative facet hypertrophy resulting in mild central\ncanal and severe left and mild right foraminal narrowing.\n\nC6-C7: Broad-based posterior disc bulge, uncovertebral joint hypertrophy, and\ndegenerative facet hypertrophy results in mild central canal narrowing, severe\nleft foraminal narrowing, and mild right foraminal narrowing.\n\nC7-T1: There is no disc bulge or central canal narrowing. There is mild left\nforaminal narrowing related to degenerative facet hypertrophy.\n\nTHORACIC:\nAlignment is normal.The vertebral body heights are maintained. There is\nvarying degrees of intervertebral disc height loss and signal changes related\nto disc desiccation.The spinal cord appears normal in caliber and\nconfiguration.Mild disc protrusions at several levels result in mild central\ncanal narrowing and mild foraminal narrowing which are not significantly\nchanged from ___ is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration. A few\nscattered T1 and T2 hyperintense foci which mildly enhance are compatible with\nhemangiomas.\n\nOTHER: None", "output": "1. Cervical spine: Multilevel degenerative changes progressed from the prior\nstudy from ___, worst at C4-5 where there is at least moderate central\ncanal narrowing with flattening of the ventral and right posterior aspects of\nthe spinal cord related to disc bulge and hypertrophy of the ligamentum\nflavum, severe left foraminal narrowing, and moderate right foraminal\nnarrowing. Severe left foraminal narrowing is also noted at C5-6 and C6-7.\n2. Thoracic spine: Mild degenerative changes, overall not significantly\nchanged from ___.\n3. No abnormal cord signal or areas of focal contrast enhancement in either\nthe cervical or thoracic spinal cord." }, { "input": "The patient is status post L3-L5 posterior decompression/laminectomies. \nEnhancing granulation tissue is noted in the laminectomy bed. Associated\noverlying soft tissue edema, but no rim enhancing collections.\n\nThe conus terminates at the L1 level. No conus lesions.\n\nNo acute vertebral body fractures. Focal fatty lesions are noted in the L1\nvertebral body.\n\nDegenerative changes of the lumbar spine as described below:\n\nAt T11-T12: There is unchanged spondylosis and disc bulge causing mild left\nand moderate right neural foraminal narrowing, articular joint facet\nhypertrophy appears unchanged.\n\nAt T12-L1 level, both neural foramina are patent, there is no evidence of\nspinal canal stenosis, mild articular joint facet hypertrophy remains\nunchanged.\n\nL1-2: No compromise of the nerve roots in the spinal canal. Moderate\nnarrowing of the right neural foramina. The left neural foramina is patent.\n\nL2-3: ___ type 2 changes involving the vertebral body endplates. \nBroad-based disc bulge with associated facet joint osteophytosis and\nligamentum flavum hypertrophy results in moderate narrowing of the right\nsubarticular zone. Severe narrowing of the right neural foramina appear\nsimilar compared to prior imaging. Mild narrowing of the left neural\nforamina.\n\nL3-4: Broad-based disc bulge, facet joint osteophytosis and ligamentum flavum\nhypertrophy results in moderate severe right subarticular zone narrowing which\nappears fairly similar compared to prior imaging. Severe bilateral neural\nforaminal narrowing appears slightly increased compared to prior.\n\nL4-5: No nerve root compromise in the spinal canal. Severe left and moderate\nsevere right neural foraminal narrowing appear slightly increased compared to\nprior imaging.\n\nL5-S1: Bilateral facet joint effusions. Mild narrowing of the subarticular\nzones, but no nerve root compromise. Severe left and moderate severe right\nneural foraminal narrowing appears slightly increased compared to prior.\n\nIn comparison with the prior examination dated ___, again disc\ndegenerative changes are noted in the lower thoracic spine at T10-T11\nconsistent with posterior disc bulging, partially evaluated in this exam.", "output": "1. The patient is status post L3-L5 posterior decompression/laminectomies. \nEnhancing granulation tissue is noted in the laminectomy bed. Associated\noverlying soft tissue edema but no rim enhancing collections.\n\n2. There is moderate right subarticular zone narrowing at the L2-3 level and\nsevere right subarticular zone narrowing at the L3-4 level which appears\nfairly similar compared to prior imaging.\n\n3. There is multilevel moderate and severe neural foraminal narrowing which\nor appears slightly increased at L3-L4, L4-5 and L5-S1 levels compared to\nprior as described above." }, { "input": "Motion artifact limits evaluation.\n\nThere are 5 lumbar-type vertebrae. S-shaped thoracolumbar scoliosis is seen\non the prior CT torso. No spondylolisthesis. Vertebral body heights are\npreserved. No evidence for osseous, epidural, or leptomeningeal metastatic\ndisease. The conus medullaris terminates at L1.\n\nT12-L1: No spinal canal or neural foraminal narrowing.\n\nL1-L2: Mild disc bulge. No spinal canal or neural foraminal narrowing.\n\nL2-L3: Mild disc bulge and minimal facet arthropathy. No spinal canal or\nneural foraminal narrowing.\n\nL3-L4: Minimal facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: Mild disc bulge and minimal facet arthropathy. No spinal canal or\nneural foraminal narrowing.\n\nL5-S1: Mild facet arthropathy. No spinal canal narrowing or significant\nneural foraminal narrowing.\n\nThere is a 4.5 x 3 mm T2 hypointense lesion in the lateral upper/mid right\nkidney on image 6:8, with intermediate signal intensity on postcontrast T1\nweighted images ___, which is not clearly discernible on the motion\nlimited precontrast axial T1 weighted images. It was previously seen on the\nMRCP from ___, but occult on multiple prior CTs. There is minimal\nhyperdensity in this area on the noncontrast CT portion of the PET-CT from ___. This most likely represents a hemorrhagic or proteinaceous cyst.", "output": "1. Motion limited exam.\n2. No evidence for metastatic disease in the lumbar spine. No spinal canal\nnarrowing or significant neural foraminal narrowing.\n3. 4.5 mm probable hemorrhagic or proteinaceous cyst is again seen in the\nlateral upper/mid right kidney." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL:\n\nThere is straightening of cervical lordosis. Vertebral body heights are\npreserved. Schmorl's nodes are seen at multiple levels of the cervical spine.\nThere is no definite focal marrow signal abnormality.\n\nLeptomeningeal enhancement is seen involving the visualized posterior fossa\nand cord. Within limits of study, there is no definite cord parenchymal\nabnormal signal or enhancement are seen.\n\n There is mild multilevel loss of disc height.\n\nC2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Bilateral facet and uncovertebral osteophytes, no spinal canal\nnarrowing, mild bilateral foraminal narrowing.\n\nC4-C5: No spinal canal or foraminal narrowing.\n\nC5-C6: Disc bulge, bilateral facet and uncovertebral osteophytes, no spinal\ncanal narrowing, moderate bilateral foraminal narrowing.\n\nC6-C7: Disc bulge, bilateral facet uncovertebral osteophytes, no spinal canal\nnarrowing, moderate right and mild left foraminal narrowing.\n\nC7-T1: No spinal canal or foraminal narrowing.\n\nTHORACIC:\nThere is moderate rightward curvature of the thoracic spine with the apex at\nT7.\n\n Vertebral body heights are preserved. Schmorl's nodes are seen at multiple\nlevels of the thoracic spine. There is no definite focal marrow signal\nabnormality.\n\nLeptomeningeal enhancement is seen involving the thoracic and visualized\nlumbar spinal cord. Within limits of study, there is no definite cord\nparenchymal abnormal signal or enhancement are seen.\n\n Intervertebral discheightsandsignalare preserved. There is no definite\nspinal canal or foraminal narrowing.\n\nOTHER:\nA 4 mm T2 hypointense lesion is seen in the right kidney (15:42), incompletely\ncharacterized.\n\nPostoperative changes related to patient's known esophagectomy and gastric\npull-through are again seen.\n\n Scattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by size criteria. Additional 6 mm\nnonspecific paraesophageal lymph node is seen (see 14:6).", "output": "1. Study is moderately degraded by motion.\n2. Diffuse leptomeningeal enhancement involving the visualized posterior fossa\nand cervical, thoracic and visualized lumbar spine. While findings may\nrepresent inflammatory process such as CIDP, leptomeningeal tumor spread is\nnot excluded on the basis of this examination.\n3. Cervical spondylosis including moderate foraminal narrowing at C5-6 and\nC6-7.\n4. 4 mm right renal possible hemorrhagic cyst, incompletely characterized.\n5. Cervical subcentimeter mediastinal nonspecific lymph nodes as described. \nIf concern for malignancy, consider FDG PET-CT for further evaluation.\n\nRECOMMENDATION(S):\n1. MRI of the brain with and without contrast.\n2. Renal ultrasound." }, { "input": "The alignment is normal. No bone marrow signal abnormalities are identified. \nA punctate focus of increased cord signal is seen at C4-C5, series 3, image 9.\nDiffuse loss of the normal T2 signal seen throughout the intervertebral discs\nof the cervical spine. Chronic compression deformities are seen involving C6\nand C7.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: Mild disc bulge is seen, which in conjunction with facet joint\narthropathy results in mild-to-moderate spinal canal narrowing. Facet joint\nand uncovertebral arthropathy results in mild right and moderate-to-severe\nleft foraminal narrowing.\n\nC4-C5: Disc bulge with a focal central disc protrusion is seen resulting in\nsevere spinal canal narrowing. Facet joint or uncovertebral arthropathy\nresults in severe right and moderate left neural foraminal narrowing.\n\nC5-C6: Disc bulge with a right central disc protrusion is seen resulting in\nmoderate to severe spinal canal narrowing. Facet joint and uncovertebral\narthropathy results in moderate to severe right and moderate left neural\nforaminal narrowing.\n\nC6-C7: Mild disc bulge is seen resulting in mild spinal canal narrowing. \nFacet joint and uncovertebral arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nC7-T1: Disc bulge is seen resulting in mild spinal canal narrowing. There is\nno neural foraminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Cervical spondylosis, most pronounced at C4-C5 and C5-C6 with moderate to\nsevere spinal canal narrowing. Subtle increased cord signal at C4-C5, is\nlikely secondary to chronic myelomalacia.\n2. Severe right and moderate left neural foraminal narrowing is seen at C4-C5\nand C5-C6. Moderate-to-severe left foraminal narrowing is seen at C3-4 level.\n3. No concerning enhancement is seen." }, { "input": "The alignment and configuration of the lumbar vertebral bodies appears\nmaintained, the conus medullaris terminates at the level of T12 and is\nunremarkable. The signal intensity in the bone marrow is slightly\nheterogeneous at the level of T12 at the inferior template, suggesting bone\nmarrow replacement for fat and sclerotic changes, previously demonstrated by\nCT of the abdomen in ___.\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 posterior disc bulge and articular joint facet\nhypertrophy, resulting in mild bilateral neural foraminal narrowing (7:5).\n\nAt L4/L5 level, there is mild disc desiccation and a moderate posterior disc\nbulge, contacting the traversing nerve roots bilaterally and causing moderate\nbilateral neural foraminal narrowing, slightly more pronounced towards the\nleft, and apparently contacting the left exiting nerve root of L4 (images 13,\n14, series 5).\n\nAt L5/S1 level, the intervertebral disc space appears maintained, there is no\nevidence of neural foraminal narrowing or spinal canal stenosis, mild\narticular joint facet hypertrophy is present with small articular or synovial\ncyst on the right (19:5). The sacroiliac joints are unremarkable .", "output": "Mild to moderate degenerative changes throughout the lumbar spine, more\nsignificant from L3/L4 through L5/S1 levels as described in detail above." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved.\nAlignment is normal. No concerning bone marrow signal abnormalities are seen.\n\nThe distal spinal cord maintains normal morphology and signal intensity, with\nthe conus medullaris terminating near the upper endplate of L2. Postcontrast\nimages demonstrate diffuse enhancement of the right L2 nerve root without\nnodularity.\n\nThere is no spinal canal or neural foraminal narrowing. There are small\nSchmorl's nodes in the endplates at T10-11, T11-12, L3-4, and L4-5. There is a\nminimal disc bulge at L4-5, a tiny central disc protrusion at L5-S1, and mild\nfacet arthropathy from L3-4 through L5-S1.", "output": "1. Diffuse contrast enhancement of the right L2 nerve root without nodularity,\nand no evidence for underlying mechanical compression. This suggests a\nnonspecific inflammatory process.\n2. The visualized distal spinal cord appears normal in morphology and signal\nintensity without abnormal enhancement.\n3. Mild degenerative changes without spinal canal narrowing, neural foraminal\nnarrowing, or nerve root impingement." }, { "input": "CERVICAL:\nLimited views of the skull base and cervical medullary junction are\nunremarkable. The paravertebral soft tissues and lung apices are\nunremarkable. There is normal cervical alignment. The vertebral body heights\nand marrow signal are preserved. The cervical spinal cord demonstrates normal\nsignal and morphology. There is no abnormal postcontrast enhancement. The\nintervertebral disc spaces demonstrate normal height and signal. There is\nC6-C7 disc osteophyte complex and left uncovertebral arthropathy causing mild\neffacement of the thecal sac and mild left neural foraminal stenosis.\n\nTHORACIC:\nLimited views of the paravertebral soft tissues and lung bases are\nunremarkable. There is a normal thoracic alignment. The vertebral bodies\ndemonstrate preserved height and marrow signal. The intervertebral disc\nspaces demonstrate normal signal and height.\n\nThe thoracic cord demonstrates normal morphology. There is T2 hyperintensity\nand correlate postcontrast enhancement within the right lateral aspect of the\nthoracic cord at the T11-T12 level extending for 1 cm in craniocaudad\ndimension (08:10; 11:26; 18:26). There is no neural foraminal or spinal canal\nstenosis.\n\nLUMBAR:\nThere is a subcentimeter right hepatic lobe cyst (11:15; 18:15). The\nremainder of the visualized paravertebral soft tissues are unremarkable.\n\nThere is normal lumbar alignment. The vertebral body heights and marrow\nsignal are preserved. There is mild low signal at the L4-L5 intervertebral\ndisc space without loss of height. The remainder of the intervertebral disc\nspaces are unremarkable. The conus demonstrates normal signal morphology,\nterminating appropriately at the L1-L2 level.\n\nAt L4-L5 there is disc bulge and mild facet arthropathy with small synovial\neffusions without significant neural foramina or spinal canal stenosis.", "output": "1. Short-segment T2 hyperintense enhancing lesion at the right lateral aspect\nof the T11-T12 thoracic cord, as described, which is new in comparison to\nprior study from ___. The signal characteristics, morphology, and\nlocation favor a demyelinating process such as multiple sclerosis, however\nthis is nonspecific.\n2. Mild degenerative changes within the cervical and lumbar spine, as\ndescribed, without spinal cord or nerve root compression." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There are mild degenerative changes that significant neural\nforaminal or spinal canal stenosis. There is no evidence of infection or\nneoplasm. There is no abnormal enhancement after contrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.The conus demonstrates normal morphology terminating\nappropriately at the L1-L2 level. There is a T2 hyperintense enhancing lesion\ncentered at the right lateral aspect of the conus at the T12 level extending\nto the right lateral medullary surface to the central cord extending for 1.7\ncm in craniocaudad dimension and measuring approximately 5 x 6 mm in AP and\ntransverse ___ (14:24; 9:; 21:8. This has mildly increased in size and\ndegree of conspicuity as compared to prior study.\n\nThere is mild disc signal hypointensity and bulging L4-L5 without significant\nneural foraminal or spinal canal stenosis.", "output": "Short-segment enhancing lesion within the right lateral aspect of the conus\nmedullaris at the T11-T12 level which has mildly increased in size and degree\nof conspicuity as compared to prior study suspicious for a demyelinating\nlesion." }, { "input": "CERVICAL:\nIn comparison with the most recent MRI examination dated ___,\nthere is a new focus of abnormal enhancement at C5 level (image 8, series 25,\nimage in 12, series 26), measuring approximately 2 mm. No other areas of\nabnormal enhancement are visualized. The cervical spine alignment is normal.\nVertebral body and intervertebral disc signal intensity appear normal. There\nmild uncovertebral hypertrophy and C4/C5 and C6/C7 levels, causing mild\nbilateral neural foraminal narrowing. The visualized paravertebral cervical\nstructures are unremarkable.\n\nTHORACIC:\nAt T11/T12 levels, there is a persistent short segment (approximately 4 x 15\nmm in sagittal projection by approximately 3.5 x 1.7 mm in transverse\ndimension), of high signal intensity with moderate pattern of enhancement as\ndemonstrated on the image 8, series 22 and image 27, series 24 with minimal\ncord expansion (image 8, series 12), which is suspicious for demyelination. \nThe thoracic spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal. There is no evidence of spinal canal or neural\nforaminal narrowing.\n\nLUMBAR:\nThe alignment of the lumbar vertebral bodies appears maintained, there is an\nunchanged Schmorl's node at the inferior endplate of L3, there is no evidence\nof neural foraminal narrowing spinal canal stenosis.\n\nAt L4/L5 level, unchanged disc desiccation and mild disc bulge is re-\ndemonstrated, causing minimal bilateral neural foraminal narrowing with no\nevidence of nerve root compression or spinal canal stenosis, mild articular\njoint facet hypertrophy appears unchanged.\n\nAt L5/S1 level, both neural foramina are patent with no evidence of spinal\ncanal stenosis. The sacroiliac joints are unremarkable. The visualized\naspect of the retroperitoneum appears grossly normal.", "output": "1. New focus of abnormal enhancement identified in the cervical spinal cord\nat the level of C5 towards the left (image 12, series 25), suggestive of\ndemyelination, with no significant cord expansion. No other new lesions are\nidentified throughout the cervical spinal cord.\n\n2. Unchanged Shore segment of abnormal enhancement and high-signal intensity\non T2 and STIR sequences in the lower thoracic spine at the level of T11 and\nT12 on the right, also suggestive of demyelination.\n\n3. The lumbar spine appears unchanged a grossly unremarkable, with minimal\ndegenerative changes at L4/L5 level as described above." }, { "input": "CERVICAL:\nThe alignment of the cervical spine is normal. The bone marrow is normal in\nsignal without enhancement. The T2 hyperintense lesion in the dorsal spinal\ncord at C1 is re-identified. No new T2 hyperintense lesions are identified\nwithin the cervical spinal cord. There is no enhancement in the spinal cord. \nThe spinal cord is normal in caliber. The height of the vertebral bodies and\nintervertebral discs are maintained. The prevertebral and paraspinal soft\ntissues are normal.\n\nAt C2-C3, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom prior.\n\nAt C3-C4, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom prior.\n\nAt C4-C5, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom prior.\n\nAt C5-C6, there is broad-based disc protrusion without spinal canal or neural\nforaminal stenosis, unchanged from prior.\n\nAt C6-C7, there is broad-based disc protrusion without spinal canal or neural\nforaminal stenosis, unchanged from prior.\n\nAt C7-T1, there is no spinal canal or neural foraminal stenosis, unchanged\nfrom prior.\n\nTHORACIC:\nThe thoracic spine is normal alignment. The bone marrow is normal in signal\nwithout enhancement. The T2 hyperintense lesions within the left dorsal\nspinal cord at T8-T9 on 14:28 and right dorsal spinal cord at T11-T12 on 11:9\nare less conspicuous in comparison the prior examination. No new T2/FLAIR\nhyperintense lesions are identified. The spinal cord is normal in caliber. \nNo enhancing lesions are identified within the spinal cord. The height of the\nvertebral bodies and intervertebral discs are maintained. No fluid\ncollections or masses are identified. The paraspinal soft tissues are normal.\nThere is no spinal canal or neural foraminal stenosis, unchanged from prior.", "output": "1. T2 hyperintense lesion in the cervical spinal cord at C1 no longer enhances\nand decreased conspicuity of the T2 hyperintense lesions in the thoracic\nspinal cord at T8-T9 and T11-T12, compatible with the patient's provided\nhistory of demyelination.\n2. No new T2 hyperintense or enhancing lesions within the cervical and\nthoracic spinal cord." }, { "input": "The vertebral body heights and alignment are maintained. The bone marrow\nsignal is normal.\n\nThe craniocervical junction is unremarkable. The cervical cord is normal in\nsignal intensity.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is disc protrusion resulting in mild spinal canal narrowing\nand ventral remodeling of the cord. There is no significant neural foraminal\nnarrowing.\n\nAt C4-C5, there is disc protrusion resulting in mild spinal canal narrowing\nand ventral remodeling of the cord. There is no significant neural foraminal\nnarrowing.\n\nAt C5-C6, there is disc bulge resulting in mild effacement of the ventral CSF\nspace. There is no significant neural foraminal narrowing.\n\nAt C6-C7, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.", "output": "Mild cervical spondylosis as detailed above." }, { "input": "3 posterior fossa metastatic lesions were better visualized on prior MR brain\ndone ___ at 20:49 and reference is made to that report. The\ncraniocervical junction appears normal. The cervical cord is normal in\nvolume, signal intensity and morphology. There is no compromise of the\ncervical cord in the spinal canal.\n\nThere is diffuse T1 hypointense, T2 and STIR hyperintense enhancing metastatic\ndisease involving the cervical and upper thoracic spine as well as upper ribs.\nThere is lytic destruction of the right aspect of the C3 vertebral body as\nwell as right pedicle and anterior aspect of the right transverse process as\nseen on prior CT neck done ___. Preserved right vertebral artery flow\nvoid. No pathological fractures.\n\nDegenerative changes of the cervical spine as described below:\n\nC2-3: No cord compromise. The neural foramina are patent.\n\nC3-4: No cord compromise. Severe narrowing of the right neural foramina. The\nleft neural foramina is patent.\n\nC4-5: No cord compromise. Moderate right and mild moderate right neural\nforaminal narrowing.\n\nC5-6: No cord compromise. Moderate severe neural foraminal narrowing\nbilateral.\n\nC6-7: No cord compromise. Moderate right and mild left neural foraminal\nnarrowing.\n\nProminent left supraclavicular lymph node (series 10, image 31).", "output": "Extensive cervical, upper thoracic spine as well as rib metastatic disease.\n\nThere is lytic destruction of the right aspect of the C3 vertebral body as\nwell as the right pedicle and anterior aspect of the right transverse process\nas seen on prior CT neck done ___. Preserved right vertebral artery\nflow void.\n\nThere is no compromise of the cervical cord in the spinal canal.\n\nNeural foraminal narrowing as described above\n\n3 posterior fossa metastatic cerebellar lesions were better visualized on\nprior MR brain done ___. Reference is made to that report." }, { "input": "Please note the study is moderately degraded by motion.\n\nTHORACIC:\nAlignment is normal.Vertebral body signal intensity appears normal. There is\nmultilevel disc space height loss and decreased signal. The spinal cord\nappears normal in caliber and configuration. There is no evidence of spinal\ncanal or neural foraminal narrowing.\n\nLUMBAR:\nThere is unchanged grade 1 anterolisthesis of L4 on L5.Vertebral body signal\nintensity appears normal. There is multilevel disc space height loss and\ndecreased signal, particularly at L4-L5 and L5-S1.The conus medullaris\nterminates at the L1 vertebral level, within expected limits. There is no\nsignal abnormality of the visualized cord or conus.\n\nAt T12-L1 there is facet arthropathyno spinal canal or neural foraminal\nstenosis.\n\nAt L1-2 there is facet arthropathy and ligamentum flavum thickening withno\nspinal canal or neural foraminal stenosis.\n\nAt L2-3 there is facet arthropathy and ligamentum flavum thickening and disc\nbulge resulting in mild spinal canal stenosis with no significant neural\nforaminal stenosis.\n\nAt L3-4 there is disc bulge, facet arthropathy and ligamentum flavum\nthickening resulting in moderate spinal canal stenosis and mild bilateral\nneural foraminal stenosis.\n\nAt L4-5 there is uncovering of the disc, facet arthropathy and ligamentum\nflavum thickening resulting in severe spinal canal stenosis, crowding the\ncauda equina, and mild bilateral neural foraminal stenosis.\n\nAt L5-S1 there is a disc bulge which crowds subarticular zones contacting but\nnot posteriorly displacing the traversing nerve roots (series 12, image 34). \nThere is no significant spinal canal narrowing. There is mild facet\narthropathy resulting in mild right and no significant left neural foraminal\nnarrowing.\n\nOTHER: There is asymmetric atrophy of the right kidney. 8 mm T2 hyperintense\nnodule of the right thyroid lobe (series 3, image 13). No further evaluation\nis recommended per current ACR guidelines for incidentally noted thyroid\nnodules. 5 mm T2 hyperintense lesion in the right hepatic segment V/VI\n((series 7, image 26), likely representing a hemangioma, which likely\ncorresponds to a lesion noted on prior CT abdomen and pelvis of ___.", "output": "1. Please note the lumbar spine portion of the study is moderately degraded\nby motion.\n2. Degenerative changes throughout the spine, worse at L4-5 resulting severe\nspinal canal stenosis, crowding the cauda equina. At L3-L4, there is moderate\nspinal canal narrowing." }, { "input": "THORACIC SPINE: There is mild exaggeration of thoracic kyphosis with apex at\nT7, slightly more prominent when compared to CTA chest of ___. \nOtherwise, thoracic alignment is anatomic. Vertebral body heights are\nmaintained. Multilevel mixed ___ type 1 and 2 changes are identified,\nwithout suspicious focal marrow lesion.\n\nThere is no abnormal enhancement or signal of the thoracic cord.\n\nThere are multilevel small central protrusions which do not result in\nsignificant spinal canal narrowing except at T9-T10 where a central protrusion\nand intervertebral osteophytes results in mild spinal canal narrowing. At\nT5-T6 and T7-T8, the disc protrusion minimally remodels the ventral aspect of\nthe cord. At T9-T10, facet arthropathy results in mild left neural foraminal\nnarrowing. Otherwise, there is no significant neural foraminal narrowing at\nthe remainder of the thoracic levels.\n\nLUMBAR SPINE: Lumbar alignment is anatomic. Vertebral body heights are\npreserved. There is no suspicious marrow signal. Disc height and signal are\npreserved. There is no abnormal enhancement of the cord, conus medullaris or\ncauda equina.\n\nT12-L1 through L3-L4: No significant spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: A left foraminal to extra foraminal zone disc protrusion and facet\nosteophyte results in moderate neural foraminal narrowing contacting the\nexiting left L4 nerve root, similar in appearance to prior examination. There\nis no significant spinal canal narrowing or right neural foraminal narrowing.\n\nL5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: There is a nonenhancing 1.2 cm T2 hyperintense cystic foci of the\nposterior visualized spleen, likely representing a hemangioma or lymphangioma.\n\nThe left kidney demonstrates multiple nonenhancing T2 hyperintense cystic\nlesions the largest is not completely within the field of view of measures\napproximately 7.0 cm in greatest dimension.\n\nIncompletely visualized is a T1 and T2 hyperintense apparent expansile lesion\nof the left ilium/acetabular roof measuring approximately 5.0 x 2.8 cm. This\nwas not within the field of view of prior examinations and could simply\nrepresent volume averaging through the acetabulum. Further evaluation with CT\npelvis is recommended or plain film radiograph is recommended.", "output": "1. Mild thoracic degenerative spondylosis, most prominent at T9-T10 where a\nsmall disc protrusion results in mild spinal canal narrowing. Facet\narthropathy results in mild left T9-T10 neural foraminal narrowing.\n2. Lumbar spondylosis at L4-L5 where a left foraminal to extra foraminal zone\ndisc protrusion and facet arthropathy results in moderate left neural\nforaminal narrowing, contacting the exiting L4 nerve root, similar appearance\nto prior exam.\n3. There is no abnormal enhancement or signal of the thoracic and lumbar cord.\n4. Incompletely visualized is a T1 and T2 hyperintense apparent expansile\nlesion of the left ilium/acetabular roof measuring approximately 5.0 x 2.8 cm.\nThis was not within the field of view of prior MRI examinations and could\nsimply represent volume averaging through the acetabulum. However further\nevaluation is recommended.\n\nRECOMMENDATION(S): Further evaluation with CT pelvis is recommended or plain\nfilm radiograph as clinically indicated." }, { "input": "There is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. Mild stable diffuse decreased bone marrow signal\nseen. Mild facet edema and fluid at L4-5 bilaterally. No focal bone marrow\nreplacing lesions identified. The intervertebral discs are normal in height\nand signal characteristics. The conus medullaris terminates at the level of\nL1-L2. There is no spinal cord signal abnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1: There is no significant spinal canal or neural foraminal stenosis.\n\nL1-L2: Facet arthropathy with no significant spinal canal or neural foraminal\nstenosis.\n\nL2-L3: Facet arthropathy with no significant spinal canal or neural foraminal\nstenosis.\n\nL3-L4: Facet arthropathy with no significant spinal canal or neural foraminal\nstenosis. A 2 mm synovial cyst posterior to the right facet.\n\nL4-L5: Disc bulge with facet arthropathy and ligamentum flavum thickening\nresulting an moderate spinal canal stenosis, subarticular zone stenosis and\nmild to moderate bilateral neural foraminal stenosis. A left-sided facet\neffusion is seen at this level.\n\nL5-S1: Facet arthropathy with no significant spinal canal stenosis and mild\nbilateral neural foraminal stenosis.", "output": "-No evidence for osteomyelitis or epidural abscess.\n-Multilevel degenerative changes, worst at L4-5 resulting in moderate spinal\ncanal stenosis at this level with subarticular zone stenosis and\nmild-to-moderate bilateral neural foraminal stenosis.\n-Mild stable diffusely decreased bone marrow signal, likely secondary to\nchronic disease." }, { "input": "Vertebral body heights are preserved. Mild retrolisthesis of C5 on C6 is\nunchanged. No concerning marrow signal abnormalities are seen.\n\nThe cerebellar tonsils are normally positioned, and the craniocervical\njunction appears unremarkable.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, there is a small central disc protrusion which indents the ventral\nthecal sac and approaches but does not contact or deform the spinal cord.\nThere is no neural foraminal narrowing. These findings are unchanged.\n\nAt C4-5 there is a central/ left paracentral disc protrusion which abuts and\nminimally remodels the left ventral spinal cord, unchanged. Cord signal\nremains within normal limits. There is moderate right and mild left neural\nforaminal narrowing by uncovertebral osteophytes, unchanged.\n\nAt C5-6, there is a mild retrolisthesis and a a right paracentral disc\nosteophyte complex, flattening the right ventral spinal cord, without evidence\nfor cord signal abnormality. There is moderate bilateral neural foraminal\nnarrowing by uncovertebral osteophytes. These findings are unchanged.\n\nAt C6-7, there is a small right paracentral disc protrusion which indents the\nventral thecal sac but does not contact the spinal cord. It appears unchanged\non sagittal images, and probably also unchanged in the axial plane allowing\nfor differences in slice selection. There is no neural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nThere is a 5 mm T2 hyperintense focus in the right vallecula.", "output": "No significant change in multilevel degenerative disease compared to ___.\n5 mm T2 hyperintense focus of the right vallecula. A mass is not excluded, and\ndirect visualization is recommended if not previously performed.\n\nRECOMMENDATION(S): Recommend direct visualization of the right vallecula if\nnot previously performed. Please see impression item 2.\n\nNOTIFICATION: The recommendation above was entered by Dr. ___ on\n___ at approximately 12:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Areas of diffusely decreased marrow signal on out of phase images throughout\nspine,, mildly decreased T1 signal, similar to that of muscle, mild associated\nmarrow enhancement. Findings may represent marrow reactive change, or diffuse\nmarrow infiltration by lymphoma.\n\nNo epidural tumor. No leptomeningeal enhancement.\n\nCERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal..\n\nMild degenerative changes. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing.\n\n There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.\n\n The spinal cord appears normal in caliber and configuration. There is no\nevidence of spinal canal or neural foraminal narrowing.\n\n There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.\n\n The spinal cord appears normal in caliber and configuration. There is no\nevidence of spinal canal or neural foraminal narrowing.\n\nIncompletely evaluated 3.3 cm lesion right posterior iliac bone, has been\ngetting progressively sclerotic since ___, likely posttreatment\nchange, this did not have uptake on PET scan from ___. Region of\nabnormal uptake on PET scan just above this abnormality is not seen today..\n\nOTHER: Subcentimeter T2 hyperintense focus in the right kidney corresponds to\na hypointense lesion on the recent CT, most likely reflecting a renal cyst. \nMarked splenomegaly.", "output": "1. Diffusely decreased marrow signal throughout spine, no focal lesions, may\nrepresent posttreatment changes, component of lymphoma is difficult to\nexclude.\n2. Incompletely evaluated 3.3 cm lesion right iliac bone, has been getting\nprogressively sclerotic since ___, likely posttreatment change, this\ndid not have uptake on PET scan from ___. Region of abnormal\nuptake on PET scan just above this abnormality is not seen today..\n3. Mild degenerative changes spine." }, { "input": "Redemonstration of diffusely decreased T1 and T2 marrow signal throughout the\nvisualized lower thoracic and lumbar spine, similar to prior exam. Mild\nenhancement following contrast. Findings could be related to post treatment\nchanges.\n\nNew, mild acute/subacute superior endplate L2 compression fracture, 2 mm\nretropulsion.\n\nNew moderate L3 compression fracture, acute subacute, approximately 50%\nvertebral body height loss centrally, 2 mm retrolisthesis.\n\nMinimal vertebral body height loss superior T12, L1 vertebral bodies, new\nsince prior, no vertebral body or paraspinal edema.. Stable appearance of L4,\nL5 vertebral bodies.\n\n\nMultilevel Schmorl's nodes. Degenerative changes, endplate hypertrophic\nchanges, diffuse disc bulges. Lumbar facet arthritis. No focal marrow signal\nabnormality. Normal visualized cord.\n\nMild central canal narrowing L2-L3, L3-L4 levels, more prominent since prior..\nNo significant foraminal narrowing at any level.\n\nHemorrhagic lesion superior central adnexum measures 6 cm, mass and\nhemorrhagic cyst, hematosalpinx, or combination. Pelvic ultrasound\nrecommended. Findings are similar compared with PET scan ___. \nSmall volume ascites. No significant edema in the adnexa on STIR images.\n\nLesion posterior right innominate bone has increased T1 signal on pre\ngadolinium images, consistent with posttreatment change.", "output": "1. New mild L 2, moderate L3 acute/subacute compression fractures, 2 mm\nretropulsion. Mild chronic L1, L4 height loss, new since prior, no edema.\n2. Mild central canal narrowing.\n3. 6 cm adnexal abnormality, in central location superior to the uterus and\nright adnexa, consider hemorrhagic cyst, hematosalpinx, endometrioma, or\ncombination. Pelvic ultrasound recommended. Given central location,\ncorrelate clinically to exclude ovarian torsion.\n4. Diffuse marrow abnormality, likely posttreatment change, refer to PET scan.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:25 am." }, { "input": "There are new post-kyphoplasty changes within the L2 and L3 vertebral bodies. \nAlignment is within normal limits. There is unchanged mild wedging, mild\nanterior height loss of the T12, L1, L2, and L3 vertebral bodies. Remaining\nvertebral bodies demonstrate preserved height. There is diffuse, mildly\nT2/STIR hyperintense, mildly T1 hypointense, enhancing signal abnormality\nwithin the imaged marrow spaces, unchanged. There is also on the FAT: IDEAL\nimages evidence of loss of normal fatty marrow signal in several areas within\nthe lumbar spine, however these appear confined to the areas of either\nkyphoplasty changes or prior fractures, most conspicuous within the L2 and L3\nvertebral bodies, with evidence of relatively spared marrow signal for example\nin the L4 and L5 vertebral bodies. Overall, marrow signal likely represents\npost-treatment change/marrow reconversion rather than diffuse lymphomatous\ninfiltration, although appearance is somewhat indeterminate.\n\nThe distal spinal cord and conus medullaris is normal and terminates at L1-2. \nThe cauda equina nerve roots are normal. Aside from enhancing marrow signal,\nthere is no additional abnormal intraspinal enhancement or epidural\ncollection.\n\nMild signal and height loss of lumbar spine intervertebral discs is consistent\nwith degenerative change. Specifically:\n\nT12-L1 through L2-3: Unremarkable.\nL3-4: Very mild posterior disc bulge, ligamentum flavum thickening, without\nsignificant spinal canal or neural foraminal narrowing.\nL4-5 and L5-S1: Unremarkable.\n\nIntrinsically T1 hyperintense lesion in the right bony ileum is partially\nvisualized, unchanged from prior.\n\nThere are small right peripelvic renal cysts. Scattered retroperitoneal lymph\nnodes are noted, not fully evaluated, better evaluated on recent FDG PET-CT. \nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. New post-kyphoplasty changes within the L2 and L3 vertebral bodies.\n2. In conjunction with recent FDG PET-CT results, diffuse abnormal marrow\nsignal most probably represents post-treatment change/marrow reconversion\nrather than diffuse lymphomatous involvement, however short-term follow-up\n(e.g. 3 months) MRI with IDEAL sequences is recommended to confirm stability.\n3. Redemonstration of mild anterior height loss of T12, L1, L2, and L3. No\nnew fracture or vertebral body height loss.\n4. No significant degenerative changes. No spinal canal or neural foraminal\nnarrowing.\n5. Intrinsically T1 hyperintense right bony ilium lesion, partially\nvisualized, as seen on priors.\n\nRECOMMENDATION(S): Short-term (e.g. 3 month) follow-up MRI lumbar spine with\nwithout contrast and with IDEAL sequences, for further evaluation of diffuse\nmarrow signal abnormality." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.\n The spinal cord appears normal in signal, caliber, and configuration.There is\nno evidence of infection or neoplasm.\n\nAt C4-C5, there is a disc bulge without spinal canal stenosis or neural\nforaminal narrowing.\nThere is no evidence of spinal canal or neural foraminal narrowing at the\nremaining cervical levels.\n\n\nTHORACIC:\nThe thoracic spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal.\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of spinal canal or neural foraminal narrowing.The visualized\nparavertebral structures in the thoracic region are unremarkable.\n\n\nLUMBAR:\nThe last rib-bearing vertebral body was characterized at T12. There is\nlumbarization of the S1 vertebral body. Alignment is normal.Vertebral body\nsignal intensity appears normal. Mild degenerative disc disease is seen at\nL5-S1 with preserved disc space height. The remaining disc space heights and\nsignal intensities are maintained.\nThe spinal cord appears normal in caliber and configuration. The conus\nmedullaris appears normal and terminates at L1-L2 level.\n\nAt L5-S1, there is a posterior disc protrusion, facet joint arthropathy, no\nspinal canal stenosis or neural foraminal narrowing.\nThere is no evidence of spinal canal or neural foraminal narrowing at the\nremaining lumbar levels.\nThere is no evidence of infection or neoplasm.\nIncidental note is made of a Te small perineural cyst in the sacral portion of\nthe thecal sac.\n\nOTHER: Visualized posterior fossa structures are unremarkable.\nNote is made of a small amount of free fluid in the deep pelvis which is\nnonspecific but likely physiologic for patient's age.", "output": "1. No evidence of cord compression or severe spinal canal stenosis.\n2. Mild degenerative changes at C4-C5 and L5-S1\n3. Small amount of free fluid in the deep pelvis is nonspecific but likely\nphysiologic for patient's age." }, { "input": "Images are moderately motion degraded.\n\nNormal spinal alignment. No worrisome osseous lesions. Benign vertebral body\nhemangioma upper thoracic spine. Subcutaneous 1.5 cm nodule posterior, upper\nneck likely represents epidermal inclusion cyst normal cord, with images\nmoderately degraded. Mild degenerative changes cervical spine, multilevel\nmild disc osteophyte complexes, posterior element hypertrophic changes.\n\nAt C2-C3 level central canal, foramina are patent.\n\nAt C3-C4 level there is minimal central canal narrowing. Mild bilateral\nforaminal narrowing.\n\nAt C4-C5 level there is mild central canal narrowing. Mild left, moderate\nright foraminal narrowing.\n\nAt C5-C6 level there is mild central canal narrowing. Mild-to-moderate left,\nmoderate right foraminal narrowing.\n\nAt C6-C7 level central canal is patent. Mild-to-moderate right, mild left\nforaminal narrowing.\n\nAt C7-T1 level central canal is patent. Mild-to-moderate bilateral foraminal\nnarrowing.\n\nAt T1-T2 level central canal is patent. Mild bilateral foraminal narrowing.\n\nAt T2-T3 level central canal is patent. Mild-to-moderate bilateral foraminal\nnarrowing.", "output": "1. Degenerative changes cervical spine.\n2. Mild central canal narrowing.\n3. Multilevel foraminal narrowing.\n4. Remainder as above." }, { "input": "Exam is limited by patient motion. Contrast were images were not obtained due\nto patient preference.\n\nCERVICAL:\nThe cervical spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. Multilevel degenerative changes are not significantly changed\ncompared with MRI ___, resulting in up to mild canal narrowing and\nmild to moderate neural foraminal narrowing at multiple levels. No severe\nspinal canal narrowing.\n\nTHORACIC:\nAlignment is normal. There is a Schmorl's node along the superior endplate of\nT6. T1/T2 hyperintense lesions in the T3 and T10 vertebral bodies are\nconsistent with a hemangiomas. Vertebral body height and marrow signal is\notherwise maintained. There is loss of normal T2 disc signal at T4-T5, with a\nsmall posterior disc bulge which results in mild spinal canal narrowing. \nThere is otherwise no evidence of significant spinal canal or neural foraminal\nnarrowing.The spinal cord appears normal in caliber and configuration.\n\nLUMBAR:\nAlignment is normal. T1/T2 hyperintense lesions in the L2 and L4 vertebral\nbodies are consistent with hemangiomas. Vertebral body height and marrow\nsignal is maintained. There is loss of normal T2 disc signal at T12-L1,\nL2-L3, L3-L4, L4-L5, and S5-S1.The spinal cord appears normal in caliber and\nconfiguration. The conus terminates at the L1 level.\n\nThere is no significant spinal canal or neural foraminal narrowing from T12-L1\nto L2-L3.\n\nAt L3-L4, a small posterior disc bulge results in mild spinal canal and\nbilateral neural foraminal narrowing.\n\nAt L4-L5, a small posterior disc bulge results in mild spinal canal and\nbilateral neural foraminal narrowing.\n\nAt L5-S1, a posterior disc bulge and facet arthropathy results in mild canal\nnarrowing, moderate right and mild left neural foraminal narrowing.\n\nOTHER: There are trace bilateral pleural effusions. There is a 1.4 x 0.6 cm\ncystic lesion in the posterior left extrapleural fat between the left seventh\nand eighth ribs, nonspecific (13:37). Again seen is bilateral\nhydroureteronephrosis, not significantly changed compared with CT abdomen and\npelvis on ___. Loculated fluid at the GE junction adjacent to a\nhiatal hernia is similar to recent CT chest and CT abdomen and pelvis,\npossibly postsurgical (13:37). A subcutaneous cystic lesion in the posterior\nneck is unchanged compared with prior MRI, likely a sebaceous cyst.", "output": "1. Exam is somewhat limited by motion. Contrast images were not obtained due\nto patient preference.\n2. No severe spinal canal narrowing, evidence of cord compression or\ncompression of the cauda equina nerve roots.\n3. Multilevel degenerative changes as described.\n4. Additional findings as above." }, { "input": "CERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.Multilevel degenerative changes are not significantly changed\ncompared to ___ or ___, resulting in up to mild canal\nnarrowing and mild-to-moderate neural foraminal narrowing at multiple levels. \nNo severe spinal canal narrowing. There is no abnormal enhancement after\ncontrast administration.\n\nTHORACIC:\nAlignment is normal.There is an unchanged Schmorl's node of the superior\nendplate of T6. T1/T2 hyperintense lesions in the T3 and T10 vertebral bodies\nare consistent with angiomas. Vertebral body height and marrow signal is\notherwise maintained. Again seen is slight loss of normal T2 disc signal at\nT4-5, with a small posterior disc bulge, which results in mild spinal canal\nnarrowing. Otherwise, there is no evidence of notable spinal canal or neural\nforaminal narrowing. Spinal cord appears normal in caliber and configuration.\nThere is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal.T1/T2 hyperintense lesions in L2 and L4 are consistent\nwith hemangiomas. Vertebral body height and marrow signal is otherwise\nmaintained. There is loss of normal T2 disc signal throughout the lumbar\nspine, consistent with mild degenerative change. There is no severe spinal\ncanal or neural foraminal narrowing. Multilevel posterior disc bulges and\nfacet arthropathy causes multilevel mild spinal canal narrowing and multilevel\nmild neural foraminal narrowing. Most severe degenerative changes cause\nmoderate right neural foraminal narrowing at L5-S1, unchanged compared to most\nrecent prior. Spinal cord appears normal in caliber and configuration. Conus\nmedullaris appears to terminate at L1. There is no abnormal enhancement after\ncontrast administration.\n\nOTHER: Small to moderate bilateral pleural effusions with adjacent compressive\natelectasis is worse compared to yesterday's exam. There is an unchanged 1.4\nx 0.6 cm cystic lesion in the posterior left extrapleural flap between the\nseventh and eighth ribs, nonspecific. Again seen is bilateral\nhydroureteronephrosis, not significantly changed compared to most recent\nprior. There is an unchanged hiatal hernia with adjacent loculated fluid,\npossibly postsurgical. Subcutaneous cystic lesion in the posterior neck, on\nthe right, is unchanged compared to prior MRI, likely sebaceous cyst.", "output": "1. No abnormal postcontrast enhancement identified on these postcontrast\nimages.\n2. Increased pleuroparenchymal changes in the lungs since the previous MRI\nstudy. Correlate with chest CT of ___.\n3. Otherwise, unchanged exam compared to ___ at 15:01." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is intermediate/mildly high T2/STIR signal of the L1 vertebral body with\nmild if any loss of vertebral body height likely representing a acute/subacute\nmild compression fracture. There is also mild 2 mm retropulsion of the\nposterosuperior endplate of the L1 vertebral body. There is no spinal\nstenosis or spinal cord compression seen. There is no evidence of ligamentous\ndisruption.\n\nThere has been interval decrease in height of the L3 vertebral body\ncompression fracture with up to 90% loss of vertebral body height. \nIntermediate to mildly high T2/STIR signal within the L3 vertebral body is\ncompatible with a subacute to chronic compression fracture deformity. There\nis also a subacute to chronic compression deformity of the T10 vertebral body\nwith up to 90% loss of vertebral body height. Signal within L3-4\nintervertebral disc likely is degenerative in nature and could be related to\nincreased mobility.\n\nThe conus medullaris terminates at the level of L1-L2.\n\nScattered reduced T2 signal and high STIR signal within the intervertebral\ndiscs is likely on a degenerative basis. There is multilevel intervertebral\ndisc height loss most significant at L3-L4 and L5-S1.\n\nAt T12-L1 there is 2 mm L1 retropulsion, ligamentum flavum thickening and\nfacet osteophytes with mild spinal canal narrowing and mild right neural\nforaminal narrowing.\n\nAt L1-2 there is mild symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes with mild spinal canal narrowing and mild bilateral neural\nforaminal narrowing.\n\nAt L2-3 there is symmetric disc bulging, 4 mm L3 retropulsion, ligamentum\nflavum thickening and facet osteophytes with moderate spinal canal narrowing\nand moderate bilateral neural foraminal narrowing (left greater than right).\n\nAt L3-4 there is 4 mm L3 retropulsion, ligamentum flavum thickening and facet\nosteophytes and retropulsion with severe spinal canal narrowing and\ncompression of the thecal sac. There is severe left and moderate to severe\nright neural foraminal narrowing.\n\nAt L4-5 there is symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes with severe spinal canal narrowing and compression of the\nthecal sac and crowding of the nerve roots. There is mild-to-moderate\nbilateral neural foraminal narrowing.\n\nAt L5-S1 there is symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes with mild-to-moderate spinal canal narrowing.\n\nOther: Redemonstrated is an incompletely characterized heterogeneously T2\nhyperintense right renal lesion measuring up to 3.8 cm. A smaller 1.8 cm T2\nhyperintense renal lesion at the lower pole of the right kidney is also\nincompletely characterized but most likely represents a cyst.", "output": "1. Degenerative in superimposed chronic traumatic changes of the lumbar spine\nmost significant at L4-L5 greater than L3-L4 where there is severe spinal\ncanal narrowing and compression of the thecal sac and crowding of nerve roots\n2. Intermediate/mildly high T2/STIR signal of the L1 vertebral body with mild\nif any loss of vertebral body height likely represents a acute/subacute\ncompression fracture. Correlate with clinical history\n3. Interval decrease in the height of the L3 vertebral body compression\nfracture with up to 90% loss of vertebral body height.\n4. Subacute to chronic compression deformity of the T10 vertebral body\nresulting in up to 90% loss of vertebral body height.\n5. Redemonstrated incompletely characterized heterogeneously T2 hyperintense\nright renal lesion measuring up to 3.8 cm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:17 am, 20 minutes\nafter discovery of the findings." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Marrow signal is\nnormal. Minimal intervertebral disc signal loss, worst at C4-C5 and C5-C6. \nThe imaged spinal cord is normal in signal.\n\n C2-C3: No significant spinal canal or neural foraminal narrowing.\n\nC3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: A disc bulge results in moderate spinal canal narrowing with effacement\nof the adjacent ventral cord and mild bilateral neural foraminal narrowing.\n\nC5-C6: A central disc protrusion results in mild spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nC6-C7: A central disc protrusion results in mild spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.", "output": "1. A disc bulge at C4-C5 result in moderate spinal canal narrowing with\neffacement of the ventral cord. No associated cord signal abnormality.\n2. Additional mild degenerative changes as described in the findings." }, { "input": "Please note the study is mildly degraded by motion.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\n___ type 1 endplate changes are seen at the superior endplate of C7. The\nvisualized portion of the spinal cord is preserved in signal and caliber. \nIntervertebral disc signal and heights are preserved. Within the limits of\nthis noncontrast study there is no evidence of infection or neoplasm. There is\nno prevertebral soft tissue swelling.. The visualized portion of the posterior\nfossa, cervicomedullary junction, paranasal sinuses and lung apicesare\npreserved.\n\nAt C2-3 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing.\n\nAt C3-4 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing..\n\nAt C4-5 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing..\n\nAt C5-6 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing..\n\nAt C6-7 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing..\n\nAt C7-T1 there is a disc bulge with no spinal canal or neural foraminal\nnarrowing..", "output": "1. Study is mildly degraded by motion.\n2. Multilevel disc bulges, as described above, most pronounced at C6-C7\nresulting in mild spinal canal stenosis and no neural foraminal stenosis." }, { "input": "CERVICAL:\nThe cervical vertebral body heights, alignment, and intervertebral disc spaces\nare preserved. No focal bone marrow signal abnormalities are evident to\nsuggest acute fracture.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nAt C4-C5, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing. At C5-C6 there is mild disc bulge with flattening\nand remodeling of the ventral spinal cord and mild-to-moderate spinal canal\nnarrowing. There is moderate left and mild right neural foraminal narrowing. \nAt C6-C7, there is mild disc bulge with remodeling along the ventral spinal\ncord and mild spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nTHORACIC:\nThere is a superior endplate deformity of the T11 vertebral body with STIR and\nT2 hyperintense signal abnormalities compatible with an acute fracture. There\nis approximately 20% loss of height anteriorly. There is approximately 2 mm\nof retropulsion of the posterior cortex with mild spinal canal narrowing. \nThere is surrounding paravertebral and prevertebral soft tissue edema centered\nat T11. There is no evidence of ligamentous injury\n\nThere is a vertebral hemangioma at T8.\n\nThe remaining thoracic vertebral body heights and alignment are maintained. \nThe spinal cord appears normal in caliber and configuration without evidence\nof edema.\n\nNo other levels demonstrate spinal canal narrowing.\n\nLUMBAR:\n There are 5 non-rib-bearing lumbar type vertebral bodies. Alignment of the\nlumbar spine is maintained. The lumbar vertebral body heights are maintained.\nThere is a focal rounded area of STIR and T2 hyperintense signal abnormality\nwithin the inferior L1 vertebral body, which demonstrates heterogeneous\ncontrast enhancement. This may represent an atypical hemangioma. There is\nmild intervertebral disc height loss at L5-S1.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of L1-L2.\n\nFrom T12-L1 through L3-L4, there is no significant disc herniation or spinal\ncanal or neural foraminal narrowing. At L4-L5, there is minimal disc bulge\nand ligamentum flavum thickening without significant spinal canal or neural\nforaminal narrowing. At L5-S1, there is mild disc bulge and ligamentum flavum\nthickening without significant spinal canal narrowing.\n\nOTHER: Small dependent consolidations within the visualized lungs likely\nrepresent atelectasis. T2 hyperintense lesions within the visualized kidneys\nstatistically likely represent cysts, largest measures up to 4 cm in the\ninferior pole of left kidney, incompletely characterized. Additionally, a\nslightly T2 hyperintense structure in the posterior right hepatic lobe is\nnonspecific and may represent a cyst.", "output": "1. Acute compression fracture of the T11 vertebral body with approximately 20%\nloss of height and approximately 2 mm of retropulsion of the posterior cortex\nresulting in mild spinal canal narrowing at this level.\n2. No additional fractures are evident.\n3. Multilevel multifactorial cervical spondylosis as described above, most\npronounced at C5-C6 and C6-C7 with mild to moderate spinal canal narrowing.\n4. No evidence of spinal cord edema." }, { "input": "Cervical spine: Patient is status post ACDF from C4 through C7. The vertebral\nbody height and alignment is maintained. There is a normal curvature. The bone\nmarrow has a normal signal intensity. The intervertebral disc have normal\nheight and signal intensities.\n\nEvaluation for neural foraminal narrowing is limited secondary to hard of\nsacrum cervical hardware From C2-C3 through C5-C6 there is no this significant\ndisc herniation or spinal canal stenosis.\n\nAt C6-C7: There is a disc protrusion which indents the anterior thecal sac\nand results in mild spinal canal narrowing. There is no definite contacting of\nthe cervical spinal cord at this level. There is no abnormal cord signal.\n\nC7-T1: There is a small broad-based disc protrusion. There is no spinal canal\nstenosis or neural foraminal narrowing.\n\nThe cervical and included upper thoracic spinal cord, and posterior fossa\ndemonstrate normal signal intensity and morphology. Diffusion images of the\ncervical spinal cord are normal.\n\nThe posterior elements and paraspinal soft tissues are normal.\n\nLumbar spine: There is levo convex scoliosis of the lumbar spine. There are\ntype ___ ___ changes involving the vertebral endplates at L4-L5. There is also\nloss of normal intervertebral disc signal and height at this level.\nIntervertebral disc signal is also mildly decreased at L2-L3 and L3-L4.\n\nOn sagittal images, the T12/L1 disc space appears unremarkable without disc\nherniation, spinal canal stenosis, or neural foraminal narrowing.\n\nL1-L2: There is no disc herniation, spinal canal stenosis, or neural\nforaminal narrowing.\n\nL2-L3: There is a disk protrusion extending into the left foramen and\ncompressing the exiting left L2 nerve root. There is mild to moderate facet\narthropathy. There is no significant spinal canal stenosis.\n\nL3-L4: There is mild posterior disc bulge with moderate bilateral facet\narthropathy and ligamentum flavum thickening. There is mild to moderate spinal\ncanal narrowing. There is no significant neural foraminal narrowing.\n\nL4-L5: There is a disc protrusion bulging into the right neural foramen\nresulting in mild right neural foraminal narrowing. The combination of disc\nmaterial and severe bilateral facet arthropathy is resulting in compression of\nthe right traversing L5 nerve root. There is no significant spinal canal\nstenosis or left neural foraminal narrowing.\n\nL5-S1: There is minimal posterior disc bulge. There is moderate to severe\nbilateral facet arthropathy with a small amount of fluid in the right facet\njoint. There is no significant spinal canal stenosis. There is moderate left\nand no significant right neural foraminal narrowing.\n\nThe conus medullaris and cauda equina have normal morphology and signal\nintensities. The conus medullaris terminates at L1-L2 level.\n\nThe posterior elements and paraspinal soft tissues are normal.", "output": "1. Disc protrusion at C6-C7 which is resulting in mild spinal canal stenosis.\nThere is no evidence of cord compression or abnormal cord signal.\n\n2. Multilevel degenerative changes in the lumbar spine with varying degrees of\nspinal stenosis and neural foraminal narrowing as detailed above." }, { "input": "Postoperative changes anterior fusion C4-C5 with plate, screws in place. \nSolid fusion across vertebral bodies.\n\nNormal alignment. No worrisome vertebral body abnormalities. No cord T2\nsignal abnormality. Degenerative changes cervical spine. Disc osteophyte\ncomplex C3-C4, C5-C6, C6-7, C7-T8 levels. Posterior element hypertrophic\nchanges. Mild congenital narrowing spinal canal.\n\nAt C2-C3 level central canal, left foramen are patent. Mild right foraminal\nnarrowing, stable.\n\nAt C3-C4 level if there is mild-to-moderate central canal narrowing, minimal\neffacement of the ventral cord, preserved CSF about cord, similar to prior. \nIf moderate right, mild left foraminal narrowing, similar to prior.\n\nAt C4-C5 level there is mild central canal narrowing. Mild-to-moderate\nbilateral foraminal narrowing, stable.\n\nAt C5-C6 level there is tiny central disc protrusion, and disc osteophyte\ncomplex. Moderate central canal narrowing, near complete effacement of CSF\nabout cord, stable. Moderate to severe bilateral foraminal narrowing, stable.\n\nAt C6-C7 level there is moderate central canal narrowing, incomplete\neffacement of CSF, similar to prior. Severe right, moderate left foraminal\nnarrowing, stable.\n\nAt C7-T1 level there is mild central canal narrowing, stable. Moderate right,\nmild left foraminal narrowing.", "output": "1. Anterior fusion C4-C5.\n2. Degenerative changes cervical spine. Mild congenital narrowing spinal\ncanal.\n3. Moderate central canal narrowing C5-C6, C6-C7, stable.\n4. Multilevel foraminal narrowing, as above, stable." }, { "input": "The cervical spine alignment appears maintained. Re-demonstration of\npostsurgical changes consistent cervical interbody fusion at C4-C5 level with\nplate locked with 2 screw screws, and spacer. No abnormal enhancement is\nvisualized on post-contrast imaging. The signal intensity throughout the\ncervical spinal cord is normal with no evidence of focal or diffuse lesions.\n\nC2-C3: Bilateral neural foramina are patent. There is no evidence of\nsignificant spinal canal stenosis.\n\nC3-C4: Mild disc bulging with left-sided uncovertebral hypertrophy causing\nmild left neural foraminal narrowing, as seen on prior MR ___. No\nsignificant spinal canal stenosis.\n\nC4-C5: Postsurgical changes including a plate with two screws with associated\nhardware susceptibility defects. Spacer placement with anterior fusion,\nunchanged from prior study. Minimal left uncovertebral hypertrophy causing\nmild left neural foraminal narrowing. No evidence of significant spinal canal\nstenosis.\n\nC5-C6: Mild spondylosis and bilateral uncovertebral hypertrophy causing thecal\nsac deformity, unchanged from prior study.\n\nC6-C7: Bilateral uncovertebral hypertrophy causing mild bilateral neural\nforaminal narrowing. No significant spinal canal stenosis.\n\nC7-T1: Mild bilateral and uncovertebral hypertrophy causing mild left and\nmoderate right neural foraminal narrowing. No significant spinal canal\nstenosis.\n\nThe visualized elements of the posterior fossa are unremarkable.", "output": "1. Postsurgical changes as described above.\n2. Mild disc bulging and spondylosis at C3-C4 and C5-C6.\n3. There is no evidence of abnormal enhancement after contrast administration.\n4. The signal intensity throughout the cervical spinal cord is normal with no\nevidence of focal or diffuse lesions.." }, { "input": "MRI THORACIC SPINE:\n\nThe localizer sequence demonstrates evidence of prior anterior cervical\ndiscectomy and fusion at C5-6.\n\nThere are 11 rib-bearing vertebrae, and a transitional vertebra at the\nthoracolumbar junction, labeled as L1 in this report. The thoracic vertebral\nbodies display normal heights. A small T1 and T2 hyperintense focus in the T11\nvertebral body is consistent with a hemangioma. The spinal cord displays\nnormal signal intensity. There is no central canal stenosis or neural\nforaminal narrowing. No abnormal contrast enhancement is seen.\n\nMRI LUMBAR SPINE: There is a transitional vertebra at the thoracolumbar\njunction labeled L1 in this report, and 4 lumbar-type vertebrae labeled L2-L5\n. T1 and T2 hyperintense focus in the L2 vertebral body is consistent with a\nhemangioma. The conus medullaris terminate near the upper endplate of L2. \nVertebral body heights are normal. Alignment is normal. There is no abnormal\ncontrast enhancement.\n\nAt the L3-4, there is mild left sided facet arthropathy with no canal or\nforaminal narrowing.\n\nAt the L4-5, there is mild left sided facet arthropathy, with no canal or\nforaminal narrowing.\n\nAt the L5-S1 level, there is severe right and mild left facet arthropathy, as\nwell as a disc bulge and endplate osteophytes, resulting in displacement of\nthe traversing right nerve root (presumably S1) posteriomedially from the\nsubarticular zone. The exiting right nerve root (presumably L5) is impinged\nwithin the moderately narrowed neural foramen.\n\nPartially visualized, at least 1.7 cm exophytic lesion is noted in the lower\npole of the right kidney, with intermediate signal intensity on pre and post\ncontrast T1 images, incompletely characterized.", "output": "1. Anterior cervical discectomy and fusion at C5-6 are noted on the localizer\nsequence, but not well evaluated.\n2. 11 rib-bearing vertebrae. Transitional vertebra at the thoracolumbar\njunction, labeled L1 in this report. 4 lumbar type vertebrae, labeled L2\nthrough L5 in this report.\n3. No significant abnormalities in the thoracic spine.\n4. At L5-S1, severe right and mild left facet arthropathy, as well as a disc\nbulge and endplate osteophytes, result in displacement of the traversing right\nnerve root (presumably S1) posteromedially from the subarticular zone and\nimpingement of the exiting right nerve root (presumably L5) within the\nmoderately narrowed right neural foramen.\n5. Partially imaged indeterminate 1.7 cm exited lesion arising from the lower\npole right kidney. Recommend ultrasound for further evaluation, in the first\ninstance." }, { "input": "Vertebral body heights and alignment are maintained. There is a tiny\nSchmorl's node along the superior endplate of C5. There is a posterior\nannular fissure at the C5-6 with mild loss of height and normal T2 signal of\nthe intervertebral disc at this level. There is no appreciable spinal canal\nor neural foraminal stenosis. The visualized spinal cord is normal in caliber\nand signal intensity.\n\n\nA left cerebellar infarct is better evaluated on the brain MRI from 1 day\nprior. In the right lobe of the thyroid gland there is a well-marginated 14 x\n16 mm T1 hyperintense, T2 hypointense lesion with a small focus of T2\nhyperintense, T1 hypointense signal along its anterior superior margin (series\n13, image 17, series 12, image 27).\n\nThere is no prevertebral paraspinal soft tissue abnormality.\n\nThe distal V2 and V3 segments of the left vertebral artery (the region of\ndissection) is not covered by the axial T1 weighted fat suppressed images. \nThere is multifocal narrowing of the V2 segment of the right vertebral artery\nwith T1 hyperintense signal, consistent with known dissection.", "output": "1. Mild degenerative disc disease at C5-6. No spinal canal or neural\nforaminal narrowing.\n\n2. Normal caliber signal intensity of the visualized spinal cord. No cord\ncompression.\n\n3. Multifocal narrowing and surrounding T1 hyperintense signal of the right\nV2 segment, consistent with known dissection. Known left distal V2/V3 segment\ndissection is excluded from the fat-suppressed axial T1 weighted images.\n\n4. 14 x 16 mm proteinaceous or hemorrhagic nodule in the right lobe of the\nthyroid may represent a large colloid cyst, but is incompletely evaluated. \nFurther evaluation with ultrasound is recommended if not performed already.\n\nRECOMMENDATION(S): Ultrasound for further evaluation of 14 x 16 mm right\nthyroid nodule, if not performed already." }, { "input": "There is no evidence of abnormal signal within the bony structures or\nligamentous regions to indicate bony injury or ligamentous disruption. Spinal\ncord shows normal intrinsic signal without extrinsic compression. There is no\nevidence of prevertebral or intraspinal hematoma. No significant disc bulge\nor herniation seen.", "output": "No significant abnormalities on MRI of cervical spine. No evidence of bony or\nligamentous injury." }, { "input": "Please note the study is moderatedegraded by motion, especially on axial\nimages.\n\nFor the purposes of numbering, the lowest rib-bearing vertebral body was\ndesignated the T12 level. Please note this differs from the numbering system\nused in the ___ CT of the lumbar spine study, in which the lowest\nrib-bearing vertebral body was designated the L1 level. Please note that this\nmethod is inappropriate for surgical planning and that prior to any\nintervention appropriate levels must be established.\n\nThe L5 vertebral body is partially sacralized. Again noted is a compression\nfracture with 6 mm retropulsion of the superior endplate at L3. Disc heights\nare preserved. There is no suspicious marrow signal at the remainder the\nvisualized levels. Remainder the vertebral body heights are maintained. The\nconus terminates at the inferior endplate of L2, within expected limits. There\nis no signal abnormality of the visualized cord.\n\nT9-10 through L1-2: There are multilevel disc herniations and the degenerative\nfacet arthropathy particularly at L1-2, without significant spinal canal or\nneural foraminal narrowing. There perineural cysts of the right T10-11, T11-12\nand T12-L1 neural foramen. Perineural cysts of the bilateral S1-2 and S2-3\nneural foramen are also noted.\n\nL2-3: There is a disc bulge as well as moderate bilateral facet arthropathy\nand thickening of the ligamentum flavum. There is approximately 6 mm\nretropulsion of the superior endplate of L3 which results in moderate to\nsevere spinal canal narrowing (series 6, image 7). There is mild\nleft-greater-than-right neural foraminal narrowing.\n\nL3-4: There is a disc bulge as well as bilateral facet arthropathy with small\nfacet joint effusions and thickening of the ligamentum flavum without\nsignificant spinal canal or left neural foraminal narrowing. There is mild\nright neural foraminal narrowing.\n\nL4-L5: There is a disc bulge as well as bilateral facet arthropathy without\nsignificant spinal canal or neural foraminal narrowing.\n\nL5-S1: there is no spinal canal or neural foraminal stenosis.\n\nOther: Dependent subcutaneous edema is noted. Both kidneys demonstrate\nmultiple incompletely characterize cystic lesions, measuring up to 4.0 cm in\nlargest diameter, similar appearance to prior CT examinations.", "output": "1. Study is degraded by motion, especially on axial images.\n2. Please note that the numbering of vertebral body levels in this study\ndesignates the lowest rib bearing vertebral body level as the T12 level, which\ndiffers from the ___ CT lumbar spine CT (where this level is\ndesignated L1, and in which the compression fracture of concern is designated\nthe L4 level). Please note that prior to any surgical intervention,\nappropriate levels should be established.\n3. Transitional lumbar spine anatomy with partial sacralization of L5\nvertebral body.\n4. Compression fracture of L3 with 6 mm retropulsion of the superior endplate\nresulting in moderate to severe spinal canal narrowing at L2-3 in combination\nwith additional degenerative changes.\n5. Additional multilevel multifactorial lumbar spondylosis as described above.\n6. Partially visualized nonspecific at least partially cystic bilateral renal\nlesions as described. While findings may represent renal cysts, other\netiologies are not excluded on the basis of this noncontrast examination.\nRecommend clinical correlation. If clinically indicated, further evaluation\nmay be obtained via renal ultrasound." }, { "input": "The left aspect of the spine, including neural foraminal, is not included on\nthe sagittal views of the lower thoracic and lumbar spine, likely related to\nchange in patient positioning.\n\nCERVICAL:\nVertebral body height and alignment is preserved. Intervertebral disc spaces\nare maintained. Bone marrow signal intensity is within normal limits.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nabnormal enhancement.\n\nThere is no evidence of cord compression, severe spinal canal stenosis or\nsignificant neural foraminal narrowing along the cervical levels.\n\nTHORACIC:\nThere is complete destruction of the T10 vertebral body. Additionally, there\nis destruction of the T9 inferior endplate and superior endplate of the T11\nvertebral bodies which demonstrated diffuse marrow edema.\nThere is a resulting kyphotic angulation at T9-T11 with retropulsion of the T9\nvertebral body. In addition, posterior to the residual T9 through T11\nvertebral bodies, there is an epidural abscess up to 8 mm in maximum AP\ndimension. The retropulsion and epidural abscess result in severe spinal\ncanal stenosis with compression of the thoracic cord (series 8, image ___\nbut no definitive cord signal abnormality. There is severe bilateral neural\nforaminal narrowing at this level.\nIn addition, there is destruction of the T9-T11 disc spaces with enhancement\nextending from the disc space into both vertebral bodies, consistent with\ninflammatory changes in the setting of osteomyelitis and discitis.\n\nSeveral ring enhancing collections are noted in the left paraspinal region\n(series 13, image ___ with the largest measuring 2.5 x 2.0 x 1.4 cm (AP X\nTR X SI) (series 13, image 18).\nAnother of rim enhancing collection is noted anteriorly to the proximal right\neleventh rib measuring 3.4 x 2.3 x 2.5 cm (AP X TR X SI) (series 13, image\n24). There is also another rim enhancing lesion within the right paraspinal\nmusculature measuring approximately 1.8 x 2.3 x 5.5 cm (AP X TR X SI) (series\n22, image 39).\n\nThere is abnormally enhancing soft tissue anteriorly to the T8 through T12\nvertebral bodies, extending over a vertical segment of approximately 8 cm and\nmeasuring up to 2 cm in AP dimension (series 21, image 8).\n\nLUMBAR:\nVertebral body height and alignment is preserved. There is decreased signal\nintensity in the L4-L5 disc space, consistent with degenerative disc disease. \nIntervertebral disc spaces appear maintained. Bone marrow signal intensity is\nwithin normal limits\n\nThe spinal cord appears normal in caliber and configuration. The conus\nterminates normally at the L1-L2 level.\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions and mild ligamentum flavum thickening but no spinal\ncanal stenosis or significant neural foraminal narrowing.\n\nThere is no evidence of cord compression, severe spinal canal stenosis or\nsignificant neural foraminal narrowing along the lumbar levels.", "output": "1. T9-T11 osteomyelitis and discitis with destruction of vertebral bodies\nresulting in focal kyphotic angulation which in combination with a posterior\nepidural abscess at this level results in severe spinal canal stenosis and\ncompression of the spinal cord but without cord signal abnormality.\n2. Inflammatory changes surrounding the T10 and T11 vertebral bodies with\nperispinal and intramuscular abscesses as described above.\n3. No evidence of cord compression, severe spinal canal stenosis or\nsignificant neural foraminal narrowing along the cervical or lumbar levels.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___.\n___ (neuroradiology fellow) via telephone on ___ at 09:18am." }, { "input": "Alignment is norm vertebral body signal intensity is normal. Fractures of the\nright C6 inferior articulating facet, and C7 lateral mass are much better\ndemonstrated on CT, as is a very small fracture the right anterolateral T1\nvertebral body. There is trace prevertebral edema at C7.\nFocal linear T2/STIR hyperintensity along the right anterior longitudinal\nligament at C6-7 is concerning for ligamentous injury (3:8).\nThere is a disc protrusion at C6-7 that flattens the anterior surface of the\nspinal cord with concern for cord compression and possible cord signal\nabnormality mostly appreciated on the sagittal STIR image (3:9).\nAt C5-6 through C7-T1, there is abnormal epidural fluid along the posterior\nmargins of the vertebral bodies,, perhaps hemorrhage (3:12). There is fluid\nin the right C6-7 facet joint as well as increased signal on the STIR images\nin the right C7 superior articular process..\n\nAt C2-3 and C3-4, there is no canal or neural foraminal narrowing.\n\nAt C4-5, posterior intervertebral osteophytes and a midline disc protrusion\nmildly indents the anterior surface of the spinal cord. Predominantly\nuncovertebral osteophytes result in mild bilateral neural foraminal narrowing.\n\nAt C5-6, a disc protrusion mildly flattens the anterior surface of the spinal\ncord. There is moderate bilateral neural foraminal narrowing due to facet and\nuncovertebral osteophytes.\n\nAs described above, a large disc protrusion at C6-7 flattens the anterior\nsurface of the spinal cord with concern for cord signal abnormality. Mild\nbilateral neural foraminal narrowing is present.\n\nAt C7-T1, there is no canal or neural foraminal narrowing.", "output": "1. Disc protrusion at C6-7 flattening the anterior surface of the spinal cord\nwith concern for abnormal spinal cord signal intensity. This is associated\nwith minimal anterior epidural fluid extending from C5-6 through C7-T1, which\ncould reflect a small amount of hemorrhage.\n2. Possible anterior longitudinal ligamentous disruption at C6-7.\n3. Fractures of the right C6 inferior articulating facet, C7 lateral mass, and\nright anterolateral T1 vertebral body are much better demonstrated on CT.\n\nNOTIFICATION: The findings were discussed with ___, m.D. by ___,\nM.D. on the telephone on ___ at 10:58 am, 5 minutes after discovery of\nthe findings." }, { "input": "There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nWithin the left sacral ala, there is a rounded T1/T2 hyperintense lesion which\ndemonstrates signal loss on fat suppressed images, compatible with focal fat\nversus hemangioma otherwise, no suspicious bone marrow signal abnormality is\ndetected.\n\nThe conus medullaris terminates at the level of L2. There is no spinal cord\nsignal abnormality detected.\n\nAt the levels of T12-L5, there is minimal posterior disc bulging without\nspinal canal stenosis or neural foraminal narrowing.\n\nL5-S1: There is a posterior disc bulge with superimposed central disc\nprotrusion minimally contacting and indenting the ventral thecal sac without\nsignificant canal stenosis or neural foraminal narrowing. The disc protrusion\ncontacts the right S1 nerve root without displacement.\n\nNo abnormal enhancement is seen within the spinal cord, cauda equina, or\nepidural space. The visualized portions of the paraspinal soft tissues are\ngrossly within normal limits.", "output": "1. Small shallow disc protrusion at L5-S1 level in contact with the right S1\nnerve root without displacement. Otherwise, minimal spondylosis of the lumbar\nspine without appreciable canal stenosis or neural foraminal narrowing.\n2. No suspicious bone marrow signal or areas of abnormal enhancement." }, { "input": "Alignment is normal. The vertebral body height is maintained at all levels. \nMinimal ___ type 1 changes at C4-C5. The marrow signal is otherwise\nunremarkable. The visualized spinal cord appears unremarkable with no focal\ncord signal abnormality or cord expansion. The prevertebral, paravertebral\nand paraspinal soft tissues appear unremarkable. The visualized posterior\nfossa structures appear unremarkable.\n\n At C2-3 there is normal disc height. Mild loss of disc signal.No spinal\ncanal or neural foraminal stenosis.\n\nAt C3-4 there is central disc osteophyte complex with mild bilateral\nuncovertebral and facet arthropathy causing mild bilateral neural foramen\nnarrowing, left greater than right.No spinal canal stenosis..\n\nAt C4-5 there is central disc osteophyte complex with bilateral uncovertebral\nand facet arthropathy causing moderate bilateral neural foraminal narrowing. \nAlso seen is indentation of ventral thecal sac contacting the ventral aspect\nof spinal cord causing moderate to severe spinal canal stenosis.\n\nAt C5-6 there is disc osteophyte complex with mild right and moderate left\nuncovertebral and facet arthropathy causing mild right and moderate left\nneural foraminal narrowing. Indentation of ventral thecal sac contacting the\nventral aspect of spinal cord with mild spinal canal stenosis.\n\nAt C6-7 there is central disc osteophyte complex with mild bilateral\nuncovertebral arthropathy causing mild bilateral neural foramen\nnarrowing.Indentation of ventral thecal sac without contacting the ventral\naspect of spinal cord.\n\nAt C7-T1 there is normal disc height. Mild loss of disc signal.No spinal\ncanal or neural foraminal stenosis.", "output": "1. Multilevel multifactorial degenerative disease of the cervical spine, worst\nat C4-C5 with moderate bilateral neural foramen narrowing and moderate to\nsevere spinal canal stenosis.\n2. No focal cord signal abnormality or enhancing lesion is seen." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. No evidence of marrow replacement. Mildly sclerotic endplates\non T1 images can be seen with chronic renal disease . The spinal cord appears\nnormal in caliber and configuration.\n\nMild degenerative changes lumbar spine, multilevel diffuse disc bulges. Mild\ncentral canal narrowing L4-5, L5-S1 levels. Mild bilateral L3-L4, L4-5\nforaminal narrowing. Central canal, foramina patent at other levels. Normal\nvisualized cord. No evidence of disc space infection. No paraspinal\ninflammatory change.\nThere is no evidence of infection or neoplasm.\n\nMultiple bilateral simple renal cysts are seen. Indeterminate bilateral renal\nmasses, stable since ___, largest in the left kidney measures 5 cm,\nbetter evaluated on prior MRI. Decreased T2 signal liver, spleen.\n\nMultiple T2 hypointense lesions are seen within the uterus, consistent the\npatient's known fibroid uterus. A partially visualized cystic lesion is\nre-demonstrated in the right adnexa, likely related to the patient's known\ncomplex right paraovarian cyst.", "output": "1. Mild degenerative changes of the lumbar spine.\n2. No evidence of spine infection.\n3. Indeterminate renal masses, stable since ___ renal MRI." }, { "input": "There is no alignment abnormality. There is no vertebral body height loss to\nsuggest compression fracture. There is no concerning focal bone marrow signal\nabnormality. Loss of intervertebral disc height an intrinsic T2 signal is\nnoted at multiple levels, a manifestation of degenerative disease. The conus\nmedullaris terminates at the level of T12-L1 There is no spinal cord signal\nabnormality detected. The prevertebral and paraspinal soft tissues are\nunremarkable.\n\nAt T11-L1, there are minimal degenerative changes noted.\n\nL1-L2: There is a mild central disc protrusion slightly indenting thecal sac\nwithout significant spinal canal narrowing. The bilateral neural foramina are\npatent.\n\nL2-L3: A broad-based disc bulge contacts the left transversing L3 nerve root,\nand mildly narrows the spinal canal.\n\nL3-L4: A broad-based, eccentric left disc bulge contacts the left transversing\nL4 nerve root and moderately narrows the left neural foramina. Hypertrophy of\nthe bilateral facets and ligamentum flavum creates mild-moderate narrowing of\nthe spinal canal.\n\nL4-L5: A mild disc bulge and hypertrophy of the ligamentum flavum and\nbilateral facet result in moderate spinal canal and mild bilateral neural\nforaminal narrowing.\n\nL5-S1: There is a left, paracentral disc protrusion moderately narrowing the\nleft neural foramina and a contacting the exiting left L5 nerve root. No\nsignificant spinal canal stenosis is appreciated at this level.", "output": "Moderate, multilevel, multifactorial degenerative changes of the lumbar spine,\nas above, most significant at the levels of L3-L4 with a disc bulge moderately\nnarrowing the left neural foramina and contacting the left transversing L4\nnerve root." }, { "input": "There is mild scoliosis of lumbar spine convex to the left in the lower lumbar\nand to the right in the upper lumbar region.\n\nFrom T11-12 through L2-3 levels disc degenerative change and mild bulging\nseen. At L3-4 disc bulging is identified with mild-to-moderate right and mild\nleft foraminal narrowing without spinal stenosis. There is no significant\ninterval change since the previous MRI examination.\n\nAt L4-5 disc bulging and facet degenerative changes seen with no evidence of\nspinal stenosis with mild narrowing of the right foramen.\n\nL5-S1 level disc bulging identified with moderate left subarticular recess and\nmoderate-to-severe left foraminal narrowing with deformity of the exiting left\nL5 nerve root. Mild narrowing of the right foramen seen.\n\nThe distal spinal cord paraspinal soft tissues are unremarkable.", "output": "Mild scoliosis of lumbar spine which has slightly increased from the previous\nMRI. Left foraminal narrowing at L5-S1 level has increased with deformity of\nthe exiting left L5 nerve root. Otherwise no significant interval change." }, { "input": "Cervical spine: The vertebral body height and alignment is maintained. The\nbone marrow has a normal signal intensity. There are multilevel disc bulges\nbut no significant spinal canal or foraminal stenosis. The cervical spinal\ncord is normal in course, caliber, and signal. The paraspinal soft tissues are\nnormal.\n\nThoracic Spine: Vertebrae are normal in stature and alignment. There are\nSchmorl's nodes at the superior endplates of T6 and T7. The intervertebral\ndisc have normal height and signal intensities. There is significant spinal\ncanal or neural foraminal stenosis. The thoracic spinal cord is mildly\ndiffusely atrophic but normal in signal. The posterior paraspinal soft tissues\nare normal.\n\nLumbar spine: The vertebral body height and alignment is maintained. There\nare degenerative endplate changes at L1-2. The bone marrow otherwise has a\nnormal signal intensity. There are multilevel disc bulges but no significant\nspinal canal or foraminal stenosis. The conus medullaris and cauda equina have\nnormal morphology and signal intensities. The conus medullaris terminates at\nL1-L2 level. The paraspinal soft tissues are normal.\n\nThere are large bilateral pleural effusions, right greater than left.", "output": "1. No cord compression. Mild diffuse thoracic spinal cord atrophy but no cord\nsignal abnormality.\n2. Mild multilevel disc bulges of the cervical and lumbar spine but without\nsignificant spinal canal or foraminal stenosis.\n3. Large bilateral pleural effusions." }, { "input": "Alignment is normal. Vertebral body heights are preserved. There is no\nevidence of fracture. There is no evidence of ligamentous injury. There is\ntype ___ ___ endplate degenerative change at C6-C7. There is otherwise no\nfocal bone marrow signal abnormality. There is no prevertebral edema. There\nis loss of T2 signal of multiple intervertebral discs, a manifestation of\ndegenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved. The spinal cord appears normal in caliber and\nconfiguration. There are minimal disc bulges at C4-C5 and C6-C7 without\nsignificant spinal canal narrowing. There are mild multilevel facet\ndegenerative changes with mild neural foraminal narrowing at the left C6-C7\nlevel. There is otherwise no neural foraminal narrowing at other levels. \nThere is no evidence of infection or neoplasm. There is no diffusion\nabnormality.", "output": "1. No evidence of fracture or ligamentous injury.\n2. No cord signal abnormality.\n3. Minimal cervical spondylosis, as described, with minimal disc bulges at\nC4-C5 and C6-C7 without significant spinal canal narrowing and mild neural\nforaminal narrowing at the left C6-C7 level. The remainder of the neural\nforamina are widely patent." }, { "input": "Alignment is normal. Vertebral bodies are normal in height. Marrow signal is\nnormal. Intervertebral discs are preserved in signal with mild disc height\nloss at C5-6. The visualized posterior fossa is normal.\nC2-3: There is no disc herniation. There is no spinal canal or neural\nforaminal stenosis.\nC3-4: There is a central disc protrusion causing mild spinal canal narrowing\nand remodeling the ventral spinal cord. There is no cord signal abnormality.\nThere is no neural foraminal narrowing.\nC4-5: There is a central disc protrusion indenting the spinal cord but not\ncausing cord signal abnormality. There are uncovertebral osteophytes causing\nmild right neural foraminal stenosis. There is no left neural foraminal\nstenosis.\nC5-6: There is a large central disc protrusion, right greater than left,\ncompressing the spinal cord with increased signal within the spinal cord (see\nsagittal water-IDEAL series 3 image 9 and axial gradient series 5, image 35). \nThe disc protrusion also causes severe bilateral neural foraminal stenosis.\nC6-7: There is a large central disc protrusion compressing the spinal cord and\ncausing increased T2 signal within the spinal cord (axial T2 series 6, image\n32). The disc protrusion also causes severe right and moderate left neural\nforaminal narrowing.\nC7-T1: There is no disc herniation. There is no spinal canal or neural\nforaminal narrowing.\nThere is mucosal thickening of the maxillary sinuses.", "output": "1. C5-6 large disc protrusion compressing the spinal cord causing increased\ncord signal. The disc protrusion also cause severe bilateral neural foraminal\nstenosis at this level.\n2. C6-7 large disc protrusion compressing the spinal cord and causing\nincreased cord signal. The disc protrusion also causes severe right and\nmoderate left neural foraminal stenosis at this level.\n\nNOTIFICATION: Findings were discovered and discussed via phone, by Dr.\n___ of radiology with Dr. ___ the ___ at 18:07 ___." }, { "input": "Please note, study is partially limited due to motion artifact. Within the\nlimitations, findings are as follows:\n\nThere is 1 mm anterolisthesis of C2 on C3, 3 mm anterolisthesis of C4 on C5,\nand 2 mm retrolisthesis of C5 on C6. There is diffuse heterogeneous marrow\nsignal abnormality with areas of hyperintense T2/STIR signal, hypointense T1\nsignal, and enhancement, compatible with osseous metastasis. This is most\nprominent at C4 through T1 levels involving the posterior vertebral bodies.\n\nThe spinal cord demonstrates linear areas of hyperintense T2 signal within the\ncord (3:9) extending from C4 through C6 levels, which is felt to most likely\nrepresent Gibbs artifact. Otherwise, the spinal cord demonstrates no abnormal\nsignal intensity or enhancement.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: No spinal canal or neural foraminal narrowing.\n\nC4-C5: There is a central disc protrusion resulting in mild effacement of the\nventral spinal canal. In conjunction with bilateral uncovertebral joint and\nfacet arthropathy, there is mild right and no significant left neural\nforaminal narrowing.\n\nC5-C6: There is a left paracentral disc bulge with mild effacement of the\nventral spinal canal. In conjunction with bilateral uncovertebral joint\nhypertrophy and facet arthropathy, there is moderate left and mild right\nneural foraminal narrowing.\n\nC6-C7: There is a central and left paracentral disc protrusion resulting in\nmild effacement of the ventral spinal canal. In conjunction with bilateral\nuncovertebral joint hypertrophy and facet arthropathy, there is moderate left\nand mild right neural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.\n\nVisualize prevertebral paraspinal soft tissues are grossly unremarkable.", "output": "1. Diffuse heterogeneous bone marrow signal abnormality with enhancement\ninvolving the visualized cervicothoracic spine, compatible with osseous\nmetastasis, and correlating with findings on recent PET-CT.\n\n2. No abnormal enhancement or signal of the cord.\n3. Multilevel spondylosis, most advanced at C4 through C7 levels, as described\nabove." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. The\nmarrow signal is slightly heterogeneous which may represent marrow\nreconversion without evidence of focal suspicious lesion. Mild loss of disc\nheight and signal spanning L2-L3 through L4-L5 is identified. There is mild\nloss of disc signal L5-S1 with mild loss of height. The conus medullaris\nterminates at the L1-L2 level, within expected limits. There is no abnormal\nsignal or enhancement of the visualized cord, conus medullaris or cauda\nequina.\n\nThere are subcortical cystic changes of the L3-L4 and L4-L5 spinous process\nease, most prominently noted at L4-L5, with associated STIR hyperintense\nsignal of the interspinous ligaments, which may be seen in the setting of\nBaastrup's disease.\n\nT11-T12: On sagittal images, there is a small central protrusion which\nresults in mild spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nT12-L1 through L2-L3: No significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: A disc bulge crowds subarticular zones contacting but not displacing\nthe traversing nerve roots. There is mild bilateral neural foraminal\nnarrowing secondary to the disc and associated facet arthropathy. Small\nbilateral joint effusions are in noted.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum does not\nsignificantly narrow the spinal canal. There is mild bilateral neural\nforaminal narrowing secondary to facet arthropathy.\n\nL5-S1: A small central protrusion and facet arthropathy is identified without\nsignificant spinal canal or neural foraminal narrowing.\n\nThe patient is status post splenectomy and left nephrectomy with associated\nmild compensatory hypertrophy of the right kidney. No visualize\nlymphadenopathy.\n\nOn scout images, there is a right adnexal 4.1 cm cystic lesion.", "output": "1. No abnormal signal or enhancement of the visualized lumbar spine. No\nevidence of metastatic disease.\n2. Mild multilevel degenerative changes as described above without severe\nspinal canal or neural foraminal narrowing.\n3. Findings compatible with L3-L4 and L4-L5 Baastrup's disease. Clinical\ncorrelation is recommended.\n4. Incidentally noted 4 cm right adnexal cystic lesion on scout images. \nFollow-up with ultrasound for better evaluation.\n\nRECOMMENDATION(S): Recommend follow-up ultrasound for incidentally noted 4 cm\nright adnexal cystic lesion incompletely evaluated on scout images." }, { "input": "Please note the study is mildly degraded by motion.\n\nCERVICAL SPINE\n\nThere is mild retrolisthesis of C4 on C5 and C5 on C6. Vertebral body heights\nare preserved. T1 and T2 hyperintense signal in the C4 vertebral body, not\nvisualized on STIR, is consistent with fat and may represent ___ type 2\ndegenerative change or a hemangioma (2:7).\n\nAt the C4 vertebral body level, there is focal template T2 hyperintense signal\nin the posterior spinal cord, eccentric to the left, measuring 3 x 4 x 8 mm\n(AP x TV x SI). The cervicomedullary junction is within normal limits and the\ncervical spinal cord is otherwise normal in caliber and signal intensity.\n\nThere is diffuse loss of height and T2 signal of the intervertebral discs in\nthe cervical spine.\n\nAt C2-3 there is moderate loss of disc height, but no disc herniation.No\nvertebral canal or neural foraminal stenosis.\n\nAt C3-4 there is moderate loss of disc height and a broad-based posterior disc\nprotrusion.No significant vertebral canal or neural foraminal stenosis.\n\nAt C4-5 there is severe loss of disc height.No vertebral canal narrowing. \nThere is mild-to-moderate left neural foraminal narrowing.\n\nAt C5-6 there is moderate to severe loss of disc height, uncovertebral\nosteophytes, and a broad-based slightly inferiorly directed posterior disc\nprotrusion.There is mild vertebral canal narrowing. Neural foraminal\nnarrowing is moderate to severe on the left and moderate on the right.\n\nAt C6-7 there is mild loss of disc height and posterior disc and\nosteophytes.There is at least moderate vertebral canal narrowing with no\nappreciable CSF surrounding the spinal cord. There is moderate to severe\nright neural foraminal narrowing. There is mild left neural foraminal\nnarrowing..\n\nAt C7-T1 there is mild loss of disc height.No vertebral canal or neural\nforaminal stenosis\n\nWithin 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.\n\n\nTHORACIC SPINE\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin 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. The esophagus is patulous.", "output": "1. Study is mildly degraded by motion.\n2. Nonspecific nonenhancing T4 posterior cervical cord lesion, consistent with\nreported history of multiple sclerosis.\n3. No prior imaging is available for comparison to determine chronicity.\n4. Multilevel degenerative change in the cervical spine as described above\nwith up to moderate narrowing of the spinal canal at C6-7 and multilevel\nneural foraminal narrowing that is at least moderate at bilateral C5-6 and\nright C6-7." }, { "input": "CERVICAL:\nThe cervical spine alignment is normal. Mild multilevel intervertebral disc\ndesiccation is noted with preservation of intervertebral disc heights. \nVertebral body signal intensity appear normal. The spinal cord appears normal\nin caliber and configuration. There is a small posterior disc bulge and\nC3-C4, C4-C5, C5-C6 and C6-C7, without spinal canal narrowing. There is no\nevidence of spinal canal or neural foraminal narrowing. There is no evidence\nof infection or neoplasm. There is no abnormal enhancement after contrast\nadministration. There is no prevertebral soft tissue swelling. No enhancing\nparaspinal soft tissue lesions are seen.\n\nTHORACIC:\nThe thoracic spine alignment is normal. Vertebral body and intervertebral disc\nsignal intensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration. There is no prevertebral\nsoft tissue swelling. No enhancing paraspinal soft tissue lesions are seen.\n\nOTHER: There is mild dependent subsegmental left lung atelectasis.", "output": "1. No abnormal spine cord signal intensity, leptomeningeal enhancement, masses\nor abscess in the cervical or thoracic spine.\n2. No cervical or thoracic spinal canal or neural foraminal stenosis.\n3. Minimal cervical spinal spondylosis.\n4. Subsegmental left lung atelectasis." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies.\nThere is mild anterior wedge compression deformity of the T12 vertebral body\nwith T2 and STIR hyperintense signal abnormalities, favoring an acute time\nframe. There is approximately 20% loss of height anteriorly. The remaining\nlumbar vertebral body heights are maintained.\n\nThere is 5 mm retrolisthesis of L2 on L3 and 2 mm of retrolisthesis of L1 on\nL2. There is moderate to severe intervertebral disc height loss at L2-L3 with\nreactive marrow endplate T2 and STIR hyperintense edema. There is mild\nintervertebral disc height loss at L4-L5. There is a Schmorl's node in the\nsuperior L1 endplate.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of L1.\n\nT11-T12: There is mild left central disc protrusion resulting in deformation\nof the anterior left thecal sac and mild spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nT12-L1: There is mild disc bulge resulting in mild spinal canal narrowing. No\nsignificant neural foraminal narrowing.\n\nL1-L2: Mild right greater than left central disc protrusions with the\nformation of the ventral thecal sac and mild spinal canal narrowing. Mild\nbilateral neural foraminal narrowing.\n\nL2-L3: Mild disc bulge with superimposed left foraminal disc protrusion\nresulting in mild-to-moderate spinal canal narrowing. Mild right and moderate\nleft neural foraminal narrowing.\n\nL3-L4: Mild disc bulge, ligamentum flavum thickening, and mild epidural fat\nhypertrophy result in no significant spinal canal narrowing. There is\nmoderate right and mild-to-moderate left neural foraminal narrowing.\n\nL4-L5: There is disc bulge and ligamentum flavum thickening resulting in mild\nspinal canal narrowing. Moderate left greater than right neural foraminal\nnarrowing with the bilateral exiting L4 nerve roots contacting the disc.\n\nL5-S1: No significant spinal canal or neuroforaminal narrowing.\n\nOther: T2 hyperintense lesions in the visualized kidneys statistically likely\nrepresent cysts.", "output": "1. Mild anterior wedge compression fracture/deformity of the T12 vertebral\nbody with approximately 20% height loss. Findings are likely acute to\nsubacute.\n2. Moderate to severe intervertebral disc height loss at L2-L3 with reactive\nmarrow edema in the endplates.\n3. 5 mm of retrolisthesis of L2 on L3 and 2 mm of retrolisthesis of L1 on L2,\nlikely degenerative.\n4. Multilevel multifactorial lumbar spondylosis, most pronounced at L4-L5 with\nmoderate bilateral neural foraminal narrowing." }, { "input": "The present MRI and concurrent CTA demonstrate ossification of the anterior\nlongitudinal ligament, which is fractured at C5-6. There is prevertebral edema\nfrom C1-2 through T3-4 levels. There is widening of the anterior C5-6 disc\nspace and edema in the anterior disk. There is no evidence for bone marrow\nedema or loss of vertebral body height. There is posterior longitudinal\nligament ossification at C4-5 and C5-6, which is fractured at C5-6. There is a\nmild retrolisthesis of C5 on C6. Disruption of the ligamentum flavum at C5-6\nis suspected, image 6:23. There is no evidence for an epidural hematoma. There\nis interspinous edema at C4-5, C5-6, and C6-7, as well as edema in the midline\nposterior paravertebral muscles throughout the cervical spine.\n\nOssification of the anterior longitudinal ligament is also discontiguous at\nC4-5, but there is no edema in the C4-5 disk.\n\nThe craniocervical junction and the visualized portion of the posterior fossa\nappear unremarkable.\n\nAt C2-3, there is no spinal canal narrowing. There is mild right neural\nforaminal narrowing by facet arthropathy.\n\nAt C3-4, the vertebral bodies a nearly completely fused. There is a central\ndisc osteophyte complex which causes moderate spinal canal narrowing with\nflattening of the ventral spinal cord, as well as severe bilateral neural\nforaminal narrowing due to uncovertebral osteophytes. Cord signal is normal.\n\nAt C4-5, there is a central disc osteophyte complex causing moderate to severe\nspinal canal narrowing and compressing the spinal cord. There is also severe,\nright greater than left neural foraminal narrowing by uncovertebral\nosteophytes.\n\nAt C5-6, retrolisthesis and a large central disc osteophyte complex, larger on\nthe right, cause severe spinal canal narrowing with spinal cord compression.\nThere is high T2 signal in the spinal cord at C5 and C6, as well as possible\nlow signal on gradient echo sequence, image 5:30, which may indicate\nhemorrhagic contusion. Neural foramina are severely narrowed by uncovertebral\nand facet osteophytes.\n\nAt C6-7, the vertebral bodies are fused. There is a disc osteophyte complex\ncausing mild spinal canal narrowing but not contacting the spinal cord. There\nis severe bilateral neural foraminal narrowing by uncovertebral osteophytes.\n\nThere is a mild disc bulge at T2-3 without spinal canal narrowing.\n\nThere is a 7 mm oval lesion with high T2 signal and low T1 signal within the\nT2 vertebral body, which appears lucent on the concurrent CTA. This imaging\nappearance is indeterminate.\n\n5 mm oval T2 hyperintense focus in the left parotid gland on image 6:3\ndemonstrates no clear correlate on the concurrent CTA.", "output": "1. At C5-6, there is a fracture through the ossified anterior and posterior\nlongitudinal ligaments, and through the intervertebral disc space, as well as\ndisruption of the ligamentum flavum. There is interspinous ligament edema from\nC4-5 through C6-7 with overlying posterior paravertebral muscle edema. There\nis severe spinal canal stenosis at C5-6 compressing the spinal cord. Abnormal\nhigh T2 signal in the cord at C5 and C6 indicate mild edema, and possible\nblood products may indicate a cord contusion.\n2. While the ossified anterior longitudinal ligament is also discontiguous at\nC4-5, there is no evidence for edema or disruption of the C4-5 disk.\n3. Multilevel degenerative disease.\n4. Indeterminate 7 mm oval bone marrow lesion in the T2 vertebral body. If\nthere are no prior exams confirming its stability, then a followup MRI with\nintravenous contrast is recommended in 2 months for reassessment.\n5. 5 mm oval T2 hyperintense focus in the left parotid gland, without a clear\ncorrelate on the concurrent CTA, compatible with a lymph node or a benign\nmixed tumor. This may also be reassessed on followup with intravenous\ncontrast." }, { "input": "There is reversal of the cervical lordosis. Vertebral body height and\nalignment is otherwise preserved. There is degenerative disc disease with\nmild disc space height loss, predominantly seen at C5-C6. Bone marrow signal\nintensity appears preserved. There is no abnormal enhancement after contrast\nadministration.\n\nInnumerable metastatic lesions throughout the visualized posterior fossa and\nmedulla including a lesion within the upper cervical cord at the level of the\ndens-possibly the cervicomedullary junction are seen.\n\nThere are no metastatic lesions in the mid to lower cervical spinal cord.\n\nAt C2-C3, there is facet joint arthropathy and uncovertebral hypertrophy, no\nspinal canal stenosis or neural foraminal narrowing.\n\nAt C3-C4, there is facet joint arthropathy and uncovertebral hypertrophy, no\nspinal canal stenosis or neural foraminal narrowing.\n\nAt C4-C5, there is a central disc protrusion with remodeling of the ventral\ncord but no cord signal abnormality, facet joint arthropathy and uncovertebral\nhypertrophy, moderate spinal canal stenosis, no significant neural foraminal\nnarrowing.\n\nAt C5-C6, there is a central disc protrusion with remodeling of the ventral\ncord but no cord signal abnormality, facet joint arthropathy and uncovertebral\nhypertrophy, moderate spinal canal stenosis, mild bilateral neural foraminal\nnarrowing.\n\nAt C6-C7, there is a shallow disc bulge, facet joint arthropathy and\nuncovertebral hypertrophy, mild spinal canal stenosis, mild bilateral neural\nforaminal narrowing, right greater than left.\n\nAt C7-T1, there is facet joint arthropathy and uncovertebral hypertrophy, no\nspinal canal stenosis or neural foraminal narrowing.\n\nLimited evaluation of the posterior fossa structures demonstrate innumerable\nenhancing lesions throughout the cerebellum brainstem and medulla.\n\nAgain noted are several subcutaneous soft tissue lesions with central necrosis\nthroughout the chest (for example series 6, image 26 and 28) as well as along\nthe subcutaneous soft tissues of the back (series 6 image 31 and series 2\nimage 5 and 10). Allowing for differences in technique, these lesions appear\neither new or enlarged from the prior CT from ___.", "output": "1. Innumerable metastatic lesions throughout the visualized posterior fossa\nand medulla including a lesion within the upper cervical cord at the level of\nthe dens-possibly the cervicomedullary junction. Please refer to the report\nfor the MR brain performed concurrently for detailed intracranial findings.\n2. Several subcutaneous soft tissue lesions with central necrosis to out the\nchest and upper back, consistent with metastatic disease. Allowing for\ndifferences in technique, these lesions appear are either new or enlarged when\ncompared to the prior CT from ___.\n3. Degenerative changes of the cervical spine with moderate spinal canal\nstenosis at C4-C5 and C5-C6 with remodeling of the ventral cord but no cord\nsignal abnormality.\n4. No evidence of osseous metastatic lesions or other lesions within the mid\nto lower cervical spinal cord." }, { "input": "Vertebral body heights and alignment are preserved. Bone marrow signal shows\nno focal concerning abnormality. No fracture is identified. The conus\nmedullaris is normal in morphology and signal intensity ending at L1-L2.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is a right paracentral disc bulge without spinal canal or\nneural foraminal narrowing.\n\nAt L2-L3, L3-L4, and L4-L5, there is no spinal canal or neural foraminal\nnarrowing.\n\nAt L5-S1, there is disc desiccation with a central disc protrusion and annular\nfissuring without spinal canal or neural foraminal narrowing.", "output": "Disc bulge with central protrusion and annular fissuring at L5-S1.\n\nNo spinal canal or foraminal narrowing at any level. No fracture." }, { "input": "The examination is new moderately degraded by motion.\n\nThe alignment of the cervical spine is normal. The fractures involving the\nright C4 transverse process, right C6 superior facet, right C6 lamina, right\nC6 pedicle, and right C7 pedicle are better visualized on the CT cervical\nspine performed ___. The bone marrow in the vertebral bodies is\nnormal. The height of the vertebral bodies and intervertebral disc spaces are\nmaintained. The intervertebral discs are diffusely desiccated. There is no\nevidence of ligamentous injury. The spinal cord is normal in signal and\ncaliber without restricted diffusion. The craniocervical junction is normal. \nThe prevertebral soft tissues are normal. There is mild right paraspinal\nedema from C4-C7.\n\nAt C2-C3, there is no spinal canal or neural foraminal stenosis.\n\nAt C3-C4, there is a mild disc bulge and mild spondylosis without spinal canal\nor neural foraminal stenosis.\n\nAt C4-C5, broad-based disc bulge and bilateral facet arthropathy cause mild\nbilateral neural foraminal stenosis. There is no spinal canal stenosis.\n\nAt C5-C6, broad-based disc bulge and bilateral facet arthropathy, causing mild\nbilateral neural foraminal stenosis. There is no spinal canal stenosis.\n\nAt C6-C7, there is broad-based disc bulge and bilateral facet arthropathy\nwithout spinal canal or neural foraminal stenosis.\n\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.", "output": "1. No evidence of spinal cord injury or ligamentous injury.\n2. Fractures of the right C4 transverse process, right C6 superior facet,\nlamina, pedicle, and right C7 pedicle are better visualized on the prior CT of\nthe cervical spine.\n3. Multilevel degenerative changes of the cervical spine as detailed above." }, { "input": "There is normal cervical alignment. The vertebral body heights are preserved.\nThe marrow signal is unremarkable. There is mild low intervertebral disc\nsignal, without significant loss of height.\n\nAt C5-C6, there is a left sided disc protrusion extending from the central to\nthe left foraminal zones likely compressing the exiting left C6 nerve root. \nThis effaces the thecal sac, contacting mildly deforming the left aspect of\nthe cord without associated edema or myelomalacia. (06:22; 2:6).\n\nThere is no significant neural foraminal or spinal canal stenosis at the\nremaining levels. The paravertebral soft tissues are unremarkable.", "output": "1. C5-C6 left sided disc protrusion with extending from the central to left\nforaminal zones likely compressing the exiting left C6 nerve root. This\neffaces the thecal sac, contacting and mildly deforming the left aspect of the\ncord without associated cord edema or myelomalacia." }, { "input": "Grade 1 retrolisthesis is seen involving L4 on L5. No bone marrow signal\nabnormalities are identified. The cord terminates at L1. No terminal cord\nsignal abnormalities are seen. Diffuse loss of the normal T2 signal seen\nthroughout the intervertebral discs of the lumbar spine.\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: A posterior annular fissure is seen within the intervertebral disc as\nwell as mild disc bulge however there is no spinal canal narrowing. There is\nno significant neural foraminal narrowing.\n\nL3-L4: Disc bulge with a focal left foraminal disc protrusion is seen, which\nin conjunction with facet joint osteophytes and ligamentum flavum thickening. \nFacet joint osteophytes contribute to mild bilateral neural foraminal\nnarrowing, left greater than right.\n\nL4-L5: Disc bulge with left paracentral disc protrusion is seen, resulting in\ncontact with the traversing left L5 nerve root. Facet joint osteophytes and\nligamentum flavum thickening results in mild spinal canal narrowing. Facet\njoint osteophytes contribute to moderate left and mild right neural foraminal\nnarrowing.\n\nL5-S1: Mild disc bulge is seen however there is no significant spinal canal\nnarrowing. Facet joint osteophytes contribute to mild bilateral neural\nforaminal narrowing.\n\nNo paraspinal or paravertebral soft tissue abnormalities are identified.", "output": "1. Lumbar spondylosis, most pronounced at L4-L5 with left paracentral disc\nprotrusion resulting in contact with the traversing left L5 nerve roots and\nmoderate left neural foraminal narrowing.\n2. No terminal cord signal abnormalities identified." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nCERVICAL, THORACIC, AND LUMBAR SPINE:\n\nThere is dextroscoliosis of the thoracic spine and levoscoliosis of lumbar\nspine. L1 vertebral body chronic minimal anterior compression deformity is\nnoted. Otherwise, vertebral body heights are preserved. There is\nsacralization of the L5 vertebral body. Multiple Schmorl's nodes are seen\nthroughout the cervical, thoracic, and lumbar spine. There is no prevertebral\nsoft tissue swelling. Grossly stable nonspecific C5 and C6 probable edema are\nagain noted. L1 vertebral body probable hemangioma is noted.\n\nPatient's previously noted mid C4 spinal cord bilateral gray matter lesion is\ngrossly unchanged (see 16, 17, 18, 26:9; 22, 20:22 on current study and 5, 6,\n7:8; 08:21 prior exam). Question minimal enhancement of left hemicord versus\nartifact (see 16, 17, 18, 26:7; 22, 28: ___.\n\nOtherwise, the visualized portion of the spinal cord is grossly preserved in\nsignal. The conus is noted at approximately mid L1 level.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine. There is loss of intervertebral disc height and signal at L1-2 and\nL2-3. Nonspecific facet joint fluid is noted at multiple levels throughout\nthe lumbar spine. Nonspecific probable dependent edema is noted in the dorsal\nlumbar soft tissues.\n\nAt C2-3 there is central disc protrusion, novertebral canal and no neural\nforaminal narrowing.\n\nAt C3-4 there is disc bulge, central disc protrusion, ligamentum flavum\nthickening, deformation of the ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, moderate to severevertebral canal\nand severe bilateral neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy,\ncentral disc protrusion, deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality, moderate to\nseverevertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, central disc protrusion, facet joint hypertrophy,\nligamentum flavum thickening, deformation of the ventral thecal sac and spinal\ncord without definite associated cord signal abnormality, moderatevertebral\ncanal and severe bilateral neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, ligamentum flavum\nthickening, facet joint hypertrophy, deformation of the ventral thecal sac and\nspinal cord without definite associated cord signal abnormality,\nmoderatevertebral canal, moderate left and severe rightneural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nDisc bulges are noted at multiple levels throughout the thoracic spine without\ndefinite evidence of moderate or severe vertebral canal or neural foraminal\nnarrowing.\n\nThere is suggested congenitally short pedicles from the L2 through L5\nvertebra.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, epidural fat, right central disc protrusion, disc\nbulge, ligamentum flavum thickening, facet joint hypertrophy,\nmoderatevertebral canal and no neural foraminal narrowing.\n\nAt L2-3 there is epidural fat, disc bulge, central disc protrusion, facet\njoint hypertrophy, ligamentum flavum thickening, moderatevertebral canaland\nmild leftneural foraminal narrowing.\n\nAt L3-4 there is epidural fat, facet joint hypertrophy, ligamentum flavum\nthickening, disc bulge contacts bilateral exiting L3 nerve roots, central disc\nprotrusion, moderate to severevertebral canal, mild left and severe\nrightneural foraminal narrowing.\n\nAt L4-5 there is disc bulge, central disc protrusion, facet joint hypertrophy,\nligamentum flavum thickening, mild-to-moderatevertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, mildvertebral canal and mild\nbilateral neural foraminal narrowing.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified.\n5 mm left thyroid nodule is noted (see 23, 29:2).", "output": "1. Study is moderately degraded by motion.\n2. Minimal interval progression of multilevel cervical spondylosis as\ndescribed, again most pronounced at C3-4 there is moderate to severe vertebral\ncanal and severe bilateral neural foraminal narrowing.\n3. C4-5 moderate to severe vertebral canal and moderate bilateral neural\nforaminal narrowing.\n4. C5-6 moderate vertebral canal and severe bilateral neural foraminal\nnarrowing.\n5. C6-7 moderate vertebral canal, moderate left and severe right neural\nforaminal narrowing.\n6. Grossly stable C4 nonenhancing cervical spinal cord gray matter lesion\ncompared to ___ prior cervical spine MRI.\n7. Question minimal left hemicord enhancement versus artifact at mid C4 level.\nIf not artifactual, differential considerations include traumatic,\ninflammatory, and neoplastic etiologies. Consider short-term follow-up\ncontrast cervical spine MRI in ___ months to evaluate for stability.\n8. Within limits of study, no definite evidence of additional spinal cord\nlesion or abnormal enhancement.\n9. Multilevel lumbar spondylosis, epidural fat and probable congenitally short\npedicles, as described, most pronounced at L3-4 where there is disc bulge\nwhich contacts bilateral exiting L3 nerve roots, moderate to severe vertebral\ncanal, mild left and severe right neural foraminal narrowing.\n10. L1-2 and L2-3 moderate vertebral canal narrowing.\n11. 5 mm left thyroid nodule.\n\nRECOMMENDATION(S): Grossly stable C4 nonenhancing cervical spinal cord gray\nmatter lesion compared to ___ prior cervical spine MRI. Question minimal\nleft hemicord enhancement versus artifact at this level. If not artifactual,\ndifferential considerations include traumatic, inflammatory, and neoplastic\netiologies. Consider short-term follow-up contrast cervical spine MRI in ___\nmonths to evaluate for stability.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:36 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Study is severely degraded by motion, especially on axial imaging. Within\nthese confines:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nGrossly stable nonspecific probable type ___ ___ changes of the C5-6 endplates\nand question edema the C5 and C6 vertebral bodies is again noted.\n\nAt upper to mid C4 level spinal cord gray matter hyperintensity is grossly\nunchanged (see 8: 16; 09:17 on current study and 22:22 on ___\nprior exam). Previously noted small focus of enhancement along the left upper\nC4 lateral margin is grossly unchanged (see 16:16; 15:8 on current study and\n28:20; 26:7 on ___ prior exam).\n\nThere is again noted loss of intervertebral disc height and signal throughout\ncervical spine. Nonspecific facet joint fluid is again noted at multiple\nlevels throughout cervical spine.\n\nAt C2-3 there is central disc protrusion, no vertebral canal and no neural\nforaminal narrowing.\n\nAt C3-4 there is disc bulge, central disc protrusion, ligamentum flavum\nthickening, deformation of the ventral thecal sac and spinal cord, moderate to\nsevere vertebral canal and severe bilateral neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy,\ncentral disc protrusion, deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality, moderate to severe\nvertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, central disc protrusion, facet joint hypertrophy,\nligamentum flavum thickening, deformation of the ventral thecal sac and spinal\ncord without definite associated cord signal abnormality, moderate vertebral\ncanal and severe bilateral neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, ligamentum flavum\nthickening, facet joint hypertrophy, deformation of the ventral thecal sac and\nspinal cord without definite associated cord signal abnormality, moderate\nvertebral canal, moderate left and severe right neural foraminal\nnarrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\n OTHER:\nLimited imaging of posterior fossa suggests focal enhancement along cerebellar\ntonsil (see 15:7). No definite paravertebral or paraspinal mass identified.", "output": "1. Study is severely degraded by motion.\n2. Grossly stable C4 spinal cord nonenhancing lesion compared to ___ prior cervical spine MRI, again compatible with myelomalacia.\n3. Grossly stable small focus of enhancement along the left upper C4 lateral\nmargin grossly unchanged compared to ___ prior exam. Motion again\nlimits evaluation spatial localization of this finding, and enhancement may be\nalong epidural margin of spinal cord or thecal sac. If finding is not\nspecifically of the spinal cord, differential considerations include volume\naveraging of adjacent vessel, and schwannoma. Recommend attention on followup\nimaging.\n4. Otherwise, grossly stable extensive multilevel cervical spondylosis\ncompared to ___ prior exam as described.\n5. Limited imaging of posterior fossa, not definitely included on prior study\nsuggests punctate left cerebellar tonsil enhancement. While finding may\nrepresent partially visualized vessel, if concern for posterior fossa mass,\nconsider dedicated contrast brain MRI for further evaluation.\n\nRECOMMENDATION(S): Grossly stable small focus of enhancement along the left\nupper C4 lateral margin grossly unchanged compared to ___ prior\nexam. Motion again limits evaluation spatial localization of this finding, and\nenhancement may be along epidural margin of spinal cord or thecal sac. If\nfinding is not specifically of the spinal cord, differential considerations\ninclude volume averaging of adjacent vessel, and schwannoma. Recommend\nattention on followup imaging." }, { "input": "Focal bony abnormalities due to metastatic disease are again identified\ninvolving predominantly the L1-L2 and L4 vertebral bodies. The bones\ninvolvement of L1 vertebra as well as that of the L4 vertebra has slightly\nincreased. Mild increase is also seen in the involvement of the L2 vertebra. \nThere is slight increase in paraspinal soft tissues on the left side at L2\nlevel with increased soft tissues within the left L2-3 neural foramen since\nthe previous MRI examination. There soft tissue changes extends to the left\nside of the thecal sac at this level without significant compression. The\ndistal spinal cord is normal in appearance.", "output": "Progressive bony metastatic disease and increase in left paraspinal soft\ntissue lesion at L2 level with increased extension to the neural foramen at\nL2-3 level and to the left side of the thecal sac since the previous MRI\nexamination. No evidence of high-grade thecal sac compression. These\nfindings are consistent with the observation on CT of the abdomen." }, { "input": "Interval replacement of the L1 through 4 vertebral bodies, consistent with\nradiation. Numerous bony metastases from L1 through S1 are redemonstrated,\nand unchanged in size and extent in the interval. In particular, the lesion\ninvolving the left L2 pedicle and facet joints is redemonstrated. Adjacent\nedema and soft tissue enhancement, however appears decreased.\n\nConus terminates at L1. Distal spinal cord, conus medullaris, and cauda\nequina nerve roots appear normal, without suspicious enhancement.\n\nMultilevel mild degenerative disc disease. Individual levels are as follows:\nL3-4: Mild disc bulge. Otherwise unremarkable.\n\nL4-5: Disc bulge with a left foraminal protrusion and annular fissure is\nminimally increased. No significant spinal canal stenosis. Mild left neural\nforaminal narrowing.\n\nL5-S1: Unchanged small right nerve root sleeve diverticulum. Otherwise\nunremarkable.", "output": "Interval radiation marrow from L1-4. Decreased edema and enhancement\nassociated with the left L2 pedicle and facet lesion. No new or progressive\ndisease." }, { "input": "Minimally enhancing T1 intrinsically hypointense and T2 hyperintense\nmetastatic lesions of the superior endplate of L1 and left superior facet,\nleft L2 posterior body, left pedicle and left L2-L3 facets, L2 spinous\nprocess, L3 spinous process, L4 left pedicle and facets and right L4 superior\nendplate is unchanged from examination of ___ but increased in\nprominence from examination of ___. No definitive new osseous lesions\nare identified. Vertebral body heights are preserved. There is mild\nincreased T1 hyperintense signal of the L1 through L4 vertebral bodies,\ncompatible with prior radiation treatment. There is no evidence of epidural\nextension of these lesions.\n\nDisc heights are preserved. The conus medullaris terminates at the L1-L2\nlevel, within expected limits. There is no signal abnormality or abnormal\nenhancement of the visualized cord, conus medullaris or cauda equina.\n\nThere are mild degenerative changes throughout the lumbar spine without\nsignificant spinal canal or neural foraminal narrowing.\n\nA 3 mm left peripheral superior renal simple cyst is noted. Otherwise, the\nremainder the prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Unchanged appearance of multiple metastatic lesions of the lumbar spine\nwithout evidence of soft tissue extension into the spinal canal or neural\nforamina since examination of ___. Most of these lesions are\nnew or more prominent when compared to examination of ___." }, { "input": "Alignment is anatomic. There is no fracture. Vertebral body and disc heights\nare preserved. Spinal cord appears normal in caliber and configuration\nwithout abnormal enhancement. Foci of low signal on T1 and T2 weighted images\nwith minimal enhancement are seen in the L1 superior endplate, L2 left\nposterior body extending into the left pedicle and left superior and inferior\nfacets, L3 right posterosuperior endplate, right L4 superior endplate, and\nleft L4 pedicle, consistent with known metastatic disease. These lesions are\nsimilar in appearance compared to MRI ___, and correspond to areas of\nsclerosis on CT from ___. The conus medullaris terminates at the\nL1-L2 level. There are mild degenerative changes throughout the lumbar spine.\n\nFrom T12-L1, through L2-L3 levels, there is no spinal canal or neural\nforaminal stenosis.\n\nAt L3-L4, there is mild anterior disc bulge, unchanged. There is no spinal\ncanal or neural foraminal stenosis.\n\nAt L4-L5, there is mild bilateral and anterior disc bulge, unchanged. There\nis no spinal canal or neural foraminal stenosis.\n\nAt L5-S1, is no spinal canal or neural foraminal stenosis.\n\nLimited evaluation of the intra-abdominal structures is unremarkable.", "output": "1. Similar appearance known lumbar metastatic disease, with no evidence of new\nmetastatic lesions when compared to MR dated ___.\n2. Similar appearance of mild multilevel degenerative changes as described\nabove." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. Since\nMRI of ___, there is interval diffuse infiltrative disease\nthroughout the entire visualized lower thoracic spine, lumbar spine and\nvisualized sacrum and iliac bones. The lesions involve the vertebral bodies\nas well as some of the lateral and posterior elements. No evidence of\nabnormal soft tissue extension with cortical breakthrough into the epidural or\nprevertebral spaces.\n\nSignal abnormality of the T10 vertebral body seen on scout images likely\ncorresponds to known blastic sclerotic lesion described on prior CT abdomen\nand pelvis ___ and ___.\n\nThe cauda equina terminates at the L1-L2 level, within expected limits. There\nis no abnormal signal or enhancement of the terminal cord, conus medullaris or\ncauda equina.\n\nT11-T12 through L3-L4: Mild degenerative changes not significantly narrow the\nspinal canal or neural foramina. Prominent sclerosis of the left L2 pedicle\nand facets are unchanged from prior exam.\n\nL4-L5: A left foraminal to central zone disc protrusion with annular fissure\ndoes not narrow the spinal canal. In conjunction with facet arthropathy,\nthere is mild left neural foraminal narrowing and no significant right neural\nforaminal narrowing.\n\nL5-S1 there is no significant spinal canal narrowing. aa a prominent right\nfacet synovial cyst flattens the exiting right L5 nerve root (series 5, image\n16; series 8, image 36). Facet arthropathy results in mild bilateral neural\nforaminal narrowing.\n\nPerineural cysts are noted in the bilateral S2-S3 neural foramina.\n\nThe visualized prevertebral and paraspinal soft tissues are grossly\nunremarkable.", "output": "1. Since examination of ___, interval diffuse infiltration of the\nmarrow throughout the visualized lower thoracic spine, lumbar spine, sacrum\nand iliac bones, concerning for worsening disease. Clinical correlation is\nrecommended. No evidence of soft tissue expansion or cortical erosion\ninvolving the epidural space or prevertebral spaces.\n2. No abnormal enhancement or signal involving the terminal cord, conus\nmedullaris or cauda equina.\n3. Minimal degenerative changes without high-grade spinal canal or neural\nforaminal narrowing. At L5-S1, a right facet synovial cyst does appear to\nimpinge on the exiting right L5 nerve root.\n4. Additional findings described above." }, { "input": "Thoracic spine:\n\nCorresponding with the findings on the radionuclide bone scan, there is a\npattern of diffuse infiltration of essentially all thoracic vertebrae by a\nheterogeneous signal pattern, as well as variable enhancement, consistent with\nwidely disseminated metastatic disease. However, despite this extensive tumor\nburden, there is negligible cord compression. There is no abnormal signal\nwithin the spinal cord. There is a likely small dorsal epidural tumor deposit\nat T4, which contacts the dorsal thecal sac margin, but does not compress the\nspinal cord. Within the limitations imposed by extensive pulsation artifacts\ndegrading the axial post-contrast enhanced scans, no other definite areas of\nabnormal enhancement are seen.\n\nAt the T10 level, there is a right paraspinal soft tissue mass, which was also\npresent on the prior CT scan of the chest from ___. Given the\nextensive bony metastatic disease, paraspinal tumor is most likely\nresponsible. There is a tiny, right sided dependent pleural fluid collection.\n\nA small, ovoid region of elevated T2 signal within the right lobe of the liver\nwas described in a report of a CT scan of the abdomen and pelvis from ___ 18 and was felt to represent either a biliary hamartoma or cyst.\n\nLumbar spine:\n\nWhen compared to the prior lumbar spine study from ___, there has\nbeen substantial progression of what was previously noted to be an\ninfiltrative pattern of metastatic disease, with particularly prominent\nprogression seen involving the T11 and 12 vertebral bodies, and to a lesser\nextent within the lumbar region. As is the case in the thoracic region, the\ntumor enhances in a heterogeneous fashion. However, despite this increasing\ndisease burden, there does not appear to have been development of a\npathological fracture. As a result, there is no new neural compressive change\nidentified. No new abnormality of the visualized distal thoracic spinal cord,\nconus medullaris, cauda equina, or limited lumbar paraspinal soft tissue\nimaging is identified. Again seen is extensive infiltration of both iliac\nbones, as well as the visualized upper sacrum.", "output": "Progression of metastatic disease involving the lumbar spine. Extensive\nthoracic spine spinal metastatic disease. Please see above report for\ndetails.\n\nComment: The low resolution sagittal scout images, used for purposes of\ncounting the thoracic vertebrae, suggests multiple areas of metastases\ninvolving the cervical spine, but without overt evidence for cord compression.\nMore definitive imaging of the cervical spine would be necessary to fully\naddress these observations." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. \nDiffuse metastatic lesions are seen throughout the thoracic and visualized\nupper cervical spine in both the vertebral bodies and posterior elements. \nDisc heights are maintained.\n\nEnhancing rounded lesions measuring up to 7 mm are seen in the left pons and\nright inferior cerebellar hemisphere, compatible with metastatic disease.\n\nIn addition, there is a peripheral 5 mm likely extramedullary enhancing lesion\n(series 7, image 18) along the right dorsal aspect of the cord at C6 with\nassociated abnormal cord signal spanning C5 through C7 measuring approximately\n2-3 mm thick (series 2, image 7).\n\nAlong the dorsal T4 epidural space is mild STIR hyperintense enhancing focus,\nsimilar in appearance to prior examination, likely representing soft tissue\nextension of osseous lesion (series 3, image 9; series 8, image 8).\n\nC2-C3 through C4-C5: Mild degenerative changes not significantly narrow the\nspinal canal or neural foramina.\n\nC5-C6: A small central protrusion and thickening of the ligamentum flavum\nresults in mild spinal canal narrowing. Uncovertebral and facet arthropathy\nresults in mild neural foraminal narrowing.\n\nC6-C7: A right central protrusion results in mild spinal canal narrowing,\nminimally remodeling the ventral aspect of the cord without underlying cord\nsignal change. Uncovertebral and facet arthropathy results in mild bilateral\nneural foraminal narrowing.\n\nC7-T1: No significant spinal canal or neural foraminal narrowing.", "output": "1. Multiple small rounded lesions measuring up to 7 mm noted in the posterior\nfossa including the left pons and right inferior cerebellar hemisphere\ncompatible with metastatic disease.\n2. 5 mm likely extramedullary peripheral enhancing lesion along the right\ndorsal aspect of the C6 cord with associated abnormal cord signal spanning C5\nthrough C7.\n3. Enhancing STIR hyperintense signal along the dorsal T4 epidural space\ncompatible with soft tissue extension of osseous lesion.\n4. Mild degenerative changes without high-grade spinal canal or neural\nforaminal narrowing.\n\nRECOMMENDATION(S): Recommend further evaluation of intracranial metastatic\ndisease with MRI head with without contrast.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:31 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Again multiple punctate nodular enhancing metastatic lesions are visualized in\nthe posterior fossa, partially evaluated and better depicted in the concurrent\ndedicated MRI of the brain, please refer to this report for details, this\nlesions were previously demonstrated on the MRI of the head dated ___. The cervical spine alignment is maintained. Vertebral body heights are\npreserved. The signal intensity in the bone marrow is heterogeneous\nconsistent with bone marrow infiltration from breast metastatic disease. \nThere is a grossly unchanged avidly enhance likely extramedullary lesion\n(image 9, series 15, image 19, series 16), measuring approximately 5 x 5 mm in\ntransverse and sagittal projections.\nThere is unchanged T2/STIR intramedullary hyperintense signal spanning from C5\nthrough C7 levels likely consistent with spinal cord edema (image 8, series\n9).\n\nUnchanged multilevel degenerative changes from C2-C3 through C5-C6 levels.\n\nAt C6-C7 level there is a right paracentral disc protrusion causing mild\nspinal canal narrowing and remottling the ventral aspect of the thecal sac\nwith no evidence of underlying coursing unchanged bilateral uncovertebral\nhypertrophy causes mild bilateral neural foraminal narrowing and appears\ngrossly unchanged.\n\nAt C7-T1 level, there is no evidence of neural foraminal narrowing or spinal\ncanal stenosis.\n\nThe visualized paravertebral structures are grossly unremarkable.", "output": "1. Unchanged numerous metastatic lesions identified in the posterior fossa,\nbetter depicted in the concurrent prior MRI examinations of the head.\n2. Unchanged 5 x 5 mm extramedullary peripherally and avidly enhancing lesion\nalong the right-sided at C6 level.\n3. Unchanged signal abnormality within the spinal cord spanning from C5\nthrough C7 levels, detected on T2 and STIR sequences, consistent with spinal\ncord edema.\n4. Unchanged heterogeneous signal identified the bone marrow, consistent with\nbreast metastatic disease.\n5. Unchanged degenerative changes at C6-C7 level." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignated the T1 level.\n\nTHORACIC SPINE:\n Vertebral body alignment is preserved. Vertebral body heights are grossly\npreserved.\n\nThere is extensive osseous metastatic disease throughout all of the thoracic\nvertebra, as well as multiple ribs bilaterally, similar compared to the MRI\ndated ___.\n\nThere is enhancing soft tissue within the left aspect of spinal canal at\nT5-T6, which appears directly contiguous with the spinal cord and extends into\nthe left neural foramen (series 19, image 21 and series 7, image 7), likely\ninvolving the exiting nerve root.\n\nHeterogeneously enhancing soft tissue adjacent to the right anterolateral T9\nand T10 vertebral bodies is similar compared to the prior chest CT, measuring\napproximately 4.3 x 1.2 cm (series 18, image 14).\n\nThe visualized portion of the spinal cord is otherwise preserved in signal and\ncaliber. Intervertebral disc heights and signal are preserved.\n\nOtherwise, the thoracic vertebral canal and neural foramina are patent without\nevidence of stenosis.\n\nLUMBAR SPINE:\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\n\nAgain, there is extensive osseous metastatic disease throughout all of the\nlumbar vertebra, extending into the sacrum, as well as the iliac bones\nbilaterally, similar in distribution compared to the MR dated ___.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber,\nterminating at L1-2.\n\nThere is loss of intervertebral disc signal throughout the lumbar spine.\n\nThere is minimal disc bulging at L2-3 and L3-4 without evidence of high-grade\nspinal canal stenosis.\n\nThere is mild neural foraminal stenosis from L2-3 through L4-5 on the right.\n\nThere is mild neural foraminal stenosis L2-3 and L3-4 the left.\n\nModerate neural foraminal stenosis at L4-5 on the left.\n\nA perineural cyst is seen within the neural foramina of L5-S1 on the right. \nMultiple additional perineural cysts are seen along sacral nerve roots\nmeasuring up to 7 mm, mostly on the right.\n\nOTHER:\nThere are small bilateral pleural effusions, new compared to ___.\n\nSubcentimeter T2 hyperintense nodular lesions within the right lung (series 9,\nimage 15, 17) are noted.\n\nSubcentimeter T2 hyperintense lesion at the liver dome is compatible with a\ncyst as seen on the prior abdominal CT.\n\nThere is a moderate amount of fluid dependently within the pelvis, also as\nseen on the prior CT", "output": "1. Study is mildly degraded by motion.\n2. Extensive osseous metastatic disease throughout all of the thoracic and\nlumbar vertebral bodies, as well as multiple ribs, the sacrum, and the iliac\nbones bilaterally, similar in distribution compared to the MR dated ___.\n3. Left T5-6 epidural enhancing soft tissue, which extends into the left\nneural foramen and likely involves the exiting nerve root, concerning for\ntumor progression.\n4. Stable enhancing soft tissue adjacent to the right anterolateral T9 and T10\nvertebral bodies spanning 4.3 (CC) x 1.2 (AP) cm.\n5. Mild to moderate spondylitic changes within the lumbar spine without\ndefinite high-grade spinal canal stenosis, and with moderate neural foraminal\nstenosis at L4-5 on the left.\n6. Two subcentimeter T2 hyperintense nodular lesions within the right lung,\nwhich should be further evaluated with a dedicated chest CT, either now or as\npart of this patient's next staging examination.\n7. New small bilateral pleural effusions. Unchanged moderate pelvic free\nfluid.\n\nRECOMMENDATION(S): Dedicated chest CT, either now or as part of this\npatient's next staging examination.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "CERVICAL:\nVertebral body height and alignment is preserved.\nUnchanged diffuse metastases involving bones the cervical spine.\nStable 5 mm intradural and extramedullary, round enhancing lesion at the C6-C7\nlevel. Stable adjacent posterior cord edema C5 through C7 level, mild cord\nexpansion.\nNo epidural tumor in the cervical spine.\nStable multilevel degenerative changes of the cervical spine, most pronounced\nat C6-C7 where there is a right paracentral disc protrusion with mild\nindentation of ventral cord and mild spinal canal stenosis but no significant\nneural foraminal narrowing.\n\n\nTHORACIC:\nComparison thoracic spine MRI ___.\nVertebral body height and alignment is preserved.\nSlightly worsened epidural enhancing soft tissue, example T5 level, in the\nleft aspect of the spinal canal at the T4-T7, causing mild-to-moderate central\ncanal narrowing, similar. No cord flattening. No cord T2 signal abnormality.\nEnhancing soft tissue component along the anterolateral aspect of the T9\nthrough T11 vertebral bodies appears similar when compared to ___\n(series 17, image ___.\nSurface enhancement about the cord at T7 likely represent leptomeningeal\nmetastases, similar.\nStable diffuse bone metastases.\nNo cord edema.\nThere are mild multilevel degenerative changes throughout the thoracic spine\nwithout significant spinal canal stenosis or neural foraminal narrowing.\n\nLUMBAR:\nThere is straightening of the lumbar lordosis. Vertebral body height and\nalignment is preserved.\nStable diffuse bone metastases. No epidural tumor. Tumor extends into the\nleft L1-L2, left L2-L3 foramina, also seen on prior.\nDiffuse leptomeningeal metastases lumbar spine, new or worsened since prior.\nThe spinal cord appears normal in caliber and configuration. The conus\nterminates normally at the L1-L2 level.\n\nUnchanged mild degenerative changes throughout the lumbar spine with\nmultilevel mild tumor and neural foraminal narrowing. Again noted are small\nperineural cysts in the sacral region.\n\nOTHER:\n\nMultiple enhancing metastatic lesions throughout the visualized posterior\nfossa are again partially seen.\nThere are small bilateral pleural effusions.\nSeveral metastatic lesions also seen along the bilateral ribs, sacrum and\npelvis, unchanged.\nThere are several well-circumscribed T2 hyperintense lesions in the visualized\nliver.\nModerate left hydronephrosis.", "output": "1. Diffuse osseous spine metastases, similar.\n2. Midthoracic spine epidural tumor extension, slightly worsened at T5,\nsimilar overall mild-to-moderate central canal narrowing.\n3. Findings consistent with Leptomeningeal metastases thoracic, lumbar spine,\nworsened. Infection could have similar appearance.\n4. Stable extramedullary metastasis cervical spine, stable C5-C7 cord edema.\n5. No cord compression.\n6. No compression fracture.\n7. Small bilateral pleural effusions.\n8. Moderate left hydronephrosis." }, { "input": "Diffuse osseous metastatic disease in the visualized lower thoracic, lumbar\nand upper sacral regions is unchanged compared to the prior study. No acute\npathologic compression fracture is identified. Overall considering the\nextensive nature of the metastatic disease, there has been no significant\ninterval change.\n\nEnhancement within the nerve roots in the lumbar region is unchanged compared\nto the prior study and could indicate leptomeningeal metastasis as suggested\npreviously. There is essentially no change in the enhancement pattern and the\nintensity compared to the prior study.\n\nNo abnormal signal is seen in the distal spinal cord. Prominent left renal\npelvis is again noted.", "output": "1. Diffuse bony metastatic disease is unchanged compared to the previous MRI\nstudy.\n2. Leptomeningeal nerve root enhancement is unchanged compared to the prior\nstudy.\n3. No evidence of an acute pathologic fracture.\n4. No epidural metastatic extension is identified or high-grade thecal sac\ncompression seen." }, { "input": "There is mild leftward deviation of the thoracic spine with may be positional\nversus secondary to scoliosis. There is possible mild straightening with\nslightly decreased thoracic kyphosis.\nThere is mild T1 hyperintensity consistent with ___ type 2 changes adjacent\nto the superior endplate of the T7 vertebral body.\nThere is T1 hyperintensity likely representing focal fat within the T8\nvertebral body. Vertebral body marrow signal is otherwise unremarkable. There\nis no evidence of bone marrow edema.\n\nIntervertebral disc signal is normal. Minimal bulge/ small protrusions noted\nin the mid thoracic spine indenting the thecal sac outline.\nNo disc herniation, no canal or foraminal narrowing appreciated.\n\nThe spinal cord appears normal in caliber and configuration.\nEvaluation of facet joints is slightly limited however there is likely mild\nfacet degenerative changes in the lower thoracic spine. There is no evidence\nof spinal canal or neural foraminal narrowing.\nThere is no evidence of infection or neoplasm.\n\nA 13 mm T2 hyperintense focus is noted in the spleen. This could represent a\ncyst or hemangioma.", "output": "1. Minimal disk bulge/small protrusions in the mid thoracic spine indenting\nthe thecal sac outline. No disc herniation, no canal or foraminal narrowing.\nMild straightening with slightly decreased thoracic kyphosis- correlate\nclinically.\n\n2. Leftward deviation of the thoracic spine which may be positional versus a\nmild scoliotic curvature.\n\n3. 13 mm T2 hyperintense lesion in the spleen. This may represent a cyst or\nhemangioma. Correlation with ultrasound could be obtained for further\nevaluation." }, { "input": "Alignment is normal. Vertebral body heights and signal intensities are\npreserved. There is mild-to-moderate disc desiccation throughout the cervical\nspine. The imaged portion of the spinal cord is normal in caliber and\nconfiguration. There is no abnormal enhancement after contrast\nadministration.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, there is a central intervertebral osteophyte that minimally indents\nthe spinal canal. There are small uncovertebral and facet osteophytes that do\nnot produce appreciable neural foraminal narrowing.\n\nAt C4-5, there are small intervertebral osteophytes that contribute to mild\nspinal canal narrowing. A left uncovertebral osteophyte mildly narrows the\nneural foramen. No right neural foraminal narrowing.\n\nAt C5-6, uncovertebral and intervertebral osteophytes contribute to minimal\nspinal canal narrowing. Uncovertebral and facet osteophytes result in\nmoderate right and mild left neural foraminal narrowing.\n\nAt C6-7, there is a disc bulge that mildly narrows the spinal canal. No\nneural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nLimited imaging of the upper thoracic spine demonstrates no spinal canal or\nneural foraminal narrowing.", "output": "1. No evidence of spinal cord compression or signal abnormality.\n2. Multilevel degenerative changes of the cervical spine, as above." }, { "input": "Alignment is anatomic. There is no STIR signal abnormality to\nsuggest acute osseous injury. There are regions of fatty marrow signal which\nare incidental. Scattered small disc bulges and mild facet arthropathy are\npresent, with no spinal canal or foraminal narrowing.\n\nA 2.2-cm mildly irregular left adnexal cyst, a mildly distended cervical\ncanal, and a small fibroid are partially evaluated in the pelvis.", "output": "1. No significant spinal canal or foraminal narrowing. There is no increased\nSTIR signal within the bone marrow to suggest acute injury. CT better\nevaluates for fracture.\n2. Mildly distended cervical canal with small uterine fibroid. Corrleate with\nmenstrual cycle and consider follow up pelvic ultrasound." }, { "input": "From T11-12 to L3-4 disc degenerative change and mild bulging seen. Incidental\nhemangiomas are seen in T12 and L1 vertebral bodies.\n\nAt L4-5 level, disk bulging and facet degenerative changes seen without spinal\nstenosis or foraminal narrowing.\n\nAt L5-S1 level with rudimentary disc is identified.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Mild multilevel degenerative changes without spinal stenosis or foraminal\nnarrowing. No compression fracture." }, { "input": "Mildly to moderately motion degraded exam.\n\nSuboccipital craniectomy, significant cerebellar atrophy, encephalomalacia,\nsimilar. Again seen is fluid collection, consistent with pseudomeningocele at\nthe suboccipital craniectomy and site of resected posterior C1 arch, similar. \nLobulated appearance of CSF ventral to the cord throughout cervical spine,\nwith septations, likely represents adhesions. Arachnoid cyst could have\nsimilar appearance. Mild flattening ventral cord at C3 level, and moderate to\nsevere at cervicothoracic junction, secondary to adhesions and lobulated CSF\nappearance; findings are similar at the cervical spine, and mild worsened at\nthe upper thoracic cord; findings have worsened since ___.\n\nNo cervical cord signal abnormality.\n\nPostoperative change upper thoracic spine. Abnormal partially seen upper\nthoracic cord, with bright T2 signal, myelomalacia, atrophy, similar.\n\nDegenerative changes cervical spine. Multilevel mild disc osteophyte complex,\nposterior mid hypertrophic changes.\n\nMultilevel mild central canal narrowing, similar.\n\nForamina are difficult to evaluate secondary to patient motion.. Probably\nmild bilateral C3-C4, mild-to-moderate left and mild right C4-C5, moderate\nleft and probably mild right C5-C6, mild-to-moderate bilateral C6-C7, mild\nbilateral C7-T1 foraminal narrowing.", "output": "1. Stable exam.\n2. Postsurgical changes.\n3. Presumed adhesions ventral spinal canal, causing mild deformity of the\ncervical cervical cord, similar. There is moderate/severe deformity upper\nthoracic cord, mildly worsened since ___, significantly worsened since\n___.\n4. Atrophy, myelomalacia upper thoracic cord, similar.\n5. Degenerative changes, as above." }, { "input": "Post T2 through T4 laminectomy. Expected postsurgical changes in the\nposterior paraspinal soft tissues without drainable fluid collection.\n\nThere is exaggerated kyphosis involving the upper thoracic spine, as seen\npreviously. Alignment is otherwise normal. Vertebral body heights and signal\nintensity appear normal. There is loss of intervertebral disc height and\nsignal from T4 through T11 compatible with degenerative change. Several small\nSchmorl's nodes are noted in the lower thoracic spine for example involving\nthe inferior endplate of the T9 vertebral body.\n\nFindings suggests dorsal cord adhesions in the upper thoracic spine at the T1\nand T2 levels corresponding to findings on prior cervical spine MRI, which\nhave progressed from ___ (series 3, image 9). The cord is highly irregular at\nthis level and appears atrophic. There is marked central abnormal cord signal\nand cord expansion of the thoracic spinal cord extending from the level of T2\nthrough T9 which did not definitely extend beyond the T2 vertebral body on\nprior MRI in ___, incompletely visualized on MRI of the cervical spine from\n___ (series 4, image 7). There are central areas of cystic change within\nthe cord suggestive of myelomalacia at the level of T3 through T5, partially\nvisualized on prior cervical spine MRI, which also appear new from ___.\n\nPost-contrast images are moderately limited by motion. Within the limits of\nthe examination, there appears to be focal central hyperenhancement within the\ncord at T2-T3 (series 9, image 15; series 8, image 7). No other areas of\nabnormal enhancement identified.\n\nThere is no more than minimal spinal canal or neural foraminal narrowing in\nthe thoracic spine.", "output": "1. Redemonstrated dorsal cord adhesions at T1-T2 as seen on prior cervical\nspine MRI progressed from ___ with adjacent cord atrophy.\n2. Marked cord edema from T2 through T9 has progressed since ___ which\nmay be due to worsening adhesions and CSF flow or ischemia. No evidence of\nspinal cord compression from extrinsic cause.\n3. Mild central enhancement within the cord at T2-T3 is indeterminate but\nraises the possibility of an underlying mass.\n4. Cystic changes in the superior thoracic spinal cord suggest myelomalacia.\n5. Expected postsurgical changes from T2 through T4 laminectomy.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:14 pm, 5 minutes after discovery\nof the findings." }, { "input": "The localizer sequence from the ___ cervical, thoracic, and lumbar\nspine MRI, as well as the present exam, demonstrate 7 cervical vertebrae, 12\nrib-bearing vertebrae, a transitional thoracolumbar junction vertebra with\nrudimentary ribs labeled T13, and 5 lumbar-type vertebrae. The numbering is\ndocumented on images 2:5, 3:8, and 09:11.\n\nTHORACIC:\n\nThoracic spine images are interpreted in conjunction with the sagittal T1\nweighted counting sequence through the cervical and thoracic spine, series 2. \nThere is a circumscribed lesion with fluid signal intensity on all sequences\nanterior to the spinal cord from C6-C7 through T2-T3. The lesion measures 1.6\ncm transverse by 1.0 cm AP in maximal axial cross-section, image 6:8, and 5.3\ncm craniocaudad on images 2:6 and 3:8. The superior margin of the lesion at\nthe level of C6 inferior endplate is not included on postcontrast T1 weighted\nimages. Otherwise, there is no evidence for contrast enhancement. The lesion\nappears to be intradural. The lesion appears to be intradural. It displaces\nthe spinal cord posteriorly and compresses the cord, with maximal cord\ncompression at the level of T2. There is edema in the cord from T1 through\nthe upper T4 level, with mild cord expansion at T3. This lesion is not\ndetectable on the ___ MRI.\n\nThe sagittal T1 weighted counting sequence through the cervical and thoracic\nspine, series 2, also demonstrates dorsal displacement of the spinal cord from\nthe craniocervical junction through the C3-C4 level, with fluid signal\nintensity anterior to the cord. While the findings at the craniocervical\njunction may be related to the patient's suboccipital craniotomy and\nassociated widening of the CSF space anterior to the cervicomedullary junction\nand upper spinal cord, there appears to be ventral spinal cord deformity cord\nflattening from C1 through C3-C4, suggesting mass effect from a suspected\nlesion anterior to the cord. This is not well assessed in the absence of T2\nweighted images and axial images through this level.\n\nMild anterior loss of height of T7 through T9 vertebral bodies is similar to\nthe prior MRI, without marrow edema. No concerning bone marrow signal\nabnormalities are seen. A subcentimeter focus of high signal on T2 weighted\nimages in the T5 vertebral body on image 3:8, with contrast enhancement on\nimage 16:9, is unchanged since ___, likely an atypical hemangioma.\n\nSmall disc protrusions at T4-T5, T5-T6, T6-T7, T7-T8, and T8-T9 minimally\nindent the ventral thecal sac without mass effect on the spinal cord.\n\nLUMBAR:\n\nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. Alignment is normal. The conus medullaris\ndemonstrates normal signal intensity, terminating at the T13-L1 level. There\nis no evidence for a mass, and no abnormal contrast enhancement. There is no\nsignificant disc disease. Prominent posterior epidural fat is present\nthroughout the lumbar spine, mildly indenting the dorsal thecal sac at L4-L5\nand L5-S1, without intrathecal nerve root crowding. There is also facet\narthropathy from L3-L4 through L5-S1, with small facet joint effusions at\nL4-L5. Bilateral L4-L5 neural foramina are mildly narrowed.", "output": "1. Compared to ___, there is a new circumscribed intradural cyst\nventral to the spinal cord from C6-C7 through T2-T3, without evidence for\ncontrast enhancement (though the superior margin of the cysts is not included\non postcontrast images), most suggestive of an arachnoid cyst. A cystic\nneoplasm is less likely.\n2. This cyst displaces the cord posteriorly with maximal cord compression at\nthe level of T2. Associated cord edema from T1 through upper T4 levels, with\nmild cord expansion at T3.\n3. Sagittal T1 weighted counting sequence through the cervical spine\ndemonstrates dorsal displacement of the spinal cord from the craniocervical\njunction through the C3-C4 level, with apparent ventral cord deformity and\nflattening from C1 through C3-C4, suggesting mass effect from another lesion\nventral to the cord.\n4. No evidence for a mass in the lumbar spine.\n5. Small mid thoracic disc protrusions without significant spinal canal\nnarrowing.\n6. Lower lumbar facet arthropathy with mild bilateral L4-L5 neural foraminal\nnarrowing.\n7. Lumbar posterior epidural lipomatosis, mildly narrowing the thecal sac at\nL4-L5 and L5-S1 without intrathecal nerve root crowding.\n\nRECOMMENDATION(S): Recommend cervical spine MRI with and without contrast.\n\nNOTIFICATION: On ___ at 16:28, Dr. ___ a preliminary\nreport to Dr. ___ the telephone, reporting an extramedullary\nintradural cysts compressing the thoracic cord with resultant focal syrinx\nformation below the level of the cyst. According to Dr. ___, Dr.\n___ that he would order a cervical spine MRI." }, { "input": "There are postsurgical changes from suboccipital craniectomy and C1\nlaminectomy with posterior fossa mass resection. Lobulated enhancing\nextra-axial soft tissue posterior and inferior to the resection cavity is\nagain seen, likely representing postsurgical granulation tissue. A posterior\npseudomeningocele is again identified, at the level of the suboccipital\ncraniotomy and C1 laminectomy. Right greater than left cerebellar\nencephalomalacia is again noted in area of resection bed. No definite\nenhancing nodular areas are seen within the resection cavity.\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nAn anterior lobulated anterior subarachnoid space widening following CSF\nintensity on all sequences without enhancement spanning roughly the C3 through\nthe T3 level measuring up to 7 mm in maximal thickness near the T1-T2 level\nproducing areas of compression of the spinal cord, most prominent from the\nlevels of C6 through T3, with apparent cord deformity with transition at the\ndistal T2 level (3:8). On sagittal on axial view, there are areas of soft\ntissue septation (6:33, 3:8), which may represent a web formation. There is\nsubtle area of T2/STIR hyperintensity within the cord spanning the T2-T3\nlevels.\n\nThere is loss of T2 signal of multiple intervertebral discs. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nThere is no abnormal focus of post contrast enhancement. There is no evidence\nof infection or neoplasm. There is no prevertebral soft tissue swelling..\n\n At C2-3 there is no disc bulge. The neural foramina are patent.\n\nAt C3-4 there is no disc bulge. The neural foramina are patent.\n\nAt C4-5 there is no disc bulge. The neural foramina are patent.\n\nAt C5-6 there is no disc bulge. Facet and uncovertebral arthropathy produce\nmild right neural foraminal narrowing the left neural foramen is patent.\n\nAt C6-7 there is no disc bulge. Facet and uncovertebral arthropathy produce\nmild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is no disc bulge. The neural foramina are patent.\n\nAt T1-T2, there is been no disc bulge or neural foraminal narrowing.\n\nLimited sagittal view of the T2-T3 and T3-T4 levels demonstrate no significant\nspinal canal or neural foraminal narrowing.", "output": "1. Postsurgical changes from left suboccipital craniectomy and C1 laminectomy\nwith posterior fossa mass resection without evidence of local disease\nrecurrence. Enhancing extra-axial soft tissue is unchanged, likely\nrepresenting granulation tissue. Associated postsurgical posterior\nmeningocele is unchanged.\n2. Likely anterior subarachnoid web at T2 level with deformity of the spinal\ncord in the lower cervical and upper thoracic region upper thoracic region \nfrom mass effect with subtle cord edema in the upper thoracic region below the\nlevel of the web.\n3. Mild degenerative disc disease.\n4. No evidence of metastasis." }, { "input": "CERVICAL:\nAgain seen are postoperative changes at the cervicomedullary junction with a\nresidual hemorrhagic collection at the posterior surgical margin, unchanged\nsince the study of ___. Again seen, and unchanged, is an\napparent ventral intradural CSF collection causing posterior displacement of\nthe spinal cord. This reaches its largest AP dimension at the T2 level and\nextends superiorly to approximately C6, although the superior margin of the\ncollection is not identified. Again seen is hyperintensity in the upper\nthoracic cord extending from approximately T2-3 to inferior T4 levels. This\nsuggests cord edema as a result of the compression caused by the cyst.\nThere are several small areas of hyperintensity on the T1 weighted images that\nappear intradural along the dorsal aspect of the spinal cord. These have not\nchanged since the prior study and perhaps represent small foci of hemorrhage\nrelated to prior surgery.\nThere are no findings to suggest tumor recurrence.\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nTHORACIC:\nThe lower cervical and upper thoracic arachnoid cyst compresses the lower\ncervical and upper thoracic spinal cord. There is associated abnormal\nincreased signal on the T2 weighted images in the upper thoracic spinal cord,\npresumably reflecting edema due to cord compression. This appears unchanged\nsince the prior study. Again seen, and unchanged, are small foci of apparent\nintradural hemorrhagic products, presumably related to prior surgery.\n\nThere are mild changes of degenerative disc disease at multiple levels with\nloss of signal of the intervertebral discs on the T2 weighted images and\nmultiple Schmorl's nodes. Alignment is normal. Vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of spinal canal or\nneural foraminal narrowing. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.", "output": "1. No evidence of tumor recurrence.\n2. Unchanged apparent anterior arachnoid cyst in the lower cervical and upper\nthoracic spine with compression of the spinal cord and cord edema.\n3. Several small areas of apparent intradural chronic hemorrhage, unchanged.\n\nNOTIFICATION: The persistent title cord edema apparently caused by cord\ncompression due to the arachnoid cyst or web was discussed by telephone with\n___ by telephone by Dr. ___ at 11:20 tenth ___, immediately upon\nreviewing the images." }, { "input": "CERVICAL AND THORACIC SPINE:\nThere is re-demonstration of postoperative changes with chronic blood products\nat the cervicomedullary junction, similar to ___. Status post\nsuboccipital craniectomy and C1 laminectomy for posterior fossa mass\nresection. A posterior pseudomeningocele is again identified at the level of\nthe suboccipital craniotomy. Cerebellar encephalomalacia is also seen in the\narea of the resection bed. There is partially seen small area of enhancement\nat the surgical bed in the inferior cerebellum, which is similar since ___.\nThere is a septation seen on series 12, image 11 at C3 level, which is\nconsistent with adhesion, similar to prior ___,\nwith mild flattening of the ventral cord at this level, and subtle T2 signal\nabnormality along the posterior cord at C3, C4 level, similar compared with ___.\nAgain seen is the ventral funnel- shaped CSF fluid collection without\nenhancement with posterior displacement of the spinal cord from approximately\nlevel C6 down to lower T2 level with greatest AP dimension at level T2 (7;\n11), measuring 5 cm in length, and 1.7 cm x 0.9 cm across, stable. There is\nmoderate cord flattening at this level, most prominent at T2 level, stable\nsince prior exams. There is moderate cord edema involving central, and\nposterior extending from T2-T3 disc space to the level of mid T4 vertebral\nbody, similar to ___, probably similar to partially seen upper\nthoracic cord on ___, without associated enhancement.\n\nAlignment is normal. Vertebral body signal intensity appear normal. Vertebral\nbody heights are preserved.\n\nThere are chronic blood products along the dorsal margin of the thecal sac in\nthe thoracic spine, similar to prior. Degenerative changes in the cervical\nspine are stable since prior. There is multilevel mild disc osteophyte\ncomplexes, posterior element hypertrophic changes causing mild central canal\nnarrowing at C3-C4, C4-C5, C5-C6 levels, similar there is mild-to-moderate\nbilateral C5-C6, C6-C7 foraminal narrowing.\n\n\nThere are multilevel mild degenerative changes loss of signal in the\nintervertebral discs in thoracic spine as well as multiple Schmorl's nodes. \nThere is mild central disc bulge at T5-T6 with anterior indentation of the\nanterior thecal sac without deformity of the spinal cord (13; 24). Similarly,\nthere is mild central disc bulge at T7-T8 with anterior indentation of the\nanterior thecal sac without deformity of the spinal cord.\n\nThere is no evidence of neural foraminal narrowing.There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. Vertebral body height and disc heights are preserved. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof spinal canal narrowing. There is mild foraminal narrowing at L4-5, L5-S1\nlevels. There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.", "output": "1. There has been no ___ since ___.\n2. There are partially seen postoperative changes at the posterior fossa.\n3. There is adhesion with intrathecal web at C3 level, with mild stable cord\nflattening ventrally, and stable mild dorsal cord T2 signal abnormality since\n___.\n4. Redemonstration of posterior displacement of the spinal cord from C6 to T2\nlevel from either a ventral arachnoid cyst, or adhesions, with spinal cord\nflattening most prominent at T2, and central and posterior spinal cord edema\nfrom T2-T4, unchanged from ___, and probably unchanged since ___. There are no new areas of cord abnormality.\n5. There are chronic blood products along the dorsal thecal sac in the\nthoracic spine, stable.\n6. There are stable degenerative changes." }, { "input": "There are 7 cervical vertebrae, 12 rib-bearing vertebrae, a transitional\nvertebra at the thoracolumbar junction, and 5 lumbar-type vertebrae, as seen\non prior total spine MRIs from ___ and ___, and on the\nthoracic and lumbar spine MRI from ___.\n\nCERVICAL:\nPost treatment changes in the posterior fossa are again partially visualized,\nincluding evidence of suboccipital craniectomy, encephalomalacia of right\ngreater than left cerebellar hemispheres with T2 hyperintensity along the\nresection bed, enhancing lobulated tissue along the craniectomy site which has\nbeen present dating back to ___ and is most consistent with\npostsurgical granulation/scar tissue, and moderate-sized suboccipital\npseudomeningocele. These are assessed more completely on the recent brain MRI\nfrom ___.\n\nAgain seen is a subarachnoid adhesion anterior to the cord at the level of C3,\nimage 5:12, with expansion of the right ventral subarachnoid space at C3\ncausing moderate right ventral cord deformity, but no associated cord signal\nabnormality. These findings are unchanged.\n\nThere is new posterior paravertebral muscle edema in the mid and lower\ncervical spine related to the interim fenestration of the ventral arachnoid\ncyst at the cervicothoracic junction. Previously noted upper thoracic spinal\ncord edema now extends superiorly to the level of C4-C5, with expansion of the\ncord from C6 through upper T2 level.\n\nVertebral body heights are preserved. Alignment is normal. There is no\nsignificant degenerative spinal canal narrowing. Neural foraminal narrowing\nby uncovertebral and facet osteophytes is again seen at several levels, mild\nat C3-C4 bilaterally, moderate at C4-C5 bilaterally, moderate on the right and\nsevere on the left at C5-C6, and severe bilaterally (right worse than left) at\nC6-C7.\n\nTHORACIC:\nThe patient is status post laminectomies from T2 through T4 and partial\nspinous process resection at T1. Previously noted fluid collection ventral to\nthe spinal cord at the cervicothoracic junction is no longer seen, consistent\nwith interim surgical fenestration. The spinal cord is now expanded from C6\nthrough upper T2 level. Cord edema now extends from C5-C6 through at least\nT2-T3 levels, compared to mid T2 through lower T4 levels previously. From\nT1-T2 through T4-T5, fluid in the laminectomy beds displaces the thecal sac\nanteriorly and severely narrows the thecal sac. Evaluation of the compressed\nspinal cord signal is limited due to the large field of view and motion\nartifact. The fluid in the laminectomy beds extends into the posterior\nparavertebral tissues and to the skin surface, demonstrating no rim\nenhancement.\n\nMild anterior wedging of several mid thoracic vertebral bodies is unchanged. \nA subcentimeter presumed fat-poor hemangioma at T5 is unchanged dating back to\n___. Alignment is normal. No signal abnormalities in the spinal\ncord are seen below the level of T4-T5. The conus medullaris terminates at\nthe level of T13-L1, as seen previously.\n\nOTHER:\nThere is trace bilateral dependent pleural fluid and bilateral dependent\natelectasis in the visualized portions of the lungs.", "output": "1. Post treatment changes in the posterior fossa are again partially\nvisualized, including suboccipital craniectomy, encephalomalacia of right\ngreater than left cerebellar hemispheres, enhancing lobulated tissue along the\ncraniectomy site which has been present dating back to ___ and is most\nconsistent with postsurgical granulation/scar tissue, and moderate-sized\nsuboccipital pseudomeningocele. These are assessed more completely on the\nrecent brain MRI from ___.\n2. Unchanged subarachnoid adhesion anterior to the cord at the level of C3\nwith expansion of the right ventral subarachnoid space and moderate right\nventral cord remodeling, but no cord signal abnormality.\n3. Status post T2 through T4 laminectomies and partial spinous process\nresection at T1. Previously noted fluid collection ventral to the cord at the\ncervicothoracic junction is no longer seen, consistent with interim\nfenestration. The spinal cord is now expanded from C6 through the upper T2\nlevel. Cord edema now extends from C5-C6 through at least T2-T3 levels,\ncompared to mid T2 through lower T4 levels previously.\n4. Fluid collection in the laminectomy beds from T1-T2 through T4-T5,\nextending into the posterior paravertebral soft tissues and to the skin, may\nrepresent a postsurgical seroma, but a pseudomeningocele cannot be excluded. \nThere is associated severe narrowing of the thecal sac at these levels, with\nlimited evaluation of the compressed spinal cord signal due to the large field\nof view and motion artifact.\n5. Spinal cord signal is normal below the level of T4-T5.\n\nNOTIFICATION: A preliminary report, including the presence of the fluid\ncollection in the laminectomy beds markedly narrowing the spinal canal and\nflattening the spinal cord, and increased cord edema, was discussed by Dr.\n___ with Dr. ___ on the telephoneon ___ at\n9:45 pm, 10 minutes after discovery of the findings." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nAlignment is grossly preserved. Increased STIR signal at the base of the\nodontoid process and bilateral pedicles, is again seen consistent with a type\n3 odontoid process fracture. Increased STIR signal abnormality is seen at the\nbase of the occiput, which may be sequelae of patient's trauma. A wedge\ncompression fracture of the T6 vertebral body appears to be chronic, given\nabsence of associated STIR signal abnormality. Mild edema is seen along the\ninterspinous ligaments of C1/C2.\n\nWithin limits of study, no definite focal cervical cord signal abnormality is\nidentified.\n\nDiffuse disc desiccation is seen throughout the cervical spine.\n\nC2-C3: There is no spinal canal narrowing. Facet joint osteophytes results\nin mild right neural foraminal narrowing.\n\nC3-C4: Disc bulge results in moderate spinal canal narrowing. Mild\nuncovertebral and facet joints arthropathy results in moderate left and mild\nright neural foraminal narrowing.\n\nC4-C5: Central disc bulge results in moderate canal narrowing. Uncovertebral\nand facet joint arthropathy results in moderate bilateral neural foraminal\nnarrowing, left greater than right.\n\nC5-C6: Central disc bulge, with a left central disc protrusion in combination\nwith facet joint osteophytes and uncovertebral arthropathy results in moderate\ncanal narrowing. Severe right neural foraminal narrowing is seen, and\nmoderate left neural foraminal narrowing is seen.\n\nC6-C7: Left central disc protrusion is seen, in combination with facet joint\narthropathy resulting in moderate thecal sac narrowing. Uncovertebral\nhypertrophy contributes to at least moderate bilateral neural foraminal\nnarrowing, left greater than right.\n\nC7-T1: Left central disc protrusion, in combination with facet joint\narthropathy results in moderate to severe canal narrowing. Uncovertebral\nhypertrophy and facet joint osteophytes results in severe bilateral neural\nforaminal narrowing.", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable acute type 3 odontoid process fracture at odontoid process\nbase.\n3. Partially visualize chronic wedge T6 vertebral body compression fracture.\n4. Within limits of study, no definite cervical spinal cord lesion\nidentified.\n5. Moderate to severe cervical spondylosis as described, most prominent at\nC4-C5 through C6-C7, where there is moderate vertebral canal narrowing.\n6. Severe C5-6 right, moderate C4-5 and C6-7 bilateral, and moderate C5-6 left\nneural foraminal stenosis.\n7. Occipital condyle/skullbase nonspecific edematous changes as described.\n8. C1-2 interspinous ligament edema, which may represent ligamentous injury." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMild misalignment with loss of normal lumbar lordosis is associated with 4 mm\nretrolisthesis of L2 over L3 and L3 over L4. No subluxation or translation is\npresent.\nThere is bone edema associated with compression deformities across the T12 and\nL1 vertebral bodies, consistent with acute fractures. A 43 (cc) x 11 (trv) x\n4 (ap) mm posterior epidural collection is seen at the T11-T12 level (2:98,\n200:17, 4:12). The collection demonstrates heterogeneous T2/STIR signal and\nis T1 isointense to the cord, likely reflecting an epidural hematoma. The\nhematoma and mild disc bulging at this T11-T12 level result in severe spinal\ncanal narrowing. No abnormal cord signal is noted.\nThere is also a loss of vertebral body height of L2 but there is no evidence\nof edema at this level, likely reflecting a chronic deformity.\n\nMultilevel degenerative changes with significant loss of intervertebral disc\nheight and disc desiccation most notable at L1-L2, L2-L3, and L5-S1 are noted.\nExcept for the acute fractures described above, bone marrow signal is overall\nheterogeneous, probably reflecting degeneration and fatty infiltration.\nThe conus terminalis ends at the level of L1.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nAt T10-T11 there is disc bulging associated with mildspinal canalnarrowing. \nNo significantneural foraminal narrowing is noted.\n\nAt T11-T12 there is mild disc bulgingand an epidural hematoma, as noted above,\nresulting in severespinal canal narrowing. Facet joints osteophytes result in\nmildneural foraminal narrowing bilaterally. There is edema associated with\nthe right facet joint, could be associated with fracture.\n\nAt T12-L1 the caudal end of the epidural hematoma and facet joints osteophytes\nresult in moderatespinal canal narrowing andmildneural foraminal narrowing\nbilaterally.\n\nAt L1-2 there is disc bulging and ligamentumflavum thickening resulting in\nmildspinal canal andneural foraminal narrowing bilaterally.\n\nAt L2-3 there is retrolisthesis and disc bulging resulting in mildspinal canal\nnarrowing and moderate to severe left, mild rightneural foraminal narrowing.\n\nAt L3-4 there is retrolisthesis, disc bulging, ligamentum flavum thickening,\nand facet osteophytes resulting in moderatespinal canal narrowing and severe\nright, moderate leftneural foraminal narrowing.\n\nAt L4-5 there is disc bulging and facet osteophytes resulting in mildspinal\ncanal narrowing and severe right, moderate leftneural foraminal narrowing.\n\nAt L5-S1 there is bulging resulting in mildspinal canal and moderate right,\nmild leftneural foraminal narrowing.\n\nIncomplete study of the thoracic spine also slightly limited by motion\ndemonstrate no definite abnormalities of the vertebral bodies. Intervertebral\ndisc bulges likely throughout the thoracic spine are most notable at T7-T8 and\nT8-T9. There is posterior soft tissue edema in the upper thoracic spine and\nprobable interspinous edema probably involving T2-T3 through T4-T5. A\nligamentous injury at these levels cannot be excluded.\n\nOTHER:\nA 2.1 x 1.8 cm cortical renal mass is seen in the left kidney (200:24). The\npartially imaged urinary bladder demonstrates a thickened wall.\nThere is atrophy of the paraspinal muscles.", "output": "1. Acute compression fractures of the T12 and L1 vertebral bodies associated\nwith a posterior epidural hematoma measuring 43 x 11 x 4 mm which, in\nassociation with a disc bulge at this level, result in severe spinal canal\nnarrowing. No cord signal abnormality.\n2. Right facet joint edema at T11-T12, could be associated with a fracture.\n3. Incomplete and limited imaging of the thoracic spine demonstrate posterior\nsoft tissue edema and probable interspinous edema involving T2-T3 through\nT4-T5. Ligamentous injury at these levels cannot be excluded.\n4. Multilevel degenerative changes as described in detail above, including\nmild retrolisthesis of L2 over L3 and L3 over L4, and spinal canal and neural\nforaminal narrowing most significant at T11-T12 through T12-L1, and L3-L4.\n5. 2.1 x 1.8 cm left cortical renal mass for which nonemergent follow-up\nultrasound is recommended.\n6. Thickening of the partially imaged urinary bladder wall, nonspecific. \nCould also be evaluated with nonemergent ultrasound.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:20 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Alignment is normal. There is mild loss of intervertebral disc height and T2\nsignal, most pronounced at the C6-C7 level. There are degenerative endplate\nmarrow signal changes and endplate osteophytes most pronounced at C5-C6 and\nC6-C7. Vertebral body and intervertebral disc signal intensity otherwise\nappear normal. The spinal cord appears normal in caliber and configuration. \nVisualized posterior fossa structures are normal.\n\nThe paraspinal and prevertebral soft tissues are unremarkable. Major vascular\nflow voids are preserved.\n\nC2-C3: There is mild facet arthropathy on the left. There is no definite\nspinal canal or neural foraminal stenosis.\n\nC3-C4: There is no evidence of spinal canal or neural foraminal narrowing.\n\nC4-C5: There is no evidence of spinal canal or neural foraminal narrowing.\n\nC5-C6: Disc bulge with endplate osteophytes and ligamentum flavum infolding\ncausing mild spinal canal narrowing. Facet and uncovertebral joint\nosteophytes cause mild bilateral neural foraminal narrowing, right greater\nthan left.\n\nC6-C7: Disc bulge with endplate osteophytes causing minimal spinal canal\nnarrowing. Facet and uncovertebral joint osteophytes cause moderate left and\nmoderate to severe right neural foraminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal stenosis.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Multilevel degenerative changes of cervical spine as described. There is\nmoderate to severe right neural foraminal stenosis at the C6-C7 level." }, { "input": "Diffuse focal abnormalities in the visualized bony structures of the lower\nthoracic and lumbar upper sacral region with low T1 and T2 signal with patchy\nareas of enhancement seen on hyperintensities on inversion recovery images\nsuggesting diffuse metastatic disease. Low signal intensity zone BM post\ngadolinium T1 images suggest sclerotic components. There is no pathologic\nfracture or retropulsion identified. There is no intraspinal mass identified.\n\nFrom T10-11 through L3-4 levels disk degenerative change and mild bulging\nseen.\n\nAt L4-5 level, disc and facet degenerative changes result in moderate spinal\nstenosis and mild narrowing of both foramina.\n\nAt L5-S1 disc and facet degenerative changes seen. There is severe right\nsubarticular recess narrowing and moderate severe right foraminal narrowing\ndue to disc bulge and facet degenerative changes.\n\nThe distal spinal cord. Paraspinal soft tissues are unremarkable", "output": "1. Diffuse metastatic disease without pathologic fracture, retropulsion or\nintraspinal mass.\n2. Moderate spinal stenosis at L4-5 and severe right subarticular recess and\nforaminal narrowing at L5-S1 level due to disc and facet degenerative changes." }, { "input": "Cervical spine:\n\nDiffuse bony abnormalities with low signal on T1 and T2 high signal on\ninversion recovery images in the visualized bony structures indicate\nmetastatic disease. There is no intraspinal mass or spinal cord neoplastic\ncompression seen.\n\nAt the craniocervical junction and C2-3 and C3-4 mild degenerative change\nseen. At C3-4 moderate left foramen narrowing is seen.\n\nAt C4-5 level, moderate to severe right-sided and moderate left-sided\nforaminal narrowing and mild spinal stenosis seen to degenerative changes.\n\nAt C5-6 disc bulging without foraminal narrowing or spinal stenosis. At C6-7\nmild disk bulging identified. Spinal cord in the cervical region demonstrate\nnormal signal. A small cystic lesion is seen in the left thyroid lobe.\n\nThoracic spine:\n\nDiffuse bony abnormality metastatic disease are identified. Small disc\nprotrusions at T7-8 and T8-9 level identified slightly indenting the thecal\nsac contacting the spinal cord without deformity. There is no intraspinal mass\nseen or neoplastic spinal cord compression identified. Mild anterior wedging\nof T8 vertebra is noted.", "output": "Diffuse bony metastatic disease. No evidence of intraspinal mass or\nneoplastic spinal cord compression. Multilevel degenerative changes." }, { "input": "Vertebral body height is preserved at all levels. The spinal cord terminates\nat T12-L1. Spinal cord and nerve root signal intensity is normal and\nhomogeneous.\n\nThe following degenerative changes are noted:\n\nT11-T12: Mild disc bulge without substantial spinal canal or neural foraminal\nnarrowing.\n\nL4-L5: Mild disc bulge. There is no substantial neural foraminal narrowing.\n\nL5-S1: There is disc desiccation, loss of disc height and a midline disc\nprotrusion that narrows the bilateral lateral recesses. There is moderate left\nneural foraminal narrowing. The right neural foramen is preserved.\n\nThere are ___ endplate changes.\n\nThe visualized intra-abdominal structures are unremarkable.", "output": "Mild to moderate lumbar spine degenerative changes most pronounced at L5-S1." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nVertebral body heights are maintained. There is redemonstration of\ndegenerative endplate changes of the inferior T11 and superior T12 vertebral\nbodies with exaggeration of the thoracic kyphosis, grossly similar to the ___\nprior examination. Otherwise, vertebral body alignment is preserved.\n\nDegenerative endplate changes are again noted at the T11-12 and L5-S1 levels.\nPreviously noted edema at these levels is decreased. The visualized portion of\nthe spinal cord is preserved in signal and caliber, with the conus noted at\nL1.\n\nThere is stable loss of intervertebral disc height and signal at the T11-12,\nL4-5, and L5-S1 levels. A stable anterior disc osteophyte is noted at the\nT11-12 level.\n\nAt T12-L1, L1-2, and L3-4 there is no spinal canal or neural foraminal\nstenosis.\n\nAt L4-5 there is a disc bulge with ligamentum flavum hypertrophy and mild\nspinal canal and mild bilateral neural foraminal stenosis.\n\nAt L5-S1 there is a left paracentral disc protrusion and disc bulge with\nligamentum flavum hypertrophy and facet joint arthropathy, resulting in\nbilateral lateral recess stenosis, moderate bilateral neural foraminal\nstenosis and mild spinal canal stenosis. An anterior disc osteophyte complexes\nalso again noted. Allowing for differences in technique, these findings are\ngrossly stable compared to the ___ prior examination.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.", "output": "1. Multilevel degenerative changes as described, most pronounced at the L5-S1\nlevel, where there is bilateral lateral recess stenosis, moderate bilateral\nneural foraminal stenosis and mild spinal canal stenosis. Findings are\ngrossly stable compared to ___ prior MRI examination.\n2. L4-5 level stable mild spinal canal and bilateral neural foraminal\nstenosis.\n3. Stable degenerative endplate changes at T11-12 and L5-S1 levels.\n4. Stable T11-12 level anterior disc osteophyte complex with loss of\nintervertebral disc height and mild exaggeration of thoracic kyphosis compared\nto ___ prior MRI examination." }, { "input": "Normal spinal alignment. Degenerative changes lower thoracic, lumbar spine. \nNarrowed T11-T12, L4-5, L5-S1 disc spaces. Multilevel diffuse disc bulges. \nMild kyphotic angulation at T11-T12 level secondary to anterior more than\nposterior disc space height loss with prominent anterior osteophytes. Lumbar\nfacet arthritis. Minimal effacement ventral cord at T11-T12 level, minimal\ncentral canal narrowing,. No cord T2 signal abnormality in the visualized\ncord.\n\nAt L1-L2, L2-L3 level central canal, foramina are patent\n\nAt L3-L4 level there is mild central canal, mild bilateral foraminal\nnarrowing.\n\nAt L4-5 level there is mild central canal narrowing. Mild left,\nmild-to-moderate right foraminal narrowing.\n\nAt L5-S1 level there is mild central canal narrowing. Mild mass effect on\ntraversing left S1 nerve from endplate hypertrophic change. Moderate\nbilateral foraminal narrowing, left greater than right.", "output": "1. Degenerative changes lower thoracic, lumbar spine.\n2. Mild central canal narrowing L5-S1 levels.\n3. Moderate bilateral L5-S1 foraminal narrowing." }, { "input": "There is cervical kyphosis at C4 through C6 levels. The alignment of the\ncervical spine is otherwise maintained. There are degenerative changes of the\ncervical spine without a suspicious marrow replacing lesion or abnormal\nenhancement.\n\nC2-C3 and C3-C4: No spinal canal or neural foraminal stenosis.\n\nC4-C5: There is a central left paracentral disc protrusion causing moderate\nspinal canal stenosis and indenting the ventral spinal cord without abnormal\nspinal cord signal intensity. There is mild left neural foraminal narrowing\nand no significant right neural foraminal narrowing.\n\nC5-C6 and C6-C7: There is a central disc protrusion with indentation of the\nventral spinal canal without spinal canal stenosis or neural foraminal\nnarrowing.\n\nC7-T1: No spinal canal or neural foraminal stenosis.\n\nThere is no abnormal enhancement after contrast administration. There are\nperineural cysts within the left neural foramina at C7-T1 and T1-T2 levels.", "output": "1. No evidence of abnormal spinal cord signal intensity or enhancement to\nsuggest a demyelinating process.\n2. Cervical kyphosis with moderate spinal canal stenosis at C4-C5 level, as\ndetailed above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. Small\nnonspecific dependent edema is noted, slightly increased compared to the prior\nexam.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is no vertebral canal or neural foraminal stenosis.\n\nAt L5-S1 there is new central disc protrusion which contacts the right S1\nnerve root within the right subarticular zone, withno vertebral canal or\nneural foraminal stenosis.", "output": "New L5-S1 disc protrusion which contacts the right S1 nerve root within the\nright subarticular zone." }, { "input": "CERVICAL:\nThe exam is mildly degraded due to motion artifact.\n\nThe craniocervical articulation appears preserved. Vertebral body height and\nalignment appear preserved. No bone marrow signal abnormality is identified. \nThere is mild intervertebral disc desiccation. There is no spinal canal or\nneural foraminal narrowing.\n\nThe cervical spinal cord appears normal in signal intensity and morphology. \nThere is no abnormal enhancement.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC:\nVertebral body height and alignment are preserved. No bone marrow signal\nabnormalities identified. There is no spinal canal or neural foraminal\nnarrowing.\n\nThe thoracic spinal cord appears normal in signal intensity and morphology. \nThere is no abnormal enhancement.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.\n\nLUMBAR:\nThere are postsurgical changes with posterior instrumented fusion and\nlaminectomy at L4-5. No fluid collection or paraspinal inflammatory changes\nidentified.\n\nLumbar vertebral body height and alignment are preserved. There is loss of\nsignal of the intervertebral discs at L4-5 and L5-S1, with associated\ndegenerative endplate change at L4-5. These are manifestations of\ndegenerative disc disease. The bone marrow signal is otherwise unremarkable.\n\nThe conus medullaris terminates at the T12-L1 level. The conus medullaris and\ncauda equina appear normal in signal intensity and morphology. There is no\nabnormal enhancement.\n\nThe prevertebral and paraspinal soft tissues are otherwise unremarkable. \nIncidental note is made of the simple right renal cyst.", "output": "1. Posterior instrumented L4-5 fusion without spinal canal narrowing or\nfindings to suggest infection.\n2. No spinal canal or neural foraminal narrowing. No abnormal cord signal or\nenhancement.\n3. Minimal cervical and lumbar degenerative disc disease." }, { "input": "CERVICAL:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved. No significant spinal\ncanal or neural foraminal narrowing.\n\nThe visualized posterior fossa is grossly unremarkable. Prevertebral and\nparaspinal soft tissues are also grossly unremarkable.\n\nTHORACIC:\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nIntervertebral disc heights and signal are preserved.\n\n\nLUMBAR:\nStatus post posterior instrumented fixation at L4-L5 with bilateral vertical\nrods and transpedicular screws with associated susceptibility artifact\npartially obscuring the adjacent structures. Vertebral body alignment is\npreserved. Vertebral body heights are preserved. There are degenerative\nendplate signal changes at L4-L5.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L1.\n\nReduced height and signal loss of the L4-L5 and L5-S1 intervertebral discs\nrepresents manifestations of degenerative change.\n\nAt L5-S1 there is a right foraminal disc protrusion making possible contact\nwith the traversing right S1 nerve root. There is mild right neural foraminal\nnarrowing. There is also a small posterior central annular fissure. Aside\nfrom the posterior central annular fissure, findings are not changed since ___.\n\nNo significant spinal canal or neural foraminal narrowing at the remaining\nlevels of the lumbar spine.\nThere is no evidence of an epidural abscess.\n\nOTHER: There is a 2.7 cm right renal cyst.", "output": "1. No evidence of an epidural abscess. No suspicious marrow or disc signal.\n2. Postsurgical changes relating to posterior instrumented fixation at L4-L5\nwhere there are bilateral vertical rods and transpedicular screws with\nassociated susceptibility artifact partially obscuring the adjacent\nstructures.\n3. Small right foraminal disc protrusion at L5-S1 makes possible contact with\nthe traversing right S1 nerve root, unchanged.\n4. Small posterior central annular fissure at L5-S1, new since ___.\n5. Otherwise, no significant spinal canal or neural foraminal narrowing of the\ncervical, thoracic or remaining levels of the lumbar spine." }, { "input": "There is dextroconvex curvature of the thoracic spine which may be\npositional. Thoracic spine osseous marrow signal is normal. Vertebral body\nheights are preserved. The alignment is otherwise anatomic. There is\nligamentum flavum thickening, partially visualized, at C7-T1, which abuts the\nposterior spinal cord but does not cause high-grade spinal canal narrowing. \nOtherwise, the thoracic spinal cord has normal contour and signal. \nPost-gadolinium images of the thoracic spine are unremarkable with no abnormal\nintradural enhancement.\n\nLUMBAR SPINE: There is a destructive process centered in the L4-L5\nintervertebral disc space, with destruction of the adjacent vertebral\nendplates, and grade 1, 5 mm, anterolisthesis of L4 on L5. An irregular,\nrim-enhancing fluid collection extends anteriorly from the disc space into the\nprevertebral soft tissues where there is phlegmonous inflammatory change\ninvolving the distal abdominal aorta which has an irregular, lobular aneurysm,\nbetter seen on the dedicated CT abdomen and pelvis, measuring 3.5 x 4.3 x 4.5\ncm (SI x AP x ML). There is also extension into a left psoas abscess which\nmeasures 3cm in greatest diameter.\n\nThere is diffuse abnormal marrow signal within the L4 and L5 vertebral bodies.\nAbnormal increased T2/STIR signal also extends into the L3-L4 and L5-S1\nintervertebral disc spaces. However, these show no enhancement.\n\nA chronic compression fracture of L3 is again demonstrated.\n\nAt L1-L2, there is a broad-based disc bulge and moderate facet arthropathy,\nbut no high-grade spinal canal narrowing.\n\nAt L2-L3, a broad-based disc bulge combines with mild retropulsion of the\nchronic L3 compression fracture and severe facet arthropathy to severely\nnarrow the spinal canal with crowding of the cauda equina. There is\neffacement of CSF posteriorly, though there is CSF anteriorly around the nerve\nroots.\n\nAt L3-L4, there is a small disc bulge and severe facet arthropathy which\nseverely narrows the spinal canal. A small amount of CSF remains anterior to\nthe nerve roots.\n\nAt L4-L5, there is osteomyelitis discitis with an abscess as described above. \nThere is posterior epidural thickening and enhancement which likely represents\nphlegmon. However, there is no epidural abscess. This process combines with\nsevere ligamentous thickening to severely narrow the spinal canal with\nnear-complete effacement of CSF. The foramina are bilaterally severely\nnarrowed as well. The inflammatory process extends into the foramina.\n\nAt L5-S1, there is diffuse loss of disc space height and a posterior bulge,\nbut no significant spinal canal narrowing. Facet arthropathy contributes to\nmoderate bilateral foraminal narrowing.", "output": "Osteomyelitis discitis at L4-L5 with anterior extension. The abscess and\nphlegmon surround a likely mycotic distal abdominal aortic aneurysm. There is\nextension into a left psoas abscess as well. Reviewing the prior CTs, this\ndestructive process has progressed steadily since ___. There is no\nevidence of drainable epidural fluid collection, though there is severe spinal\ncanal narrowing at L4-L5.\n\nFindings were discussed with ___, clinician caring for patient, at 11am\non ___." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nMild lower lumbar facet arthritis. Mild atrophy of the lower paraspinal\nmusculature.\n\nAt L1-L 2, L2-L3, L3-L4, L4-5 levels central canal, foramina are patent.\n\nAt L5-S1 level, central canal is patent. Mild bilateral foraminal narrowing.", "output": "1. Mild degenerative changes lumbar spine." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc T2 signal at all visualized levels. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nWithin 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.\n\n At C2-3 there is mild posterior disc bulge indenting the ventral thecal sac\nwithout significant spinal canal narrowing. Facet and uncovertebral\narthropathy produces mild bilateral neural foraminal narrowing.\n\nAt C3-4 there is mild posterior disc bulge indenting the ventral thecal sac\nwithout significant spinal canal narrowing. Uncovertebral and facet\narthropathy produces moderate left and mild right neural foraminal narrowing.\n\nAt C4-5 there is mild posterior disc bulge indenting the ventral thecal sac\nwithout significant spinal canal narrowing. Uncovertebral and facet\narthropathy produce moderate left and mild right neural foraminal narrowing.\n\nAt C5-6 there is mild posterior disc bulge indenting the ventral thecal sac\nwithout significant spinal canal narrowing. Uncovertebral and facet\narthropathy produce moderate left and mild right neural foraminal narrowing.\n\nAt C6-7 there is mild posterior disc bulge producing mild spinal canal\nnarrowing. Uncovertebral and facet arthropathy produces moderate left and\nmild right neural foraminal narrowing.\n\nAt C7-T1 there is no significant spinal canal narrowing. Uncovertebral and\nfacet arthropathy is minimal, without significant neural foraminal narrowing.\n\nSagittal views of the T1-T2, T2-T3 and T3-T4 levels demonstrate a mild\nposterior disc protrusion at T2-T3 without significant associated spinal canal\nnarrowing. There is mild facet arthropathy without significant neural\nforaminal narrowing.", "output": "1. Multilevel cervical spondylosis, as described above, most notable for mild\nspinal canal narrowing at C6-C7 with moderate neural foraminal narrowing at\nthe left C3-C4, left C4-C5, left C5-C6 and left C6-C7 levels.\n2. No evidence of cervical spine cord signal abnormality." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Degenerative loss of disc height is\nmild-to-moderate at C5-C6, unchanged from prior exam. The visualized\nposterior fossa is grossly unremarkable.\n\nThere is a right lateral cord lesion at the C3-C4 level (series 5 and 6, image\n14 and 12 respectively; series 3, image 8), without abnormal enhancement,\nwhich is less well seen on the prior examination, likely secondary to\ndifferences in technique.\n\nA prominent C7-T1 right lateral cord lesion is unchanged from prior exam.\n\nC2-C3 through C3-C4: No significant spinal canal or neural foraminal\nnarrowing.\n\nC4-C5: A small central protrusion results in mild spinal canal narrowing. \nUncovertebral facet arthropathy results in mild left and no significant right\nneural foraminal narrowing, unchanged from prior exam.\n\nC5-C6 through C7-T1: No significant spinal canal or neural foraminal\nnarrowing.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. No\nsuspicious marrow signal. Vertebral body hemangiomas at T5 and spinous\nprocess hemangioma T12 is identified. Disc heights are maintained.\n\nThere are scattered thoracic cord nonenhancing lesions at T3-T4, T5-T6 as well\nas T8, which appear similar to prior examination. No definite new lesions. \nNo abnormal cord enhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nOTHER: There is a heterogeneous 1.1 cm right posterior lobe of the thyroid\nnodule (series 5, image 29).\n\nOn T1 postcontrast image, there is a 9 mm hyperintense rounded focus of the\nleft upper lobe (series 16, image 1), without corresponding signal abnormality\non additional sequences, which is felt to likely represent artifact.\n\nThe visualized prevertebral paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. A right lateral C3-C4 nonenhancing cord lesion is identified, not well seen\non prior examination. This is felt to be likely secondary to differences in\ntechnique as suggestion of a lesion may be seen on sagittal STIR sequence on\nthe prior exam, although not confirmed on axial sequence.\n2. A right lateral C7-T1 cord lesion is unchanged.\n3. Additional nonenhancing lesions of the thoracic spine at T3-T4, T5-T6 and\nT8 appear similar to prior exam, although slightly better visualized on the\ncurrent exam.\n4. There is no new enhancing cervical and thoracic cord lesion.\n5. There is no high-grade spinal canal or neural foraminal narrowing.\n6. A 1.1 mm right posterior lobe of the thyroid nodule, previously described.\n7. There is a T1 postcontrast hyperintense 9 mm rounded focus of the left\nupper lobe, felt to most likely represent artifact. However, if there is\nclinical concern, a CT chest without contrast can be performed to confirm the\nfinding.\n8. Additional findings as described above." }, { "input": "The patient is status post C5 through C7 ACDF. Metallic artifact from the\nhardware results in suboptimal evaluation of the adjacent structures. Within\nthis confines: Cervical alignment is anatomic. No suspicious marrow signal. \nThe disc heights and non operative levels are within expected limits. The\nvisualized posterior fossa and brain is grossly unremarkable. There is T2\nhyperintense cord signal at C5-C6 similar in appearance to prior exam of ___ on axial sequences but slightly more prominent on sagittal\nsequences.\n\nThere is baseline mild spinal canal narrowing secondary to congenital\nshortening of the pedicles.\n\nC2-C3: There is mild bilateral neural foraminal narrowing.\n\nC3-C4: There is a small central protrusion. Mild uncovertebral facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nC4-C5: A small central protrusion is identified. Uncovertebral facet\narthropathy results in moderate left and mild right neural foraminal\nnarrowing.\n\nC5-C6: Since the prior examination, interval development of a prominent right\ngreater than left intervertebral osteophyte which results moderate to severe\nspinal canal narrowing and effacement of the right ventral aspect of the cord.\nUncovertebral facet arthropathy results in severe bilateral neural foraminal\nnarrowing.\n\nC6-C7: Intervertebral osteophytes results in moderate spinal canal narrowing.\nUncovertebral facet arthropathy results in severe bilateral neural foraminal\nnarrowing.\n\nC7-T1: A disc protrusion and intervertebral osteophyte results in moderate\nspinal canal narrowing. Uncovertebral and facet arthropathy results in severe\nspinal canal narrowing.\n\nA 3 mm T2 hyperintense nodule is identified in the right lobe of the thyroid. \nNo further evaluation is suggested by current ACR guidelines for incidentally\nnoted thyroid nodules. The remainder the thyroid is unremarkable. There is\nno cervical lymphadenopathy by size criteria. The visualized prevertebral and\nparaspinal soft tissues are otherwise unremarkable.\n.", "output": "1. The patient is status post C5 through C7 ACDF. No abnormal enhancement is\nidentified.\n2. Since prior examination of ___, there is interval development of prominent\nC5-C6 right eccentric intervertebral osteophyte resulting in moderate to\nsevere spinal canal narrowing and remodeling of the right ventral aspect of\nthe cord. There may be minimally increased cord signal hyperintense signal at\nthe C5-C6 level when compared to prior exam which may represent progressive\nmyelomalacia. No definitive cord expansion to suggest edema.\n3. Bilateral severe neural foraminal narrowing at C5-C6 and C6-C7.\n4. There is no abnormal marrow signal.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Mild retrolisthesis at L2 on L3, and L3 on L4 levels remains unchanged. \nHeterogeneous signal in the bone marrow appears also stable consistent with\n___ type 2 endplate changes, irregular contour at L2-L3, and L3-L4 level is\nconsistent with Schmorl's nodes. The conus medullaris is unremarkable\nterminates at the level of T12-L1.\n\nAt T12-L1 level, there is minimal central disc bulge with no evidence of\nneural foraminal narrowing or spinal canal stenosis.\n\nAt L1-L2 level, there is interval progression and more prominent posterior\ndisc protrusion with disc material extruded superiorly, causing anterior\nthecal sac deformity (images 25, 26, series 300), additionally there is mild\nbilateral articular joint facet hypertrophy ligamentum flavum thickening\ncausing mild crowding of the nerve roots within thecal sac, there is no\nevidence of neural foraminal narrowing.\n\nAt L2-L3 level, there is irregular contour of the endplates with bone marrow\nreplacement for fat consistent with a combination ___ type 2 endplate\nchanges and Schmorl's node. There is a slightly larger and more pronounced\ndiffuse disc protrusion, causing anterior thecal sac deformity and bilateral\nneural foraminal narrowing, contacting the traversing nerve roots bilaterally,\nmoderate articular joint facet hypertrophy and ligamentum flavum thickening\nappears grossly unchanged.\n\nAt L3-L4 level, ___ type 2 endplate changes are again seen as well as\nSchmorl's node, diffuse disc bulge causing anterior thecal sac deformity\nappears grossly unchanged, contacting the traversing nerve roots bilaterally,\nmoderate articular joint facet hypertrophy and ligamentum flavum thickening\nare more pronounced on the left, however stable since the prior exam.\n\nAt L4-5 level, there is diffuse disc bulge, causing mild anterior thecal sac\ndeformity and bilateral neural foraminal narrowing, contacting the traversing\nnerve roots bilaterally, moderate articular joint facet hypertrophy ligamentum\nflavum thickening remain unchanged and also more pronounced towards the left.\n\nAt L5-S1 level, there is disc desiccation and diffuse disc bulge, contacting\nthe traversing nerve roots bilaterally, producing moderate bilateral neural\nforaminal narrowing, contacting the exiting nerve roots bilaterally, moderate\narticular joint facet hypertrophy remains unchanged. The sacroiliac joints\nand the visualized paravertebral structures are grossly unremarkable.", "output": "1. Unchanged mild retrolisthesis at L2 on L3, and L3 on L4 levels.\n\n2. Interval progression and more prominent posterior disc protrusion\nidentified at L1-L2 level, impinging the thecal sac, with material extruded\nsuperiorly as described detail above.\n\n3. Interval progression and slightly larger diffuse disc protrusion\nidentified at L2-L3 level causing anterior thecal sac deformity and bilateral\nneural foraminal narrowing, contacting the traversing nerve roots bilaterally.\n\n4. Relatively stable degenerative changes identified at L3-L4, L4-5 and L5-S1\nlevels." }, { "input": "There is 2 mm retrolisthesis of C5 on C6. The alignment of the cervical spine\nis otherwise maintained. The vertebral body heights are maintained at all\nlevels. There are stable ___ type 1 changes along the endplates of C5-C6\nwith enhancement on postcontrast images. This is most likely degenerative in\netiology. However, underlying infection is not completely excluded. No\noverlying epidural collection is seen.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\nThere is loss of intervertebral disc height and signal at all levels in\nkeeping with disc degeneration.\n\nThere is no prevertebral soft tissue swelling. The visualized portion of the\nposterior fossa, cervicomedullary junction are preserved.\n\nAt C2-C3, no neural foramina or spinal canal stenosis is seen.\n\nAt C3-C4, there is central disc protrusion indenting the ventral thecal sac. \nNo neural foramina or spinal canal stenosis is seen.\n\nAt C4-C5, no neural foramina or spinal canal stenosis is seen.\n\nAt C5-C6, there is central disc osteophyte complex indenting the ventral\naspect of cord resulting and mild spinal canal stenosis. Uncovertebral and\nfacet arthropathy results in mild bilateral neural foramen narrowing.\n\nAt C6-C7, and C7/T1 levels, no neural foramina or spinal canal stenosis is\nseen.\n\nThis is unchanged compared to the prior study.", "output": "1. Stable edema with enhancement along the C5-C6 endplates. This is favored\nto be degenerative in etiology. However, given the presence of enhancement,\ninfectious or inflammatory etiology is not excluded though favored to be less\nlikely.\n2. Stable my multilevel multifactorial degenerative disease of the cervical\nspine, without high-grade neural foramina or spinal canal stenosis at any\nlevel." }, { "input": "Please note the study is severely degraded by motion, especially in the\ncervical and lumbar spine. Within these confines:\n\nCERVICAL:\nThere is 2 mm retrolisthesis of C5 on C6. The alignment of the cervical spine\nis otherwise maintained. The vertebral body heights are maintained at all\nlevels. There are ___ type 1 changes along the endplates of C5-C6 with\nenhancement on postcontrast images. This is most likely degenerative in\netiology. However, underlying infection is not completely excluded. No\noverlying epidural collection is seen.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThere is loss of intervertebral disc height and signal at all levels in\nkeeping with disc degeneration.\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 are preserved.\n\nAt C2-C3, no neural foramina or spinal canal stenosis is seen.\n\nAt C3-C4, there is central disc protrusion indenting the ventral thecal sac. \nNo neural foramina or spinal canal stenosis is seen.\n\nAt C4-C5, no neural foramina or spinal canal stenosis is seen.\n\nAt C5-C6, there is central disc osteophyte complex indenting the ventral\naspect of cord resulting and mild spinal canal stenosis. Uncovertebral and\nfacet arthropathy results in mild bilateral neural foramen narrowing.\n\nAt C6-C7, no neural foramina or spinal canal stenosis is seen.\n\nAt C7-T1, no neural foramina or spinal canal stenosis is seen.\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare maintained at all levels. No abnormal marrow signal is seen. The\nvisualized thoracic spinal cord appears unremarkable without focal cord signal\nabnormality or cord expansion.\n\nThe intervertebral disc height and signal is maintained at all levels.\n\nThe visualized lung parenchyma, prevertebral and paravertebral soft tissues\nappear unremarkable.\n\nNo neural foramina or spinal canal stenosis is seen at any level.\n\nLUMBAR:\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. The marrow signal appears unremarkable. The\nvisualized lower spinal cord appears unremarkable with the conus terminating\nat L1-L2.\n\nThere is loss of intervertebral disc signal at L2-L3 and L3-L4, likely\nsecondary to disc desiccation. The disc heights are maintained at all levels.\n\nThe visualized prevertebral, paravertebral and paraspinal soft tissues appear\nunremarkable.\n\nNo neural foramen or Spinal canal stenosis is seen at any level.", "output": "1. Study is severely degraded by motion.\n2. Edema with enhancement along the C5-C6 endplates. While findings are\nsuggestive of degenerative changes, differential considerations of infectious\nor inflammatory etiology are not excluded on the basis examination. If\nclinically indicated, consider correlation with serum inflammatory markers.\n3. Within limits of study, no definite epidural collection is seen.\n4. Mild multilevel multifactorial degenerative disease of the cervical spine\nwithout high-grade neural foramina or spinal canal stenosis at any level.\n5. Unremarkable MRI of the thoracic spine\n6. Multilevel degenerative changes described." }, { "input": "On the sagittal images, there is no malalignment or loss of vertebral body\nheight. No suspect marrow lesions are seen. The craniovertebral junction is\nunremarkable. The cord is normal in signal intensity and morphology.\n\nAxial images at C2-C3 demonstrate mild disk bulge without significant\nstenosis.\n\nAt C3-C4 there is a disc osteophyte complex with mild central stenosis and\nmoderate bilateral foramen narrowing from uncovertebral hypertrophy.\n\nAt C4-C5 there is a disc bulge with effacement of ventral thecal sac. There is\nmoderate left and mild right foramen narrowing.\n\nAt C5-C6 there is a disc osteophyte complex with mild effacement of ventral\nthecal sac and mild left foramen narrowing.\n\nAt C6-C7 there is a disc bulge and osteophyte with no significant central or\nforamen narrowing. There is effacement of ventral thecal sac.\n\nAt C7-T1 no significant stenosis.\n\nThe visualized soft tissues of the neck are unremarkable.", "output": "Mild multilevel degenerative changes. No significant change compared to the\nprior study." }, { "input": "Vertebral body heights are within normal limits. There is mild\nanterolisthesis C3 on C4, mild retrolisthesis of C5 on C6, mild retrolisthesis\nof C6 on C7. There is near complete loss of disc height at C4-C5 with partial\nfusion of C4 and C5 vertebral bodies, most likely degenerative based on\nappearances. Moderate loss of disc height is also seen at C5-C6 and C6-C7. \nThere are mild discogenic bone marrow changes at several levels.\n\nEvaluation of spinal cord signal on sagittal images is limited by artifacts. \nNo definite cord signal abnormality is seen in 2 planes.\n\nThe cerebellar tonsils are normally positioned, and the craniocervical\njunction appears unremarkable. Concurrent brain MRI is reported separately.\n\nC2-C3: No spinal canal or neural foraminal narrowing.\n\nC3-C4: The disc is uncovered by mild anterolisthesis with a shallow\nbroad-based central disc protrusion, partially covered by endplate\nosteophytes. The ventral thecal sac is mildly indented without spinal cord\ncontact. Severe bilateral neural foraminal narrowing by uncovertebral as well\nas facet osteophytes.\n\nC4-C5: There is a relatively narrow based central disc protrusion covered by\nendplate osteophytes, which contacts and minimally deforms the ventral spinal\ncord. However, CSF surrounds the cord laterally and posteriorly. There is\noverall mild-to-moderate spinal canal narrowing. There is mild right and\nmild-to-moderate left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC5-C6: Mild retrolisthesis, broad-based central disc protrusion with endplate\nosteophytes, as well as infolding of the ligamentum flavum, cause moderate to\nsevere spinal canal narrowing with mild ventral cord deformity. Severe\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Mild retrolisthesis and a left paracentral disc protrusion covered by\nendplate osteophytes cause mild spinal canal narrowing with minimal left\nventral cord deformity. Moderate to severe right and severe left neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nSagittal images through the T4-T5 level demonstrate a small right paracentral\ndisc protrusion without significant spinal canal narrowing. No axial images\nthrough this level.\n\nThere is a partially visualized T2 hyperintense focus at the right lung apex,\nat least 1 cm on image 8:33.", "output": "1. Multilevel cervical degenerative disease. Spinal canal stenosis is\nmoderate to severe at C5-C6, with mild ventral cord deformity, and\nmild-to-moderate at C4-C5 with minimal ventral cord deformity. Neural\nforaminal narrowing is advanced at multiple levels.\n2. Evaluation of spinal cord signal is limited by artifacts on sagittal\nimages. No definite cord signal abnormalities are seen in 2 planes.\n3. Partially visualized lesion at the right lung apex, at least 1 cm.\n\nRECOMMENDATION(S): Chest CT.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 09:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "There is bone marrow edema at the site of the minimally displaced C6 anterior\nsuperior corner fracture seen on the preceding CT, without significant loss of\nvertebral body height. There is associated disruption of the anterior\nlongitudinal ligament. There is mild prevertebral edema from C2-C3 through\nC7-T1. There is no C5-6 disc edema, and no posterior longitudinal ligament\nedema or disruption.\n\nThere is interspinous ligament edema at C4-C5 extending to the ligamentum\nflavum. No clear evidence for ligamentum flavum edema or disruption. There\nis milder edema in the interspinous ligaments at C5-C6 and C2-C3. There is\nalso edema in the midline posterior paravertebral tissues along the entire\ncervical spine.\n\nThere is high signal on STIR images in the C3-C4 disc without disc disruption,\nand without extension to the anterior longitudinal or posterior longitudinal\nligament, most likely on the degenerative basis.\n\nThere is no evidence for an epidural collection. No spinal cord signal\nabnormalities are identified.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa appears unremarkable.\n\nEvaluation of multilevel degenerative disease on axial images is somewhat\nlimited by motion artifact. The following observations are made:\n\nC2-C3: No spinal canal narrowing. Severe left neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nC3-C4: Small central disc protrusion indents the ventral thecal sac without\nspinal cord contact. Mild spinal canal narrowing. Mild right and moderate to\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Central disc protrusion indents the ventral thecal sac and approaches\nthe ventral spinal cord without clear evidence for cord remodeling. \nMild-to-moderate spinal canal narrowing. Moderate right and moderate to\nsevere left neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC5-C6: Broad-based central/left paracentral disc protrusion mildly indents the\nventral thecal sac without spinal cord contact, with mild spinal canal\nnarrowing. Moderate right and moderate to severe left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Small central disc protrusion indents the ventral thecal sac without\nspinal cord contact or significant spinal canal narrowing. Mild right and\nmoderate left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC7-T1: No spinal canal narrowing. Severe bilateral neural foraminal narrowing\nby severe facet arthropathy as well as uncovertebral osteophytes.", "output": "1. The previously seen minimally displaced C6 anterior superior corner\nfracture demonstrates associated bone marrow edema, focal disruption of the\nanterior longitudinal ligament, and mild prevertebral edema extending along\nthe cervical spine.\n2. Interspinous ligament edema at C4-C5, and to a lesser extent at C5-C6 and\nC2-C3, without clear evidence for ligamentum flavum edema or disruption. \nOverlying edema in the midline posterior paravertebral soft tissues along the\ncervical spine.\n3. High signal on STIR images in the C3-C4 disc, without disc disruption, and\nwithout extension to the anterior longitudinal posterior longitudinal\nligament, most likely degenerative in etiology.\n4. No evidence for epidural collection or spinal cord signal abnormality.\n5. Multilevel degenerative disease. Spinal canal narrowing is\nmild-to-moderate at C4-C5 and mild at other levels. Advanced neural foraminal\nnarrowing at multiple levels, as detailed above.\n\nNOTIFICATION: Electronic preliminary report was provided at 7:23 a.m. by Dr.\n___, including the disruption of the anterior longitudinal\nligament and interspinous ligament edema." }, { "input": "CERVICAL: Cervical vertebral body height and alignment are preserved. There\nare degenerative endplate changes throughout the cervical spine. No\nsuspicious bone marrow signal abnormality is identified.\n\nThe cervical spinal cord appears normal in morphology and signal intensity.\n\nAt C2-3, there is moderate spinal canal narrowing due to a broad-based disc\nprotrusion and ligamentum flavum thickening. There is moderate right and mild\nleft neural foraminal narrowing due to uncovertebral joint arthropathy.\n\nAt C3-4, there is a mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint arthropathy result in\nsevere bilateral neural foraminal narrowing.\n\nAt C4-5, there mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint arthropathy result in\nsevere bilateral neural foraminal narrowing.\n\nAt C5-6, there is moderate spinal canal narrowing due to broad-based disc\nosteophyte complex and ligamentum flavum thickening. Uncovertebral and facet\njoint arthropathy result in severe bilateral neural foraminal narrowing.\n\nAt C6-7, there is severe spinal canal narrowing with flattening of the cord\ndue to a broad-based disc osteophyte complex and ligamentum flavum thickening.\nUncovertebral and facet joint arthropathy result in severe bilateral neural\nforaminal narrowing.\n\nAt C7-T1, there is mild spinal canal narrowing due to a broad-based disc\nosteophyte complex. Uncovertebral and facet joint arthropathy result in\nsevere bilateral neural foraminal narrowing.\n\nThe prevertebral and paraspinal soft tissues are unremarkable.\n\nTHORACIC: Thoracic vertebral body height and alignment are preserved. There\nare degenerative endplate changes throughout the thoracic spine. No\nsuspicious bone marrow signal abnormality is identified.\n\nThe thoracic spinal cord appears normal in morphology and signal intensity.\n\nThere is moderate spinal canal narrowing at T9-10 due to a broad-based disc\nprotrusion and ligamentum flavum thickening. There is mild narrowing of the\nlevels due to small disc protrusions. There is moderate to severe bilateral\nneural foraminal narrowing at T9-10 due to facet arthropathy.\n\nThere is a 6 mm focus within the spleen that appears hyperintense on T2\nweighted images, indeterminate although likely a benign acquired cyst. A 1.7\ncm right sided epidermal inclusion cyst at the T11-T12 level is also noted\n(series 11, image 14)..\n\nThe prevertebral and paraspinal soft tissues are otherwise unremarkable.\n\nLUMBAR: Lumbar vertebral body height is preserved. There is mild degenerative\nspondylolisthesis at L4-5. There are degenerative endplate changes with\nsevere loss of disc height at L1-2 and L2-3. No suspicious bone marrow signal\nabnormality is identified.\n\nThe conus medullaris terminates at the T12-L1 level. The conus medullaris\nappears normal in morphology and signal intensity. There is undulation of the\ncauda equina nerve roots due to spinal stenosis as detailed below.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-2, there is severe spinal canal narrowing due to a disc bulge with a\nsuperimposed left paracentral disc extrusion with inferior migration,\nligamentum flavum thickening, and facet arthropathy. There is severe left\nsubarticular zone narrowing with impingement on the traversing left L2 nerve\nroot. There is moderate bilateral neural foraminal narrowing.\n\nAt L2-3, there is severe spinal canal narrowing due to a disc bulge,\nligamentum flavum thickening, and facet arthropathy. There is impingement on\nthe traversing bilateral L3 nerve roots due to subarticular zone narrowing. \nThere is severe bilateral neural foraminal narrowing.\n\nAt L3-4, there is a severe spinal canal narrowing due to a disc bulge,\nligamentum flavum thickening, and facet arthropathy. There is impingement on\nthe traversing bilateral or nerve roots within the subarticular zone. There\nis severe bilateral neural foraminal narrowing.\n\nAt L4-5, there is very severe spinal canal narrowing due to a disc bulge,\nligamentum flavum thickening, and facet arthropathy. There is impingement on\nthe traversing bilateral L5 and likely other nerve roots. There is severe\nbilateral neural foraminal narrowing.\n\nAt L5-S1, there is mild spinal canal narrowing and facet arthropathy. There\nis possible impingement on the traversing left S1 nerve root within the\nsubarticular zones. There is very severe bilateral neural foraminal\nnarrowing.\n\nThere is mild degenerative change at the bilateral sacroiliac joints.\n\nThere are several subcentimeter lesions within the kidneys that appear\nhyperintense on T2 weighted images, indeterminate although likely simple\ncysts.\n\nThe prevertebral and paraspinal soft tissues are otherwise unremarkable.", "output": "1. Lumbar degenerative disc disease with severe spinal canal narrowing at\nL1-2, L2-3, L3-4, and L4-5, most severe at L4-5 with impingement of nerve\nroots at multiple levels as detailed above.\n2. Cervical degenerative disc disease, with severe spinal canal narrowing at\nC5-6 and moderate canal narrowing at other levels as detailed above. There is\nsevere neural foraminal narrowing at multiple levels.\n3. Thoracic degenerative disc disease, with moderate spinal canal and neural\nforaminal narrowing at T9-10.\n4. Additional findings as described above." }, { "input": "In comparison to the prior study of ___, there are interval\npostsurgical changes of left L5-S1 hemilaminectomy and discectomy. There is\nenhancing soft tissue in the left subarticular zone that is hypointense on T1\nand T2 weighted images, consistent with scarring/granulation tissue (series 6,\nimage 39); series 8, image 41. Residual/recurrent disc protrusion (series 2,\nimage 12; series 5, image 41) likely impinges on the traversing left S1 nerve\nroot within the subarticular zone. There is mild left and no significant\nright neural foraminal narrowing.\n\nVertebral body heights and alignment are maintained. A disc bulge at L ___\nresulting in minimal narrowing of the spinal canal and bilateral neural\nforamina is unchanged. There is no disc herniation, spinal canal, or neural\nforaminal narrowing elsewhere. There is no epidural or paraspinal fluid\ncollection.\n\nThe distal spinal cord is normal in caliber and signal intensity. Nerve roots\nof the cauda equina are grossly unremarkable.", "output": "1. Interval postsurgical changes of L5-S1 hemilaminectomy and discectomy.\n2. Enhancing soft tissue moderately narrowing the left subarticular zone at\nL5-S1 likely represents scarring/granulation tissue a superimposed\nresidual/recurrent disc protrusion, appears to impinge the traversing left S1\nnerve root within the left subarticular zone.\n3. Unchanged disc bulge at L4-5 resulting in minimal spinal canal and\nbilateral neural foraminal narrowing.\n4. Additional findings as described above." }, { "input": "There is no vertebral body height loss to suggest compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L2. There is no abnormal signal or\nenhancement of the terminal cord, conus medullaris or cauda equina.\n\nMinimal degenerative changes are noted at T12-L1 through L3-L4.\n\nL4-L5: A mild disc bulge indents the ventral thecal sac and combines with\nfacet arthropathy to result in minimal canal stenosis with minimal left neural\nforaminal narrowing, unchanged from the prior exam.\n\nL5-S1: The patient is status post left L5-S1 hemilaminectomy with stable\npostsurgical changes. A left central recurrent disc extrusion severely\nnarrows the left subarticular zone, resulting in moderate canal stenosis, with\na background of mild bilateral neural foraminal narrowing. The disc\nherniation is significantly bigger than postoperative examination of ___. This residual disc extrusion combines with enhancing postsurgical soft\ntissue to compress the descending left S1 nerve root, an unchanged finding.\n\nThe remainder of the visualized paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Status post left L5-S1 hemilaminectomy and discectomy, with stable\npostsurgical changes.\n2. Recurrent left central disc extrusion with minimal surrounding minimal\npostsurgical enhancing fibrosis/scarring, resulting in narrowing of the left\nsubarticular recess and compression of the descending left S1 nerve root. The\ndisc herniation is significantly larger when compared to prior examination.\n3. Mild background spondylosis of the lower lumbar spine, detailed above and\nunchanged from the previous examination.\n4. Additional findings as described above." }, { "input": "Vertebral body signal intensity appears normal. There is multilevel disc\ndesiccation. The spinal cord appears normal in caliber and configuration. \nThere is posterior fusion at L4-L5. L3-L5 laminectomy changes are seen. \nStable grade 1 anterolisthesis is seen at L4-L5. T2 hyperintense signal is\nnoted in the bilateral paraspinal muscles. There is a 4.4 cm x 1.2 cm x 1 cm\ncentrally T2 hyperintense, minimally peripherally enhancing fluid collection\nin the posterior paraspinal soft tissues for, at the level of L4-L5 with no\nextension into the spinal canal.\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is no spinal canal or neural foraminal stenosis. Mild facet\narthropathy is seen.\n\nAt L2-3 there is no spinal canal or neural foraminal stenosis. Mild facet\narthropathy is seen.\n\nAt L3-4 there is no spinal canal or neural foraminal stenosis. Mild enhancing\ngranulation tissue is noted without significant encroachment into the spinal. \nMild facet arthropathy is seen.\n\nAt L4-5 there is mild enhancing granulation tissue which encroaches on the\nspinal canal resulting in mild spinal canal narrowing. There is no\nsignificant neural foraminal narrowing.\n\nAt L5-S1 there is mild spinal canal stenosis secondary to moderate facet\narthropathy.\n\nThere is a 3.6 cm T2 hyperintense nonenhancing cyst in the left anterior lower\nrenal pole. Multiple partially visualized T2 hyperintense lesions are seen in\nthe liver.", "output": "1. Postsurgical changes at L4-L5 with a 4.4 cm T2 hyperintense, minimally\nperipherally enhancing fluid collection in the paraspinal soft tissues at the\nlevel of L4-L5 which may represents a postoperative seroma, hematoma or\npotentially early infection.\n\n2. Posterior fusion at L4-L5 with stable grade 1 anterolisthesis of L4 on L5. \nNo significant spinal canal or neuroforaminal stenosis.\n\n3. T2 hyperintense signal in the bilateral paraspinal muscles, likely\npostsurgical changes or denervation injury.\n4. Incompletely characterized renal and hepatic cysts.\n\nRECOMMENDATION(S): Point 1: Clinical correlation with CBC is recommended.\nPoint 4: Correlation with prior imaging is recommended. Further evaluation\nwith ultrasound or dedicated MRI as clinically indicated." }, { "input": "CERVICAL:\nAlignment is normal.There are no findings to suggest infection. There is no\nencroachment on the spinal cord. There are changes of degenerative disc\ndisease including disc bulges and loss of signal of the intervertebral discs\non the T2 weighted images. There is no abnormal enhancement after contrast\nadministration. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of infection or neoplasm.\n\n\nTHORACIC:\nAlignment is normal.There is loss of signal of the intervertebral discs on the\nT2 weighted images, a manifestation of degenerative disc disease. There is a\nsmall midline protrusion of the T6-7 disc that indents the spinal cord. There\nis no other evidence of canal encroachment. The spinal cord appears normal in\ncaliber and configuration. There is no evidence of infection or neoplasm. \nThere is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal.There is near complete loss of the L5-S1 disc with loss of\nsignal of the remaining disc material. There are osteophytes at L5-S1 mildly\nencroach on the spinal canal. There is a right neural foraminal narrowing at\nL5-S1 due to intervertebral and facet osteophytes. There is no other canal\nencroachment. There is no evidence of infection or neoplasm. There is no\nabnormal enhancement after contrast administration\n\n\nOTHER:", "output": "1. Degenerative disc disease with disc protrusion at T6-7 encroaching on the\nspinal cord. No evidence of infection." }, { "input": "Mucous retention cyst is incidentally noted in the left maxillary\nsinus. Alignment is near anatomic. There is mild kyphotic curvature at C2-3\nand C3-4. Osseous marrow signal is normal for a patient of this age. \nVertebral body height and intervertebral disc height is maintained. The pre-\nand post-vertebral soft tissues are unremarkable. The anterior and posterior\nlongitudinal ligaments, ligamentum flavum and facet capsule ligaments are\nunremarkable. There is no significant spinal canal or foraminal narrowing. \nThere is no epidural fluid collection.", "output": "No evidence of ligamentous injury. No significant spinal canal\nor foraminal narrowing." }, { "input": "There is motion artifact degrading quality of the T2 gradient acquisition.\nThere is straightening of the normal cervical lordosis. Vertebral bodies\nremain aligned. No focal suspicious marrow lesion identified. Intervertebral\ndisc height loss identified at C4-5 and C6-7 as most notably at C5-6. The\nspinal cord is normal in signal and caliber. There is 5 mm inferior\ndisplacement of the cerebellar tonsils below the foramen magnum compatible\nwith a Chiari malformation. Other included portions of the posterior fossa are\nunremarkable.\n\nThe craniocervical junction is unremarkable. At C2-3, there is no significant\ncanal or foraminal narrowing.\n\nAt C3-4 there is a small posterior disc bulge without significant canal or\nforaminal narrowing. Mild facet joint hypertrophy seen at this level\nbilaterally.\n\nAt C4-5, there is a posterior disc osteophyte complex and right greater than\nleft uncovertebral joint hypertrophy. Again, this is seen to indent the right\nventral aspect of the spinal cord. No significant foraminal narrowing is\nidentified.\n\nAt C5-6, posterior disc osteophyte complex and bilateral uncovertebral joint\nhypertrophy causes effacement of the ventral CSF and may contact the right\nventral aspect of the cord which is slightly flattened. There is moderate\nbilateral foraminal narrowing.\n\nAt C6-7 the posterior disc osteophyte complex and uncovertebral joint\nhypertrophy are seen with mild canal narrowing. There is moderate left\nforaminal and minimal right foraminal narrowing. Other included more inferior\nlevels are unremarkable.", "output": "1. Multilevel degenerative changes most notably at C4-5 through C6-7 similar\nto prior. Disc osteophyte complexes eccentric towards the right appear to\ncontact the ventral aspect of the cord which is indented at the C4-5 level and\nslightly flattened at the C5-6 level. No intrinsic cord signal abnormality.\n\n2. Inferior herniation of the cerebellar tonsils compatible with Chiari\nmalformation." }, { "input": "Thoracic spine alignment is maintained. Vertebral body heights and disc spaces\nare preserved. Within the superior T6 vertebral body, there is a 7 mm\nwell-defined T2 and STIR hyperintense lesion without abnormal T1 signal.\n\nThe thoracic cord is normal in morphology and signal intensity. There is no\nsignificant spinal canal or neural foraminal narrowing.\n\nThe ascending thoracic aorta is aneurysmal measuring up to 4.4 cm in AP\ndimension.\n\nA small T2 hyperintense lesion within the posterior right hepatic lobe\ncorresponds to a small hypodense lesion seen on the ___ abdomen CT. A\nsmall T2 hyperintense lesion within the right kidney likely represents a cyst.", "output": "1. No thoracic cord compression or abnormal cord signal.\n2. T6 vertebral body lesion most consistent with atypical hemangioma.\n3. Ascending thoracic aortic aneurysm." }, { "input": "THORACIC:\nAlignment is normal. There is diffuse low T1 signal throughout the thoracic\nvertebral bodies likely representing a combination of hyperplastic marrow\nand/or sclerosis from chronic bone infarcts.\n\nScattered T2/STIR hyperintensity most prominently involving the T9 and T10\nvertebral bodies and to a lesser extent the T3 through T6 vertebral bodies\nraises suspicion for superimposed bone infarcts.\n\nThere also multilevel central endplate compression deformities seen at T9\nthrough T12. There is no evidence of abnormal postcontrast enhancement. No\ndefinite evidence of osteomyelitis discitis. The spinal cord appears normal\nin caliber and configuration. There is no evidence of spinal canal or neural\nforaminal narrowing.\n\nLUMBAR:\nThere is straightening of the lumbar spine. There is diffuse T1 hypointensity\ninvolving the lumbar vertebral bodies and visualized bony pelvis likely\nrepresenting a combination of hyperplastic marrow and/or sclerosis from\nchronic bone infarcts. Scattered T2/STIR hyperintensity involving the L1\nthrough L5 vertebral bodies and visualized bony pelvis raises suspicion for\nsuperimposed bone infarcts.\n\nSTIR hyperintensity and T1 hypointensity within the left sacrum may represent\na site of prior bone graft harvesting. Alternatively this may also represent\nan additional site of osseous infarct.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of spinal canal or neural foraminal narrowing.There is no abnormal\nenhancement after contrast administration.", "output": "1. Findings compatible with scattered acute to subacute bone infarcts\ninvolving the thoracic and lumbar spine and visualized bony pelvis correlating\nwith the patient's history of sickle cell disease.\n2. Superimposed diffuse T1 hypointensity involving the thoracic and lumbar\nvertebral bodies likely represent a combination of hyperplastic marrow and/or\nsclerosis from chronic bone infarcts.\n3. The region of STIR hyperintensity and T1 hypointensity within the left\nsacrum possibly correlates with a site of prior bone graft harvesting. \nAlternatively this may also represent an additional site of osseous infarct.\n4. Multilevel central endplate compression deformities of the lower thoracic\nand lumbar spine correlate with the patient's history of sickle cell disease." }, { "input": "The cervical spine alignment is normal. Vertebral body heights are\nmaintained. Marrow signal is normal. The cervical spinal cord is normal in\ncaliber and signal intensity. Mild signal height loss of intervertebral discs\nis consistent with degenerative change. Specifically:\n\nC2-3: Is unremarkable.\nC3-4: Small posterior disc osteophyte complex causes very mild spinal canal\nnarrowing, does not touch the spinal cord. No neural foraminal narrowing.\nC4-5: Is unremarkable.\nC5-6: Small posterior disc osteophyte complex causes mild spinal canal\nnarrowing and slight ventral cord remodeling. No neural foraminal narrowing.\nC6-7: Small posterior central disc protrusion causes mild spinal canal\nnarrowing, does not touch the spinal cord. Uncovertebral and facet\nosteophytes cause mild left neural foraminal narrowing. No right neural\nforaminal narrowing.\nC7-T1: Is unremarkable.\n\nPrevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Very mild cervical spondylosis. Spinal canal narrowing is mild at C5-6\nand C6-7 levels.\n2. Neural foraminal narrowing is mild on the left at C6-7; no other site of\nneural foraminal narrowing identified of the cervical spine.\n3. No cord signal abnormality or other acute abnormality." }, { "input": "Spinal labeling has been provided on series 5, image 11, and is based on the\nlast costal process seen on the CT performed on the prior day. There is\nsacralization of the L5 vertebral body.\n\nModerate anterior wedge compression deformity of L1 is demonstrated, however\nwithout definite evidence of increased STIR signal abnormality, of\nindeterminate chronicity. Severe compression fracture of L2 with vertebral\nplana centrally and moderate retropulsed bowing of the posterior cortex into\nthe central canal. Mild compression deformity of the L3 vertebral body,\nspecifically the loss of height of the middle column demonstrates mild\nincreased STIR/T2 signal abnormality.\nMild enhancement is seen involving the L3 vertebral body.\n\nThe presacral mass, is partially visualized and better evaluated on the MRI of\nthe sacrum performed on the same day.\n\nT12-L1: Mild central disc bulge is seen however there is no significant\nspinal canal stenosis. Facet joint and endplate arthropathy contributes to\nmild left and moderate right neuroforaminal narrowing.\n\nL1-L2: Left central disc bulge is seen, which in combination with ligamentum\nflavum hypertrophy contributes to moderate canal narrowing. Facet joint\narthropathy contributes to mild left neuroforaminal narrowing. The right\nneuroforamen is patent.\n\nL2-L3: Left central disc bulge is seen, which in combination with facet joint\narthropathy contributes to mild canal narrowing. Facet joint osteophytes\ncontribute to severe left and moderate right neuroforaminal narrowing.\n\nL3-L4: Central disc bulge, and ligamentum flavum hypertrophy contributes to\nmild canal narrowing. Facet joint osteophytes contribute to severe left and\nmoderate right neuroforaminal narrowing.\n\nL4-L5: Mild central disc bulge is seen, which in combination with ligamentum\nflavum hypertrophy contributes to mild canal narrowing. Facet joint\nosteophytes in the left facet joint effusion is seen resulting in moderate to\nsevere left and moderate right neuroforaminal narrowing.", "output": "1. Spinal labeling has been provided on series 5, image 11 based on the last\ncostal process of the prior CT. Note is made of sacralization of the L5\nvertebral body.\n2. Moderate anterior wedge compression deformity of L1, is of indeterminate\nchronicity.\n3. Severe compression fracture with vertebral plana centrally of L2 and\nmoderate retropulsed bowing of the posterior cortex in the central canal,\nresults in moderate canal narrowing. This is also of indeterminate\nchronicity, and an underlying neoplastic or inflammatory process cannot be\nexcluded but appears less likely. No definite enhancement is seen.\n4. Increased STIR hyperintensity of L3, with mild enhancement and loss of \nheight of the middle column, suggest a subacute compression deformity.\n5. Presacral mass, incompletely visualized on this exam, better evaluated on\nthe dedicated MRI of the sacrum." }, { "input": "Correlation with a thoracic MR of ___ suggest that there may be 6\nlumbar type vertebral bodies. However, the CT out is not definitive and\ncorrelation with complete spine imaging may be helpful if treatment planning\nrequires certainty about the levels. Were there is of this report, the lowest\nmultiple level will be taken to be L5-S1.\n\nThere is S-shaped scoliosis of the spine with levoscoliosis of the lumbar\nspine with its apex at L1-L2. The alignment of the lumbar spine is otherwise\nmaintained. The vertebral body heights are maintained at all levels. There\nare ___ type 2 changes at L4-L5. No focal abnormal marrow signal is seen. \nThe visualized lower spinal cord appears unremarkable with the conus\nterminating at T12-L1.\n\nThe visualized retroperitoneal, paravertebral and paraspinal soft tissues\nappear unremarkable. The visualized upper bilateral sacroiliac joints appear\nunremarkable.\n\nNo abnormal enhancement is seen on postcontrast images.\n\nAt T12-L1, there is mild loss of intervertebral disc signal. The disc height\nis maintained. Bilateral neural foramen and spinal canal are patent.\n\nAt L1-L2, there is mild loss of intervertebral disc signal. The disc height\nis maintained. Bilateral neural foramen and spinal canal are patent.\n\nAt L2-L3, there is mild loss of disc height and signal with broad-based disc\nbulge and bilateral facet arthropathy with ligamentum flavum thickening. \nBilateral neural foramen and spinal canal are patent.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc bulge\nand bilateral facet arthropathy with ligamentum flavum thickening resulting in\nmild right neural foramen narrowing. Left neural foramen and spinal canal are\npatent.\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\nbilateral neural foramen narrowing. The spinal canal is patent.\n\nAt L5-S1, there is loss of disc height and signal with broad-based disc bulge\nand bilateral facet arthropathy. Bilateral neural foramen are patent. Spinal\ncanal is patent.\n\nThese findings are relatively unchanged compared to the prior study from ___.", "output": "1. Stable multilevel multifactorial degenerative disease of the lumbar spine,\nworst at L4-L5 with mild bilateral neural foramen narrowing. Spinal canal is\npatent at all levels.\n2. Stable moderate levoscoliosis of the lumbar spine with the apex at L1-L2.\n3. No abnormal enhancement is seen on postcontrast images.\n4. Note the ambiguity of counting the lumbar levels. For the purpose of this\nreport the lowest movable level is termed L5-S1." }, { "input": "CERVICAL SPINE:\nThere is stable reversal of the cervical lordosis. Vertebral body heights are\npreserved. There is no marrow signal abnormality.\n\nThere is a short-segment nonenhancing T2 hyperintense lesion within the right\nlateral cervical cord measuring 2 mm at the C2 level (6:7; 03:10).\nThere is a short segment nonenhancing T2 hyperintense lesion within the\nventral midline cervical cord measuring 3 mm at the C3-C4 level (3:9; 06:14)\nThere is a short segment nonenhancing T2 hyperintense lesion within the dorsal\nmidline cervical cord measuring 2 mm at the C3 level (3:9; 06:11).\n\nThere is loss of intervertebral disc signal at all levels of the cervical\nspine. There is no evidence of infection or neoplasm. There is no\nprevertebral soft tissue swelling.. The visualized portion of the posterior\nfossa, cervicomedullary junction are preserved.\n\nAt C2-C3 there is no significant neural foramina or spinal canal stenosis.\n\nAt C3-C4 there is no significant neural foraminal spinal canal stenosis.\n\nAt C4-C5 there are uncovertebral osteophytes causing moderate bilateral neural\nforaminal stenosis without significant spinal canal stenosis.\n\nAt C5-C6 there are uncovertebral osteophytes causing moderate right and mild\nleft neural foraminal stenosis without significant spinal canal stenosis.\n\nAt C6-C7 there is no significant neural foramina or spinal canal stenosis.\n\nTHORACIC SPINE:\nThere is a rightward dextroscoliosis of the thoracic spine. The vertebral\nbody heights are preserved. The marrow signal is unremarkable. There is mild\nlow intervertebral disc signal. There is no significant neural foramina or\nspinal canal stenosis.\n\nThere is central cord T2 hyperintensity centered at the T9 level measuring up\nto 4 mm in diameter (13:11) extending for 3 cm and craniocaudad dimension\nthere is associated underlying enhancement measuring 3 mm AP x 9 mm CC x 4 mm\nAP (16:11; 14:16).\n\nThere is mild prominence central cord T2 signal from a T3-T4 through T6-T7\nmeasuring between 1 and 2 mm without associated postcontrast enhancement.\n\nThere are small sub cm cysts versus hemangiomas within the liver.", "output": "1. Short-segment central T2 hyperintense enhancing lesion within the thoracic\ncord at the T9 level suspicious for demyelination.\n2. Additional short-segment T2 hyperintense nonenhancing peripheral lesions at\nthe C2 and C3 levels, as described.\n3. Prominent central T2 hyperintense signal throughout thoracic spinal cord, \nmeasuring up to 1 mm without associated postcontrast enhancement from T3-T4\nthrough T6-T7. Finding may represent a small degenerative syrinx versus\nnonenhancing lesion. Compared to ___ prior exam, extent of hydromyelia is\nincreased between T8 through T10 levels." }, { "input": "Prevertebral soft tissue edema is identified at C3-6 levels. Linear STIR\nhyperintensities at C4-5 and C6-7 anterior disc space extending anteriorly to\nthe prevertebral soft tissues are suspicious for anterior longitudinal\nligament injury, although no discrete focal defect in the anterior\nlongitudinal ligament is identified. There is mild T2 hyperintensity in the\nspinal cord at C4-5 level in setting of severe spinal canal narrowing\nsecondary to degenerative changes, as described below.\n\nMild reversal of cervical lordosis centered at C5-6 is similar to before and\nlikely degenerative. There is no evidence of infection or neoplasm.\n\n Multilevel degenerative changes are severe:\nAt the craniocervical junction, ligament thickening causes moderate spinal\ncanal narrowing.\nAt C3-4, spinal canal narrowing is mild.\nAt C4-5, posterior disc bulge, left eccentric endplate osteophytes, and\nligamentum flavum thickening cause severe spinal canal narrowing with near\ncomplete loss of surrounding CSF space. There is flattening of the cord. \nNeural foraminal narrowing is moderate on the right and mild on the left.\nAt C5-6, right eccentric intervertebral osteophytes results in moderate spinal\ncanal narrowing, flattening the right ventral aspect of the cord. \nUncovertebral and facet arthropathy results in moderate\nleft-greater-than-right neural foraminal narrowing.\nAt C6-7, posterior disc bulge, endplate osteophytes, and ligamentum flavum\nthickening cause moderate spinal canal narrowing. CSF space at the anterior\nand posterior aspect of the spinal cord is completely effaced, however it is\npreserved lateral to the cord. Neural foraminal narrowing is moderate\nbilaterally.\n\nThe visualized prevertebral and paraspinal soft tissues are otherwise grossly\nunremarkable.", "output": "1. Signal abnormality at the C4-5 and C6-7 anterior disc space with\nsurrounding prevertebral soft tissue edema is suspicious for anterior\nlongitudinal ligament injury, although no discrete defect is identified.\n2. There is cord signal abnormality at C4-5, suspicious for cord edema, in\nsetting of severe spinal canal narrowing secondary to degenerative changes.\n3. Severe multilevel degenerative changes most notable for severe spinal canal\nnarrowing at C4-5. Spinal canal narrowing is moderate at the craniocervical\njunction, C5-6, and C6-7 levels.\n\nNOTIFICATION: Above findings were discussed with ___ team by\n___, M.D. during neurology radiology conference on ___ at 10:10\nam, 2 minutes after discovery of the findings." }, { "input": "In the interval since the prior study patient has undergone laminectomy for\nresection of the intradural neoplasm demonstrated at L3. The laminectomy\ndefect extends from L2 through L4. There is a large fluid collection within\nthe defect. No dural defect is identified.\nThere is peripheral enhancement of the fluid collection that may be\npostoperative reaction. Early infection would have a similar appearance. The\nfluid collection minimally indents the posterior margin of the thecal sac but\ndoes not encroach on the nerve roots.\nThere is minimal intradural enhancement at the surgical site, most prominent\non image 10 of series 7 and image 8 of series 21. Given the prior presence of\nan enhancing neoplasm, this could represent a small amount of residual tumor. \nHowever, this may also represent simple inflammatory reaction after surgery. \nContinued attention on follow-up imaging is recommended.\nImages of the remainder of the spinal canal demonstrate degenerative changes\nwith loss of signal of the intervertebral discs on the T2 weighted images and\nmild bulges of the disc. These findings are unchanged since the prior study. \nThere is no evidence of spinal canal or neural foraminal compromise.", "output": "1. Status post resection of an intradural masses at L3 with expected\npostoperative changes.\n2. Postoperative fluid collection at the laminectomy site with peripheral\nenhancement. This is a common after laminectomy but superimposed infection\ncannot be excluded.\n3. Small focus of intradural enhancement at the previous location of the\ntumor. This may represent inflammation or a small amount of residual\nneoplasm." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nAgain seen are postoperative changes status post laminectomy for resection of\nintradural neoplasm at L3. Laminectomy defect extends from L2-L4. Large\nfluid collection within the defect is decreased in size compared to prior. \nThere is a small tract, which arises from the L3-4 facet joint on the left and\ninto the collection. This is felt to represent a small synovial tract and\nassociated cyst (series 3; image 77). No dural defect is identified.\n\nThe remains peripheral enhancement of the fluid collection that likely\nrepresents expected postoperative change. Early infection would have a\nsimilar appearance on imaging. Minimal posterior indentation of the thecal\nsac by this collection, without encroachment nerve roots at this level, is\nunchanged.\n\nMinimal intradural enhancement at the surgical site remains, decreased in\nconspicuity compared to prior (series 9; image 22). Findings are more likely\nrepresent resolving simple inflammatory reaction after surgery, given that no\nnew or increasing areas of enhancement are present, which would be more\nconvincing for recurrence/residual tumor.\n\nThroughout the lumbar spine, there are minimal degenerative changes with\npreservation of vertebral body alignment and heights. There is been interval\nincrease in signal of L1 through L5 vertebral bodies, likely increase in fatty\ncontent from post radiation changes. No concerning drop-in marrow signal is\nidentified to suggest neoplasia. Intervertebral disc heights are relatively\npreserved, with the exception of L5-S1. There is loss of intervertebral disc\nsignal, suggestive of degenerative change. Multilevel posterior disc bulges,\nmost prominent at L2-3, cause mild to no spinal canal or neural foraminal\nnarrowing. No severe spinal canal or neural foraminal narrowing is noted from\nT12-S1.", "output": "1. Status post resection of intradural mass at L3, shown to be Ewing sarcoma,\nwith expected postoperative changes. No metastatic disease identified in the\nremaining lumbar spine.\n2. Postoperative fluid collection in the laminectomy bed with peripheral\nenhancement is decreased in size compared to prior. Superimposed infection is\ndifficult to exclude.\n3. New tract is seen from the left L3-4 facet joint into the collection,\nlikely synovial cyst. No dural defect is identified.\n4. Small focus of intradural enhancement at previous location of tumor is\ndecreased in conspicuity compared to prior. Findings favor inflammation as\nopposed to residual tumor/neoplasm. No new or increasing intradural\nenhancement.\n5. Unchanged mild degenerative findings throughout the lumbar spine." }, { "input": "Again seen are postoperative changes status post laminectomy from L2-L4 for\nresection of intradural neoplasm at L3. There is stable large fluid\ncollection within the laminectomy defect, measuring 6.7 x 1.3 x 1.0 cm,\npreviously measuring 6.4 x 1.3 x 1.4 cm. There is redemonstration of a small\ntract arising from the left L3-L4 facet joint extending into the collection\nsuggestive of a small synovial tract and associated cyst (8; 27). There is no\ndural defect. Persistent peripheral enhancement of the fluid collection is\nagain likely postoperative change. There is again minimal posterior\nindentation of the left posterior aspect of the thecal sac at this level,\nsimilar to prior. Minimal dural enhancement at the surgical site appears less\nconspicuous compared to prior (8; 21) and likely represents postsurgical\nchange. Slightly more inferiorly at the L3-L4 level, there is a possible\nfocus of enhancement along the left posterior aspect of the spinal canal,\npossibly corresponding to the left L4 nerve root, new compared to prior,\nattention on follow-up (8; 25).\n\nThere are again multilevel degenerative changes including diffuse posterior\ndisc bulge results in mild spinal canal narrowing from L1-L2 through L4-L5. \nThere is no high-grade neural foraminal narrowing bilaterally. Grade 1\nretrolisthesis of L2-L3 is noted. Vertebral body height and signal intensity\nappear normal. Conus medullaris terminates at the L1 vertebral body level.\n\n\nOther: Fibroid uterus better characterized on prior pelvic ultrasound. \nSubcutaneous edema is noted in the lumbar posterior soft tissues, similar to\nprior.", "output": "1. Status post resection of L3 intradural mass proven to be Ewing's sarcoma\nand status post L2-L4 laminectomy with expected postoperative changes.\n2. Possible focus of enhancement within the left posterior aspect of the\nspinal canal at L3-L4 possibly corresponding to the left L4 nerve root is new,\nattention on follow-up.\n3. Continued decrease in conspicuity of focus of intradural enhancement at\nlocation of prior tumor, more suggestive of postsurgical inflammatory changes\nrather than residual tumor.\n4. Stable appearance of a tract from the left L3-L4 facet joint into the fluid\ncollection at the laminectomy site. Enhancement surrounding the fluid\ncollection is similar to prior. Again, superimposed infection is difficult to\nexclude.\n5. Mild degenerative changes throughout the lumbar spine is similar to prior.\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 again postsurgical changes from laminectomy at the L2 through L4\nlevels for resection of previous L3 mass. A fluid collection is seen in the\nlaminectomy defect measuring approximately 5.1 x 0.9 by 1.2 cm, mildly\ndecreased. A small tract is again seen between this collection and the L3-L4\nfacet joint, less conspicuous than previously. There continues to be\nenhancement surrounding the fluid and involving the surgical bed, which is\nsimilar to the previous exam. However, enhancement in the posterior spinal\ncanal appears increased slightly compared to the previous examination, for\nexample image 24 and 31 series 9 and image 25 series 9 as well as on the\nsagittal images, image 11 of series 8, appearing to extend along several nerve\nroots although without clear nodularity, now seen on both the right and left.\n\nDegenerative changes are again noted throughout the lumbar spine including\nsmall disc protrusions at several levels and mild loss of intervertebral disc\nheight at L5-S1, causing mild spinal canal narrowing most prominently at the\nL3-L4 level, and mild neural foraminal narrowing at the L5-S1 level on the\nleft.", "output": "1. Postsurgical changes from L2 through L4 laminectomy and resection of L3\nintradural mass, with expected postoperative changes. The size of fluid\ncollection in the laminectomy bed has decreased compared to the previous exam.\n2. Apparent increase in enhancement along multiple nerve roots in the lumbar\n___ at the surgical site. The lack of nodularity favors that this\nrepresents inflammatory or post treatment change rather than tumor, but\ncontinuing follow-up is recommended.\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 again postsurgical changes from laminectomy at the L2 through L4\nlevels for resection of previous intradural L3 mass lesion.\nA fluid collection is seen in the laminectomy defect measuring approximately\n7.5 x 10 x 5 cm (AP, TV, SI directions; respectively), not superior unchanged\ncompared to previous examination.\n\nThere is no definite abnormal intradural enhancement. The previously\ndescribed multifocal intradural enhancement is not appreciated in this\nexamination. There is similar degree of surgical bed irregular enhancement\nspecially along peripheral aforementioned collection with extension to dorsal\nepidural space inseparable from dorsal thecal sac opposing laminectomy site;\nunchanged since previous examination.\n\nThere is no definite aggressive osseous process. Included lower spinal cord,\nconus medullaris and cauda equina fibers show normal shape and signal\nintensity.\n\nUnchanged degenerative changes are again noted throughout the lumbar spine\nincluding small disc protrusions at several levels and mild loss of\nintervertebral disc height at L5-S1, causing mild spinal canal narrowing most\nprominently at the L3-L4 level, and mild neural foraminal narrowing at the\nL5-S1 level on the left.", "output": "1. Status post lumbar spine intradural mass resection with L2-L4 laminectomy\nwith postoperative changes. Essentially unchanged laminectomy site\ncollection.\n2. No definite suspicious abnormal intradural enhancement.\n3. No aggressive osseous process.\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 patient is status post L2 through L4 laminectomy. There is a\nmultiloculated fluid collection in the surgery bed, immediately posterior to\nthe thecal sac measuring 5 x 6 x 44 mm, slightly decreased in size as compared\nto ___. On postcontrast imaging, there is enhancement in the soft\ntissues along the surgery tract, posterior to the thecal sac and surrounding\nthe above described fluid collection which peripherally enhances.\n\nAlignment is normal. Unchanged T1 high-signal intensity in the bone marrow of\nthe lower thoracic vertebral bodies, and lumbar spine consistent with bone\nmarrow replacement for fat, likely related with induced postradiation changes.\nThe spinal cord appears normal in caliber and configuration.\n\nT12-L1: Normal.\n\nL1-L2: There is shallow central disc protrusion with tear of the annulus\nfibrosus and prominence of the posterior epidural fat with no significant\nspinal canal or neural foraminal narrowing.\n\nL2-L3: The posterior spinal canal is decompressed secondary to laminectomy. \nThere is shallow circumferential disc bulge. There is no significant spinal\ncanal or neural foraminal narrowing.\n\nL3-L4: The posterior spinal canal is decompressed by laminectomy. There is a\nbroad-based posterior disc bulge and bilateral facet arthropathy with no\nspinal canal and no neural foraminal narrowing.\n\nL4-L5: The posterior thecal sac is decompressed by laminectomy. There is\nbilateral facet arthropathy with no spinal canal and no neural foraminal\nnarrowing.\n\nL5-S1: There is a broad-based posterior disc bulge with no spinal canal, no\nright neural foraminal, and mild to moderate left neural foraminal narrowing.\n\n There is no evidence of infection or neoplasm.\n\nThere is edema in the soft tissues of the surgical bed. There are joint\neffusions in the left L2-L3 and bilateral L3-L4 facet joints.", "output": "1. The patient is status post laminectomy of the L2 through L4 vertebrae. In\nthe surgical bed, there is a fluid collection immediately posterior to the\nthecal sac which is slightly decreased in size as compared to ___,\nlikely representing a postoperative seroma or less commonly and a\npseudomeningocele. There is enhancement and edema of the soft tissues of the\nsurgical bed and surrounding the fluid collection, likely postsurgical. \nRecommend clinical correlation to exclude infection.\n2. Joint effusions of the left L2-L3 and bilateral L3-L4 facet joint.\n3. Unchanged diffuse bone marrow replacement for fat throughout the lower\nthoracic and lumbar vertebral bodies.\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": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is dextroscoliosis of the lumbar spine. Vertebral body heights are\npreserved. There is no marrow signal abnormality.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber, with conus at approximately L1-2 level, and with no definite abnormal\nenhancement on postcontrast imaging.\n\nA 1.4 cm x 1.6 cm x 3.3 cm (AP x TV x SI) homogeneously enhancing T2\nhypointense probable intradural lesion is seen in the spinal canal at the\nlevel of L3. This results in severe narrowing of the spinal canal with\nclumping of the nerve roots.\n\nThere is loss of intervertebral disc signal at L4-5 and L5-S1. There is loss\nof intervertebral disc height at L5-S1.\n\nT12-L1: There is facet hypertrophy, epidural fat, no spinal canal and no\nforaminal narrowing.\n\nL1-L2: There is disc bulge, epidural fat, facet joint hypertrophy, ligamentum\nflavum thickening, mild spinal canal and no foraminal narrowing.\n\nL2-L3: There is disc bulge, right paracentral disc protrusion, thickening of\nthe ligamentum flavum, bilateral facet hypertrophy, epidural fat, and partial\npresence of mass centered at L3 vertebral body, mild-to-moderate spinal canal\nand no neural foraminal narrowing.\n\nL3-L4: There is disc bulge, epidural fat, thickening of the ligamentum flavum,\nbilateral facet hypertrophy, severe spinal canal narrowing (secondary to the\npreviously described mass), and no neural foraminal narrowing.\n\nL4-L5: There is bulge, epidural fat, facet joint hypertrophy, ligamentum\nflavum thickening, right paracentral disc protrusion, mild spinal canal and no\nneural foraminal narrowing. Nonspecific bilateral facet joint fluid is noted.\n\nL5-S1: There is disc bulge, right paracentral disc protrusion, bilateral facet\nhypertrophy, no spinal canal and no neural foraminal narrowing.\n\n OTHER:\n\nThe common bile duct is dilated measuring up to 7 mm. No filling defect is\nvisualized.\n\nA 2.4 x 2.5 cm predominantly cystic lesion with a blood fluid level is seen in\nthe mid pelvis (07:39). This structures suggested to be contiguous with the\nright ovary, suggestive of hemorrhagic cyst.\n\nProbable dependent edema is noted in the dorsal lumbar soft tissues.", "output": "1. Study is moderately degraded by motion.\n2. 1.4 x 1.6 x 3.3 cm probable intradural homogeneously enhancing mass at the\nlevel of L3, resulting in severe spinal canal narrowing and clumping of the\nnerve roots at L3-4 and contributing to mild-to-moderate vertebral canal\nnarrowing L2-3. Differential considerations include meningioma, schwannoma and\nmetastatic lesion.\n3. Additional multilevel lumbar spondylosis as described, without definite\nevidence of moderate or severe vertebral canal or neural foraminal narrowing.\n4. Dilated common bile duct without filling defect.\n5. 2.5 cm hemorrhagic cyst in the mid pelvis suggests be contiguous with the\nright ovary. If clinically indicated, consider correlation with pelvic\nultrasound.\n\nRECOMMENDATION(S):\n1. Abdominal ultrasound for further evaluation of the dilated common bile\nduct.\n2. Ultrasound of the pelvis for further evaluation of the probable right\novarian hemorrhagic cyst.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:57 am, 5 minutes after\ndiscovery of the findings." }, { "input": "Spine numbering a shown on series 2, image 10\n\nMinimal deviation towards the left side, can be positional or related to mild\nlevoscoliosis come on the localizing images. Minimal retrolisthesis of L2\nover L3 and L3 over L4.\nThere is normal lumbar alignment otherwise.\nThe vertebral body heights are preserved. The marrow signal is slightly\nhypointense, can relate to cellular red marrow; otherwise unremarkable.\nThere is mild signal from L3-S1 with mild loss of height at L5-S1.\n\nThe conus demonstrates normal signal morphology, terminating appropriately the\nL1 level.\n\nAt T12-L1 there is no significant neural foraminal or spinal canal stenosis.\n\nAt L1-L2 there is no significant neural foramina or spinal canal stenosis.\n\nAt L2-L3 there is no significant neural foramina or spinal canal stenosis. \nPossible mild facet changes.\n\nAt L3-L4 there is disc bulge without significant neural foramina or spinal\ncanal stenosis.\n\nAt L4-L5 there is asymmetric left disc bulge with a left foraminal protrusion\nwith annular fissure and prominence of the dorsal epidural fat causing mild\nleft neural foraminal stenosis without significant spinal canal stenosis. No\nsignificant change except for slightly increased conspicuity of the annular\nfissure. Likely left hemi laminotomy.\n\nAt L5-S1 there is interval decrease in the previously noted left-sided disc\nherniation; left L5 hemilaminotomy/ hemilaminectomy with a small amount of\nenhancing postsurgical scar/granulation tissue contacting the traversing left\nS1 nerve root with mild encasement (11:18). There is disc bulge, facet\nintervertebral arthropathy without significant neural foramina or spinal canal\nstenosis.\n\nThere is no evidence infection or neoplasm.\nThe paravertebral soft tissues are unremarkable.", "output": "L4-5: Asymmetric left-sided disc bulge with left foraminal protrusion, left\nneural foraminal narrowing with mild deformity on the left L4 nerve; no\nsignificant change compared to prior\nL5-S1: Decrease in the previously noted left-sided disc herniation; new small\namount of postsurgical granulation/scar tissue contacting and partly encasing\ntraversing left S1 nerve root. Disc bulge and degenerative changes at L5-S1\nwithout significant neural foraminal or spinal canal stenosis.\nNo evidence of recurrent disc herniation, nerve root or cord compression." }, { "input": "T1 images are significantly motion degraded. The exam was not completed due\nto patient discomfort and no axial images were obtained.\n\nAlignment appears normal. There is significant ___ type 2 endplate changes\nof the superior endplate of T12, with prominent Schmorl's node.. Vertebral\nbody and intervertebral disc heights and signals are otherwise within normal\nlimits.\n\nThere is mild congenital narrowing of the lumbar spinal canal. There is no\nevidence of disc protrusions. Multilevel facet degenerative changes.\nDiffuse disc bulge contributes to mild central canal narrowing at T11-T12.\nThere is mild-to-moderate bilateral T10-T11, T11-T12 foraminal narrowing.\nMild bilateral L4-5, L5-S1 foraminal narrowing.\nSpinal cord appears normal in configuration, caliber, and signal intensity.\n\n\n There is left greater than right fluid signal within facet joints of L4-L5\nand of the posterior elements more so on the right, may be reactive, consider\ninflammatory or infectious process, including septic arthritis.\n\nsymmetric edema of the paraspinal muscles from the L2-L5 levels and\nprevertebral edema extending from the L4 to S2 which may be reactive or\ninflammatory. No definite evidence of fluid collection.. There is no\nevidence of discitis or osteomyelitis. There is no evidence of epidural\ncollection.", "output": "1. Motion limited, incomplete exam secondary to patient discomfort.\n2. Edema within bilateral L4-5 facet joints, and posterior elements, more\nprominent on the right. Differential considerations include reactive change,\ninflammatory arthritis, septic arthritis.\n3. Edema of the paravertebral muscles and prevertebral fluid in the lower\nlumbar and sacral spine may be reactive or inflammatory.\n4. No evidence of discitis, osteomyelitis, epidural collection, or fracture.\n5. Mild congenital spinal canal narrowing, and degenerative changes, as above." }, { "input": "CERVICAL:\nAlignment is preserved. Vertebral body heights are preserved. Re-identified\nare diffuse T1 and T2 hypointense metastatic lesions throughout the cervical\nspine, with involvement of the posterior elements with a few of these lesions\ndemonstrating water/ideal hyperintensity, and a subtle scattered areas of\nassociated postcontrast enhancement. Involvement is most prominent at the C5\nlevel, with diffuse involvement of the vertebral body. No associated\npathologic fracture is identified. There is minimal thin anterior epidural\nenhancement at the C5 level (18:10), suggestive of minimal extra cortical soft\ntissue extension into the anterior epidural space, though without significant\nspinal canal narrowing. There is no other focus of definite extra cortical\nsoft tissue extension or epidural involvement. There is no prevertebral soft\ntissue edema.\n\nThere is loss of T2 signal of the intervertebral discs, a manifestation of\ndegenerative disc disease.\n\nThe spinal cord is preserved in signal and caliber. The visualized posterior\nfossa and cervicomedullary junction is preserved. There is no epidural\ncollection.\n\nSmall disc protrusions and endplate osteophytes are noted at the C4-C5, C5-C6,\nC6-C7 and C7-T1 levels, minimally indenting the ventral thecal sac without\nsignificant spinal canal narrowing. There is no significant spinal canal\nnarrowing. Facet and uncovertebral osteophytes produce moderate neural\nforaminal narrowing at the left C2-C3 level, severe right and moderate to\nsevere left neural foraminal narrowing C3-C4 level, mild right greater than\nleft narrowing at the C4-C5 level, severe left and moderate right narrowing at\nthe C5-C6 level, mild-to-moderate bilateral narrowing at the C6-C7 level, and\nmild right greater than left narrowing at the C7-T1 level.\n\nTHORACIC:\nAlignment is preserved. Vertebral body heights are preserved. Re-identified\nare diffuse T1 and T2 hypointense metastatic lesions, with some lesions\ndemonstrating water/ideal hyperintensity, with heterogeneous areas of mild\nenhancement. There is diffuse involvement of the T3 and T12 vertebral bodies.\nLesions involve the posterior elements. There is no associated pathologic\nfracture or definite extra cortical soft tissue extension. There is no\nprevertebral soft tissue edema.\n\nThere is loss of T2 signal of the intervertebral disc, a manifestation of\ndegenerative disc disease.\n\nThe spinal cord is preserved in signal and caliber. There is otherwise no\nepidural collection.\n\nTiny disc protrusions are seen at multiple levels without significant spinal\ncanal narrowing. Facet and endplate osteophytes produce up to mild neural\nforaminal narrowing at multiple levels. No high-grade neural foraminal\nnarrowing is seen. Facet degenerative changes are seen at multiple levels.\n\nLUMBAR:\nAlignment is preserved. Vertebral body heights are preserved. Re-identified\nare diffuse T1 and T2 hypointense metastatic lesions with some lesions\ndemonstrating minimal areas of T2/water ideal hyperintensity minimal areas of\npatchy enhancement. Extent of disease appears unchanged since ___. There is near diffuse involvement of the L1, L2, L4 and L5 vertebral\nbodies as well as the S1 level. There is minimal, thin anterior epidural\nenhancement at the T12, L1 and L2 levels suggestive of extra cortical soft\ntissue extension, without significant associated spinal canal narrowing. \nAdditionally, at the S1 level, there is roughly 33 x 7 mm area of anterior\nepidural soft tissue enhancement producing mild spinal canal narrowing,\ncompatible with extra cortical soft tissue extension, with minimal extension\ninto the bilateral S1-S2 neural foramina. There is no pathologic fracture. \nThere is no prevertebral soft tissue edema.\n\nThe distal spinal cord is preserved in signal and caliber. The conus\nmedullaris terminates at the mid L1 level.\n\nAt T12-L1, there is no significant spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is mild disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nAt L2-L3, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L3-L4, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L4-L5, there is minimal disc bulge without significant spinal canal\nnarrowing. Facet and endplate osteophytes produce mild right neural foraminal\nnarrowing. The left neural foramen is patent.\n\nAt L5-S1, there is mild disc bulge without significant spinal canal narrowing.\nEndplate osteophytes produce mild right neural foraminal narrowing. There is\nextension of anterior epidural soft tissue into the left neural foramen,\nadjacent to\nthe nerve root, representing extra cortical soft tissue extension of tumor,\nproducing mild-to-moderate neural foraminal narrowing.\n\nOTHER: The visualized lungs are grossly clear. Extensive bony metastatic\nlesions are noted throughout the remainder of the visualized osseous\nstructures including the ribs and visualized pelvis. The visualized\nretroperitoneum is notable for a 4 mm cystic lesion within the spleen, as CT\npreviously seen on CT examination.", "output": "1. Diffuse, sclerotic osseous metastatic disease, involving all visualized\nosseous structures, as seen on prior examinations.\n2. Unchanged anterior epidural extra cortical soft tissue involvement at the\nS1 and S2 levels, mildly narrowing the spinal canal with extension into the\nbilateral S1-S2 neural foramina producing mild-to-moderate narrowing.\n3. Minimal anterior epidural soft tissue involvement involving the C5, T12, L1\nand L2 levels without associated significant spinal canal narrowing.\n4. No evidence of pathologic fracture.\n5. No cord signal abnormality.\n6. Additional degenerative findings, as described above." }, { "input": "Alignment is normal. Vertebral body heights are preserved. Redemonstrated\nare diffuse T1 and T2 hypointense metastatic lesions throughout the cervical\nspine with extension to the posterior elements. There also sclerotic\nmetastasis involving skullbase, including occipital condyle on both sides,\nclivus, similar to prior. There is continued areas of scattered post-contrast\nenhancement. No significant change in soft tissue extension into the anterior\nepidural space at C5-6 with mild associated spinal canal narrowing. \nParavertebral soft tissue extension along the anterior left margin of C5, C6\nvertebral bodies is mildly more prominent since prior. No associated\npathologic fracture is identified.\n\nLoss of T2 signal of the intervertebral discs is compatible with degenerative\nchange/desiccation.\n\nStable multilevel degenerative changes. No significant associated spinal\ncanal narrowing.\n\nAt C2-C3 level, central canal is patent. There is mild right and moderate\nleft foraminal narrowing.\nAt C3-C4 level central canal is patent. Moderate to severe bilateral\nforaminal narrowing, similar.\nAt C4-C5 level central canal is patent there is moderate to severe bilateral\nforaminal narrowing, similar to prior. On left side, there is suggestion of\nmild left foraminal enhancement, which may be from tumor extension,, similar.\nAt C5-C6 level there is mild-to-moderate central canal narrowing, mild cord\nflattening, similar to prior, no cord edema. There is moderate to severe\nbilateral foraminal narrowing, similar to prior, with some enhancement within\nbilateral foramina, similar, may represent tumor infiltration.\nAt C6-7 level central canal is patent. There is moderate to severe bilateral\nforaminal narrowing, similar. Mild soft tissue infiltration enhancement of\nthe left foramen, consistent with tumor involvement.\nAt C7-T1 level central canal is patent. There is moderate right, and\nmild-to-moderate left foraminal narrowing. Minimal tumor extension at\ninferior left foramen.\n\nTh there is some artifact on axial post gadolinium images, no is no definite\nevidence of cord of nerve root involvement on sagittal images. There is no\ncord edema.", "output": "1. Extensive sclerotic osseous metastases involving skullbase, cervical,\nthoracic spine, similar to prior.\n2. Paravertebral tissue extension at C5, C6, C7 levels is mildly worsened,\nthere is enhancement of foramina at left C4-C5, bilateral C5-C6, left C6-C7,\nleft C7-T1 levels, suggestive of tumor infiltration. Mild epidural tumor\nextension at C5-C6 level, mild-to-moderate central canal narrowing, similar to\nprior.\n3. Multilevel significant foraminal narrowing." }, { "input": "Multiple T1 and T2 low signal areas are identified in the thoracic vertebral\nbodies consistent with sclerotic metastatic disease. Considering the\ndifferences in slice selection, there has been no significant interval change\nin the distribution and appearance of the metastatic lesions. There is no new\ncompression fracture seen. There is no retropulsion or spinal stenosis. \nThere is no intraspinal mass or spinal cord compression seen. No abnormal\nsignal seen within the spinal cord.", "output": "Diffuse sclerotic bony metastatic disease is identified in the thoracic\nvertebral bodies not significantly changed from the previous MRI examination. \nNo evidence of intraspinal mass. No cord compression or abnormal signal\nwithin the spinal cord." }, { "input": "Examination is mildly motion degraded, moderate of the axial series.\n\nRe-identified is diffuse T1 and T2 hypointense sclerotic metastatic\ninvolvement of the visualized spine, with near diffuse involvement of the C6,\nT1, T3, T12, and L1 vertebral bodies. Multiple areas of involvement extending\ninto the posterior spinal elements as well as of the ribs are seen. There is\nslightly greater bony replacement in the left aspect of the T9 vertebral body,\nwith areas of heterogeneous enhancement with a lesion in totality measuring up\nto 30 x 19 mm which appears worsened compared to the ___ examination,\nthough the extensive involvement at other levels appears roughly similar given\ndifference of slice selection. Otherwise, there is no vertebral body height\nloss or alignment abnormality.\n\nExtensive enhancing paravertebral soft tissue deposits appears similar to the\nprior chest CT exam. A right paravertebral deposit at T5-T6 collectively\nmeasures roughly 34 x 14 mm, with a portion of the enhancing soft tissue\nextending minimally into the right neural foramen at this level. Ill-defined\nheterogeneous soft tissue deposit at the left T8-T9 paravertebral level\nmeasures roughly 39 x 15 mm. This also may minimally extend into the distal\nmost aspect of the left neural foramen. Similarly, there appears to be some\nsoft tissue involvement of the left T9-T10 neural foramen. There is also\nenhancing soft tissue involvement extending into and expanding the left\nT11-T12 neural foramina measuring roughly 15 x 13 mm (18:30), which encroaches\nupon the left epidural space (15:30). There is also a thin rind of enhancing\nepidural soft tissue measuring 24 x 3 mm at the T12 level, extending minimally\nto the T11 and L1 level, indenting the ventral thecal sac without significant\nspinal canal narrowing (15:33). This appears minimally worsened. Moderate to\nlarge right and small to moderate left pleural effusions are seen. Areas of\nenhancing soft tissue pleural deposits were better characterized on the prior\nchest CT examination. There is apparent compressive atelectasis of the right\nlung base.\n\nThere is no focal spinal cord signal abnormality. No other enhancing\nintrathecal lesions are seen. A tiny disc protrusion is noted at the T7-T8\nlevel, without significant spinal canal narrowing. There is no significant\nspinal canal narrowing at all visualized levels. Apart from the areas of soft\ntissue neural foraminal involvement, there is no significant neural foraminal\nnarrowing.\n\nMediastinal lymphadenopathy was better assessed on the prior dedicated chest\nCT.", "output": "1. Diffuse sclerotic metastatic disease throughout the thoracic spine and\nvisualized ribs, appearing minimally worsened compared to the prior MR\nexamination from ___, mainly at the T9 vertebral body level. No\nvertebral body height loss or alignment abnormality.\n2. Minimal interval worsening of a thin rind of anterior epidural enhancing\nsoft tissue metastasis along the posterior aspects of the T11, T12, and L1\nvertebral bodies measuring up to 24 x 3 mm at the T12 level.\n3. Diffuse perivertebral enhancing soft tissue metastatic deposits as seen on\nthe prior chest CT, worsened compared to the prior MR, with minimal areas of\ndistal neural foraminal involvement at the right T5-T6, left T8-T9, and left\nT9-T10 levels, worst at the left T11-T12 level where there is diffuse\ninvolvement and expansion of the neural foramen with encasement of the exiting\nnerve root.\n4. No focal spinal cord signal abnormality or other areas of intrathecal\ninvolvement.\n5. Mediastinal lymphadenopathy was better assessed on the prior chest CT\nexamination." }, { "input": "There are numerous hypointense osseous metastases involving the anterior and\nposterior elements of the cervical spine and the included upper thoracic spine\nto the level of T3, as well as the visualized lower clivus and occipital\ncondyles, as seen on prior studies, without evidence for significant change\ncompared to ___.\n\nThere is mild prevertebral edema from C2-C3 through C5-C6, and minimal\nprevertebral edema from C5-C6 through T1-T2, increased compared to minimal\nprevertebral fluid seen from C3-C4 through C4-C5 on the ___ MRI. \nHigh signal in the anterior aspect of the C5-C6 intervertebral disc and linear\nhigh signal through the ossified anterior longitudinal ligament along the\nanterior inferior corner of C5 are unchanged compared to ___. Mild\nretrolisthesis of C5 on C6 is also unchanged. No clear acute disruption of\nthe anterior longitudinal ligament is seen. No evidence for edema or\ndisruption involving the posterior longitudinal ligament or the posterior\nligamentous complex. No evidence for epidural collection. Unchanged minimal\nanterolisthesis of C7 on T1.\n\nEvaluation of spinal cord signal is limited by artifacts. There is\nquestionable mild patchy hyperintensity the central cord from C4 through C6,\nversus artifact, without evidence for cord swelling. No contrast enhancement\nin the spinal cord. No leptomeningeal contrast enhancement.\n\nC2-C3: No spinal canal narrowing. Mild to moderate left neural foraminal\nnarrowing by uncovertebral and facet osteophytes. No change since the ___ MRI.\n\nC3-C4: No spinal canal narrowing. Severe right and moderate to severe left\nneural foraminal narrowing by uncovertebral and facet osteophytes. No change\nsince the prior cervical spine MRI.\n\nC4-C5: No spinal canal narrowing. Moderate bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes, similar to the prior\ncervical spine MRI.\n\nC5-C6: Mild retrolisthesis and posterior endplate osteophytes, as well as\ninfolding of the ligamentum flavum, moderately narrow the spinal canal, left\nmore than right, with ventral spinal cord remodeling. Moderate to severe\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes. \nNo change since the prior cervical spine MRI.\n\nC6-C7: No spinal canal narrowing. Minimal right and moderate left neural\nforaminal narrowing by uncovertebral and facet osteophytes. No change since\nthe prior cervical spine MRI.\n\nC7-T1: Minimal anterolisthesis and tiny central disc protrusion without spinal\ncanal narrowing. No significant neural foraminal narrowing, though bilateral\nfacet arthropathy is present.\n\nThere are partially visualized pleural effusions at the included lung apices,\nright greater than left, as seen on the preceding cervical spine CT.", "output": "1. Mild prevertebral edema in the cervical spine. No clear evidence for\nanterior longitudinal ligament disruption. No evidence for edema or\ndisruption of the intervertebral discs, posterior longitudinal ligament or\nposterior ligamentous complex.\n2. Unchanged mild retrolisthesis of C5 on C6 and minimal anterolisthesis of C7\non T1. No acute subluxation.\n3. Extensive osseous metastatic disease and multilevel degenerative disease,\nsimilar to ___.\n4. Partially visualized pleural effusions, right greater than left.\n\nNOTIFICATION: Electronic wet reading was provided at the time of final\ndictation, 14:19 on ___." }, { "input": "Diffuse osseous metastatic disease is again demonstrated. C6, T1, T3, T9,\nT11, T12, and L1 vertebral bodies are completely are almost completely\nreplaced by metastatic lesions. Numerous discrete metastatic lesions are\npresent in other vertebral bodies and throughout the posterior elements. No\nsignificant change in the extent of osseous lesions is seen compared to ___. No new pathologic fracture is seen; mild loss of height is\nagain seen affecting muscle vertebral bodies without significant interval\nchange. Multiple rib lesions are also noted but not optimally assessed on\nthis exam.\n\nMild right anterior epidural enhancement from at T8 (axial images 22:35-38) is\nunchanged. Mild bilateral anterior epidural enhancement at T11 and T12 is\nunchanged.\n\nMildly prominent veins along the dorsal surface of the distal spinal cord\nbelow the T7 level are unchanged dating back to the earliest available\nthoracic spine MRI from ___. Allowing for the large field of view,\nthere is no evidence for spinal cord signal abnormalities. The conus\nmedullaris terminates at L1.\n\nAnterior paravertebral soft tissue masses are again seen at multiple levels. \nRight anterior paravertebral lesion at T5-T6 extends slightly into the right\nneural foramen, similar to prior. Left anterior paravertebral lesion at T8-T9\nmay extend minimally into the distal left neural foramen, also similar to\nprior. Left anterior paravertebral lesion at T11-T12 extends medially into\nthe left neural foramen, with minimal extension to the left lateral epidural\nspace indenting the left lateral thecal sac, image 23:24, unchanged.\n\nSmall disc bulge is again seen at T7-T8, indenting the ventral thecal sac\nwithout significant spinal canal narrowing.\n\nRight larger than left pleural effusions, with suspected loculation which is\nmore prominent on the right than left all, are again partially visualized,\nsimilar to the ___ chest CT. Apparent right upper pleural nodularity\nis better seen than on the prior chest CT, likely due to differences in\nmodalities. Subcarinal lymphadenopathy is again partially visualized. There\nis a fluid level in the visualized thoracic esophagus.", "output": "1. Compared to ___, there is no significant change in diffuse\nosseous metastatic disease.\n2. Unchanged mild right anterior epidural enhancement from at T8, and mild\nbilateral anterior epidural enhancement at T11 and T12.\n3. Bilateral anterior paravertebral soft tissue masses are again seen at\nmultiple levels. Left anterior paravertebral T11-T12 lesion extends into the\nleft neural foramen, with minimal extension into the left lateral epidural\nspace indenting the left lateral thecal sac, unchanged. Slight extension into\nthe right T5-T6 and left T8-T9 neural foramina is also unchanged.\n4. Unchanged mildly prominent veins along the dorsal surface of the distal\nspinal cord below the level of T7 dating back to the earliest available\nthoracic spine MRI from ___.\n5. Right larger than left pleural effusions with suspected loculation are\nagain partially visualized, similar to the ___ chest CT. Apparent\nright upper pleural nodularity is better seen on the prior chest CT, likely\ndue to differences in modalities. Subcarinal lymphadenopathy is again\npartially visualized." }, { "input": "Straightening of lumbar lordosis is demonstrated. There is transitional\nlumbosacral anatomy with L5 considered to be transitional segment in keeping\nwith the prior study. The conus medullaris terminates at the superior L1 level\nand is unremarkable.\n\nAt T12/L1, no significant findings. At L1/L2, no significant finding\n\nAt L2/L3, similar minimal disc bulge without significant central stenosis or\nforaminal narrowing.\n\nAt L3/L4, similar minimal disc bulge without significant central stenosis or\nforaminal narrowing.\n\nAt L4/L5, mild disc bulge and ligamentous hypertrophy are present. There is\nmild central stenosis and mild foraminal narrowing\n\nAt L5/S1, bilateral laminectomy changes are re-identified. Approximately 12 mm\nleft paracentral inferiorly directed disc extrusion/herniation is\nre-identified. There is narrowing of the left S1 lateral recess. Overall\nappearance is similar to the prior study with mild central stenosis and\nmoderate bilateral foraminal narrowing. The sacroiliac joints are normal .\nThe visualized paravertebral structures are unremarkable.", "output": "1. Transitional lumbosacral anatomy with L5 considered a transitional segment.\n\n2. Status post L4-5 laminectomies with a similar appearance of left\nparacentral disc extrusion/herniation and mild associated central stenosis and\nmoderate foraminal narrowing.\n\n3. Straightening of lumbar lordosis." }, { "input": "Assuming that the lowest rib-bearing segment is T12, there are 5 lumbar type\nvertebral bodies.\n\nMild grade 1 anterolisthesis of L4 on L5 is again demonstrated. Sagittal\nalignment is otherwise maintained. The vertebral bodies are normal in height.\nMultilevel degenerative changes include loss of intervertebral disc height and\nT2 signal with accompanying degenerative endplate marrow signal changes and\nendplate osteophyte formation.\n\nThe visualized distal spinal cord and conus medullaris are normal. The conus\nmedullaris terminates at L1-L2.\n\nAt L1-L2, there is mild facet arthropathy but there is no evidence of spinal\ncanal or neural foraminal narrowing.\n\nAt L2-L3, there is a mild diffuse disc bulge with ligamentum flavum infolding\nand facet arthropathy causing mild narrowing of the spinal canal. There is\nmild bilateral neural foraminal narrowing. Disc material contacts the exiting\nright L2 nerve root without compression, image 15 series 4.\n\nAt L3 L4, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy causing mild narrowing of the spinal canal and\nmild-to-moderate right neural foraminal narrowing. There is no significant\nleft neural foraminal narrowing.\n\nAt L4-L5, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy causing mild to moderate spinal canal narrowing and\nnarrowing of the lateral recesses with possible compression of the bilateral\ntraversing L5 nerve roots, right more so than left. There is minimal right\ngreater than left neural foraminal narrowing with no exiting nerve root\ncompression.\n\nAt L5-S1, there is a diffuse disc bulge with facet arthropathy causing no\nsignificant narrowing of spinal canal although there is narrowing of the\nlateral recesses with probable compression of the traversing S1 nerve roots,\nright more than left. There is no significant narrowing of the neural\nforamina.\n\nThere is atrophy of the posterior paraspinal musculature. A rounded T2\nhyperintense structure to the left of the aorta formed by convergence of\nadjacent tubular structures at the L1-L2 level may reflect a left-sided\ncisterna chyli. Colonic diverticulosis.", "output": "1. Multilevel degenerative changes of the lumbar spine as detailed above. \nFindings are most pronounced at the L4-L5 and L5-S1 levels with possible\ntraversing L5 and S1 nerve root compression.\n2. A rounded oval structure formed a confluence of tubular structures in the\nretroperitoneum may reflect a left-sided cisterna chyli.\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": "There is 1 mm anterolisthesis of C7 on T1. The vertebral body heights are\npreserved. There is heterogeneous marrow signal. The vertebral body heights\nare preserved. There is low intervertebral disc signal with mild loss of\nheight at C6-C7.\n\nAt C2-C3 there is no significant neural foramina or spinal canal stenosis.\n\nAt C3-C4 there is central disc protrusion and uncovertebral and facet\nosteophytes causing mild spinal canal narrowing and moderate right and severe\nleft neural foraminal stenosis.\n\nAt C4-C5 there is central disc protrusion and uncovertebral, intervertebral,\nand facet osteophytes causing mild spinal canal narrowing and severe bilateral\nneural foraminal stenosis.\n\nAt C5-C6 there is central disc protrusion and uncovertebral, intervertebral,\nand facet osteophytes causing moderate spinal canal stenosis which contacts\nand minimally deforms the left aspect of the spinal cord without associated\ncord signal abnormality. There is severe bilateral neural foraminal stenosis.\n\nAt C6-C7 there is central disc protrusion and uncovertebral, intervertebral,\nand facet osteophytes causing moderate spinal canal stenosis which contacts\nthe left aspect of the cord without compression or cord signal abnormality. \nThere is moderate right and severe left neural foraminal stenosis.\n\nAt C7-T1 there are facet osteophytes and ligamentum flavum infolding causing\nmoderate spinal canal stenosis without significant neural foraminal stenosis. \nThere is mild marrow edema at the facet joints, which is likely degenerative.\n\nThere is edema within the right paraspinal musculature which extends into the\nC5-C6 and C6-C7 intraspinal ligaments and the nuchal ligament without\nligamentous disruption. The anterior longitudinal ligament, posterior\nlongitudinal ligament, and ligamentum flavum are intact. There is prominence\nof the atlanto dens interval which measures approximately 3 mm containing\nheterogeneous T2 signal which has increased in comparison to ___. The\ntectorial and transverse ligaments are intact. There is no prevertebral\nedema.", "output": "1. Edema within the right paraspinal musculature, consistent with muscular\nstrain. The edema extends into the C5-C6 and C6-C7 intraspinal ligaments and\nthe nuchal ligament without fibrous disruption which may represent reactive\nedema versus ligament strain.\n2. Intact anterior longitudinal, posterior longitudinal, and flavum ligaments.\nNo evidence of facet capsule disruption.\n3. Prominent atlantodens interval likely secondary to an effusion and synovial\nproliferation, which is increased in comparison to ___. The tectorial and\ntransverse ligaments are intact.\n4. Multilevel degenerative changes of the cervical spine, as described, most\nsignificant within the neural foramen where there is severe stenosis at left\nC3-C4, bilateral C4-C5, bilateral C5-C6, and left C6-C7.\n5. Minimal cord deformity at multiple levels of moderate spinal canal\nstenosis, without evidence of significant compression or cord edema." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level, similar compared to prior.Please note\nthat this method is inappropriate for surgical planning.\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. The conus terminates at T12-L1. The\nprevertebral, paravertebral and paraspinal soft tissues appear unremarkable.\n\nThere is loss of intervertebral disc height and signal at L5-S1. The disc is\nmaintained at all other levels.\n\nFrom T12-L1 to L4-L5, bilateral neural foramina and spinal canal are patent.\n\nAt L5-S1, there is central and left paracentral disc protrusion, measuring\napproximately 4 mm in AP dimension, unchanged compared to the prior study\nindenting the ventral thecal sac and narrowing the left subarticular recess\nimpinging the traversing S1 nerve root and causing moderate left neural\nforaminal narrowing. Also seen right subarticular disc extrusion extending\ninferiorly measuring approximately 11 x 8 mm, unchanged compared to the prior\nstudy causing narrowing of the right lateral recess impinging on the\ntraversing right S1 nerve root and causing severe right neural foraminal\nnarrowing. The spinal canal is patent.", "output": "1. Stable central and left paracentral disc protrusion at L5-S1 causing\nmoderate left neural foramen narrowing and narrowing of left subarticular\nrecess potentially impinging the traversing left S1 nerve root.\n2. Stable right subarticular disc extrusion extending inferiorly from L5-S1\ncausing severe right neural foraminal narrowing and narrowing of right lateral\nrecess impinging the traversing right S1 nerve root.\n3. The remaining lumbar spine appears unremarkable without neural foramina or\nspinal canal stenosis." }, { "input": "Vertebral body alignment is preserved. Anterior fusion of C5-C6 is seen. \nVertebral body heights are preserved. There is no marrow signal abnormality.\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nIntervertebral disc signal and heights are preserved. There is no\nprevertebral soft tissue swelling.. The visualized portion of the posterior\nfossa, cervicomedullary junction, paranasal sinuses and lung apicesare\npreserved.\n\nAt C2-3 there is facet arthropathy withno spinal canal or neural foraminal\nstenosis.\n\nAt C3-4 there is facet arthropathy withno spinal canal or neural foraminal\nstenosis.\n\nAt C4-5 there is disc bulge and facet arthropathyresulting in moderate right\nneural foraminal stenosis and no significant spinal canal stenosis.\n\nAt C5-6 there is disc bulge, uncovertebral hypertrophy and facet arthropathy\nresulting in mild spinal canal stenosis, with no significant neural foraminal\nstenosis.\n\nAt 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. Postsurgical changes in the cervical spine with multilevel degenerative\nchanges, as described above.\n2. No evidence for pachymeningeal enhancement." }, { "input": "CERVICAL:\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Disc height and signal are maintained. \nThe visualized posterior fossa is grossly unremarkable.\n\nThere is no definite signal abnormality or enhancement of the cord itself. \nMultiple ventral and dorsal nerve roots demonstrate thickening and abnormal\nenhancement (for example, at C5-C6 (series 17, image 17).\n\nC2-C3: A right central protrusion results in mild spinal canal narrowing,\nminimally remodeling the ventral aspect of the cord. Uncovertebral facet\narthropathy results in mild bilateral neural foraminal narrowing.\n\nC3-C4: No significant spinal canal or neural foraminal narrowing.\n\nC4-C5: A left central protrusion with annular fissure minimally remodels the\nleft ventral aspect of the cord. There is no significant spinal canal or\nneural foraminal narrowing.\n\nC5-C6: There is a 4 mm right perineural cyst. There is no significant spinal\ncanal or neural foraminal narrowing.\n\nC6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.\n\nThe visualized prevertebral and paraspinal soft tissues are grossly\nunremarkable.\n\nTHORACIC:\nThoracic alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion. Specifically, there is no evidence of\nbone marrow signal abnormality corresponding to the T4 vertebral body where\nthere is a history lymphomas involvement. There is no definitive cord signal\nabnormality. As with the cervical spine, the dorsal and ventral nerve roots\nare diffusely thickened demonstrating postcontrast enhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nLumbar alignment is anatomic. Vertebral body heights are preserved. \nSuspicious marrow lesions identified. The conus medullaris terminates at the\nL2 level, within expected limits.\n\nThere is diffuse thickening and enhancement of the cauda equina nerve roots as\nwell as the lumbar peripheral nerves within the foraminal and extraforaminal\nregions.\n\nNo significant spinal canal or neural foraminal narrowing is identified,\nallowing for mild degenerative changes.\n\nOTHER: There is bilateral gravity dependent atelectasis of the lung bases,\nwhich is more confluent at the right lung base raising the possibility for a\nsuperimposed consolidation.\n\nA 1.3 cm T2 hyperintense nonenhancing cystic lesion of the right superior\nrenal pole demonstrating a single nonenhancing septation is compatible with a\nBosniak 2 cyst. There are multiple nonenhancing T2 hypointense cystic lesions\nin the left kidney measuring up to 1 cm, likely representing hemorrhagic\ncysts.", "output": "1. There is diffuse thickening and abnormal enhancement of the cervical and\nthoracic ventral and dorsal nerve roots as well as of the cauda equina and\nlumbar peripheral nerves. Overall the findings are compatible with given\nhistory of ___. However, given the patient's history of stage\nIV lymphoma, lymphomas involvement should be excluded.\n2. No definite cord signal abnormality is identified. There is no evidence of\nhigh-grade spinal canal or neural foraminal narrowing.\n3. Multiple nonenhancing T2 hypointense cystic lesions in the left kidney\nmeasuring up to 1 cm, likely representing hemorrhagic cysts. This could be\nfurther evaluated with ultrasound.\n4. Bilateral dependent atelectasis of the lung bases. Clinical correlation\nfor more confluent focus in the right lung base for superimposed\nconsolidation.\n5. Additional findings as described above." }, { "input": "2 mm retrolisthesis L2 on L3, L3 on L4 and L4 on L5 is similar in appearance\nto prior examination of ___. Mild anterior wedge shape of L1 is also\nunchanged since ___. Otherwise, vertebral body heights are preserved. There\nis no suspicious marrow signal.\nThere is a rudimentary disc at S1-S2. Disc desiccation and mild loss of disc\nheight of the lumbar spine is also unchanged. The conus medullaris terminates\nat the L1 vertebral level, within expected limits. There is no signal\nabnormality of the visualized cord, conus medullaris or cauda equina.\n\nT11-T12 and T12-L1: Unremarkable.\n\nL1-L2: On sagittal images, there is a small disc bulge without significant\nspinal canal narrowing. There is no significant neural foraminal narrowing.\n\nL2-L3: On sagittal images, a bulge with central annular fissure and epidural\nfat results in mild spinal canal narrowing. Mild bilateral facet arthropathy\nresults in mild right greater than left neural foraminal narrowing.\n\nL3-L4: A disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. There is mild left neural foraminal narrowing\nsecondary to facet arthropathy.\n\nL4-L5: A posterior disc protrusion, slightly eccentric to the left crowds the\nsubarticular zones, greater on the left, contacting the traversing L5 nerve\nroots. Bilateral facet arthropathy results in moderate to severe bilateral\nneural foraminal narrowing.\n\nL5-S1: A disc bulge crowds the subarticular zones without contacting the\ntraversing nerve roots. There is no significant spinal canal narrowing. \nBilateral facet arthropathy results in severe bilateral neural foraminal\nnarrowing.\n\nThe above findings are essentially unchanged since ___.\n\nSTIR hyperintense subcutaneous signal is noted most compatible dependent\nedema. Prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis, most prominent at L4-L5 where\nthere is moderate to severe bilateral neural foraminal narrowing and L5-S1\nwhere there is severe bilateral neural foraminal narrowing. At L4-L5, there\nis crowding of the subarticular zones greater on the left contacting the\ntraversing nerve roots.\n2. These changes are similar since ___." }, { "input": "Decreased T1 and increased inversion recovery signal is identified involving\nthe left lateral mass of C1 and extending to the anterior arch of C1\nindicative of marrow infiltrative process. There is mild compression of the\nlateral mass of C1 identified. There is no evidence of soft tissue epidural\nextension to the spinal canal. Mild increased T1 and T2 signal in the upper\ncervical vertebral bodies could be related to early changes from radiation\ntherapy. There is no spinal canal narrowing seen. There are no other focal\nabnormalities within the cervical vertebral bodies or in the upper thoracic\nvertebral bodies of 2 T3 level. There is no spinal cord compression seen. \nMild multilevel degenerative changes are identified.", "output": "Marrow infiltrative process involving the left lateral mass and anterior arch\nof C1 vertebra without epidural extension. While overall appearance does not\nappear to be changed since the CT (considering differences in technique),\nearly changes of radiation therapy are seen in the upper cervical vertebral\nbodies." }, { "input": "There is mild lumbar scoliosis with concavity on the right and maximum\nangulation at the level of L3. Grade II anterolisthesis of L4-L5 is seen\nwithout spondylolysis. A Schmorl's node is seen involving the superior aspect\nof L1. Endplate degenerative changes are seen L3-L4. The cord terminates at\nL1 and is normal in caliber and signal intensity. There is multilevel loss of\ndisc height and disc desiccation.\n\nAt T11-T12 level, there is diffuse disc bulge causing minimal anterior thecal\nsac deformity, there is no evidence of neural foraminal narrowing or spinal\ncanal stenosis. Mild articular joint facet hypertrophy is seen.\n\nT12-L1: There is minimal diffuse disc bulge causing mild anterior thecal sac\ndeformity with no evidence of neural foraminal narrowing or spinal canal\nstenosis, there is mild bilateral articular joint facet hypertrophy. \nIrregular contour at the superior endplate of L1 on the left is consistent\nwith Schmorl's node.\n\nL1-L2: There is no evidence of neural foraminal narrowing or spinal canal\nstenosis, there is minimal bilateral articular joint facet hypertrophy.\n\nL2-L3: A disc bulge is seen with bilateral facet hypertrophy and mild\nbilateral epidural lipomatosis. There is moderate spinal canal narrowing with\nmild right and moderate left foraminal narrowing.\n\nL3-L4: There is diffuse disc bulging causing mild anterior thecal sac\ndeformity, contacting the traversing nerve roots, causing mild left and\nmoderate right neural foraminal narrowing, there is bilateral articular joint\nfacet hypertrophy and mild ligamentum flavum thickening.\n\nL4-L5: Uncovering of the disc related with grade I anterolisthesis, bilateral\narticular joint facet hypertrophy resulting in moderate bilateral neural\nforaminal narrowing.\n\nL5-S1: There is narrowing of the intervertebral disc space with a rudimentary\ndisc and posterior spondylosis, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis\n\nThere is no evidence of infection or neoplasm.", "output": "1. Multilevel degenerative changes of the lumbar spine, worst at L2-3 and\nL4-5, as above.\n2. Grade 1 anterolisthesis at L4-5 level, mild dextro lumbar scoliosis." }, { "input": "Vertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. 2.2 cm right adnexal\ncyst, most likely physiologic, seen on scout images only. Few benign\nvertebral body hemangiomas. No worrisome lesions.\nThere is congenital narrowing lumbar spinal canal. Multilevel degenerative\nchanges. There is minimal retrolisthesis of L2 on L3. Multilevel diffuse\ndisc bulges. Disc space narrowing at L4-5 level. Multilevel advanced facet\narthritis.\n\nAt L1-L2 level central canal is patent. Patent bilateral foramina.\nAt L2-L3 level there is annular disc tear. Mild to moderate central canal\nnarrowing. Effaced thecal sacs on both sides. Mild bilateral foraminal\nnarrowing.\nAt L3-L4 level there is annular disc tear. Moderate central canal narrowing,\nmild mass effect on bilateral L4 nerve root sleeve origins from diffuse disc\nbulges, facet arthritis. Preserved CSF within thecal sac. Mild-to-moderate\nbilateral foraminal narrowing, similar.\nAt L4-5 level there is annular disc tear diffuse disc bulge. Small right\nparamedian, inferior intermediate to dark T2 signal disc extrusion, extending\n0.8 cm below disc space, measuring 0.5 cm in AP diameter, extending into the\nright lateral recess, exerting mass effect on the traversing right L5 nerve. \nModerate central canal narrowing, preserved CSF. Effaced thecal sacs in both\nsides, more prominent on the right. Mass effect on the bilateral L5 nerve\nroot sleeve origins. Moderate bilateral foraminal narrowing.\nAt L5-S1 level there is early termination of the thecal sac with mildly\nprominent epidural fat. There is no contribution to central canal narrowing\nfrom degenerative changes. Annular disc tear. Mild-to-moderate left, mild\nright foraminal narrowing.", "output": "1. Degenerative changes lumbar spine.\n2. Congenital narrowing lumbar spinal canal.\n3. Moderate central canal narrowing L3-L4, L4-5 levels.\n4. Right paramedian, inferior disc extrusion at L4-5 level extends into the\nright lateral recess, exerting mass effect on traversing right L5 nerve.\n5. Moderate bilateral L4-5 foraminal narrowing..\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:37 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is straightening of the lumbar spine. Vertebral body heights are\npreserved. Redemonstrated are hemangiomas within the L1 and L3 vertebral\nbodies. There is a focus of fatty marrow within L5 vertebral body.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L1-L2.\n\nDiffusely reduced T2 signal within the intervertebral discs is likely on a\ndegenerative basis.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\n\nThe pedicles appear congenitally shortened resulting and diffuse mild\nnarrowing of the spinal canal.\n\nAt T12-L1 there is no significant spinal canal neural foraminal narrowing.\n\nAt L1-L2 there is no significant spinal canal or neural foraminal narrowing.\n\nAt L2-L3 there is mild symmetric disc bulging, ligamentum flavum thickening\nand facet osteophytes with mild bilateral neural foraminal narrowing. There\nare small bilateral facet joint effusions. Note is made of a small central\nannular fissure, unchanged.\n\nAt L3-L4 there is a small annular fissure (unchanged) and mild left neural\nforaminal narrowing. Superimposed mild symmetric disc bulging, ligamentum\nflavum thickening and facet osteophytes result in minimal spinal canal\nnarrowing.\n\nAt L4-L5 there is no significant change in the annular fissure (unchanged) and\nsmall right paracentral disc extrusion extending approximately 0.8 cm pole low\nthe disc space and measuring approximately 0.5 cm in AP diameter. The disc\nextrusion extends into the right lateral recess and exerts mass effect on the\ntraversing right L5 nerve root. There is superimposed moderate spinal canal\nnarrowing and mild-to-moderate bilateral neural foraminal narrowing.\n\nAt L5-S1 there is no significant spinal canal or neural foraminal narrowing.\n\nOverall, degenerative findings are similar to that seen on ___.", "output": "1. Stable degenerative changes of the lumbar spine most significant at L4-5\nwhere there is a right central disc extrusion demonstrating inferior migration\nand causing mass effect on the traversing right L5 nerve root. Moderate\nspinal stenosis and indentation of the thecal sac at L4-5 level is also\nunchanged.\n2. Unchanged annular fissures at L2-L3, L3-L4 and L4-L5." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. The lumbar\nvertebral body heights and alignment are maintained. Small unchanged\nhemangiomas are noted in the L1, L3, and L5 vertebral bodies. In comparison\nto prior exams, there are interval postsurgical changes of microdiscectomy at\nL4-L5 and right L5 hemilaminectomy.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of L1-L2.\n\nT12-L1: No significant spinal canal or neural foraminal narrowing.\n\nL1-L2: Minimal disc protrusion with no significant spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Disc protrusion, ligamentum flavum thickening, facet hypertrophy and\nepidural fat hypertrophy result in mild spinal canal narrowing and mild left\ngreater than right neural foraminal narrowing. Tiny annular fissure is\nunchanged. Minimal nonspecific facet joint fluid is present.\n\nL3-L4: Disc bulge with tiny annular fissure, ligamentum flavum thickening, and\nfacet hypertrophy result in mild spinal canal narrowing and mild bilateral\nneural foraminal narrowing. Minimal nonspecific left facet joint fluid is\npresent.\n\nL4-L5: Interval postsurgical changes of microdiscectomy at L4-L5 and right L5\nhemilaminectomy. Small disc bulge with tiny right central annular fissure,\nligamentum flavum thickening, and facet hypertrophy result in mild spinal\ncanal narrowing and mild-to-moderate bilateral neural foraminal narrowing.\n\nL5-S1: There is facet hypertrophy and nonspecific facet joint fluid. No\nsignificant spinal canal narrowing. Mild-to-moderate bilateral neural\nforaminal narrowing.\n\nFollowing the administration of contrast, there is enhancement in the surgical\nresection area at L5 along the ventral, rightward, and posterior aspects of\nthe thecal sac compatible with granulation tissue (image ___ of series 9).\n\nOther: There is diverticulosis of the visualized sigmoid colon.", "output": "1. Interval postsurgical changes of microdiscectomy at L4-L5 and right L5\nhemilaminectomy with tiny residual disc bulge and right central annular\nfissure.\n2. Enhancement in the surgical resection at L5 is compatible with granulation\ntissue along the ventral, rightward, and posterior aspects of the thecal sac.\n3. Multilevel multifactorial degenerative changes of the lumbar spine as\ndescribed above." }, { "input": "The imaged posterior fossa appears normal. The craniocervical junction\nappears normal. The cervical cord is normal in volume and signal intensity. \nNo epidural collection.\n\nNo acute vertebral body fracture. No malalignment. The craniocervical\nligaments appear intact. No prevertebral collection.\n\n\nCervical spondylosis in the form of intervertebral disc desiccation,\nbroad-based disc osteophyte complexes, facet joint arthropathy and ligamentum\nflavum hypertrophy as described below.\n\nC1-2: No cord or nerve root compromise.\n\nC2-3: No cord or nerve root compromise.\n\nC3-4: No cord compromise. Moderate neural foraminal narrowing bilateral.\n\nC4-5: No cord compromise. Mild right neural foraminal narrowing. The left\nneural foramina is patent.\n\nC5-6: Broad-based disc osteophyte complex effaces the CSF space anterior to\nthe cord. There is normal cord signal intensity as well as preservation of\nthe CSF space posterior to the cord. Moderate severe neural foraminal\nnarrowing bilateral.\n\nC6-7: Broad-based disc osteophyte complex completely effaces the CSF space\nanterior to the cord. There is mild cord deformation. There is almost no CSF\npresent posterior to the cord at this level. There is no increased cord\nsignal intensity. Severe neural foraminal narrowing bilateral.\n\nC7-T1: No cord on nerve root compromise.\n\n\nWeb-like T2 isointense structure is again noted in the right carotid bulb. \nPlease refer to MRA of the neck done ___ for a full description.\n\nOther: Small mucous retention cyst in the right maxillary sinus is\nincompletely imaged.", "output": "No acute spinal fracture or cord injury.\n\nCervical spondylosis most marked at the C5-6 and C6-7 levels resulting in\nspinal canal narrowing as described above.\nCervical spondylosis also results in multilevel neural foraminal narrowing as\ndescribed above\n\nWeb-like T2 isointense structure is again noted in the right carotid bulb.\nPlease refer to MRA of the neck done ___ for a full description." }, { "input": "There is unchanged grade 1 anterolisthesis C3 over C4, and and at C4 over C5.\nOtherwise sagittal alignment is maintained.\nVertebral body heights is maintained. There there is no aggressive osseous\nlesions. There is underlying multilevel degenerative changes affecting\nvertebral bodies evidenced by endplate irregularities and multilevel ___\ntype 2 changes.\n\nThere are multilevel disc degenerative disease evidenced by disc desiccation,\ndisc height loss more pronounced at the level of C5-C6 and C6-C7, disc\nosteophyte complexes formation, facet arthropathy, uncovertebral arthropathy\nand ligamentum flavum thickening. There is underlying multilevel spondylitic\nspinal canal stenosis most severe at C3-C4.\n\nCervical cord show normal signal intensity and volume. There is underlying\nmultilevel cord shape deformations more pronounced at C3-C4 level no definite\nabnormal intramedullary signal intensity. Posterior fossa structures and\ncervicomedullary junction is within normal limits.\n\nC2-C3: There is no disc bulge spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: There is central disc protrusion with superimposed severe facet\narthropathy and ligamentum flavum thickening causing moderate to severe spinal\ncanal stenosis with complete effacement of subarachnoid space. There is\nunderlying cervical cord shaped formation with no underlying definite abnormal\nintramedullary signal intensity. There is mild-to-moderate bilateral neural\nforaminal narrowing at this level.\n\nC4-C5: There is small central disc protrusion superimposed facet arthropathy\nand ligamentum flavum thickening causing effacement of the ventral\nsubarachnoid CSF space with mild spinal canal stenosis. There is mild right\nand moderate left neural foraminal narrowing.\n\nC5-C6: There is central diffuse disc bulge with superimposed facet arthropathy\nligamentum flavum thickening causing mild spinal canal stenosis. There is\nmoderate right and mild left neural foraminal narrowing.\n\nC6-C7 there is small central disc bulge with no significant spinal canal\nstenosis. There is mild bilateral neural foraminal narrowing.\n\nC7-T1 there is no disc bulge, spinal canal stenosis or neural foraminal\nnarrowing.\n\nIncidental finding of of multiple bilateral small perineural cyst noted at the\nlevels of C6-C7, C7-T1 and T1-T2.", "output": "1. Multilevel severe disc degenerative disease with sagittal malalignment\ncausing multilevel spondylitic spinal canal and neural foraminal compromise as\ndetailed.\n2. There is moderate severe spinal canal stenosis at C3-C4 level, with no\nunderlying definite abnormal cervical cord signal abnormality." }, { "input": "Images are degraded by motion artifact. Within these confines:\n\nThere is 4 mm retrolisthesis of L5 on S1, likely degenerative in nature. \nOtherwise, lumbar spine alignment is normal. Vertebral body signal\nintensities appear normal, with the exception of the L5-S1 endplates which\ndemonstrates Schmorl's nodes as well as type 1 degenerative ___ endplate\nchanges. There is intervertebral disc space narrowing at T12-L1, L3-L4 and\nL5-S1. The spinal cord appears normal in caliber and configuration,\nterminating as the conus medullaris at the L1-L2 level. There is bunching of\nthe cauda equina nerve roots from the L1 through L3-L4 level.\n\nT12-L1: Evaluation is limited secondary to lack of axial imaging at this\nlevel. There is a small diffuse disc bulge with mild right and no significant\nleft neural foraminal narrowing.\n\nL1-L2: There is no significant disc bulge, spinal canal or neural foraminal\nnarrowing.\n\nL2-L3: There is a small disc bulge without significant spinal canal stenosis\nbut with moderate bilateral neural foraminal narrowing.\n\nL3-L4: There is a large diffuse disc bulge with thickening of the ligamentum\nflavum and bilateral facet osteophytes with bilateral facet joint effusions\nresulting in severe spinal canal stenosis with impingement of the cauda equina\nnerve roots as well as severe bilateral neural foraminal narrowing with\nimpingement of the exiting L3 nerve roots. There is bunching of the cauda\nequina nerve roots above the level of L3-L4.\n\nL4-L5: Diffuse disc bulge with ligamentum flavum thickening and bilateral\nfacet arthropathy resulting in mild spinal canal stenosis. There is severe\nbilateral neural foraminal stenosis with impingement of the exiting L4 nerve\nroots.\n\nL5-S1: There is grade 1 retrolisthesis of L5 on S1 along with a disc bulge,\nligamentum flavum thickening and bilateral facet osteophytes. There is mild\nspinal canal stenosis. There is severe bilateral neural foraminal stenosis\nwith impingement of the exiting L5 nerve roots.", "output": "Images degraded by motion artifact. Within these confines:\n\n1. Multilevel degenerative changes of the lumbar spine, most prominent at\nL3-L4 where there is severe spinal canal stenosis.\n2. There is severe bilateral neural foraminal narrowing from L3-L4 through\nL5-S1.\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": "Please note that only sagittal images of the cervical spine were obtained, and\nthese images are significantly degraded by motion artifact, rendering this\nexam essentially nondiagnostic.\n\nThe patient is status post C3-C5 posterior spinal fusion. There is mild\nkyphosis , centered at C4-C5. Vertebral body and intervertebral disc signal\nintensities are not well evaluated. Spinal cord signal intensity is not well\nevaluated.\n\nDegenerative changes encroach on the spinal canal without definite contact\nwith the spinal cord. The neural foramina are not well assessed on this study.", "output": "Please note that only sagittal images of the cervical spine were obtained, and\nthese images are significantly degraded by motion artifact, rendering this\nexam essentially nondiagnostic. Consider repeat MRI of the cervical spine,\npossibly with sedation if clinically indicated.\n\nStatus post C3-C5 posterior spinal fusion. There is multilevel degenerative\nchanges. The neural foramina are not well evaluated." }, { "input": "Alignment is normal. Again seen are Schmorl's nodes in the superior endplates\nof the L3, L4 and L5 vertebral bodies. Although present previously, the L5\nvertebral body Schmorl's node has high signal intensity on the STIR images,\nsuggesting a recent component of fracture. There is a hemangioma in the L2\nvertebral body. There is loss of signal of the intervertebral discs on the T2\nweighted images, a manifestation of degenerative disease.\nAxial images from T12 to L2 demonstrate no significant abnormalities.\nAt L2-3 there is mild bulging of the intervertebral disc but no encroachment\non the thecal sac or neural foramina.\nAt L3-4 bulging of the disc, facet osteophytes and thickening of the\nligamentum flavum produce moderate narrowing of the spinal canal. There is\nmild narrowing of the left neural foramen.\nAt L4-5, facet osteophytes and disc bulging produce mild narrowing of the\nspinal canal bilaterally. The superior facet contacts the traversing right L5\nnerve root at the level of the intervertebral disc. The neural foramina\nappear normal.\nAt L5-S1 the spinal canal and left neural foramina appear normal. Mild\nbulging of the disc into the right neural foramina just contacts the exiting\nL5 nerve root.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm.", "output": "1. Mild changes of degenerative disc disease." }, { "input": "Degenerative changes lumbar spine. Multilevel disc space narrowing. \nMultilevel endplate Schmorl's nodes, diffuse disc bulges, lumbar facet\narthritis. Benign L2 hemangiomas. No worrisome osseous lesions. Normal\nvisualized cord. Minimal L3-L4, L4-5 anterolisthesis, degenerative in\netiology, stable. Edema associated with superior L5 Schmorl's node has\nimproved. Mild endplate edema L5-S1, likely degenerative.\n\nAt L1-L2, patent central canal, patent foramina.\n\nAt L2-L3, mild central canal narrowing, similar. Patent right foramen. Mild\nleft foraminal narrowing, similar.\n\nAt L3-L4 mild-to-moderate central canal narrowing, stable, preserved CSF. \nMild-to-moderate left, mild right foraminal narrowing, stable.\n\nAt L4-5, mild central canal narrowing. Minimal mass effect on traversing\nright intrathecal L5 nerve.. Mild bilateral foraminal narrowing, similar.\n\nAt L5-S1, mild central canal narrowing, stable. Mild-to-moderate right, mild\nleft foraminal narrowing, stable.\n\nBenign simple cyst right kidney, similar. 9 mm focus of sclerosis right\nposterior dominant bone, similar compared with CT ___, most likely\ndegenerative.", "output": "1. Degenerative changes lumbar spine, similar.\n2. Mild-to-moderate central canal narrowing L3-L4 level, similar.\n3. Multilevel foraminal narrowing, as above, similar." }, { "input": "Normal alignment. Benign T2 hemangioma. Focus of very dark T1-T2 and STIR\nsignal C6 vertebral body, low most likely benign bone island. Multilevel\ndegenerative changes, disc space narrowing, disc osteophyte complexes,\nposterior element hypertrophic changes. No cord T2 signal abnormality.\n\n\nAt C1-2 through C3-4, there is no spinal canal canal or neural foraminal\nnarrowing.\n\nC4-C5, mild central canal narrowing. Mild left, moderate right foraminal\nnarrowing..\n\nAt C5-C6, mild-to-moderate central canal narrowing, nearly completely efface\nCSF, no cord flattening. Severe right, moderate left foraminal narrowing.\n\nAt C6-C7,, mild central canal narrowing, minimal effacement ventral cord by\ndisc osteophyte complex. Moderate right, mild-to-moderate left foraminal\nnarrowing.\n\nAt C7-T1, mild central canal narrowing. Severe left, mild right foraminal\nnarrowing.", "output": "1. Degenerative changes cervical spine.\n2. Mild-to-moderate central canal narrowing C5-C6 level.\n3. Multilevel significant foraminal narrowing, as above." }, { "input": "The conus terminates at the L1-2 level. No conus masses. No epidural\ncollections.\n\nThere is no acute vertebral body fractures.\n\nMild edema is noted in relation to the right L4-5 facet joint with no abnormal\nenhancement postcontrast. No conclusive findings to suggest bony metastatic\ndisease.\n\nMultilevel degenerative changes of the lumbar spine as described below:\n\nT12-L1: No cord or nerve root compromise. The neural foramina are patent\n\nL1-2: No conus or nerve root compromise. The neural foramina are patent.\n\nL2-3: No nerve root compromise. The neural foramina are patent.\n\nL3-4: No nerve root compromise. Mild narrowing of the neural foramina, but no\nnerve root compromise.\n\nL4-5: Minimal grade 1 anterolisthesis of L4 on L5. Broad-based disc bulge\nwith associated facet joint osteophytosis and ligamentum flavum hypertrophy\nresults in moderate narrowing of the left subarticular zone. The neural\nforamina are mildly narrowed bilateral.\n\nL5-S1: Epidural lipomatosis results in a trefoil shape of the thecal sac with\nloss of CSF outlining the nerve roots. Mild narrowing of the left neural\nforamina. The right neural foramina is patent.\n\nNote is made of abdominal carcinomatosis and moderate ascites. Mildly\npatulous esophagus. Simple appearing bilateral small renal cysts.", "output": "1. No conclusive evidence of spinal metastatic disease.\n2. No acute vertebral body fractures. Multilevel degenerative changes of the\nlumbar spine most marked at the L4-5 level as described above.\n3. Epidural lipomatosis involving the lower lumbar and sacral spinal canal.\n4. Note is made of abdominal carcinomatosis and moderate ascites." }, { "input": "Cervical spine:\nNumbering of the cervical spine is provided on series 8, image 7.\nAlignment of the cervical spine is normal. There is no evidence of infection.\nVertebral body heights are preserved. Vertebral body and intervertebral disc\nsignal intensity appear normal. There is a 4.3 x 1.1 cm (CC x AP) extradural\nmass within the dorsal spinal canal extending from C7 through T3 (series 18,\nimage 9) that partially encases the cervical cord (27:9) and causes severe\ncord compression at this level. There is homogeneous enhancement, but\nnotably, enhances less compared to the surrounding meninges (18:7). Increased\nSTIR signal within the cord at these levels suggests cord edema/contusion\n(Series 11, Image 8). The mass extends into, and obliterates the left neural\nforamen at C7-T1 and T1-T2. Additional degenerative changes are as follows:\nAt C2-C3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-C4, there is a right paracentral protrusion (9:12) that indents the\nthecal sac, without spinal canal or neuroforaminal narrowing.\n\nC4-C5, there is a disc bulge that results in mild spinal canal narrowing. No\nneural foraminal narrowing at this level.\n\nAt C5-C6, and C6-C7, there is disc bulging that indents the ventral thecal\nsac, without significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1, there is cord compression resulting in cord edema/contusion from the\nmass described above.\n\nThoracic spine:\nNumbering of the thoracic spine is provided on series 11, image 9.\nAlignment of the thoracic spine is normal. There is no evidence of infection.\nVertebral body heights are preserved. Vertebral body and intervertebral disc\nsignal intensity appear normal. As noted in the cervical spine section above,\nthere is severe compression with edema/contusion in the lower thoracic spine\nextending through the superior aspect of T3 as a result of the dorsal\nextradural mass. Vertebral body and intervertebral disc signal intensity\nappear normal. Between T3-T12, there is no spinal canal or neuroforaminal\nnarrowing.\n\nLumbar spine:\nNumbering of the lumbar spine is provided on series 12, image 11.\nAlignment of the lumbar spine is normal. There is no evidence of infection or\nneoplasm. Vertebral body heights are preserved, and marrow signal intensity\nappears normal. There is disc desiccation at L5-S1. Remaining intervertebral\ndiscs demonstrate normal signal.\n\nAt T12-L1 and L1-L2, there is no spinal canal or neuroforaminal narrowing.\n\nAt L2-L3, there is mild ligamentum flavum hypertrophy without significant\nspinal canal or neuroforaminal narrowing.\n\nAt L3-L4 and L4-L5, there is disc bulging and facet joint arthropathy, without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt L5-S1, there is disc bulging with a superimposed central protrusion that\nindents the thecal sac without significant spinal canal narrowing. Bilateral\nneuroforaminal narrowing is mild at this level.", "output": "1. 4.3 x 1.1cm homogeneously enhancing extradural spinal canal mass extending\nfrom C7-T3, causing severe cord compression and cord edema/contusion at these\nlevels. There is also extension into and obliteration of the left C7-T1 and\nT1-T2 neural foramens. Its appearance, including partial encasement of the\ncord, heavily favors lymphoma or leukemia. Meningioma is also on the\ndifferential, although somewhat atypical in this case given less avid\nenhancement compared to the surrounding meninges. Neuroblastoma is unlikely in\nthis age group.\n2. Mild degenerative changes in the cervical and lumbar spine, most prominent\nat L5-S1 where there is disc bulging/superimposed central protrusion without\ncritical spinal canal narrowing at this level.\n\nNOTIFICATION: Preliminary findings were telephoned to Dr. ___ by ___\n___ on ___ at 12:59PM, at time of discovery." }, { "input": "Evaluation of the lumbar spine and sacrum is incomplete secondary to patient\nmotion and uncontrollable leg spasm.\n\nCERVICAL:\nAgain demonstrated is a 4.9 x 1.2 x 3.8 cm enhancing extradural mass extending\nwithin the spinal cord from the level of C7-T3 (series 19, image 13; series\n21, image 2), which previously measured 4.1 x 1.1 x 3.2 cm. The mass\ndisplaces the spinal cord anteriorly and to the right, and circumferentially\nsurrounds the cord at the level of C8-T3, completely filling the spinal canal\n(series 20, image 35). Mild bony resorption is noted posterior to T1 and T2\n(series 19, image 14). Overall, the vertebral bodies appear intact without\nbony invasion. Immediately inferior to the mass, there is an area of mild\nfocal expansion of the spinal cord posterior to the body of T3 (series 5,\nimage 10) with a mild fluid signal in the cord.\n\nThe mass extends into and obliterates the neural foramen on the left side at\nC7-T1, T1-T2 and T2-T3. At T1-T2, the mass extends out of the left foramina\nby 1.5 cm, previously 1.1 cm in ___.\n\nAlignment is preserved.Vertebral body and intervertebral disc signal intensity\nappear normal.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal.Inferior to the level of T3, the transverse foramina are patent\nwith no evidence of spinal canal narrowing. There is no abnormal enhancement\nafter contrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is posterior disc bulge ligamentum flavum hypertrophy most\nprominent L2-3, L3-4 and L4-5 without evidence of spinal canal or neural\nforaminal narrowing.There is no evidence of infection or neoplasm. There is\nno abnormal enhancement after contrast administration.\n\nOTHER: The level of the sacral ulcer is not included within the study.", "output": "1. Interval increase in size and extent of an enhancing extradural mass within\nthe spinal cord spanning C7-T1, now measuring 4.9 x 1.2 x 3.8 cm at its\ngreatest extent, previously 4.1 x 1.1 x 3.2 cm. There is obliteration of the\nleft neural foramina spanning C7-T3, with extension of the mass outside the\nforamina at T1-2 by 1.5 cm, which represents an increase from ___.\n2. The sacral ulcer is out of the field of view of this exam. No abnormal\nsignal is demonstrated within S1-S3. For further evaluation of sacral ulcer,\nconsider dedicated pelvis MR.\n\n___: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:33 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "The localizer sequence, series 4, demonstrates 7 cervical, 12 rib-bearing, and\n5 lumbar-type vertebrae.\n\nCERVICAL:\nVertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are seen. The craniocervical junction\nappears unremarkable. The spinal cord demonstrates normal morphology and\nsignal intensity. No evidence for pathologic contrast enhancement. There are\nsmall central disc protrusions from C3-C4 through C6-C7 mildly indenting the\nventral thecal sac without spinal cord contact or significant spinal canal\nnarrowing. There is no significant neural foraminal narrowing.\n\nTHORACIC:\nThere is mild anterior wedging of T7 and T11 vertebral bodies without marrow\nedema. Alignment is normal. No concerning bone marrow signal abnormalities\nare seen. The spinal cord demonstrates normal morphology and signal\nintensity. No evidence for pathologic contrast enhancement. No evidence for\nspinal canal or neural foraminal narrowing.\n\nLUMBAR:\nVertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are seen. The conus medullaris demonstrates\nnormal morphology and signal intensity, terminating at L1-L2.\n\nL1-L2: Minimal facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nL2-L3: Mild facet arthropathy with several small subchondral cysts along the\nright facet joint. No spinal canal or neural foraminal narrowing.\n\nL3-L4: Mild facet arthropathy. No spinal canal or neural foraminal narrowing.\n\nL4-L5: Mild disc desiccation with a minimal disc bulge. Mild facet\narthropathy. No spinal canal narrowing. Minimal bilateral neural foraminal\nnarrowing without checked on the exiting L4 nerve root.\n\nL5-S1: Mild-to-moderate facet arthropathy. No spinal canal narrowing. \nMinimal bilateral neural foraminal narrowing without mass effect on the\nexiting L5.\n\n\nOTHER:\nThere are bilateral thyroid nodules, up to 1.7 x 1.3 cm in the right lower\npole on images 5:7, 12:6.\n\nThere is a questionable 1-2 mm pulmonary nodule in the right lower lobe on\nimage 13:20, versus a prominent blood vessel.\n\nThere are two adjacent T2 hyperintense foci in hepatic segment 6 measuring 3\nmm in 2 mm on image 13:31, statistically likely cysts.\n\nFollicular activity is incidentally noted in the left ovary, localizer image\n3:8.", "output": "1. Normal appearance of the spinal cord and conus medullaris. Unremarkable\nappearance of the intrathecal nerve roots.\n2. Small central disc protrusions from C3-C4 through C6-C7 without significant\nspinal canal narrowing or spinal cord contact.\n3. Mild degenerative changes in the lumbar spine with minimal L4-L5 and L5-S1\nneural foraminal narrowing, but no mass effect on the exiting nerve roots.\n4. Bilateral thyroid nodules, up to 1.7 cm on the right.\n5. Questionable 1-2 mm pulmonary nodule in the right lower lobe.\n\nRECOMMENDATION(S):\n1. Thyroid nodule. Outpatient thyroid ultrasound recommended, if not\npreviously performed elsewhere. ___ College of Radiology guidelines\nrecommend further evaluation for incidental thyroid nodules of 1.0 cm or\nlarger in patients under age ___ or 1.5 cm in patients age ___ or ___, or with\nsuspicious findings. Suspicious findings include: Abnormal lymph nodes (those\ndisplaying enlargement, calcification, cystic components and/or increased\nenhancement) or invasion of local tissues by the thyroid nodule. ___, et\nal, \"Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of\nthe ACR Incidental Findings Committee\". J ___ ___ 12:143-150.\n2. For incidentally detected nodules smaller than 6 mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended. See the ___ ___\n___ Guidelines for the Management of Pulmonary Nodules Incidentally\nDetected on CT\" for comments and reference:\n___\n\nNOTIFICATION: Electronic preliminary report by Dr. ___ on ___\nat 9:28 ___:\nCord or cauda equina compression: No\nCord signal abnormality: No\nEpidural collection: No\nOther: There is no abnormal enhancement postcontrast. There are no focal bone\nmarrow signal abnormalities.\nFinal read pending.\n\nDr. ___ paged Dr. ___ regarding the thyroid ultrasound\nrecommendation on ___ at 09:50." }, { "input": "Alignment is normal. There are ___ type 1 and type 2 signal intensity\nchanges at the vertebral endplates at multiple levels. There is a hemangioma\nin the L2 vertebral body. There is a small amount of fluid in the facet\njoints bilaterally, greater on right than left, at L2-3 peer Axial images from\nT12 through L3 demonstrate no other abnormalities.\n\nAt L3-4, there is bulging of the discs and bilateral facet osteophytes. The\ndisc bulge minimally narrows the spinal canal. The osteophytes mildly narrow\nthe neural foramina.\n\nAt L4-5, intervertebral osteophytes and a midline disc protrusion combine with\na disc bulge to produce mild -moderate narrowing of the spinal canal. The\ntraversing L5 nerve roots contact the lateral portions of the disc protrusion\nbilaterally. There are bilateral facet osteophytes but no compression of the\nnerve roots in the neural foramina.\n\nAt L5-S1, there is a large right-sided disc protrusion that extends just to\nthe left of midline. This compresses the thecal sac and severely displaces\nand compresses the right S1 nerve root. Bilateral facet osteophytes are\npresent but there is no evidence of nerve root compression in the neural\nforamina. The left neural foramen is moderately narrow.\n\n\nAfter contrast administration, there is epidural enhancement surrounding the\nL5-S1 disc fragment. There is also mild epidural enhancement at L4-5\nposterior to the disc bulge.\n\nThe spinal cord appears normal in caliber and configuration.", "output": "1. Degenerative disc disease with midline and right-sided disc protrusion at\nL5-S1 compressing the right S1 nerve root.\n2. Disc bulge at L4-5 contacting the traversing L5 nerve roots bilaterally." }, { "input": "The vertebral bodies are normal in height and alignment. There is a probable\nhemangioma in the L2 vertebral body. ___ type 2 endplate degenerative\nchanges are most prominent at L5-S1.\n\nThe visualized distal spinal cord is within normal limits.\n\nFrom T11-12 through L2-3, there is no disc herniation, spinal canal, neural\nforaminal narrowing.\n\nAt L3-L4, there is a mild disc bulge that in combination with mild bilateral\nfacet osteophytes results in mild bilateral neural foraminal narrowing. \nSpinal canal narrowing is mild.\n\nAt L4-L5, there is a diffuse disc bulge with a superimposed posterior central\ndisc protrusion that indents the anterior thecal sac and results in mild\nnarrowing of the spinal canal. The combination of the disc protrusion and\nfacet osteophytes produces narrowing of the lateral portions of the spinal\ncanal and compression of the traversing L5 nerve roots bilaterally, somewhat\nmore severe on the right than left. There is no neural foraminal narrowing.\n\nAt L5-S1, there is a diffuse disc bulge with a superimposed posteriorly and\ninferiorly directed right sided disc extrusion that extends inferiorly from\nthe interspace and severely narrows the compresses the right S1 nerve root\nagainst the lamina (series 7, image 33). The extruded disc appears larger\ncompared to the prior examination. The disc indents the anterior thecal sac,\nright greater than left, and results in mild narrowing of the spinal canal. \nBilateral facet osteophytes contribute to moderate bilateral neural foraminal\nnarrowing, unchanged.\n\nThere is no epidural or paraspinal fluid collection.", "output": "1. Progression of L5-S1 right sided disc extrusion resulting in compression\nof the right S1 nerve root.\n\n2. Persistent L4-L5 disc bulge with superimposed central protrusion resulting\nin compression of the bilateral L5 nerve roots, slightly worse compared to\nprior examination.\n\n3. Unchanged moderate neural foraminal narrowing at L5-S1." }, { "input": "Study is mildly degraded by motion.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is minimal levoscoliosis of lumbar spine. There is transitional anatomy\nwith partial sacralization of L5. Vertebral body heights are preserved. L2\nvertebral body probable hemangioma is again seen. L5-S1 type ___ ___ changes\nare noted. L4-5 and L5 superior endplate probable type ___ ___ changes are\nseen.\n\nPostoperative changes related to patient's known L5-S1 microdiskectomy and\nright hemilaminectomy are seen. Enhancing granulation tissue is noted to\nsurround the descending right S1 nerve root (see 5, 07:36).\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal at L4-5 and L5-S1,\nunchanged. Nonspecific facet joint fluid is noted at multiple levels\nthroughout the lumbar spine.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is asymmetric left disc bulge, neural fat, facet joint\nhypertrophy, mildvertebral canal and no neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, facet joint hypertrophy, epidural fat,\nmildvertebral canal and mild bilateral neural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy which contacts bilateral\nexiting L3 nerve roots, epidural fat, addendum flavum thickening,\nmild-to-moderatevertebral canal and mild bilateral neural foraminal narrowing.\n\nAt L4-5 there is disc bulge, central disc protrusion, new left subarticular\nzone disc extrusion which contacts the exiting left L4 nerve root,\nmoderatevertebral canal, moderate right and mild leftneural foraminal\nnarrowing.\n\nAt L5-S1 there is disc bulge, facet joint hypertrophy, enhancing probable\ngranulation tissue surrounding the descending right S1 nerve root, novertebral\ncanal and moderate bilateral neural foraminal narrowing.\n\nOTHER:\n There is no paravertebral or paraspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Postsurgical change related to L5-S1 microdiskectomy and right\nhemilaminectomy with probable granulation tissue surrounding the right\ndescending S1 nerve root.\n3. Multilevel lumbar spondylosis and epidural fat as described, most\npronounced at L4-5, where there is new left subarticular zone disc extrusion\nwhich contacts exiting left L4 nerve root, moderate vertebral canal, moderate\nright and mild left neural foraminal narrowing.\n4. L3-4 facet joint hypertrophy contacts bilateral exiting L3 nerve roots,\nwith mild-to-moderate vertebral canal and mild bilateral neural foraminal\nnarrowing.\n5. L5-S1 moderate bilateral neural foraminal narrowing." }, { "input": "The patient is status post anterior spinal fusion of C5-C6 with artifact\nrelated to the hardware, partially obscuring the C5 and C6 vertebral bodies. \nThe remainder of the bone marrow is normal in signal. The height of the\nvertebral bodies are maintained.\n\nThe spinal cord at C5-C6 is slightly expanded. There is ill-defined intra\nmedullary T2 hyperintense signal within the C5-C6 spinal cord with a small,\nfocal area of ill-defined enhancement on 7:8 and 8:18. The remainder of the\nspinal cord is normal in signal.\n\nNo fluid collections or masses are identified.\n\nAt C2-C3, there is bilateral facet arthropathy without spinal canal or neural\nforaminal stenosis, unchanged from prior.\n\nAt C3-C4, broad-based disc protrusion and bilateral facet arthropathy flatten\nand remodel the spinal cord, causing mild spinal canal and mild-to-moderate\nbilateral neural foraminal stenosis, unchanged from prior.\n\nAt C4-C5, broad-based disc protrusion and bilateral facet arthropathy flattens\nand remodels the spinal cord, causing mild-to-moderate spinal canal stenosis,\nmoderate left, and mild right neural foraminal stenosis, unchanged from prior.\n\nAt C5-C6, there has been interval reduction of the previous broad-based disc\nprotrusion without spinal canal or neural foraminal stenosis.\n\nAt C6-C7, broad-based disc protrusion and bilateral facet arthropathy cause\nminimal left neural foraminal stenosis, unchanged from prior. There is no\nspinal canal stenosis.\n\nAt C7-T1, there is no spinal canal or neural foraminal stenosis.\n\nThe prevertebral and paraspinal soft tissues are normal.", "output": "1. Postsurgical changes status post anterior spinal fusion of C5-C6 with\nslight interval expansion of the C5-C6 spinal cord, where there is ill-defined\nT2 hyperintense signal and enhancement, which may represent postoperative\nedema. Continued follow-up is recommended.\n2. Stable multilevel degenerative changes in the remainder of the lumbar\nspine, most advanced at C4-C5, where there is mild-to-moderate spinal canal,\nmoderate left neural foraminal, and mild right neural foraminal stenosis." }, { "input": "From T10-T11 through L3-4 levels mild disc degenerative changes are identified\nat without significant disc bulge herniation or spinal stenosis.\n\nAt L4-5 level, disc bulging and as shallow central protrusion are seen without\nspinal stenosis. Disc bulging results in moderate left and mild right\nforaminal narrowing without compression of exiting nerve roots.\n\nAt L5-S1 level disc bulging and a small central protrusion are seen without\ndisplacement of nerve roots. There is moderate left and mild right foraminal\nnarrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative changes in the lumbar region. Moderate left foraminal\nnarrowing at L4-5 and L5-S1 levels. No spinal stenosis seen.\n2. No evidence of focal disc herniation or nerve root displacement or\ncompression." }, { "input": "Alignment remains anatomic. Again demonstrated is disc desiccation\nat L5-S1. The conus medullaris terminates at the level of the inferior\nendplate of L1 with normal contour and signal. From L1 through L4, there is\nno significant degenerative change or narrowing.\n\nProminent posterior epidural fat is again demonstrated, particularly from L3\nthrough L5.\n\nAt L4-L5, there is a small disc bulge and moderate bilateral facet arthropathy\nbut no evidence of nerve root impingement.\n\nAt L5-S1, there is evidence of recent left hemilaminectomy. Post-operative\nchanges within the posterior paraspinal soft tissues include a 3.3 AP x 1.2\nTRV x 3.7 CC cm fluid collection within the subcutaneous soft tissues. There\nhas been interval microdiscectomy with resulting decrease in size of the left\nparacentral disc extrusion seen on the ___ MRI. In the region of the\nextrusion, there is now T1/T2 hypointense enhancing material which displaces\nposteriorly the traversing left S1 nerve roots in the subarticular zone. This\nis likely granulation tissue or scar. There is no free disc fragment or\nepidural fluid collection. A small residual amount of disc material remains\nas a broad-based protrusion at this level. Mild increased STIR signal within\nthe L5-S1 endplate may be post-surgical as well.", "output": "Changes of recent left L5-S1 hemilaminectomy with\nmicrodiscectomy. The region of the extruded disc has been now replaced by\nenhancing tissue which displaces the traversing left S1 nerve root and is\nlikely scar or granulation tissue." }, { "input": "The patient is status post posterior spinal fusion of L5-S1 and bilateral\nlaminectomies at L5. Susceptibility artifact from bilateral intrapedicular\nscrews and an intervertebral disc spacer slightly limits evaluation at L5-S1. \nThe alignment of the lumbar spine is normal. The bone marrow is normal in\nsignal. The intervertebral disc at L4-5 is desiccated. The conus medullaris\nterminates at L1-L2. The spinal cord and nerve roots of the cauda equina are\nnormal in signal. No epidural fluid collections are identified. There is no\nabnormal enhancement.\n\nAt T12-L1, there is no significant disc herniation, spinal canal, neural\nforaminal stenosis.\n\nAt L1-L2, there is no significant disc herniation, spinal canal, or neural\nforaminal stenosis.\n\nAt L2-L3, there is no significant disc herniation, spinal canal, or neural\nforaminal stenosis.\n\nAt L3-L4, there is disc bulge, ligamentum flavum thickening, and bilateral\nfacet hypertrophy with no significant spinal canal or neural foraminal\nstenosis.\n\nAt L4-L5, disc bulge, ligamentum flavum thickening, and bilateral facet\nhypertrophy cause mild spinal canal and mild bilateral neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt L5-S1, there is no significant disc herniation, spinal canal, or neural\nforaminal stenosis.", "output": "1. Status post posterior spinal fusion at L5-S1 and bilateral laminectomies at\nL5 with no evidence of infection.\n2. Mild, multilevel degenerative changes of the lumbar spine, most prominent\nat L3-L4 with mild spinal canal and mild bilateral neural foraminal stenosis." }, { "input": "There is evidence of anterior cervical discectomy and fusion from C4-C6. The\nhardware is not assessed on MRI. Mild retrolisthesis of C3 on C4 is unchanged\ncompared to the ___ CT. The vertebral body heights are preserved. \nThe marrow signal is unremarkable, where not obscured by hardware related\nartifact.\n\nThe cerebellar tonsils are normally positioned. The spinal cord demonstrates\nnormal signal.\n\nAt C2-C3, there is a broad-based central disc protrusion without significant\nspinal canal or neural foraminal stenosis.\nAt C3-C4, there is uncovertebral arthropathy and a right paracentral disc\nextrusion causing moderate bilateral neural foraminal stenosis and moderate\nspinal canal stenosis there is mild flattening of the ventral spinal cord. \nThere is no associated intrinsic cord signal abnormality.\nAt C4-C5, there is left paracentral disc osteophyte, causing mild to moderate\nspinal canal narrowing with mild left ventral spinal cord deformity. No\nsignificant neural foraminal stenosis.\nAt C5-C6, there is no significant neural foraminal or spinal canal stenosis.\nAt C6-C7, there is no significant neural foraminal or spinal canal stenosis.\nAt C7-T1, there is no significant neural foramina or spinal canal stenosis.\n\nAbove described degenerative changes, spinal canal narrowing, and neural\nforaminal narrowing appear similar to the prior CT allowing for differences in\nmodalities.", "output": "1. Status post ACDF at C4-C6 with unchanged mild retrolisthesis of C3 on C4.\n2. At C3-C4, a right paracentral disc extrusion moderately narrows the spinal\ncanal with mild flattening of the ventral spinal cord, but no cord signal\nabnormality. Bilateral neural foramina are moderately narrowed by\nuncovertebral osteophytes.\n3. At C4-C5, a left paracentral disc osteophyte complex mildly to moderately\nnarrows the spinal canal with mild flattening of the ventral spinal cord, but\nno cord signal abnormality." }, { "input": "THORACIC:\nThe alignment is normal. The bone marrow signal is within normal limits. The\ncord is unremarkable. Mild multilevel loss of disc height is seen. Disc\nbulges are seen at T7-8, T8-9, T9-10, T10-11 and T11-12 without spinal canal\nor foraminal narrowing. There is no abnormal enhancement.\n\n\nLUMBAR:\nThere is mild retrolisthesis of L5-S1. Type ___ ___ changes are seen at\nL5-S1. The cord terminates at L1 and is unremarkable. There is multilevel\nloss of disc height.\n\n T12-L1: No spinal canal or foraminal narrowing.\n\nL1-L2: Disc bulge, bilateral facet osteophytes, mild spinal canal narrowing,\nmild right and no left foraminal narrowing.\n\nL2-L3: Disc bulge, small central disc protrusion, bilateral facet osteophytes\nand effusions, mild spinal canal narrowing, no foraminal narrowing.\n\nL3-L4: Disc bulge, bilateral facet osteophytes, moderate spinal canal\nnarrowing, moderate bilateral foraminal narrowing.\n\nL4-L5: Disc bulge, central disc protrusion, bilateral facet osteophytes, mild\nspinal canal narrowing, mild right and moderate left foraminal narrowing.\n\nL5-S1: Retrolisthesis, disc bulge, bilateral facet osteophytes, no spinal\ncanal narrowing, severe bilateral foraminal narrowing.\n\nThere is no abnormal enhancement.\n\n\nOTHER:\nA nonenhancing subcentimeter T2 hyperintense lesion is seen in the left\nkidney, likely a simple renal cyst.", "output": "1. No abnormal enhancement or inflammatory changes.\n2. Degenerative changes of the thoracic and lumbar spine, worst at L3-4 with\nmoderate spinal canal and moderate foraminal narrowing.\n\nRECOMMENDATION(S): Management of Incidental Renal Cyst Completely\nCharacterized on CT or MRIBosniak I or II- No further workup\n\nReference:\n\nHerts BR, ___ SG, ___ NM, et. Al. Management of the Incidental Renal\nMass on CT: A White Paper of the ACR Incidental Findings Committee. J ___\n___ ___" }, { "input": "Vertebral bodies are normal in height and alignment. There is no bone marrow\nsignal abnormality.\n\nThe cervical spinal cord is normal in caliber and signal intensity. There is\nno evidence of cord compression. There is no abnormal enhancement.\n\nAt C6-C7, a diffuse posterior disc protrusion that is eccentric to the right\ncontacts the anterior spinal cord and results in mild narrowing of the spinal\ncanal and mild right neural foraminal narrowing. There is no significant\nspinal canal or neural foraminal narrowing otherwise.\n\nThere is no prevertebral paraspinal soft tissue abnormality. There is no\nevidence of an epidural fluid collection.", "output": "1. Normal morphology and signal intensity of the cervical spinal cord. No\ncord compression.\n\n2. Mild multilevel degenerative changes as described above without\nsignificant spinal canal or neural foraminal stenosis, more significant at\nC6-C7.\n\n3. No evidence of fracture or ligamentous disruption." }, { "input": "From T10-T11 through L1-2 levels disc degenerative changes identified. At\nL2-3 mild disc bulging is seen without spinal stenosis with a shallow\nbroad-based right-sided protrusion minimally indenting thecal sac.\n\nAt L3-4 level, there is disc bulging identified with mild thickening of the\nligaments resulting in moderate spinal stenosis which is unchanged from the\nprior study. There is mild narrowing of the right foramen and moderate\nnarrowing of the left foramen with slight deformity of the exiting left L3\nnerve root within the foramen which is unchanged from the prior study.\n\nAt L4-5 level, endplate degenerative changes are identified with low T1 and\nhigh inversion recovery signal which is new since the prior study. There is\ndecreased disc height. There is disc bulging and a central protrusion which\nextends slightly to the left side and narrows the left subarticular recess. \nThere is moderate spinal stenosis which appears increased from the prior\nstudy. There is moderate bilateral foraminal narrowing seen which is\nincreased from the prior study.\n\nAt L5-S1 level, there is disc bulging identified without spinal stenosis with\nmild narrowing of the foramina.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "Progression of degenerative changes predominantly at L4-5 level where there is\nnow moderate spinal stenosis seen with moderate bilateral foraminal narrowing\nand endplate degenerative changes. Other degenerative changes as described\nabove are stable compared to the prior study." }, { "input": "Alignment is unchanged compared to ___. vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration. The visualized posterior fossa is within\nexpected limits. The craniocervical junction and anterior atlantodental\ninterval are unremarkable.\n\nAt C2-C3, there is no significant spinal canal narrowing. Uncovertebral facet\narthropathy results in at least moderate right and no significant left neural\nforaminal narrowing.\nAt C3-4, posterior disc bulge and bilateral uncovertebral and facet joint\nhypertrophy cause mild spinal canal and severe right and moderate left neural\nforaminal narrowing.\nAt C4-5, posterior disc bulge and bilateral uncovertebral and facet joint\nhypertrophy cause mild spinal canal and moderate right and moderate to severe\nleft neural foraminal narrowing.\nAt C5-6, posterior disc bulge causes moderate spinal canal narrowing but with\npreservation of CSF around the cord. Moderate to severe bilateral neural\nforaminal narrowing is present.\nAt C6-7, posterior disc bulge causes moderate spinal canal narrowing but with\npreservation of CSF around the cord. Moderate to severe right and severe left\nneural foraminal narrowing is present.\nAt C7-T1, spinal canal and bilateral neural foraminal narrowing are mild.\n\nOverall appearance of multilevel degenerative changes are similar to ___.\n\nVisualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes of the cervical spine including multiple\nmoderate to severe neural foraminal narrowing is similar to ___. \nThere is moderate spinal canal narrowing at C5-C6 and C6-C7.\n2. No cord signal abnormality.\n3. Additional findings described above." }, { "input": "Lumbar spine numbering is based on that established on prior examination of\n___. 4 mm anterolisthesis of L4 on L5 and 2 mm retrolisthesis of L2 on L3\nare similar in appearance to prior examination. Vertebral body heights are\npreserved. There is no focal suspicious marrow lesion. ___ type 1 L4-L5\nand and ___ type 2 L5-S1 and mixed L2-L3 endplate changes are identified. \nLoss of disc height and signal at L2-L3, L4-L5 and L5-S1 is severe. Vacuum\ndisc phenomenon is seen at L4-L5 and L5-S1. Mild STIR hyperintense signal of\nthe L2-L3 disc likely represents degenerative changes and calcification. The\nloss of disc height have progressed from prior examination. Loss of L3-L4\ndisc height is moderate. The conus medullaris terminates at the T12-L1 level,\nwithin expected limits. There is no signal abnormality of the visualized\ncord.\n\nT11-T12: A disc bulge does not significantly narrow the spinal canal. There\nis no significant neural foraminal narrowing.\n\nT12-L1 and L1-L2: No significant spinal canal or neural foraminal narrowing.\n\nL2-L3: A disc bulge results in mild spinal canal narrowing, crowding the\nbilateral subarticular zones without impingement of the traversing nerve\nroots. In combination with facet arthropathy there is moderate right and no\nsignificant left neural foraminal narrowing.\n\nL3-L4: A disc bulge does and prominent epidural fat results in mild spinal\ncanal narrowing. In combination with facet arthropathy there is mild right no\nsignificant left neural foraminal narrowing.\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. A disc bulge and\nthickening of the ligamentum flavum results in moderate spinal canal\nnarrowing. There is severe crowding of the bilateral subarticular zones\ncontacting and likely impinging on the traversing L5 nerve roots (series 8,\nimage 11). In combination with facet arthropathy, there is severe left and\nmild right neural foraminal narrowing. Prominent bilateral facet joint\neffusions are identified.\n\nL5-S1: A disc bulge results in mild spinal canal narrowing. In combination\nwith facet arthropathy, there is moderate bilateral neural foraminal\nnarrowing.\n\nA T2 hyperintense 1.4 cm cystic lesion in the mid left renal pole (series 9,\nimage 17) appears to demonstrate a septation. There is enlargement of the\napparent left adrenal gland with a 1.8 cm nodule (series 9, image 6). The\nremainder the visualized prevertebral and paraspinal soft tissues are", "output": "1. Multilevel multifactorial lumbar spondylosis as described above, progressed\nfrom examination of ___. The findings are most prominent at L4-L5 where\nthere is anterolisthesis of L4 on L5 as well as the large disc bulge resulting\nin severe crowding of the bilateral subarticular zones likely impinging on the\ntraversing L5 nerve roots bilaterally. In addition, there is severe left\nneural foraminal narrowing.\n2. At L5-S1, there is moderate bilateral neural foraminal narrowing.\n3. There is a T2 hyperintense 1.4 cystic lesion in the mid left renal pole\nwhich appears to demonstrated septation.\n4. There is enlargement of the apparent left adrenal gland measuring up to 1.8\ncm.\n\nRECOMMENDATION(S): Dedicated MRI adrenal and renal mass could be performed\nfor further evaluation of a apparent 1.8 cm nodular enlargement of the left\nadrenal gland and 1.4 cm cystic lesion of the left mid renal pole which\ndemonstrates an apparent septation." }, { "input": "Alignment is preserved. Vertebral body heights are preserved. There is mild\ndegenerative pannus at C1-C2, with mild edema within the odontoid process,\nlikely degenerative. There is otherwise no focal bone marrow signal\nabnormality. There is no prevertebral soft tissue edema.\n\nThe visualized spinal cord is preserved in signal and caliber. The visualized\nposterior fossa and cervicomedullary junction is preserved.\n\nTrace disc protrusions and endplate osteophytes are noted at the C4-C5, C6-C7\nand C7-T1 levels, minimally indenting the ventral thecal sac without\nsignificant spinal canal narrowing. There is no significant spinal canal\nnarrowing at all visualized levels.\n\nUncovertebral and facet osteophytes produce moderate neural foraminal\nnarrowing at the left C2-C3 level, severe left and moderate to severe right\nneural foraminal narrowing at C3-C4, moderate to severe right and\nmild-to-moderate left neural foraminal narrowing at C4-C5, mild bilateral\nneural foraminal narrowing at C5-C6, mild right greater than left neural\nforaminal narrowing at C6-C7, mild left-greater-than-right neural foraminal\nnarrowing at C7-T1, and moderate neural foraminal narrowing at the right T1-T2\nlevel. The remainder of the neural foramina are patent.\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel cervical spondylosis, as described, without significant spinal\ncanal narrowing, and up to severe neural foraminal narrowing at the left C3-C4\nlevel, moderate to severe neural foraminal narrowing at the right C3-C4 and\nright C4-C5 level, and moderate neural foraminal narrowing at the left C2-C3,\nand right T1-T2 level.\n2. Mild odontoid degenerative pannus and associated minimal edema.\n3. No cord signal abnormality or compression." }, { "input": "12 rib-bearing vertebrae are present. Vertebral body heights are within\nnormal limits. There is a T1 hyperintense hemangioma within the T8 vertebral\nbody. No suspicious bone marrow signal abnormalities are seen. Alignment is\nnormal.\n\nSagittal images through the lower cervical spine demonstrate a disc protrusion\nplus/ minus endplate osteophytes mildly indenting the ventral thecal sac at\nC6-C7. The spinal cord does not appear contacted. There are no axial images\nthrough this level.\n\nWithin the left T10-T11 neural foramen, there is a T2 hyperintense, T1\nhypointense , smoothly marginated structure measuring 1.3 cm transverse, 0.9\ncm AP, 1.2 cm craniocaudad, images 7:16, 3:6. This most likely represents a\nnerve root sleeve diverticulum or a pseudomeningocele, and less likely nerve\nsheath tumor.\n\nNo spinal canal or neural foraminal narrowing is seen the thoracic spine. The\nvisualized lower cervical and thoracic spinal cord demonstrates normal\nmorphology and signal intensity, with the conus medullaris terminating near\nthe upper endplate of L1.", "output": "1. 1.3 x 0.9 x 1.2 cm smoothly marginated structure within the left T10-T11\nneural foramen most likely represents a nerve root sleeve diverticulum or a\npseudomeningocele, and less likely nerve sheath tumor.\n2. Spondylosis is partially visualized at C6-C7. No significant degenerative\nchange is seen in the thoracic spine.\n\nRECOMMENDATION(S): Recommend thoracic spine MRI with and without contrast.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:41 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The alignment of the thoracic spine is normal. The focal fatty marrow\ndeposition within the T8 vertebral body is unchanged. There is no abnormal\nenhancement within the bone marrow. The height of the vertebral bodies are\nmaintained. The spinal cord is normal in signal and caliber. The conus\nmedullaris terminates at T12-L1. An oval, well-circumscribed, homogeneously\nT2 hyperintense, T1 hypointense, nonenhancing lesion in the left T10-T11\nneural foramen measures 0.7 (AP) x 1.2 (TV) x 1.1 (SI) cm , unchanged in size\nand appearance from the prior examination. No new masses are identified. The\nparaspinal soft tissues are normal. There is no spinal canal or neural\nforaminal stenosis.\n\nThe multiple focal cortical scars, involving the right kidney, are unchanged.", "output": "1. Unchanged, homogeneously T2 hyperintense, T1 hypointense, nonenhancing\nlesion in the left T10-T11 neural foramen most likely represents a perineural\nroot sleeve cyst.\n2. No new masses.\n3. Stable multilevel thoracic spondyloarthropathy.\n4. Partially visualized, grossly stable right renal cortical scarring. If\nclinically indicated, renal ultrasound may be obtained further evaluation" }, { "input": "The thoracic vertebral bodies are normal in height and alignment. A T1 and\nmildly T2/water IDEAL hyperintense lesion in the T8 vertebral body is\nunchanged and probably represents an intraosseous hemangioma (series 4, image\n7). No suspicious osseous lesion is identified. There is no disc herniation. \nThere is no spinal canal narrowing.\n\nThe thoracic spinal cord is normal in caliber and signal intensity. There is\nno cord compression.\n\nNonenhancing linear areas of low signal in the subcutaneous fat and posterior\nparaspinal soft tissues centered at approximately T10/T11, should be\ncorrelated with history of prior intervention/injection in this region (series\n8, image 6). There is no epidural or paraspinal fluid collection. Previously\nnoted perineural cyst in the region of the left T10/T11 neural foramen is no\nlonger identified however there is a smaller nonenhancing area of low T1 and\nT2 signal in the same location which may represent an involuted cyst or scar\ntissue. This results in moderate to severe narrowing of the neural foramen. \nThere is no neural foraminal narrowing in the thoracic spine otherwise.\n\nMultifocal cortical scarring of the right kidney is unchanged.", "output": "1. Previously noted T2 hyperintense perineural cyst in the left T10/T11 neural\nforamen is no longer present. In this location, there is a smaller\nnonenhancing T1 and T2 hypointense lesion that may represent an involuted cyst\nor scar tissue. This results in moderate to severe narrowing of the left\nT10/T11 neural foramen. Interval development of linear hypointense signal\nabnormality in the posterior subcutaneous tissues at this level, likely\nrepresenting scarring should be correlated with history of intervention. No\nfluid collection.\n2. No new lesion is identified.\n3. The thoracic spinal cord is normal in caliber and signal intensity without\nabnormal enhancement." }, { "input": "There are 12 rib-bearing vertebrae. T12 vertebral body demonstrates a\nsuperior endplate fracture with approximately 45% loss of height compared to\napproximately 15% loss of height on ___, with unchanged minimal\nsuperior posterior corner retropulsion without significant spinal canal\nnarrowing. There is edema throughout the T12 vertebral body confirming a\nrecent fracture. There is mild edema extending into the anterior aspect of\nthe bilateral pedicles.\n\nLeft T8 vertebral body hemangioma is again noted.\n\nNo evidence for spinal cord signal abnormalities. No evidence for an\nenhancing epidural or intrathecal mass.\n\nAgain seen are tiny disc bulges and disc protrusions at multiple thoracic\nlevels without spinal canal narrowing. There is mild facet arthropathy at\nT9-T10 with mild neural foraminal narrowing. There is unchanged hypointensity\nin the left T10-T11 neural foramen at the site of a prior perineural cyst,\nimages 7:15, 10:16. There are incompletely evaluated degenerative changes in\nthe visualized lower cervical spine.", "output": "1. Recent T12 superior endplate fracture is again seen with expected marrow\nedema, demonstrating approximately 45% loss of height compared to\napproximately 15% loss of height on ___. Unchanged minimal\nsuperior posterior corner retropulsion without significant spinal canal\nnarrowing.\n2. Unchanged hypointensity in the left T10-T11 neural foramina at the site of\na prior perineural cyst." }, { "input": "Redemonstration of T12 compression fracture, now with low T1 and T2 signal\nmaterial consistent with vertebroplasty. Edema has decreased compared to the\nprevious examination. Otherwise, the vertebral bodies are normal in height. \nMultilevel degenerative endplate marrow signal changes and endplate\nosteophytes are noted along with diffuse mild loss of T2 signal intervertebral\ndisc height in the thoracic intervertebral discs. T8 hemangioma.\n\nThe thoracic spinal cord remains normal in caliber and in signal.\n\nAgain demonstrated are multiple minimal disc bulges and protrusions as well as\nmild facet arthropathy most pronounced at the T9-T10 level. There is mild\nnarrowing of the left T9-T10 neural foramen. There is again hypointensity in\nthe left T10-T11 neural foramen at previous surgical site. At the remaining\nlevels, there is no evidence of spinal canal or neural foraminal narrowing. \nThere are partially imaged degenerative changes in the lower cervical spine. \nNo abnormal leptomeningeal enhancement. No enhancing masses are seen. There\nis no evidence of infection or neoplasm.", "output": "1. Redemonstration of T12 compression fracture, now post vertebroplasty. No\nnew compression fracture.\n2. Stable appearance of the left T10-T11 neural foramen at site of previous\nperineural cyst resection. No new neural foraminal or spinal canal stenosis\nis evident." }, { "input": "CERVICAL:\nAlignment of the cervical spine is anatomic. There is abnormal T1\nhypointensity of the C7 vertebral body is consistent with metastatic\nreplacement. There is retropulsion of the posterior vertebral wall cortex\nwith moderate spinal canal narrowing with mild deformity of the spinal cord\nwithout high-grade spinal cord compression. There is no abnormal cord signal.\nThere is no significant neural foraminal narrowing. Vertebral body heights\nare preserved.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. There is no evidence of spinal canal or neural foraminal\nnarrowing.No worrisome lesion involves the thoracic spine.\n\nLUMBAR:\nThere are five lumbar-type vertebral bodies which are normal in height and\nalignment. Bilateral L5 spondylolysis with grade 1 anterolisthesis of L5 with\nrespect to S1 is stable. Bone marrow signal intensity is within normal limits\nwithout a worrisome lesion. Conus terminates at the L1-L2 level.\n\nA 3.5 x 1.9 cm T2 isodose slightly hyperintense partially intradural and\npartially extradural mass occupying and expanding the right neural foramen at\nthe L5-S1 level is not appreciably changed. Secondary moderate canal\nnarrowing with displacement of the traversing cauda equina roots posteriorly\nand laterally to the left is noted. From the T12 through L3 levels, there is\nno significant canal or foraminal narrowing. A diffuse disc bulge with left\ncentral disc protrusion at the L3-L4 level results in narrowing of the\nsubarticular recesses, left greater than right. Facet joint hypertrophy\nresults in moderate left and mild-to-moderate right foraminal narrowing.\n\nDiffuse disc bulge with central disc protrusion at the L4-L5 level with\nassociated facet joint hypertrophy results in moderate bilateral foraminal\nnarrowing.\n\nOTHER: Mediastinal nodes and pulmonary metastases are better appreciated on CT\nchest dated ___. New since ___ is bilateral\nhydronephrosis. Right adrenal gland nodularity is noted, more conspicuous\nrelative to prior examination and worrisome for metastatic involvement.", "output": "1. Metastatic marrow replacement of the C7 vertebral body is associated with\nexpansion of the posterior vertebral body wall posteriorly resulting and\nmoderate spinal canal narrowing. No abnormal cord signal.\n\n2. Re- demonstration of partially intradural partially extradural mass\noccupying and expanding the right neural foramen at the L5-S1 level, not\nappreciably changed since prior examination performed ___.\n\n3. New bilateral hydronephrosis and right adrenal gland nodularity would be\nbetter evaluated by dedicated abdominopelvic imaging.\n\n4. Re- demonstration of mediastinal nodes and pulmonary metastases as\ndescribed on chest CT dated ___." }, { "input": "At T11-12-T12-L1 and L1-2 levels mild disc degenerative changes are\nidentified. At L2-3 level, disc degenerative change and bulging seen. There\nis a central disc protrusion indenting the thecal sac. There is\nmild-to-moderate spinal stenosis seen. There is mild narrowing of right\nforamen.\n\nAt L3-4 level, there is disc bulging seen without spinal stenosis or foraminal\nnarrowing.\n\nAt L4-5 level, disc bulging is seen with central and right-sided disc\nprotrusion with moderate narrowing of the right subarticular recess and mild\nindentation of the thecal sac. There is mild-to-moderate right and minimal\nleft foraminal narrowing.\n\nAt L5-S1 level, disc bulging and a broad-based central to the right side disc\nprotrusion identified without displacement of nerve root. There is moderate\nright and moderate-to-severe left foraminal narrowing seen.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Disc protrusions at L2-3 and L4-5 levels with indentation of the thecal\nsac. Moderate narrowing of the right subarticular recess at L4-5 level.\n2. Disc bulging and disc protrusions resulting in moderate right and\nmoderate-to-severe left foraminal narrowing at L5-S1 level.\n3. Degenerative changes at other levels as described." }, { "input": "Alignment is normal. There is mild disc height and signal intensity loss at\nthe L2-3, L4-5, and L5-S1 levels. ___ 2 type endplate changes at the L2-3,\nL3-4, and L5-S1 levels. Vertebral body heights and signal intensities are\notherwise preserved.. The spinal cord appears normal in caliber and\nconfiguration. The conus terminates at the L1 level.\n\nAt T12-L1, a mild bulge slightly encroaches on the spinal canal without\ncontacting the conus. The neural foramina appear normal.\nAt L1-L2, there is no spinal canal or neural foraminal narrowing.\nAt L2-L3, broad-based disc bulge and midline disc protrusion encroaches on the\nthecal sac and migrates inferiorly along the posterior margin of the L3\nvertebral body. This produces moderate spinal canal narrowing. The neural\nforamina appear normal.\nAt L3-L4, a disc bulge and midline disc protrusion minimally narrow the spinal\ncanal without contact with the nerve roots. The neural foramina appear\nnormal.\nAt L4-L5, a disc bulge and midline disc protrusion mildly narrow the spinal\ncanal. The traversing L5 nerve roots are contacted by the disc and caught\nbetween the disc bulge and the facet joints. There is mild bilateral neural\nforaminal narrowing.\nAt L5-S1, a disc bulge mildly encroaches on the spinal canal but contacts and\nposteriorly displaces the traversing right S1 nerve root. A lateral disc\nprotrusion and intervertebral osteophyte encroaches on the lateral left L5-S1\nneural foramen, contacting the exiting L5 nerve root.\n\nParaspinal soft tissues are unremarkable. No abnormal postcontrast\nenhancement. Known right-sided renal mass is not well evaluated on this\nnondedicated exam.", "output": "1. Midline disc protrusions at L2-3 and L3-4 encroach on the thecal sac.\n2. Disc bulge and midline disc protrusion at L4-5 encroach on the traversing\nL5 nerve roots.\n3. Disc bulge at L5-S1 displaces the right S1 nerve root posteriorly.\n4. Lateral protrusion and intervertebral osteophytes compress the left L5\nnerve root in the neural foramen.\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": "There is unchanged minimal retrolisthesis of L5 on S1. Vertebral body height\nand alignment is otherwise maintained. Degenerative disc disease is\npredominantly seen at L5-S1 and to a lesser degree at L4-L5. Note is made of\n___ type type 1 degenerative endplate changes at L5-S1 in addition to\nsclerotic changes at this level on the prior CT. The bone marrow signal is\notherwise within normal limits.\n\nThe spinal cord appears normal in caliber and configuration. The conus\nterminates normally at the T12-L1 level.\n\nAt L4-L5, there is a disc bulge, facet joint arthropathy with small bilateral\nfacet joint effusions and ligamentum flavum thickening, no spinal canal\nstenosis, mild bilateral neural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge, facet joint osteophytes, no spinal canal\nstenosis, mild to moderate bilateral neural foraminal narrowing. The disc\nbulge may be contacting the right L5 nerve root in the neural foramen (series\n201, image 718) but there is no evidence of impingement.\n\nThere is no disc herniation, spinal canal stenosis or significant neural\nforaminal narrowing at the remaining lumbar levels.\n\nSeveral bilateral partially visualized round T2 hyperintense lesions in both\nkidneys most likely represent renal cysts as previously visualized on the CT.", "output": "1. Mild degenerative changes of the lower lumbar spine without cord\ncompression or severe spinal canal stenosis.\n2. Mild to moderate bilateral neural foraminal narrowing at L5-S1 with the\ndisc bulge possibly contacting the right L5 nerve root in the neuroforamen but\nwithout evidence of impingement." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. There is no cord T2 signal abnormality. There is no evidence\nof infection or neoplasm. There is advanced degenerative changes in the\ncervical spine. There is multilevel disc space narrowing, disc osteophyte\ncomplexes, posterior element degenerative changes.\n\nAt C2-C3 level central canal and right foramen are patent. There is mild left\nforaminal narrowing, stable since prior.\nAt C3-C4 level there is mild central canal narrowing, stable since prior. \nThere is moderate to severe left, and mild right foraminal narrowing, stable.\nAt C4-C5 level there is moderate central canal narrowing, stable since prior. \nThere is severe bilateral foraminal narrowing, stable.\nAt C5-C6 level there is small broad-based right paramedian, inferior disc\nprotrusion, of intermediate T2 signal, new since prior exam. There is severe\ncentral canal narrowing, with mild flattening of the cord, incomplete\neffacement of CSF about cord, more prominent since prior. There is no cord T2\nsignal abnormality. There is severe right, and moderate to severe left\nforaminal narrowing, similar to prior.\nA C6-C7 level there is dark T2 signal small right paramedian, superior disc\nprotrusion and moderate central canal narrowing, minimal flattening of the\ncord, near complete effacement of CSF about cord, similar to prior. There is\nno cord T2 signal abnormality. There is severe bilateral foraminal narrowing,\nstable on the right, mildly more prominent on the left.\nAt C7-T1 level there is mild central canal narrowing, stable since prior. \nThere is mild-to-moderate left, and mild right foraminal narrowing, stable\nsince prior.", "output": "1. There are advanced degenerative changes in the cervical spine. There is\nnew small disc protrusion at C5-C6 level and severe central canal narrowing,\nmild flattening of the cord, worsened since prior.\n2. There is moderate central canal narrowing at C4-C5, C6-C7 levels, similar.\n3. There is multilevel significant foraminal narrowing." }, { "input": "There is minimal grade 1 L4 on L5 anterolisthesis, stable since prior exam. \nVertebral body and intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof infection or neoplasm. There is advanced degenerative changes in the\nlumbar spine with multilevel disc space narrowing. There is advanced lumbar\nfacet arthritis, with bilateral L4-5 facet joint effusions, also present on\nprior exam. There is multilevel endplate hypertrophic changes, diffuse disc\nbulges. There is mild congenital narrowing of the lumbar spinal canal.\n\nAt L1-L2 level there is mild central canal narrowing, mildly more prominent\nsince prior, with tiny inferior central disc protrusion. There is\nmild-to-moderate right foraminal narrowing, more prominent since prior. There\nis mild left foraminal narrowing, similar.\nAt L2-L3 level there is mild central canal narrowing, stable, with mild\nnarrowing of the left lateral recess, stable. There is mild bilateral\nforaminal narrowing, stable.\nAt L3-L4 level there is moderate central canal narrowing, without complete\neffacement of CSF, similar. Lateral recesses are narrowed, more prominent on\nthe left, stable since prior exam. There is moderate left, and mild right\nforaminal narrowing, stable since prior.\nAt L4-5 level there is moderate to severe central canal narrowing, with\nincomplete effacement of CSF within thecal sac, similar. There is prominent\nthickening of ligamentum flavum with prominent facet arthritis, similar. \nLateral recesses are narrowed, stable. There is severe right foraminal\nnarrowing, and moderate left foraminal narrowing, stable since prior.\nAt L5-S1 level central canal is patent. There is mild narrowing of the right\nlateral recess, similar. There is mild to moderate right, and mild left\nforaminal narrowing, similar. There is broad-based right foraminal, far\nlateral disc bulge, stable since prior.\n\nThere are bilateral renal cysts, also seen on prior exam.", "output": "1. There are advanced degenerative changes in the lumbar spine. There is\nmoderate to severe central canal narrowing and grade 1 L5 anterolisthesis at\nL4-5 level, similar to prior.\n2. There is multilevel significant foraminal narrowing." }, { "input": "Overall there has been no significant interval change since the previous MRI\nstudy.\n\nAt T11-12 to L1-2 levels disc degenerative change and mild bulging seen.\n\nAt L2-3 level, disc bulging and facet degenerative changes seen with mild\nindentation of the thecal sac and mild narrowing of the subarticular recesses.\nThere is no foraminal narrowing.\n\nAt L3-4 level, disc bulging and facet degenerative changes result in moderate\nspinal stenosis with mild bilateral foraminal narrowing.\n\nAt L4-5 level, diffuse disc bulge and facet degenerative changes result in\nsevere spinal stenosis as before. There is severe right and moderate left\nforaminal narrowing as before.\n\nAt L5-S1 level, disc bulging is seen without spinal stenosis. There is mild\nto moderate right and mild left foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Overall no significant interval change since the previous MRI study of ___.\n2. Severe spinal stenosis and right foraminal narrowing at L4-5 level and\nmoderate spinal stenosis at L3-4 level. Other degenerative changes as\ndescribed above." }, { "input": "CERVICAL:\n2 mm retrolisthesis of C4 on C5 is unchanged from prior exam. Otherwise,\ncervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Degenerative loss of disc height is severe\nspanning C4-C5 through C7-T1, similar to slightly progressed from prior exam. \nThere is no abnormal signal or enhancement of the cord.\n\nThere is mild spinal canal narrowing at baseline secondary to congenital\nshortening of the pedicles.\n\nC2-C3: There is no significant spinal canal or neural foraminal narrowing.\nC3-C4: A central protrusion and congenital shortening of the pedicles results\nin mild spinal canal narrowing. Uncovertebral and facet arthropathy results\nin severe left and moderate right neural foraminal narrowing.\nC4-C5: A central protrusion with thickening of ligamentum flavum results in\nmoderate to severe spinal canal narrowing minimally remodeling the cord. \nUncovertebral and facet arthropathy results in severe bilateral neural\nforaminal narrowing. The degree of neural foraminal and spinal canal\nnarrowing has progressed from prior exam.\nC5-C6: A central protrusion with intervertebral osteophytes, congenital\nshortening of the pedicles and thickening of the ligamentum flavum results in\nsevere spinal canal narrowing, similar to slightly progressed from prior exam.\nUncovertebral and facet arthropathy results in severe bilateral neural\nforaminal narrowing, progressed from prior exam.\nC6-C7: A central protrusion with thickening of the ligamentum flavum results\nin mild spinal canal narrowing, similar to prior exam. Uncovertebral and\nfacet arthropathy results in severe right and moderate left neural foraminal\nnarrowing, similar to prior exam.\nC7-T1: No significant spinal canal narrowing. There is mild-to-moderate left\nand mild right neural foraminal narrowing.\n\nThere is no evidence of high-grade spinal canal or neural foraminal narrowing\nof the visualized upper thoracic spine to the T3 level.\n\nVisualized prevertebral paraspinal soft tissues are grossly unremarkable.\n\nLUMBAR:\nExamination is mildly motion degraded. In addition, the patient is status\npost L3 through L5 laminectomy with fusion via bilateral pedicle screws and\nrods since examination of ___. Metallic artifact from the\nhardware results in suboptimal evaluation of adjacent structures. Within\nthese confines:\n\nLumbar alignment is anatomic. Vertebral body heights are preserved. There is\nno focal suspicious marrow signal. The conus medullaris terminates at the\nL1-L2 level, within expected limits. No significant enhancing granulation\ntissue encroaches on the spinal canal or neural foramina.\n\nThere is a single 2-3 mm focus of linear enhancement along the right S1\ntraversing nerve root at the L5 level (series 4, image 40), which could\npotentially represent a small schwannoma versus postsurgical sequela.\n\nT11-T12 and T12-L1: No significant spinal canal narrowing. Facet arthropathy\nbilaterally presents in mild neural foraminal narrowing.\n\nL1-L2: A disc bulge with thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing. In conjunction with facet arthropathy, there\nis moderate bilateral neural foraminal narrowing. This is similar to prior\nexam.\n\nL2-L3: A disc bulge with thickening of the ligamentum flavum and epidural fat\nresults in severe spinal canal narrowing, significantly progressed from prior\nexam. There is buckling of the cauda equina superiorly. In conjunction with\nfacet arthropathy, there is moderate bilateral neural foraminal narrowing,\nwhich appears to have progressed from prior exam.\n\nL3-L4: The patient is decompressed. Loss of disc height results in\nmild-to-moderate bilateral neural foraminal narrowing, overall similar to\nprior exam.\n\nL4-L5: The patient is decompressed. Loss of disc height results mild to\nmoderate bilateral neural foraminal narrowing, similar to prior exam.\n\nL5-S1: The patient is decompressed. Degenerative changes results in mild to\nmoderate bilateral neural foraminal narrowing, similar to prior exam.\n\nMultiple renal and parapelvic cysts are identified. Allowing for postsurgical\nchanges, visualized prevertebral paraspinal soft tissues are unremarkable.", "output": "1. The patient is status post L3 through L5 laminectomy with without\nsignificant enhancing relation tissue encroaching on the spinal canal or\nneural foramina.\n2. There is new adjacent level degenerative disease of L2-L3 where a disc\nbulge with thickening of ligamentum flavum and prominent epidural fat results\nin severe spinal canal narrowing, severely crowding the cauda equina resulting\nand buckling superiorly. There is also moderate bilateral neural foraminal\nnarrowing, progressed from prior exam.\n3. Linear 2 mm enhancement associated with the S1 traversing nerve root at the\nL5 level is identified, potentially representing a small schwannoma versus\npostoperative sequela.\n4. Multilevel multifactorial cervical spondylosis most prominent at C4-C5\nwhere there is moderate to severe spinal canal narrowing and at C5-C6 where\nthere is severe spinal canal narrowing, remodeling the cord without underlying\ncord signal change. There is severe left C3-C4, severe bilateral C4-C5,\nsevere C5-C6 and severe right C6-C7 neural foraminal narrowing. These changes\nappear to have slightly worsened from prior examination.\n5. Additional findings 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.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:45 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is grade 1 anterolisthesis of L4 on L5 and minimal retrolisthesis of L5\non S1, grossly unchanged compared to ___ prior exams. Vertebral body heights\nare maintained. There are L5-S1 type ___ ___ endplate changes. The spinal\ncord appears normal in caliber and configuration. The conus medullaris\nterminates at L2.\n\nThere is loss of intervertebral disc height and signal at all visualized\nlevels of the lumbar spine and the visualized portion of the lower thoracic\nspine. There is near complete loss of L5-S1 intervertebral disc, similar to\nprior examinations.\n\nThere is no paravertebral or paraspinal mass identified. The visualized\nportion of the sacroiliac joints are preserved. Multiple bilateral probable\nrenal cysts are partially visualized.\n\nT12- L1: Question minimal right epidural enhancing tissue versus artifact\nmeasuring up to 5 mm (see 3,9:14, 8,11:13). Disc bulge results in mild\nvertebral canal stenosis. There is no neural foraminal stenosis.\n\nL1-L2: No vertebral canal or neural foraminal stenosis.\n\nL2-L3: No spinal canal stenosis. Left-sided foraminal zone disc protrusion,\nand facet joint hypertrophy cause mild left neural foraminal stenosis. \nSignificant right neural foraminal stenosis.\n\nL3-L4: Disc bulge and ligamentum flavum hypertrophy cause mild vertebral\ncanal stenosis. There is no neural foraminal stenosis.\n\nL4-L5: Disc bulge and ligamentum flavum hypertrophy, along with vertebral\nbody subluxation cause moderate vertebral canal stenosis. In combination with\nfacet joint hypertrophy there is moderate bilateral neural foraminal stenosis.\n\nL5-S1: Disc bulge and ligamentum flavum hypertrophy cause mild vertebral\ncanal stenosis. This in addition to facet joint hypertrophy cause mild\nbilateral neural foraminal stenosis.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel moderate degenerative changes of the lumbar spine as described,\nmost pronounced at L4-5, where there is moderate vertebral canal and bilateral\nneural foraminal stenosis. Allowing for differences technique, L4-5 level\nfindings are grossly unchanged compared to ___ prior exam.\n3. Question 5 mm right T12-L1 enhancing epidural soft tissue, with\ndifferential consideration of degenerative change or artifact, without\ndefinite associated vertebral canal or neural foraminal stenosis. If\navailable, consider correlation with available prior lumbar spine MRI. \nRecommend correlation with neurologic exam and attention on follow-up imaging.\nIf clinically indicated, consider correlation with CSF analysis.\n4. Multiple bilateral probable small renal cysts.\n\nRECOMMENDATION(S): Question 5 mm right T12-L1 enhancing epidural soft tissue,\nwith differential consideration of degenerative change or artifact, without\ndefinite associated vertebral canal or neural foraminal stenosis. If\navailable, consider correlation with available prior lumbar spine MRI.\nRecommend correlation with neurologic exam and attention on follow-up imaging.\nIf clinically indicated, consider correlation with CSF analysis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 22:13 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nMinimal anterolisthesis of L3 on L4 and of L5 on S1 were not seen on the CT\nfrom ___. Mild retrolisthesis of L4 on L5 is unchanged compared to\nthe CT from ___. No suspicious bone marrow signal abnormalities are\nseen. There are scattered T1 hyperintense hemangiomas in the bone marrow. \nDiscogenic bone marrow changes are present in the endplates at multiple\nlevels, most extensive at L4-L5 throughout and at L3-L4 on the right. There\nis loss of disc height and Schmorl's nodes from L3-L4 through L5-S1.\n\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating at T12-L1.\n\nT11-T12: Tiny right paracentral endplate osteophyte extends superiorly (image\n100:74) without mass effect on the thecal sac. Mild facet arthropathy. No\nsignificant spinal canal or neural foraminal narrowing.\n\nT12-L1: There is a mild disc bulge, a shallow right paracentral disc\nherniation extending superiorly, and mild facet arthropathy. The thecal sac\nis mildly narrowed without mass effect on the conus medullaris or intrathecal\nnerve roots. No significant neural foraminal narrowing.\n\nL1-L2: There is a mild disc bulge, a narrow-based right paracentral disc\nherniation extending superiorly, and mild facet arthropathy. The thecal sac\nis mildly indented without mass effect on the intrathecal nerve roots. The\ndisc herniation courses medial to the traversing L2 nerve root (in supine\nposition), without evidence for associated mass effect. There is no\nsignificant neural foraminal narrowing.\n\nL2-L3: Mild disc bulge, larger on the left than right, and mild facet\narthropathy. No significant spinal canal narrowing. Minimal left neural\nforaminal narrowing.\n\nL3-L4: There is a minimal anterolisthesis, a disc bulge, mild infolding of the\nligamentum flavum, and moderate, right greater than left facet arthropathy\nwith small right facet joint effusion. The thecal sac is mildly narrowed\nwithout crowding of the intrathecal nerve roots. Traversing right L4 nerve\nnerve root is contacted in the subarticular zone without evidence for\ncompression. Moderate right neural foraminal narrowing with abutment of the\nexiting right L3 nerve root. Mild to moderate left neural foraminal\nnarrowing.\n\nL4-L5: There is a mild retrolisthesis, a disc bulge and endplate osteophytes\nwhich are larger on the right than left, infolding of the ligamentum flavum,\nand severe, left greater than right facet arthropathy. The thecal sac is\nmildly narrowed without significant crowding of the intrathecal nerve roots. \nThere is abutment of bilateral traversing L5 nerve roots and posterior\ndisplacement of the right L5 nerve root. There is moderate to severe\nbilateral neural foraminal narrowing with abutment of the exiting L4 nerve\nroots.\n\nL5-S1: There is a minimal anterolisthesis, a disc bulge which is larger on the\nright than left, and severe, left greater than right facet arthropathy. No\nmass effect on the thecal sac. Traversing L5 nerve root may be contacted in\nthe subarticular zone without compression. Mild-to-moderate right and\nmoderate left neural foraminal narrowing with abutment of the exiting left L5\nnerve root.\n\nDegenerative changes of the partially imaged sacroiliac joints are noted.\n\nThe right kidney is rotated, as seen on the ___ CT, with dilatation\nof the calyces and extrarenal pelvis and presumed UPJ obstruction. The UPJ\nobstruction is likely partial, since there is no cortical thinning in the\nright kidney. There are multiple T2 hyperintense lesions of varying sizes in\nthe right kidney and partially visualized left kidney, larger than on the CT\nfrom ___, statistically likely cysts. The largest in the left\nkidney measures 1.5 cm on image 8:4.", "output": "1. Multilevel degenerative disease in the lumbar and included lower thoracic\nspine.\n2. Mild narrowing of the thecal sac at multiple levels without mass effect on\nthe intrathecal nerve roots.\n3. Mass effect on multiple traversing and exiting nerve roots in the\nsubarticular zones and neural foramina, as detailed above.\n4. The right kidney is rotated, as seen on the CT from ___, with\npersistent dilatation of the collecting system and presumed UPJ obstruction. \nThe UPJ obstruction is likely partial, since no cortical thinning is seen in\nthe right kidney." }, { "input": "Multiple sequences are limited by motion artifact. There are 7 cervical, 12\nthoracic, and 5 lumbar-type vertebrae. The numbering is documented on images\n3:10, 9:10, and 9:9.\n\nCERVICAL:\nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. Alignment is within normal limits. The cerebellar\ntonsils are normally positioned. Evaluation of spinal cord signal is limited\nby motion artifact, but no definite signal abnormalities are seen. Dural\nenhancement in the proximal cervical spine is unchanged compared to ___. Ossification of the posterior longitudinal ligament is again seen\nmildly to moderately narrowing the spinal canal at C5 and C6. Small disc\nprotrusions also indent the ventral thecal sac at multiple levels, as seen\npreviously. Right C7-T1 perineural cyst is again noted. There is no fluid\ncollection.\n\nTHORACIC:\nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. Allowing for motion artifact, no spinal cord sub\nabnormalities are seen. Small disc protrusions are again seen at multiple\nlevels without significant spinal canal narrowing or mass effect on the spinal\ncord. Multiple perineural cysts are again seen bilaterally, most numerous in\nthe lower lumbar spine. There is no fluid collection. No definite abnormal\ncontrast enhancement is seen allowing for motion artifact.\n\nLUMBAR:\nCoronal images again demonstrate dextroconvex scoliosis centered at L1-L2. \nThere is no evidence for spondylolisthesis. Vertebral body heights are\npreserved. No suspicious bone marrow signal abnormalities are seen. There\nare increased, now extensive ___ type 1 discogenic bone marrow changes in\nthe endplates at L4-L5. The conus medullaris terminates at L1-L2 with normal\nmorphology. Pachymeningeal contrast enhancement in the lumbar spine and\nvisualized upper sacral levels is similar to ___. Multiple Tarlov\ncysts are again partially visualized in the sacrum. There is no evidence for\nfluid collection.\n\nT12-L1: There is a broad-based left paracentral, foraminal, and\nextraforaminal disc protrusion. The left subarticular zone is narrowed\nwithout compression of the traversing L1 nerve root. The spinal canal is\nmildly narrowed on the left without mass effect on the distal spinal cord. \nThere is some degree of left neural foraminal narrowing; evaluation is limited\nby scoliosis. The exiting left T12 nerve root is contacted by the disc\nprotrusion.\n\nL1-L2: There is a disc bulge and facet arthropathy mildly narrowing the\nthecal sac without mass effect on the intrathecal nerve roots or conus\nmedullaris. Left subarticular zone is narrowed without frank compression of\nthe traversing left L2 nerve root. There is some degree of bilateral neural\nforaminal narrowing, but evaluation is limited by scoliosis.\n\nL2-L3: Disc bulge, facet arthropathy and posterior epidural fat causes\nmoderate spinal canal narrowing with crowding of the intrathecal nerve roots,\nas well as abutment of the traversing L3 nerve roots in the subarticular\nzones, progressed since ___. There is some degree of bilateral neural\nforaminal narrowing, probably mild, but evaluation is limited by scoliosis.\n\nL3-L4: There is a disc bulge, facet arthropathy, and posterior epidural fat\ncausing moderate to severe spinal canal narrowing with crowding of the\nintrathecal nerve roots, and abutment of the traversing L4 nerve roots in the\nsubarticular zones, progressed since ___. There is at least mild to moderate\nbilateral neural foraminal narrowing, but evaluation is limited by scoliosis.\n\nL4-L5: There is a disc bulge and facet arthropathy narrowing right greater\nthan left subarticular zones with abutment of the traversing L5 nerve roots,\nand mildly narrowing the thecal sac without significant mass effect on the\nintrathecal nerve roots, not significantly changed. There is moderate right\nneural foraminal narrowing, similar to prior.\n\nL5-S1: There is a disc bulge and left foraminal endplate osteophytes, the\nlatter contacting the exiting left L5 nerve root in the moderately narrowed\nneural foramen. No significant spinal canal narrowing. No significant change\nsince the prior MRI.\n\nOTHER:\n1.5 cm right level IIa lymph node on image 7:8 is top-normal. A left renal\ncystic lesion is noted.", "output": "1. Motion limited exam.\n2. Unchanged multiple perineural cysts in the thoracic spine and multiple\npartially visualized Tarlov cysts in the sacrum. No evidence for a fluid\ncollection to suggest CSF leak.\n3. Unchanged pachymeningeal contrast enhancement in the upper cervical spine,\nin the lumbar spine, and at the included upper sacral levels.\n4. No significant change in cervical degenerative disease and ossification of\nthe posterior longitudinal ligament with mild to moderate spinal canal\nnarrowing.\n5. Mild thoracic degenerative changes without significant spinal canal\nnarrowing.\n6. Progression of multilevel lumbar degenerative disease. Spinal canal\nstenosis is no moderate to severe at L3-L4 and moderate at L2-L3, with\ncrowding of the intrathecal nerve roots." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. No focal\nsuspicious marrow lesion. Mild ___ type 1 endplate changes associated with\ndegenerative osteophytes at the T11-T12 level is identified. Mild loss of\ndisc height at L5-S1 with associated loss of disc signal. The conus\nmedullaris terminates at the L1-L2 level, within expected limits. There is no\nsignal abnormality of the terminal cord.\n\nT10-T11 through T12-L1: There are small disc bulges which do not narrow the\nspinal canal or neural foramina.\n\nL1-L2 through L4-L5: There is no spinal canal or neural foraminal narrowing.\n\nL5-S1: Right eccentric disc bulge does not narrow the spinal canal. There is\ncrowding of the subarticular zones contacting but not posteriorly displacing\nthe traversing nerve roots. Conjunction with facet arthropathy, there is mild\nbilateral neural foraminal narrowing. Small bilateral facet joint effusions\nis identified, with synovial cysts projecting posteriorly into the paraspinal\nmuscles.\n\nThere is STIR hyperintense signal along the paraspinal muscles and\ninterspinous regions spanning L2 through L4-L5, which is nonspecific and but\nmay represent muscle edema/strain. Clinical correlation is recommended.\n\nA simple cyst measuring 1.2 cm in left renal midpole is unchanged from prior\nexamination. Mild diffuse nodularity/hyperplasia of the left adrenal gland,\nunchanged since ___. Otherwise, the visualized prevertebral paraspinal soft\ntissues are unremarkable and unchanged from prior exam.", "output": "1. There is no spinal canal or significant neural foraminal narrowing. No\nevidence for cauda equina compression.\n2. Multilevel lumbar spondylosis most prominent at L5-S1 where there is a\nsmall right eccentric disc bulge which does not significantly narrow the\nspinal canal. There is mild neural foraminal narrowing.\n3. STIR hyperintense signal of the paraspinal muscles interspinous regions\nspanning L2 through L4 L5, nonspecific, but may represent muscle edema/strain.\nClinical correlation is recommended.\n4. Additional findings as described above." }, { "input": "Alignment is normal. There is mild height loss of the C7 vertebral body,\nwhich demonstrates marrow edema and a linear transverse line compatible with\nan acute fracture. There is marrow edema in the anterior, inferior C4\nvertebral body at the site of the anteroinferior endplate fracture seen on the\nprior CT. Remaining vertebral heights are preserved. Marrow signal elsewhere\nin the cervical spine is within normal limits. The cervical spinal cord is\nnormal in caliber and signal intensity.\n\nThere is a likely acute extra axial hematoma within the cervical spine\nposteriorly, extending from the level of approximately C3 at the left\nsuperolateral aspect of the spinal canal, where it is small in caliber,\ninferiorly into the thoracic spine, widest in caliber over an approximately 7\ncm distance at the level of the T1-T4 vertebral bodies, where measures up to\n0.9 cm in width, causing at least moderate overall spinal canal narrowing with\ncontact and anterolateral displacement of the spinal cord and slight cord\nremodeling. No cord signal abnormality.\n\nThere is marrow edema in the pars interarticularis and lamina and pedicles of\nC3 and C4 on the right, with trace intervening facet joint fluid, raising\nsuspicion for facet joint capsule disruption at this level. There is also\ntrace right C2-3 and C4-5 facet joint fluid, degenerative change versus acute\ninjury.\n\nThere is extensive edema and likely hematoma within the suboccipital and\nposterior paraspinal musculature overlying the mid to upper cervical spine. \nThere is extensive STIR hyperintense signal in the region of the interspinous\nligaments, consistent with injury or disruption, from at least C2-3 inferiorly\nto the level of C5-6. Known multilevel spinous process fractures extending\nfrom C2-C7, as well as involving the bilateral C7 pars interarticularis, were\nbetter assessed on prior outside hospital CT.\n\nThere is probable focal disruption of the anterior longitudinal ligament at\nthe level of C4-5 (see series 3, image 9). The posterior longitudinal\nligaments appears intact.\n\nThere is trace prevertebral edema throughout the cervical spine, most\nconspicuous at the level of the C7 fracture.\n\nThere is background moderate cervical spine degenerative changes, with\nmultilevel posterior disc bulges causing moderate spinal canal narrowing at\nC3-4, C4-5, and C5-6, with slight ventral cord contact and cord remodeling at\nthese levels. Neural foraminal narrowing due to degenerative changes is seen\nat multiple levels, worst (moderate) bilaterally at C5-6 due to uncovertebral\nand facet osteophytes.", "output": "1. Posterior acute spinal hematoma, likely with both epidural and subdural\ncomponents, extending from C3 to at least the level of T4, largest in diameter\n(up to 9-10 mm) from T1-T4 over an approximately 8 cm range length, with mass\neffect on the cord, causing central canal narrowing and right anterolateral\ndisplacement of the thoracic cord. No cord signal abnormality.\n2. Extensive posterior ligamentous complex injury, including evidence of\ninjury or disruption to the interspinous ligaments spanning at least C2-3\ninferiorly to the level of C5-6.\n3. Apparent focal disruption of the anterior longitudinal ligament (ALL) at\nC4-5.\n4. Although no discrete fracture is seen on the CT or on this study, there is\nmarrow edema on either side of the right C3-4 facet joint, with trace facet\njoint fluid, raising the possibility of injury to the joint capsule at this\nlevel. Similarly, trace but less conspicuous facet joint fluid also on the\nright at C2-3 and ___ reflect degenerative changes or subtle injury to\nthese joint capsules.\n5. Known fractures through the C2-C7 spinous processes as well as the right\nand left C7 pars interarticularis, better assessed on outside hospital CT.\n6. Marrow edema associated with the transverse fracture through the C7\nvertebral body and the anteroinferior endplate fracture of the C4 vertebral\nbody, also better visualized by CT.\n7. Small volume multilevel prevertebral fluid, most conspicuous at C7.\n\nNOTIFICATION: The findings were discussed with ___ M.D. by\n___, M.D. on the telephone on ___ at 3:25 pm and again\nat 4:15 p.m. after modification to impression points #'s 1 and 3, 5 minutes\nafter discovery of the findings." }, { "input": "When compared to CT torso ___, there is interval development of\nan acute fracture through the ossified anterior longitudinal ligament at T5-T6\nextending through the T6 vertebral body and bilateral pedicles. This results\nin interval severe retrolisthesis T5 on T6, bony retropulsion of the posterior\nsuperior T6 vertebral body and retrolisthesis of the T6 vertebral body, and\nsevere spinal canal narrowing, remodeling the cord. There is no definite cord\nsignal abnormality. Additionally, there is disruption of the anterior and\nposterior longitudinal ligaments at this level.\n\nAt C7, there is marrow edema and a linear transverse line compatible with an\nacute fracture, unchanged from MR cervical spine ___.\n\nExtending from the level of T1-T4, there is a T2 hypointense, T1 mildly\nhyperintense collection compatible with extramedullary hematoma, unchanged in\nsize (4:8). The collection contacts the spinal cord at the level of T3.\n\nSurgical hardware extends from T9 through L1 and limits evaluation.\n\nThere are background severe thoracic spine degenerative changes. This\nincludes loss of intervertebral disc height (most notably at T6-T7), disc\ndesiccation, disc bulge (resulting in contact of the spinal cord at T1),\nvertebral body disc height loss (most notably at T6 and T7), marrow signal\nchanges, and joint osteophytosis.\n\nOther: Bilateral pleural effusions. Bilateral renal cysts.", "output": "1. Severe spinal canal narrowing at T5-T6, with remodeling of the cord without\ndefinite cord signal abnormality. This is secondary to a Chance type fracture\nof the ossified T5-T6 anterior longitudinal ligament with extension through\nthe T6 vertebral body and bilateral pedicles with bony retropulsion and\nretrolisthesis of the posterosuperior T6 vertebral body.\n2. Extramedullary hematoma extending from T1-T4 is unchanged in size.\n3. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 12:07 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "CERVICAL:\nThe moderate to severe C7 vertebral body compression fracture is unchanged. \nThere is no retropulsion, however disc protrusion remains unchanged causing\nanterior thecal sac deformity, there is no evidence of lesion or abnormal\nsignal within the spinal cord at this level.\n\nC2-C3: Posterior disc bulge and ligamentum flavum thickening causing mild\nspinal canal narrowing. No neural foraminal stenosis.\n\nC3-C4: Posterior disc bulge and ligamentum flavum thickening causing mild\nspinal canal narrowing. Mild right neural foraminal narrowing.\n\nC4-C5: Posterior disc bulge and ligamentum flavum thickening causing moderate\nspinal canal narrowing. Mild right neural foraminal narrowing.\n\nC5-6: Posterior disc bulge and ligamentum with thickening within mild spinal\ncanal narrowing and moderate right neural foraminal narrowing.\n\nC6-C7: Posterior disc bulge not causing spinal canal or neural foraminal\nstenosis.\n\nC7-T1: Posterior disc bulge indenting the thecal sac, not causing significant\nspinal canal or neural foraminal narrowing.\n\nAlignment is normal. There is mild loss of intervertebral disc height at\nC5-C6. Vertebral body and intervertebral disc signal intensity otherwise\nappear normal.The spinal cord appears normal in caliber and configuration.\n\nThere is a fluid collection posterior to the posterior elements of C4 and C5,\nin the left side of the neck, measuring 23 mm (SI) x 6.7 mm (AP) x 23 mm (TV).\nThis may be postoperative in nature and may represent a seroma. Does the\npatient have any symptoms or signs of infection?\n\nTHORACIC:\nChronic T6 and T12 vertebral body fractures with retropulsion and associated\nretrolisthesis T5 on T6 and T11 on T12, appear unchanged. The spinal cord is\ndeviated at the level of retropulsion at T6, but there is no spinal cord\ncompression. No definite T2 hyperintensity is identified within the\ncord.Vertebral body and intervertebral disc signal intensity appear normal. \nThere is no evidence of infection or neoplasm. Note is made of a loculated\nright pleural effusion, which is chronic.\n\nLUMBAR:\nChronic L2, L3 and L4 vertebral fractures. Vertebroplasty at L3 and L4. \nAppearances are unchanged. The spinal cord appears normal in caliber and\nconfiguration, on terminates at L1-L2 level.There is no evidence of infection\nor neoplasm.\n\nL1-L2: Diffuse disc bulge causing mild spinal canal narrowing. No neural\nforaminal narrowing.\n\nL2-L3: Diffuse disc bulge causing mild spinal canal narrowing. No neural\nforaminal narrowing.\n\nL3-L4: Central disc/posterior osteophyte causing mild-to-moderate spinal canal\nnarrowing. Bilateral facet joint arthropathy causing moderate bilateral\nneural foraminal narrowing.\n\nL4-L5: Posterior osteophyte and ligamentum flavum thickening causing moderate\nspinal canal narrowing. In association with bilateral facet joint arthropathy\nthere is bilateral neural foraminal narrowing, moderate on the right and mild\non the left.\n\nL5-S1: Diffuse disc bulge causing mild spinal canal narrowing. There is no\nsignificant neural foraminal narrowing.\n\nOTHER: There is a 1.8 cm right adrenal mass, which is not fully characterized\non this MRI and may represent an adrenal adenoma. Note is made of bilateral\nsimple renal cysts.", "output": "1. Chronic T6 vertebral body fracture with retropulsion associated\nretrolisthesis of T5 and T6, with deviation of the cord at this level but no\nfrank evidence of cord compression, there is persistent CSF fluid surrounding\nthe cord at the level of the retropulsion.\n2. No change compared with previous, post spinal fusion.\n3. Fluid collection noted in the left posterior neck posterior to C4 and C5. \nThis may represent a postoperative seroma. Does the patient have any symptoms\nor signs of infection?" }, { "input": "New from prior examination of ___ is T2 hyperintense central cord the signal\nwith associated cord expansion extending from the cervicomedullary junction to\nthe to C5 vertebral level. There is 2.0 x 0.6 x 0.4 cm (SI, AP, TRV)\nenhancement along the left aspect of the cord at the C2 level. Subtle T2\nhyperintense nonenhancing signal of the T2 cord corresponds to prior lesion\ndescribed on examination of ___, significantly improved in size, with\nassociated mild cord volume loss. The visualized posterior fossa is otherwise\ngrossly unremarkable.\n\nCervical alignment is anatomic. Vertebral body heights are preserved. There\nis no focal suspicious marrow lesion on STIR sequences. Degenerative loss of\ndisc height and signal is mild at C3-C4 and C4-C5.\n\nC2-C3: A small central protrusion does not narrow the spinal canal. There is\nno significant neural foraminal narrowing.\n\nC3-C4: A small central protrusion and thickening ligamentum flavum results in\nmild spinal canal narrowing. Uncovertebral and facet arthropathy results in\nmild bilateral neural foraminal narrowing.\n\nC4-C5: There is no significant spinal canal narrowing. Uncovertebral and\nfacet arthropathy results in mild left and no significant right neural\nforaminal narrowing.\n\nC5-C6: There is no significant spinal canal or neural foraminal narrowing. \nUncovertebral facet arthropathy results in mild bilateral neural foraminal\nnarrowing.\n\nC6-C7 and C7-T1: No significant spinal canal or neural foraminal narrowing.\n\nIncidental note is made of a 4 mm right lobe of the thyroid T2 hyperintense\nnodule, for which no further evaluation is suggested by current ACR\nrecommendations for incidentally noted thyroid nodules. Otherwise,\nprevertebral and paraspinal soft tissues are unremarkable.", "output": "1. T2 hyperintense central cord signal with expansion of the cord spanning the\ncervicomedullary junction to the C5 level, with enhancement along the left\naspect of the C2 level. The findings are overall compatible with NMO given\nprior history.\n2. Subtle T2 hyperintense signal of the T2 cord with associated mild volume\nloss corresponding to lesion described on prior examination of ___.\n3. Additional findings as described above." }, { "input": "THORACIC SPINE: The vertebral body height and alignment are maintained. The\nbone marrow signal is unremarkable.\n\nThere is no significant spinal canal or neural foraminal narrowing. The\nthoracic cord is normal in signal intensity and morphology. There is no\nabnormal enhancement.\n\nThere are small bilateral pleural effusions.\n\nLUMBAR SPINE: There is mild levoscoliosis of the lumbar spine. The vertebral\nbody heights and alignment are maintained. There is left hemi-sacralization of\nthe L5 vertebral body.\n\nConus medullaris is normal in appearance and terminates at mid L1 level.\n\nAt L1-L2 there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nThere is no abnormal enhancement.", "output": "No findings of discitis osteomyelitis or epidural abscess.\n\nOtherwise unremarkable thoracic and lumbar spine MRI." }, { "input": "The lumbar spine alignment is normal, vertebral body and intervertebral disc\nsignal intensity appear normal. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. There is a 6 x 6\nmm perineural (Tarlov) cyst involving the proximal right L5 nerve root. The\nleft ovary contains multiple small cysts.", "output": "1. There is no evidence of spinal canal stenosis or neural foraminal\nnarrowing.\n2. There is a perineural nerve root cyst at L5 on the right.\n3. Multiple left ovarian cysts. In the correct clinical setting (PCOS)\ndedicated pelvic ultrasound may performed." }, { "input": "The conus terminates at the L1-2 level. No conus masses. No abnormal\nenhancing lesions.\n\nThe vertebral bodies are normal in number and interrelationship. No acute\nvertebral body fracture.\n\nDegenerative changes of the lumbar spine as described below:\n\nT12-L1: No cord or nerve root compromise.\n\nL1-2: No conus or nerve root compromise.\n\nL2-3: Mild left paracentral disc protrusion, but no nerve root compromise. \nThe neural foramina patent.\n\nL3-4: Central and right paracentral disc extrusion with inferior migration\ninto the right lateral recess posterior to the L4 vertebral body where it\ncompromises the traversing right L4 nerve root. The neural foramina are\npatent bilateral.\n\nL4-5: Central disc protrusion resulting in mild subarticular zone narrowing,\nbut no nerve root compromise. Mild neural foraminal narrowing, but no nerve\nroot compromise.\n\nL5-S1: No nerve root compromise in the spinal canal. Mild neural foraminal\nnarrowing bilateral.", "output": "1. At the L3-4 level there is a central and right paracentral disc extrusion\nwith inferior disc migration into the right lateral recess posterior to the L4\nvertebral body where it compromises the traversing right L4 nerve root." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of infection or neoplasm. There are degenerative changes\nin the lumbar spine without the level diffuse disc bulges, mild lumbar facet\narthritis. There is mild narrowing of L4-5 disc space, more prominent since\nprior. Cystic lesion in the right hepatic lobe, shown on MRI abdomen from ___ to represent benign hemangioma, stable.\n\nAt the L1-L2 level, central canal, bilateral foraminal are patent.\nAt L2-L3 level there is central annular disc tear, less prominent previously\nseen broad-based central disc protrusion. Mild central canal narrowing, less\nprominent. Bilateral foramina are patent.\nAt the L3-L4 level there is new annular disc tear. There is more prominent\ndiffuse disc bulge, with mild central canal narrowing. There is mild\nbilateral foraminal narrowing, more prominent since prior.\nAt L4-5 low these new left paramedian, medial foraminal, superior small disc\nextrusion,, with intermediate to dark T2 signal disc fragment which measures\n0.4 cm in AP diameter, and extends 1 cm above endplate. There is mild central\ncanal narrowing, more prominent since prior, with more prominent encroachment\non traversing intrathecal segment of left L5 nerve. Previously seen left\nforaminal component of disc protrusion is less apparent. There is moderate\nleft foraminal narrowing, less prominent since prior. There is mild to\nmoderate right foraminal narrowing, similar.\nAt L5-S1 level central canal is patent. There is mild bilateral foraminal\nnarrowing, similar to prior.", "output": "1. There is new small left paramedian, superior, medial left foraminal L4-5\ndisc extrusion, contributing to mild central canal narrowing, encroachment on\ntraversing left L5 nerve, and moderate left L4-5 foraminal narrowing." }, { "input": "Study is somewhat limited by motion. Alignment is normal. Vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration.\nAt C3-4, there is minimal disc bulging.\nAt C4-5, there is mild disc bulging, uncovertebral hypertrophy, and mild\nbilateral neural foraminal narrowing.\nAt C5-6, there is significant disc bulging with significant impingement on the\nthecal sac and apparent contact of the spinal cord. There is moderate\nbilateral neural foraminal narrowing.\nThere is no evidence of infection or neoplasm. Mild nodularity in the right\nthyroid lobe is partially evaluated.", "output": "1. Multilevel disc bulging and bilateral neural foraminal narrowing as\ndescribed above, worst at C5-6 level.\n2. Mild nodularity in the right thyroid lobe is partially evaluated. If\nclinically warranted, evaluation with thyroid ultrasound may be considered." }, { "input": "CERVICAL:\n\nThere is no evidence of vertebral body height loss. Millimetric\nanterolisthesis of C7 on T1 is noted, likely degenerative. The bone marrow\nsignal is normal.\n\nMultilevel degenerative changes are as follows:\n\nC2-C3: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nC3-C4: A posterior disc bulge indents the ventral thecal sac with moderate to\nsevere canal narrowing. This combines with uncovertebral osteophytes result\nin moderate severe right and severe left neural foraminal narrowing.\n\nC4-C5: Posterior disc bulging with a superimposed central disc protrusion and\nleft-sided foraminal disc protrusion results in moderate canal stenosis,\nindenting mildly contacting the ventral cord at this level. This combines\nwith uncovertebral joint osteophytes to result in moderate severe right and\nsevere left neural foraminal narrowing.\n\nC5-C6: A mild posterior disc bulge is seen without significant canal\nnarrowing, combining with uncovertebral joint osteophytes result in moderate\nright and moderate to severe left neural foraminal narrowing.\n\nC6-C7: Posterior disc bulging indents the ventral thecal sac, contacting and\ndeforming the ventral cord with moderate canal narrowing, combining with\nuncovertebral osteophytes result in moderate severe right and severe left\nneural foraminal narrowing.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\n\nTHORACIC:\nThere is mild anterior vertebral body wedging and height loss at T7 and T8\nwith mild focal kyphosis. Additionally, increased T2/stir signal with\nassociated T1 hypointensity and postcontrast enhancement is seen involving the\nT7 inferior and T8 superior endplates. The intervertebral disc also enhances,\nand is worrisome for findings of osteomyelitis with discitis. Traumatic\ncompression fractures alternative there is an appropriate history. No\nevidence of epidural extension or paraspinal spread.\n\nMild multilevel disc bulging is seen throughout the thoracic spine, without\nappreciable canal stenosis or neural foraminal narrowing within the thoracic\nspine.\n\n\nLUMBAR:\nVertebral body heights are maintained. There is grade 1 anterolisthesis of L4\non L5. The remainder of the sagittal spinal alignment is grossly maintained. \nThe conus medullaris terminates at the level of L1-L2.\n\nFocal T2/stir signal is noted involving predominantly the inferior endplate of\nL4 posteriorly, with minimal involvement of the superior endplate of L5, with\nextension across the intervertebral disc space. This is associated with T1\nhypointensity and postcontrast enhancement. Again, there is no evidence for\nepidural/intraspinal or paraspinal spread. No appreciable prevertebral edema.\n\nT12-L1: There is no spinal canal or neural foraminal stenosis.\n\nL1-L2: Mild posterior disc bulging is seen without appreciable canal or neural\nforaminal narrowing.\n\nL2-L3: There is no spinal canal or neural foraminal stenosis.\n\nL3-L4: Posterior disc bulging flattens the ventral thecal sac combining with\nfacet arthropathy and thickening of ligamentum flavum to result in moderate\ncanal narrowing with crowding of the cauda equina nerve roots. The disc bulge\nminimally contacts the bilateral descending L4 nerve roots. Neural foraminal\nnarrowing is moderate on the left mild-to-moderate on the right.\n\nL4-L5: A large posterior disc bulge with superimposed central disc protrusion\nflattens and slightly indents the ventral thecal sac. This combines with\nthickening of the omentum flavum, facet arthropathy, and a small left facet\njoint effusion to result in moderate canal narrowing with crowding of the\ncauda equina nerve roots. Additionally, there is bilateral subarticular\nrecess narrowing with a disc bulge contacting the bilateral descending L5\nnerve root. Neural foraminal narrowing is moderate severe on the right and\nmoderate on the left, with disc bulge contacting the bilateral exiting L4\nnerve roots at this level.\n\nL5-S1: Posterior disc bulging with a superimposed central disc protrusion are\nnoted without appreciable canal narrowing. However, neural foraminal\nnarrowing is moderate on the right and moderate to severe on the left with a\ndisc bulge contacting the bilateral exiting L5 nerve roots at this level.\n\nThere is a punctate, 1-2 mm focus of equivocal enhancement seen along a\ndescending right cauda equina nerve root at the level of L4 (16:10, 20:24). \nOtherwise, there is no evidence for intramedullary, additional sites of\nleptomeningeal, or epidural enhancement. No epidural fluid collection is\nidentified.\n\nThere are large, bilateral pleural effusions seen with adjacent atelectasis.", "output": "1. Focal endplate irregularity with T2 hyperintensity, T1 hypointensity, and\npostcontrast enhancement extending across the intervertebral disc spaces seen\nat T7-T8 and T4-T5. In the appropriate clinical context, these findings are\nworrisome for ostiomyelitis and discitis. ___ type 1 degenerative changes\nare felt much less likely.\n2. No evidence of epidural extension, paraspinal extension, or epidural\ncollection/abscess.\n3. Solitary punctate focus of equivocal enhancement involving a descending\nright-sided nerve root at the level of L4. Findings may represent a small\nnerve sheath tumor versus leptomeningeal involvement, potentially\ninflammatory, infectious, or neoplastic. Recommend close attention on\nfollow-up.\n4. Background degenerative changes of the cervical spine, as detailed above. \nFindings are most notable at the level of C4-5 with moderate canal stenosis,\nsevere left and moderate to severe right neural foraminal narrowing.\n5. Multilevel degenerative changes of the lumbar spine, also detailed above. \nFindings are most notable at the level of L4-L5 with moderate canal narrowing,\nsevere right and moderate left neural foraminal narrowing.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 09:56 on ___, 2 minutes after interpretation." }, { "input": "Alignment is anatomic. Homogeneous low marrow signal on T1- and T2-weighted\nimages, with mild homogeneous increased signal on STIR is seen with no\nsuspicious focal osseous lesion. There is disc desiccation, mild, most\nprominent in the lower lumbar spine. The conus medullaris terminates at the\nlevel of the mid-L1 vertebral body with normal contour and signal. \n\nThe lower lumbar spinal canal appears congenitally narrowed, primarily due to\nshort pedicles.\n\nSmall diffuse disc bulges with anterior osteophytes are visualized only in the\nsagittal plane at T11-T12 and T12-S1 and L1-L2. There is no evidence of nerve\nroot impingement at these levels.\n\nAt L2-L3, a moderate diffuse disc bulge combines with moderate bilateral facet\narthropathy to mildly narrow the spinal canal and efface the caudal aspects of\nthe neural foramina without evidence of nerve root impingement.\n\nAt L3-L4, a mild diffuse disc bulge combines with moderate bilateral facet\narthropathy and congenitally short pedicles to mildly narrow the spinal canal.\nThe caudal aspects of the neural foramina are effaced without evidence of\nnerve root impingement.\n\nAt L4-L5, diffuse disc bulge, larger on the left, combines with moderate\nbilateral facet arthropathy to moderately narrow the left subarticular zone\nwith probable impingement of the traversing left L4 nerve root. Less severe\nchanges are seen on the right. There are changes in the left posterior\nparaspinal soft tissues and posterior elements suggestive of left laminotomy\nat this level with expected deformity of the thecal sac. The foramina are\npatent. However, disc abuts the traversing left L4 nerve root in the far\nlateral zone.\n\nAt L5-S1, a broad-based disc protrusion, slightly greater on the left, and\ncongenital short pedicles moderately narrow the left greater than right\nsubarticular zones with probable impingement of the traversing left L5 nerve\nroot. This combines with moderate facet arthropathy to mildly narrow the\nforamina bilaterally without evidence of foraminal nerve root impingement.\n\nThere are expected chronic post-operative changes at the L4-L5 and L5-S1\nlevels in the posterior paraspinal soft tissues.\n\nPost-gadolinium images reveal no suspicious intradural enhancement. \n\nPartially visualized structures of the abdomen and pelvis are significant for\na distended urinary bladder with a right-sided diverticulum, similar to the\nCT. Mild paraaortic lymphadenopathy is also again demonstrated.", "output": "1. No evidence of osteomyelitis, discitis or other spinal infection.\n2. Chronic post-operative changes at L4-L5 with underlying degenerative\ndisease and congenital stenosis. This is most prominent at L4-L5 and L5-S1,\nwhere there is probable impingement upon the left-sided traversing nerve roots\nin those subarticular zones.\n3. Diffusely T1- and T2-hypointense vertebral bone marrow signal may relate\nto the immunosuppressive medications for hepatic transplant patient's and/or\nchronic hematologic abnormality (history of ITP, s/p splenectomy); correlate\nwith clinical and laboratory data.\n4. Mild paraortic lymphadenopathy and urinary bladder distention with\ndiverticulum, unchanged from ___ CT." }, { "input": "There is 1 mm retrolisthesis of C5 on C6. Alignment is otherwise maintained. \nVertebral body heights are maintained. There are no focal abnormally\nenhancing osseous lesions. The vertebral body signal intensity appears\nnormal. There is mild disc desiccation with loss of intervertebral disc\nheight predominately at C5-C6. The visualized portion of the spinal cord\nappears normal. There is no abnormal cord enhancement or enhancing lesions in\nthe spinal canal. The prevertebral and paraspinal soft tissues are within\nnormal limits.\n\nC2-C3: No significant spinal canal or neural foraminal stenosis.\n\nC3-C4: Tiny posterior disc protrusion without significant spinal canal or\nneural foraminal narrowing.\n\nC4-C5: Mild posterior disc bulge and ligamentum flavum thickening without\nsignificant spinal canal stenosis and mild right neural foraminal narrowing.\n\nC5-C6: Diffuse posterior disc bulge, ligamentum flavum thickening,\nuncovertebral and facet joint arthropathy results in moderate narrowing of the\nspinal canal with flattening of the spinal cord and severe right and moderate\nto severe left neural foraminal stenosis (6:22).\n\nC6-C7: Mild posterior disc bulge, ligamentum flavum thickening, uncovertebral\nand facet arthropathy results in mild spinal canal narrowing with moderate\nbilateral neural foraminal stenosis.\n\nC7-T1: Mild central disc protrusion indents the ventral thecal sac without\nsignificant spinal canal or neural foraminal stenosis.", "output": "1. No enhancing osseous or intraspinal lesions to suggest metastatic disease.\n2. Multilevel cervical spondylosis, most advanced at C5-C6 level, where there\nis moderate spinal canal stenosis, mild cord deformity without associated\nsignal abnormality, severe right and moderate to severe left neural foraminal\nstenosis as detailed above." }, { "input": "THORACIC SPINE:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of spinal canal or neural foraminal narrowing. ___\ntype 2 endplate changes are noted predominantly involving the inferior\nendplate of T7 suggestive of Schmorl's node. There is no evidence of\ninfection or neoplasm.\n\nLUMBAR SPINE:\n There is no vertebral body height loss to indicate compression fracture.\nVertebral body alignment is within normal limits, without evidence for\nsubluxation.\n\nThere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L1-L2. There is no spinal cord signal\nabnormality detected.\n\nThere are multilevel degenerative changes as follows:\n\nT12-L1: There is desiccation and mild disc bulge with no significant spinal\ncanal or neural foraminal stenosis.\n\nL1-L2: There is a mild posterior disc bulge and thickening of the ligamentum\nflavum resulting in mild canal stenosis with mild bilateral neural foraminal\nnarrowing.\n\nL2-L3: There is a posterior disc bulge with bilateral facet hypertrophy and\nthickening of the ligamentum flavum resulting in mild canal stenosis, with\nmild to moderate left and mild right neural foraminal narrowing.\n\nL3-L4: A posterior disc bulge with facet hypertrophy and thickening ligamentum\nflavum results in moderate canal stenosis with moderate left and moderate\nright neural foraminal narrowing.\n\nL4-L5: A posterior disc bulge and thickening of ligamentum flavum results in\nmoderate to severe spinal canal stenosis with moderate right and moderate\nsevere left neural foraminal narrowing.\n\nL5-S1: A posterior disc bulge with superimposed central disc protrusion and\nbilateral facet hypertrophy results in moderate canal stenosis with moderate\nsevere right and moderate severe left neural foraminal narrowing. The disc\nbulge at this level contacts the bilateral exiting L5 nerve roots.\n\nNumerous bilateral T2 hyperintense renal cysts are noted, incompletely\nvisualized.", "output": "1. No evidence of critical spinal canal stenosis, fracture, subluxation, or\nabnormal cord signal within the thoracic spine.\n2. Multilevel spondylosis of the lumbar spine, as detailed above. Findings\nare most notable at L4-L5 with moderate severe spinal canal stenosis and\nmoderate right with moderate to severe left neural foraminal narrowing.\n3. Posterior disc bulge at L5-S1 contacting the bilateral exiting L5 nerve\nroots.\n4. Numerous bilateral T2 hyperintense renal cysts, incompletely characterized\non this nondedicated examination, but raising concern for polycystic kidney\ndisease. Correlate with any known history of such." }, { "input": "Alignment is normal. Again seen are postoperative changes after instrumented\nanterior fusion at C5-6. There is severe narrowing of the spinal canal with\nflattening of the spinal cord and high signal in the cord on the T2 weighted\nimages. The material causing cord encroachment from anteriorly is hypointense\nto marrow on the T1 weighted images and inhomogeneously hyper and hypointense\non the T2 weighted images with a hypointense rim. This likely represents\nthickening of the ligamentum flavum, probably with ossification, but\ncorrelation with CT may be helpful to better characterize it. Posteriorly,\nthickening of the ligamentum flavum encroaches on the spinal canal and\ncontributes to deformity of the spinal cord.\n\nThere is loss of height of the intervertebral discs at C3-4 and C4-5. There\nis loss of signal of the discs throughout the cervical spine on the T2\nweighted images. There are ___ type 2 signal intensity changes of the\nvertebral endplates at C3-4 and C4-5. These are manifestations of\ndegenerative disc disease.\n\nThere is a small midline protrusion of the C2-3 intervertebral disc that\ntouches and slightly flattens the anterior surface of the spinal cord. The\nneural foramina appear normal.\n\nThere is ossification of the posterior longitudinal ligament along the\nposterior margin of the C3 vertebral body. This contributes to spinal canal\nnarrowing and deformity of the adjacent spinal cord.\n\nAt C3-4, broad bulging of the disc flattens the anterior surface of the spinal\ncord. Intrinsic hyperintensity of the spinal cord on the T2 weighted images\nbegins at the inferior border of C3. Uncovertebral osteophytes produce mild\nbilateral neural foraminal narrowing.\n\nThere is thickening of the posterior longitudinal ligament along the posterior\nmargin of the C4 vertebral body. This contributes to spinal canal narrowing\nand flattening of the anterior surface of the spinal cord. There is bilateral\nsevere narrowing of the neural foramina, apparently due to uncovertebral\nosteophytes. This area is partially obscured by artifacts from the fusion\nhardware.\n\nThickening of the posterior longitudinal ligament at the C4-5 level also\nproduces severe narrowing of the spinal canal and flattening of the spinal\ncord. There is severe bilateral neural foraminal narrowing.\n\nThere is thickening of the posterior longitudinal ligament and perhaps\nossification along the posterior margin of the C5 vertebral body. This\nseverely narrows the spinal canal and deforms the spinal cord. Spinal cord\nsignal intensity is markedly elevated on the T2 weighted images.\n\nAxial imaging at C5-6 demonstrates severe spinal canal narrowing by the\nthickened and perhaps ossified posterior longitudinal ligament. There appears\nto be at least moderate narrowing of the right neural foramen, although\nimaging is obscured by artifacts from the fusion hardware.\n\nAt C6-7, there is poorly visualized bulging of the disc that appears to\ncontact the anterior surface of the spinal cord. The neural foramina appear\nnormal.\n\nThe C7-T1 level demonstrates no spinal canal or neural foraminal narrowing. \nThere is no evidence of infection or neoplasm.", "output": "1. Severe spinal canal narrowing due to thickening and likely ossification of\nthe posterior longitudinal ligament.\n2. Hyperintensity of the spinal cord on the T2 weighted images from C3-C7 due\nto cord encroachment.\n\nNOTIFICATION: The findings of severe cord encroachment and hyperintensity\ndiscussed by telephone by Dr. ___ with Dr. ___ at 1:35 pm\n___ 10 minutes after viewing the images. The finding was also entered\nin the Radiology Department non urgent critical imaging findings system." }, { "input": "Overall cervical lordosis is maintained, and vertebral body heights. Mild\ndegenerative again noted at the craniocervical junction, as well as at the\nC2-3 and C3-4 levels.\n\nAt C4-5, there is intervertebral disc space narrowing, bilateral uncovertebral\njoint hypertrophy, facet hypertrophy, and slight retrolisthesis of C4 on C5. \nBilateral neural foraminal narrowing at this level is moderate, along with\nmild central canal narrowing.\n\nAt C5-6, there is degenerative disc disease, with bilateral uncovertebral\njoint hypertrophy and facet joint hypertrophy, resulting in moderately severe\nbilateral neural foraminal narrowing, along with moderate central canal\nnarrowing, also contributed by focal infolding of the ligamentum flavum (2:7).\n\nAt C6-7, bilateral uncovertebral hypertrophy is mild.\n\nAt C7-T1, there is mild degenerative disc disease, with slight anterolisthesis\nof C7 on T1.\n\nOverall slightly mottled appearance of the bone marrow signal throughout the\ncervical and upper thoracic spine is unchanged compared to the prior study,\nlikely related to osteopenia. The spinal cord is normal in caliber and\nconfiguration throughout its course, with no intrinsic signal intensity\nabnormality detected.", "output": "1. Multilevel cervical spondylosis has mildly advanced since the prior MRI\nfrom ___, with no significant spinal cord compression or intrinsic\nsignal abnormality.\n2. Slight retrolisthesis of C4 on C5 and slight anterolisthesis of C7 on T1,\nmildly progressed." }, { "input": "There is significant S-shaped scoliosis of the thoracolumbar spine with\nmultiple levels of lateral subluxation. Grade 1 anterolisthesis of L4 on L5\nis likely degenerative. With the exception of endplate degenerative signal\nchanges, bone marrow signal intensity is within normal limits. The terminal\nspinal cord is normal in caliber and configuration and the conus medullaris\nterminates at L2. There is bunching of the cauda equina nerve roots from L2\nthrough L4.\n\nAt T12-L1, there is minimal diffuse disc bulge, facet degenerative change and\nligamentum flavum thickening resulting in minimal spinal canal narrowing. \nThere is no neural foraminal narrowing.\n\nAt L1-2, there is mild diffuse disc bulge, ligamentum flavum thickening and\nfacet degenerative change resulting in mild spinal canal narrowing. The left\nlateral recess is narrowed. There is moderate left and mild right neural\nforaminal narrowing.\n\nAt L2-3, there is lateral subluxation, diffuse disc bulge, intervertebral and\nfacet osteophytes, and ligamentum flavum thickening contributing to moderate\nspinal canal narrowing. The right lateral recess is markedly narrowed. There\nis moderate bilateral neural foraminal narrowing. Overall, this is more\nsevere compared to ___.\n\nAt L3-4, there is diffuse disc bulge, intervertebral and facet osteophytes,\nand ligamentum flavum thickening contributing to moderate spinal canal\nnarrowing and narrowing of both lateral recesses. Moderate right and mild\nleft neural foraminal narrowing is present. Overall, this is more severe in\ncomparison with ___.\n\nAt L4-5, there is anterolisthesis, diffuse disc bulge, ligamentum flavum\nthickening and facet degenerative change contributing to severe spinal canal\nnarrowing with compression of the cauda equina nerve roots. There is moderate\nright and mild-to-moderate left neural foraminal narrowing. This has\nprogressed compared to ___.\n\nAt L5-S1, there is disc bulge without spinal canal narrowing. Mild bilateral\nneural foraminal narrowing is present.", "output": "1. Overall, multilevel degenerative changes of the lumbar spine have\nprogressed in comparison with ___. There is now severe spinal canal\nnarrowing at L4-5 with compression of the cauda equina nerve roots. \nAdditional levels of moderate spinal canal narrowing are also present at L2-3\nand L3-4.\n\n2. Likely related to these extensive degenerative changes is clumping of the\ncauda equina nerve roots, and may also be related to arachnoiditis.\n3. Additional degenerative changes 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": "There is grade 1 anterolisthesis of C3 on C4 (2 mm), and grade 1\nretrolisthesis of C5 on C6 (2 mm), which are unchanged. Otherwise, vertebral\nbody alignment appears preserved. Vertebral body height is maintained. There\nis generalized intervertebral disc desiccation with intervertebral disc space\nheight loss particularly at C6-C7. Bone marrow signal is unremarkable, except\nfor ___ type 2 endplate degenerative changes, particularly at C6-C7 . The\nspinal cord demonstrates normal morphology and signal intensity. The\nvisualized posterior cranial fossa and craniocervical junction are\nunremarkable. The prevertebral and paraspinal soft tissues are unremarkable.\nThere is no evidence of ligamentous injury or acute fracture.\n\nThe spinal canal is capacious, without evidence of narrowing at any level.\n\nC2-C3: No significant disc herniation, spinal canal or neural foraminal\nnarrowing.\n\nC3-C4: There is a minimal central disc protrusion, as well as mild facet\narthropathy and uncovertebral osteophytes, resulting in no significant spinal\ncanal or neural foraminal narrowing.\n\nC4-C5: There is a central disc protrusion which effaces the ventral thecal sac\nand contacts with the ventral cord. There is no significant indentation or\nremodeling of the cord or cord signal abnormality. There are also\nuncovertebral osteophytes, mild ligamentum flavum thickening and mild facet\narthropathy, without spinal canal or neural foraminal narrowing.\n\nC5-C6: There is mild diffuse disc bulge, right greater than left uncovertebral\nosteophytes, mild ligamentum flavum thickening and mild facet arthropathy,\nwith moderate bilateral neural foraminal narrowing. There is no significant\nspinal canal narrowing. There is interval resolution of the previously seen\nbroad-based disc extrusion, compared to study of ___.\n\nC6-C7: There is minimal diffuse disc bulge, uncovertebral osteophytes and\nfacet arthropathy, without evidence of neural foraminal or spinal canal\nnarrowing.\n\nC7-T1: No evidence of disc herniation, spinal canal or neural foraminal\nnarrowing.\n\nNote is made of an ovoid T2 hyperintense lesion at the posterior margin of the\nleft parotid gland, measuring approximately 8 mm, which may simply represent\nan intraparotid lymph node; this region was not imaged previously.", "output": "1. Mild to moderate multilevel spondylosis, particularly at C5-C6 and C6-C7,\nwithout evidence of spinal canal narrowing, cord signal abnormality or\nsignificant cord deformity. There is moderate bilateral C5-C6 neural foraminal\nnarrowing.\n\n2. Compared to study of ___, there has been interval resolution of C5-C6\nbroad based disc extrusion.\n\n3. No evidence of ligamentous injury or acute fracture." }, { "input": "This study is incomplete. The patient was unable still and could not follow\ncommands per technologist's note. Only sagittal T2 and stir images are\navailable but they are extremely motion limited. There is edema corresponding\nto the known L3 vertebral body burst fracture. No prevertebral soft tissue\nedema. Evaluation of the spinal canal is markedly limited but the cord appears\nto terminate before this level.", "output": "Extremely limited study demonstrates a known L3 vertebral body fracture\nwithout high-grade narrowing of the spinal canal ." }, { "input": "Nondisplaced fracture of the right lateral mass of C2, which extends to the\nanterior margin of the right transverse foramen, is better assessed on the\npreceding CT. There is fluid in the joint between the right lateral masses of\nC1 and C2, and mild posterior paravertebral edema along the right lateral mass\nof C2. There is a mild edema in the interspinous ligament at C1-C2. No clear\ninvolvement of the ligamentum flavum is seen. Posterior longitudinal and\nanterior longitudinal ligaments appear intact. No evidence for prevertebral\nedema. No edema in the discs or vertebral body bone marrow. No\nspondylolisthesis.\n\nNo epidural collection. Normal spinal cord morphology and signal.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa\nappears unremarkable.\n\nNo spinal canal narrowing. Mild right C3-C4 neural foraminal narrowing by\nuncovertebral and facet osteophytes.", "output": "1. Nondisplaced fracture of the right lateral mass at C 2, which extends to\nthe anterior margin of the right transverse foramen, is better assessed on the\npreceding CT.\n2. Fluid in the joint between the right lateral masses of C1 and C 2. Mild\nposterior paravertebral edema along the right lateral mass of C2. Mild edema\nin the C1-C2 interspinous ligament without clear evidence for ligamentum\nflavum involved.\n3. Anterior and posterior longitudinal ligaments appear intact. No\nspondylolisthesis, disc edema, vertebral body marrow edema.\n4. No epidural collection. Normal spinal cord signal.\n\nRECOMMENDATION(S): If clinically warranted, MRA neck with fat-suppressed\naxial T1 weighted images could better assess for right vertebral artery\nintramural hematoma/dissection at C2.\n\nNOTIFICATION: Preliminary report in PACS by Dr. ___ ___\nat 14:03 states \"Alignment is anatomical. No evidence of significant central\ncanal or neural foraminal stenosis. No cord signal abnormality. No evidence of\nligamentous injury. No prevertebral abnormality.\"" }, { "input": "CERVICAL:\nVertebral body heights are preserved. Minimal retrolisthesis of C4 on C5 and\nof C5 on C6 appears unchanged. No concerning bone marrow signal abnormalities\nare seen.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa demonstrates no concerning signal abnormalities.\n\nEvaluation of spinal cord signal is slightly limited by artifacts. No clear\nevidence for spinal cord signal abnormalities.\n\nC2-C3: Shallow central disc protrusion without spinal canal narrowing. Mild\nbilateral facet arthropathy without neural foraminal narrowing.\n\nC3-C4: Broad-based central disc protrusion indents the ventral thecal sac\nwithout spinal cord contact. Moderate right and moderate to severe left\nneural foraminal narrowing by uncovertebral and facet osteophytes, similar to\nthe ___ CT allowing for differences in modalities.\n\nC4-C5: Minimal retrolisthesis, broad-based disc protrusion and endplate\nosteophytes mildly indent the ventral thecal sac without spinal cord contact. \nSevere bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes. Appearances are similar to the prior CT allowing for differences\nin modalities.\n\nC5-C6: Minimal retrolisthesis, broad-based left paracentral disc protrusion\nand endplate osteophytes are present, approaching and mildly remodeling the\nleft ventral spinal cord. Mild to moderate spinal canal narrowing. Severe\nbilateral neural foraminal narrowing by uncovertebral and facet osteophytes. \nAppearances are similar to the prior CT allowing for differences in\nmodalities.\n\nC6-C7: Right paracentral disc protrusion mildly remodels the right ventral\nspinal cord. Mild-to-moderate spinal canal narrowing. Moderate bilateral\nneural foraminal narrowing by uncovertebral and facet osteophytes. \nAppearances are similar to the prior CT allowing for differences in\nmodalities.\n\nC7-T1: Small right paracentral disc protrusion indents the ventral thecal sac\nwithout spinal cord contact. Moderate right neural foraminal narrowing by\nuncovertebral and facet osteophytes. No significant left neural foraminal\nnarrowing is seen though left facet arthropathy is present.\n\nSagittal images through T1-T 2, T2-T3, and T3-T4 levels demonstrate no\nevidence for spinal canal or neural foraminal narrowing. There are no axial\nimages through these levels.\n\nLUMBAR:\nThere are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nMinimal retrolisthesis of L1 on L2, of L2 on L3, of L3 on L4, and of L4 on L5\nis unchanged. No suspicious bone marrow signal abnormalities are seen. A\nfat-poor hemangioma in the right superior aspect of L3 vertebral body has been\npresent since the lumbar spine MRI from ___. There are large Schmorl's\nnodes in the L3-L4 endplates, with associated extensive ___ type 1\ndiscogenic marrow changes. There are also extensive ___ type 2 discogenic\nbone marrow changes at L5-S1 and fusion of L5 and S1 vertebral body.\n\nThe distal spinal cord appears unremarkable. The conus medullaris terminates\nat L1-L2.\n\nMultilevel lumbar degenerative disease appears similar to the recent CT\nmyelogram from ___ allowing for differences in modalities.\n\nT12-L1: Minimal disc bulge and facet arthropathy without spinal canal or\nneural foraminal narrowing.\n\nL1-L2: Minimal retrolisthesis. Mild disc bulge and facet arthropathy. \nProminent posterior epidural fat. The thecal sac is mildly narrowed without\ncrowding of the intrathecal nerve roots. No significant narrowing of the\nsubarticular zones or neural foramina.\n\nL2-L3: Minimal retrolisthesis. Mild disc bulge, larger on the left than\nright. Mild-to-moderate facet arthropathy. Prominent posterior epidural fat.\nThe thecal sac is mildly narrowed without crowding of the intrathecal nerve\nroots. There is left greater than right subarticular zone narrowing with\nabutment of the traversing L3 nerve roots. Minimal narrowing of the\nproximal/caudal left neural foramina without mass effect on the exiting L2\nnerve root.\n\nL3-L4: There is a minimal retrolisthesis, moderate disc bulge which is larger\non the left than right, infolding of the ligamentum flavum, moderate facet\narthropathy, and prominent posterior epidural fat. There is moderate\nnarrowing of the thecal sac with crowding of the intrathecal nerve roots. \nThere is left greater than right subarticular zone narrowing with abutment of\nleft greater than right traversing L4 nerve roots. The traversing left L4\nnerve root may be impinged. There is mild-to-moderate bilateral neural\nforaminal narrowing with abutment of the exiting L3 nerve roots.\n\nL4-L5: There is a mild retrolisthesis, a moderate disc bulge, a possible\nsuperimposed small central disc protrusion, infolding of the ligamentum\nflavum, moderate facet arthropathy with bilateral facet joint effusions, and\nprominent posterior epidural fat. There is mild-to-moderate narrowing of the\nthecal sac with mild crowding of the intrathecal nerve roots. There is\nimpingement of bilateral traversing L5 nerve roots in the subarticular zones. \nThere is mild-to-moderate right and moderate left neural foraminal narrowing\nwith abutment of the left greater than right exiting L4 nerve roots.\n\nL5-S1: There is severe loss of disc height and fusion of the vertebral bodies.\nThere is a disc bulge, larger on the right than left, covered by endplate\nosteophytes, with asymmetric right paracentral endplate osteophytes, and\nmoderate facet arthropathy. No mass effect on the intrathecal nerve roots. \nTraversing right S1 nerve root is abutted in the subarticular zone. There is\nmoderate bilateral neural foraminal narrowing with abutment of the exiting L5\nnerve roots. Again seen is mild dural ectasia along traversing the left S1\nnerve root.\n\nOTHER:\nProminent nonenlarged bilateral anterior and right posterior cervical lymph\nnodes are similar to the cervical spine CT from ___.\n\nT2 hyperintense cystic lesions are again seen in the visualized portions of\nthe kidneys.", "output": "CERVICAL SPINE:\n\n1. Left paracentral disc protrusion at C5-C6 and right paracentral disc\nprotrusion at C6-C7 with associated endplate osteophytes and minimal\nretrolisthesis, cause mild ventral cord remodeling and mild-to-moderate spinal\ncanal narrowing. No evidence for cord signal abnormalities allowing for\nmotion artifact.\n2. Advanced multilevel cervical neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n3. No significant change compared to the CT from ___ allowing for\ndifferences in modalities.\nLUMBAR SPINE:\n\n1. Multilevel lumbar degenerative disease and epidural lipomatosis, similar to\nthe recent CT myelogram from ___ allowing for differences in\nmodalities.\n2. Moderate spinal canal stenosis at L3-L4 with crowding of intrathecal nerve\nroots. Mild-to-moderate spinal canal stenosis at L4-L5 with mild crowding of\nthe intrathecal nerve roots.\n3. Multilevel subarticular zone narrowing with mass effect on traversing nerve\nroots, and multilevel neural foraminal narrowing, as detailed above." }, { "input": "Examination is limited due to acquisition of limited sequences.\n\nThere is rightward curvature of the thoracic spine. Mild degenerative changes\nthoracic spine. Few small Schmorl's nodes. No acute fracture. No paraspinal\nedema. No focal marrow signal abnormalities are evident..\n\nLimited evaluation of the right thorax demonstrates patchy areas of dependent\nconsolidation in the right lung, small right pleural effusion, better\ndemonstrated on the recent CT. Comparison CT ___ at 03:11 p.m. \nalso demonstrates moderate anterior right pneumothorax.", "output": "1. Limited MRI examination.\n2. No evidence of acute fracture.\n3. CT from ___ demonstrates moderate right pneumothorax." }, { "input": "THORACIC SPINE:\nThere is mild rightward curvature of the thoracic spine. Otherwise, alignment\nis normal. There is mild superior endplate deformity of the T4, T5 vertebral\nbodies, consistent with Schmorl's nodes, no associated edema in the vertebral\nbodies or paravertebral edema to suggest acute fractures. Mild degenerative\nchanges pre\n\nIntervertebral disc signal intensity is maintained. The spinal cord appears\nnormal in caliber and configuration without evidence of edema. There is no\nevidence of spinal canal or neural foraminal narrowing. There is no evidence\nof infection or neoplasm.\n\nNo focal fluid collections are identified.\n\nLUMBAR SPINE:\nThe lumbar vertebral body heights and alignment are grossly maintained. No\nfocal marrow signal abnormalities are identified to suggest acute fracture. \nNonenhancing sclerotic lesion identified in the posterior L1 vertebral body,\nmost likely benign bone island. Mild multilevel intervertebral disc\ndesiccation.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of T12-L1.\n\nAt T12-L1, L1-L2, and L2-L3, patent central canal, patent foramina.\n\nL3-L4: Small shallow left central disc protrusion with tiny annular fissure,\nligamentum flavum thickening, and facet hypertrophy. Patent central canal. \nMild foraminal narrowing.\n\nL4-L5: Minimal posterior disc bulge, ligamentum flavum thickening, and facet\nhypertrophy without significant spinal canal narrowing. Mild-to-moderate\nright, mild left foraminal narrowing.\n\nL5-S1: Disc bulge, tiny central disc protrusion,, ligamentum flavum\nthickening, and facet hypertrophy without significant spinal canal narrowing. \nNo neural foraminal narrowing.\n\nBenign left innominate bone island.\n\nOther: Consolidation within the dependent portion of the right greater than\nleft lungs may reflect a combination of atelectasis and contusion given the\nclinical history. Component of aspiration cannot be excluded. New right\nchest tube is partially visualized. Trace bilateral pleural effusions. \nMultiple displaced right-sided rib fractures better seen on CT.\n\nEdema is noted in the right rotator cuff musculature. Paraspinal musculature\nis unremarkable.\n\nA nasoenteric tube is visualized coursing through the esophagus. An\nendotracheal tube is partially visualized. Secretions are present in the\ntrachea.\n\nT2 hyperintense lesions in the left greater than right kidneys without\nevidence of enhancement are more consistent with cysts, no further follow-up\nis indicated.", "output": "1. Normal cord. No vertebral body fracture. No ligamentous injury..\n2. Dependent consolidations in the right greater than left lungs, largely\natelectasis, consider component of contusion, aspiration.\n3. Rib fractures..\n4. Degenerative changes lumbar spine, as above." }, { "input": "Lumbar spine alignment is normal. Vertebral body heights and disc spaces are\npreserved. Bone marrow signal is heterogeneous with areas of red marrow\nreconversion without focal suspicious abnormality.\n\nThe conus medullaris is normal in morphology and signal intensity and\nterminates at the level of L1-L2. The cauda equina demonstrates normal\nmorphology is well.\n\nThere is no abnormal enhancement.\n\nT12-L1, L1-L2 and L2-L3: There are mild facet degenerative changes without\nsignificant spinal canal or neural foraminal narrowing.\n\nL3-L4: A mild diffuse disc bulge, facet degenerative changes and thickening of\nthe ligamentum flavum are present without significant spinal canal or neural\nforaminal narrowing.\n\nL4-L5: There is a diffuse disc bulge with a small annular tear, thickening of\nthe ligamentum flavum and facet arthropathy contributing to mild spinal canal\nnarrowing with narrowing of both subarticular zones. Small bilateral facet\njoint effusions are present. A 12 mm lesion adjacent to the left facet is\ncompatible with a complex synovial cyst.\n\nL5-S1: There is a diffuse disc bulge and facet degenerative changes without\nsignificant spinal canal narrowing. The disc bulge narrows both subarticular\nrecesses and contacts the left traversing S1 nerve root. There is mild left\nneural foraminal narrowing.\n\nNumerous T2 hyperintense lesions are seen within both kidneys compatible with\nmultiple renal cysts.", "output": "1. Mild multilevel degenerative changes without high-grade spinal canal or\nneural foraminal narrowing.\n2. No evidence for discitis- osteomyelitis. A small heterogeneous collection\nadjacent to the left L4-L5 facet is compatible with a complex synovial cyst." }, { "input": "From T12-L1 through the L3-4 disk bulging is identified and degenerative\nchanges are seen. There is mild narrowing of foramina at L3-4 level.\n\nAt L4-5 level, th disc and facet degenerative change are seen. There is a\nright-sided disk herniation seen which indents the thecal sac and extends\ninferiorly to the right lateral recess of L5. This could result mutation of\nright L5 nerve root. In addition, there is mild scoliosis and disc protrusion\nnoted in the right forearm and there is moderate-to-severe narrowing of the\nforamina and compression of exiting right L4 nerve root.\n\nAt L5-S1 level disk bulging identified with facet degenerative changes. There\nis moderate left-sided and moderate right-sided foraminal narrowing at this\nlevel with disc protrusions encountered with the exiting L5 nerve roots in\nboth foramina.\n\nThe distal spinal cord is normal in appearance. Paraspinal soft tissues are\nunremarkable.", "output": "Multilevel degenerative changes with mild scoliosis lower lumbar spine.\nRight-sided disk herniation at L4-5 level indenting the thecal sac and\nextending inferiorly to the right lateral recess of L5 which could result in\nan additional right L5 nerve root. Moderate-to-severe right-sided foraminal\nnarrowing at L4-5 level with moderate bilateral foraminal narrowing at L5-S1\nlevel." }, { "input": "CERVICAL: The alignment is normal. The bone marrow appears to be diffusely\nheterogeneous. Diffuse loss of T2 signal is seen within the intervertebral\ndiscs of the cervical spine. No cord signal abnormalities are identified. No\nabnormal enhancement is seen within the spinal cord.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: There is no spinal canal or neural foraminal narrowing.\n\nC4-C5: Disc bulge is seen resulting in mild spinal canal narrowing at this\nlevel. There is no neural foraminal narrowing.\n\nC5-C6: Disc bulge is seen resulting in mild spinal canal narrowing at this\nlevel however there is no neural foraminal narrowing.\n\nC6-C7: Disc bulge is seen resulting in mild spinal canal narrowing. \nUncovertebral osteophytes result in mild left neural foraminal narrowing. The\nright neural foramen is patent.\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\nNo paravertebral or paraspinal soft tissue abnormalities are identified.\n\nTHORACIC:\nAlignment is normal.Intervertebral disc signal intensity appear normal. The\nspinal cord appears normal in caliber and configuration. There is no evidence\nof spinal canal or neural foraminal narrowing.There is no evidence of abnormal\nenhancement throughout the thoracic spine after contrast administration.\n\nLUMBAR:\nThe alignment is normal. Mild loss of T2 signal is seen within the\nintervertebral disc at L4-L5. Otherwise, the intervertebral disc signal\nintensity appears unremarkable. The conus terminates at L1-L2. No terminal\ncord signal abnormalities are identified. There is no evidence of abnormal\nenhancement or thickening of the cauda equina nerve roots. Mild disc bulge is\nseen at L5-S1, otherwise there is no significant spinal canal or neural\nforaminal narrowing.\n\nOTHER: Re demonstrated is a large right pelvic mass, likely secondary to a\nfibroid, unchanged compared to the prior PET-CT from ___. \nIncidentally noted is a mildly prominent common bile duct and pancreatic duct,\nsimilar to the torso CT from ___. 1.1 x 1.5 cm right adrenal\nlesion, is unchanged compared to the prior exam.", "output": "1. No evidence of abnormal enhancement within the cervical, thoracic, or\nlumbar spine.\n2. Diffusely heterogeneous bone marrow signal, may be secondary to a systemic\nprocess such as anemia however an infiltrative neoplastic process cannot be\nexcluded. Recommend correlation with clinical labs.\n3. Mild disc bulges from C4-C5 through C6-C7 results in mild spinal canal\nnarrowing at this level. No significant degenerative changes within the\nthoracic or lumbar spine." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \nThere is mild diffuse heterogeneity of the bone marrow, likely representing\nareas of fatty replacement. Otherwise, no focal bone marrow signal\nabnormality is seen.\n\nThere is mild loss of T2 signal of the intervertebral discs, a manifestation\nof degenerative disc disease. The intervertebral disc heights are otherwise\nrelatively well preserved.\n\nThe spinal cord is preserved in signal and caliber. There is no epidural\ncollection. There is no abnormal focus of post contrast enhancement.\n\nThere is no significant spinal canal or neural foraminal narrowing at all\nvisualized levels.\n\nThere is mild dependent atelectasis. The visualized lungs are otherwise\nclear. The visualized thyroid gland is grossly unremarkable. 15 x 12 mm\nright adrenal nodule is unchanged compared to the prior examinations,\ndemonstrating no abnormally increased FDG uptake on the prior PET-CT\nexamination, statistically likely to represent adenoma. The remainder of the\nvisualized upper retroperitoneum is grossly unremarkable.", "output": "1. Mild thoracic degenerative disc disease without significant spinal canal or\nneural foraminal narrowing.\n2. No spinal cord signal abnormality.\n3. No epidural collection or abnormal focus of post contrast enhancement. No\nevidence of recurrent lymphomas involvement within the thoracic spine.\n4. Stable 15 x 12 mm indeterminate right adrenal nodule, statistically likely\nto represent adrenal adenoma." }, { "input": "Please note, evaluation is limited due to lack of contrast administration and\nmotion degradation. Within the confines of this study:\n\nTHORACIC:\nThe alignment of the thoracic spine is maintained. The vertebral body heights\nare preserved. The intervertebral disc space and signal are preserved. There\nis no evidence of spinal canal stenosis or neural foraminal narrowing. The\nspinal cord is normal in caliber morphology without cord compression or cord\nedema. There is redemonstration of right adrenal nodule measuring 0.9 cm\n(image 3, series 16).\n\nLUMBAR:\nEvaluation is limited due to motion degradation. There is partially sacralized\nL5 vertebral body. The alignment of the lumbar spine is maintained. The\nvertebral body heights and intervertebral disc space are preserved. The conus\nmedullaris terminates at L2. There is no evidence of spinal canal stenosis or\nneural foraminal narrowing. There is posterior paraspinal soft tissue edema. \nOtherwise, prevertebral and paraspinal soft tissues appear unremarkable.", "output": "1. Please note, evaluation is limited due to motion degradation and lack of\nintravenous contrast. Within the confines of this study:\n2. No evidence of cord compression or cord edema.\n3. No evidence of spinal canal stenosis or neural foraminal narrowing.\n4. Incompletely characterized and indeterminate right adrenal nodule.\n\nRECOMMENDATION(S): Recommend repeat imaging with intravenous contrast when\nthe patient is better able to tolerate examination." }, { "input": "There is a 1.2 cm rounded lesion within the anterior L4 vertebral body\ndemonstrating hypointense T1 and T2 signal, hyperintense STIR signal, without\ndefinite enhancement after contrast administration (15:12, 14:12). This\nappears more conspicuous in comparison with the prior MRI from ___. There is no associated retropulsion component or extension into the\nposterior elements. There is no associated enhancing soft tissue component.\n\nOtherwise, in correlation with the recent noncontrast lumbar spine performed\non the same date, there is no evidence of other discrete focal bone marrow\nsignal abnormality. There is no spinal canal stenosis or neural foraminal\nnarrowing. There is no abnormal enhancement of the cauda equina nerve roots. \nUnchanged soft tissue edema in the posterior aspect of the lumbar region (11:\n3).", "output": "1. Small focal rounded lesion within the anterior L4 vertebral body as\ndescribed above, that appears more conspicuous in comparison with the prior\nMRI from ___. Finding is nonspecific. Although this may\nrepresent an atypical hemangioma, possibility of underlying malignancy cannot\nbe excluded. Recommend short-term contrast-enhanced study to further assess.\n2. No associated retropulsion component or extension into the posterior\nelements. No evidence of enhancing soft tissue component or\nenhancement of the cauda equina nerve roots.\n3. No evidence of spinal canal stenosis or neural foraminal narrowing.\n4. Please refer to recent noncontrast lumbar spine MRI performed the same date\nfor additional details.\n\nRECOMMENDATION(S): Recommend short-term contrast-enhanced study to further\nassess findings described in impression 1 above." }, { "input": "There is mild anterior wedging of the C6 vertebral body without marrow edema. \nThere is minimal retrolisthesis at C3-4 and C4-5, and minimal anterolisthesis\nat C7-T1. There are ___ type 2 discogenic bone marrow changes in the\nendplates at C4-5 and C6-7.\n\nThe cerebellar tonsils are normally positioned. Concurrent brain MRI is\nreported separately.\n\nSagittal T2 weighted images demonstrate apparent small foci of high T2 signal\nin the spinal cord at the level of C2 on the left, at the level of C2-3 in the\nmidline, and at the level of C3 to the right of midline, images ___. These\nare not seen on the T2 weighted IDEAL images or axial T2 weighted images.\nThere are likely artifactual.\n\nAt C2-3, there is a small central disc osteophyte complex which indents the\nventral thecal sac but does not significantly narrow the spinal canal. There\nis no neural foraminal narrowing.\n\nAt C3-4, there is a a broad-based central disc osteophyte complex which\nindents the ventral thecal sac but does not contact the spinal cord. There is\nmild right and moderate left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nAt C4-5, there is a broad-based central disc osteophyte complex which mildly\nflattens the ventral spinal cord. There is mild right and severe left neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nAt C5-6, there is a minimal broad-based central disc protrusion which indents\nthe ventral thecal sac but does not contact the spinal cord. There are tiny\nbilateral uncovertebral osteophytes without significant neural foraminal\nnarrowing.\n\nAt C6-7, there is a broad-based central disc protrusion with endplate\nosteophytes, which indents the ventral thecal sac but does not contact the\nspinal cord. There is moderate to severe right and mild to moderate left\nneural foraminal narrowing by uncovertebral osteophytes.\n\nAt C7-T1, there is no spinal canal narrowing. There is left facet arthropathy\nwith mild left neural foraminal narrowing.\n\nThere is a right thyroid nodule measuring 10 mm craniocaudad by 6 mm AP x 6 mm\ntransverse.", "output": "1. Multilevel degenerative disease, as detailed above.\n2. Sagittal T2 weighted images demonstrate apparent foci of high signal in the\nspinal cord at C2 and C3, without confirmation on sagittal T2 weighted IDEAL\nimages or axial T2 weighted images. These are likely artifacts.\n3. Mild chronic compression of C6 vertebral body.\n4. 10 mm right thyroid nodule.\n\nRECOMMENDATIONS: Recommend thyroid ultrasound, if not previously performed\nelsewhere." }, { "input": "CERVICAL:\nThere is 2 mm retrolisthesis of C3 on C4. Vertebral body height and alignment\nis otherwise preserved. There is multilevel degenerative disc disease\nresulting in mild disc space height loss at C3-C4 and C6-C7.\nBone marrow signal intensity is within normal limits.\n\nThere are mild degenerative changes along the cervical levels with small disc\nbulges or disc protrusions partially resulting in mild flattening of the\nventral cord but without cord signal abnormality. The spinal cord is\notherwise normal in caliber and configuration. There is no epidural\ncollection or abnormal enhancement after contrast administration.\n\nIn addition, there is facet joint arthropathy, uncovertebral hypertrophy and\nmild ligamentum flavum thickening throughout the cervical levels which\npartially results in mild and moderate neural foraminal narrowing.\n\nTHORACIC:\nVertebral body height and alignment is preserved. Intervertebral disc spaces\nappear grossly maintained. Note is made of a Schmorl's node along the\nsuperior endplate of the T6 vertebral body. Bone marrow signal intensity is\notherwise within normal limits.\n\nThe spinal cord is normal in caliber and configuration. There is no evidence\nof cord compression, severe spinal canal stenosis or significant neural\nforaminal narrowing along the lumbar levels. There is no epidural collection\nor abnormal enhancement after contrast administration.\n\nLUMBAR:\nPostsurgical changes after right L3-L4 hemilaminectomy are again noted. There\nis increased STIR signal throughout the operative bed, paraspinal muscles,\nright psoas muscle, as well as involving the endplates at L3-4 on the right,\nall of which is most likely postoperative in nature. Enhancing granulation\ntissue seen throughout the resection bed.\nNote is made of a small fluid collection in the subcutaneous soft tissues\nsubjacent to the surgical incision site measuring up to 5.1 cm in maximum SI\ndimension and 2.8 cm in maximum AP dimension which demonstrates minimal\nsurrounding enhancement on the postcontrast sequence and therefore most likely\nrepresents a postoperative seroma (series 25, image 21 and series 21, image\n11).\n\nIs unchanged 3 mm retrolisthesis of L2 on L3 and 4 mm anterolisthesis of L4 on\nL5. Vertebral body height and alignment is otherwise preserved. There is\nmultilevel degenerative disc disease, most pronounced at L4-L5 and L5-S1 where\nthere is moderate to severe disc space height loss and ___ type 2\ndegenerative endplate changes.\n\nThe spinal cord is normal in caliber and configuration. The conus terminates\nnormally at the L1-L2 level. The cauda equina nerve roots appear\nunremarkable. There is no epidural collection or abnormal enhancement after\ncontrast administration.\n\nThere are multilevel degenerative changes of the lumbar spine, most pronounced\nat L2-L3 with there is a disc bulge, facet joint arthropathy, moderate\nligamentum flavum thickening and prominence of the posterior epidural fat, all\nof which results in moderate spinal canal stenosis and moderate bilateral\nneural foraminal narrowing. There is also effacement of the lateral recesses\nbilaterally with likely compression of the traversing L3 nerve roots.\n\nAt L3-L4, there is a disc bulge, facet joint arthropathy and asymmetric severe\nleft ligamentum flavum thickening, all of which results in moderate bilateral\nneural foraminal narrowing but no spinal canal stenosis. There is effacement\nof the left lateral recess with the disc bulge at least contacting the left\ntraversing L4 nerve root.\n\nOtherwise, there is no evidence of cord compression or severe spinal canal\nstenosis along meaning lumbar levels.\nSevere bilateral neural foraminal narrowing is noted at L4-L5 and L5-S1,\npartially with compression of the nerve roots within the neuroforamen.\n\nOTHER: Small right pleural effusion and bibasilar dependent atelectasis. \nSubcentimeter T2 hyperintense lesions in both kidneys most likely represent\nrenal cysts.", "output": "1. No evidence of epidural collection, cord compression or severe spinal canal\nstenosis.\n2. Postsurgical changes after right L3-L4 hemilaminectomy with expected\npostsurgical changes.\n3. Small fluid collection in the subcutaneous soft tissues subjacent to the\nincision site with minimal surrounding enhancement most likely represents a\npostoperative seroma. However, an early phlegmon or abscess formation is not\nentirely excluded and clinical correlation is suggested.\n4. Mild multilevel degenerative changes throughout the cervical spine\npartially with mild remodeling of the ventral cord secondary to small disc\nherniations but without cord signal abnormality.\n5. Degenerative changes of the lumbar spine are most pronounced at L2-L3 where\nthere is moderate spinal canal stenosis and compression of the traversing L3\nnerve roots as well as at L4-L5 and L5-S1 where there is compression of the\nexiting nerve roots within the neuroforamen." }, { "input": "There is mild anterolisthesis of C5 on C6 and C6 on C7. The vertebral body\nheights are maintained. The bone marrow signal of the cervical spine is\nunremarkable.\n\nThe cervical spinal cord is normal in signal and morphology. There is no\ncerebellar tonsillar ectopia.\n\nThe paraspinal and prevertebral soft tissues appear unremarkable.\n\nAt the C2-C3 level, the spinal canal and neural foramina appear normal.\n\nAt the C3-C4 level, there is bilateral uncovertebral facet arthropathy which\ncause mild right neural foraminal narrowing. The left neural foramen and\nspinal canal appear normal.\n\nAt the C4-C5 level, uncovertebral and facet arthropathy cause mild right\nneural foraminal narrowing. The spinal canal and left neural foramen appear\nnormal.\n\nAt the C5-C6 level, the spinal canal and neural foramina appear normal.\n\nAt the C6-C7 level, uncovertebral facet arthropathy cause mild left neural\nforaminal narrowing. The spinal canal and right neural foramen appear normal.\n\nAt the C7-T1 level, the spinal canal and neural foramina appear normal.", "output": "1. Mild multilevel cervical spondylosis including mild neural foraminal\nstenoses. No evidence cord compressionor critical spinal canal stenosis." }, { "input": "There is no evidence of mass or abnormal enhancement in the lumbar spine. A\nsubtle focus of enhancement seen on series 8, image 11, distal to the conus\nappears to be due to vascular enhancement. There is no enhancement of the\nlumbar cauda equina nerves identified. Mild multilevel degenerative changes\nidentified without spinal stenosis or foraminal narrowing. There is no focal\ndisc herniation.", "output": "No abnormal enhancement or mass lesion seen MRI of the lumbar spine. No\nabnormal signal within the distal spinal cord. Mild degenerative changes." }, { "input": "Vertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. There is no epidural or intrathecal mass, and no\npathologic leptomeningeal contrast enhancement. Spinal cord signal is normal.\n\nThe cerebellar tonsils are normally positioned. There is mild volume loss in\nthe partially visualize cerebellum, as seen on the ___ brain MRI.\n\nC2-C3: Tiny right uncovertebral osteophytes without significant neural\nforaminal narrowing. No spinal canal narrowing.\n\nC3-C4: Shallow broad-based disc protrusion is present without significant\nspinal canal narrowing. Tiny bilateral uncovertebral osteophytes without\nsignificant neural foraminal narrowing.\n\nC4-C5: Broad-based central disc protrusion with overlying endplate\nosteophytes, slightly larger on the right than left, indent the ventral thecal\nsac and minimally remodel the spinal cord on the right. There is overall mild\nspinal canal narrowing. There is moderate right and mild to moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes. These\nfindings are similar to the prior MRI.\n\nC5-C6: Broad-based central disc protrusion with endplate osteophytes indent\nthe ventral thecal sac and mildly remodel the ventral spinal cord, with mild\nto moderate spinal canal narrowing. There is moderate, right greater than\nleft neural foraminal narrowing by uncovertebral and facet osteophytes. These\nfindings are similar to the prior MRI.\n\nC6-C7: There is a right paracentral disc protrusion which indents the ventral\nthecal sac but does not contact the spinal cord. There is no significant\nneural foraminal narrowing, though tiny uncovertebral osteophytes are present\non the right. This is similar to the prior MRI.\n\nC7-T1: No spinal canal or neural foraminal narrowing.\n\nSagittal images through the T1-T2 level are unremarkable.\n\nSagittal images through the T2-T3 level demonstrate a central/right\nparacentral disc protrusion which indents the ventral thecal sac but does not\ncontact the spinal cord, similar to the prior MRI.\n\n11 x 7 mm bilobed subcutaneous nodule abutting the skin surface in the left\nsuboccipital fat, images 6:10 and 02:14, is unchanged since the prior MRI and\ncompatible with a sebaceous cyst.", "output": "1. No evidence for intramedullary, leptomeningeal, epidural, or osseous\nmalignancy in the cervical spine.\n2. Cervical degenerative disease is unchanged compared to ___, with mild\nventral cord deformation at C4-C5 and C5-C6, but no cord signal abnormalities.\nModerate neural foraminal narrowing is present at C4-C5 on the right and at\nC5-C6 bilaterally." }, { "input": "Cervical spine:\n\nThere is heterogenous bone marrow identified in the visualized vertebral body.\n\nAt the craniocervical junction and C2-3 and C3-4 levels mild degenerative\nchange.\n\nAt C4-5, C5-6 and C6-7 mild disc bulging seen without spinal stenosis or\nforaminal narrowing.\n\nFrom C7-T1 to T4-5 mild degenerative change seen. The spinal cord shows\nnormal intrinsic signal without extrinsic compression. The prevertebral soft\ntissue thickness is maintained.\n\nLumbar spine:\n\nHeterogenous marrow signal is identified is in the cervical spine. There is\nno compression fracture. From T11-12 through L2-3 levels mild disc\ndegenerative changes seen. At L3-4 and L4-5 mild disc bulging identified\nwithout spinal stenosis but with facet degenerative changes.\n\nAt L5-S1 level severe facet degenerative changes and mild anterolisthesis of\nL5 over S1 seen. There is mild left-sided and moderate right-sided foraminal\nnarrowing. There is no spinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Heterogenous marrow signal is a nonspecific finding which could be due to\nmarrow hyperplasia such as anemia or due to marrow replacement process such as\nmyelofibrosis or myeloma. Clinical correlation recommended.\n2. Mild multilevel degenerative changes subtle to spine high-grade spinal\nstenosis or foraminal narrowing.\n3. Mild multilevel degenerative changes including mild spondylolisthesis of L5\nover S1 due to facet degenerative changes." }, { "input": "2 mm anterior subluxations of C3 on C4 and C7 on T1 are seen. Multilevel loss\nof vertebral and disc height is seen. The spinal cord appears normal in\ncaliber and configuration.\n\nC2-C3: A disc bulge is seen with bilateral uncovertebral hypertrophy. There\nis no significant spinal canal or foraminal narrowing.\nC3-C4: A disc bulge is seen with ligamentous hypertrophy and bilateral\nuncovertebral and facet arthropathy. There is moderate spinal canal narrowing\nwith mild bilateral foraminal narrowing.\nC4-C5: A disc bulge is seen with bilateral uncovertebral hypertrophy. There\nis mild spinal canal narrowing without foraminal narrowing.\nC5-C6: A disc bulge is seen with a central disc protrusion, distorting the\nventral cord. There is associated bilateral uncovertebral and facet\narthropathy. Mild spinal canal narrowing is seen with mild right and moderate\nleft foraminal narrowing.\nC6-C7: A disc bulge is seen with bilateral uncovertebral and facet\narthropathy. There is no significant spinal canal narrowing. There is\nmoderate left foraminal narrowing.\nC7-T1: Bilateral uncovertebral and facet arthropathy is seen. There is no\nsignificant spinal canal narrowing. There is moderate left foraminal\nnarrowing.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Moderate cervical spondylosis, worst at C3-4 at C5-6, as above." }, { "input": "CERVICAL:\nThe patient is status post anterior cervical spinal fusion of C4 through C6. \nThe C4, C5, and C6 vertebral bodies are fused, unchanged from the prior\nexamination. A 5 mm retrolisthesis of C3 on C4 has progressed from the prior\nexamination. The bone marrow is heterogeneous, related to degenerative\nendplate changes. There is no abnormal enhancement within the bone marrow. \nThe craniocervical junction is normal. The intervertebral disc spaces of\nC6-C7 and C7-T1 are mildly narrowed. The intervertebral discs are diffusely\ndesiccated. There is faint T2 hyperintense signal within the spinal cord at\nC3-C4. No enhancement within the spinal cord is identified. No epidural\nfluid collections or masses are identified. The paraspinal muscles are\nnormal.\n\nAt C2-C3, central disc protrusion and bilateral facet arthropathy cause mild\nbilateral neural foraminal stenosis. There is no spinal canal stenosis.\n\nAt C3-C4, right central disc protrusion flattens, deforms, and remodels the\nthecal sac, causing severe spinal canal stenosis. Bilateral facet arthropathy\ncauses severe right and moderate to severe left neural foraminal stenosis.\n\nAt C4-C5 bilateral facet arthropathy cause moderate bilateral neural foraminal\nstenosis. There is no spinal canal stenosis.\n\nAt C5-C6, bilateral facet arthropathy cause severe left and mild right neural\nforaminal stenosis. There is no spinal canal stenosis.\n\nAt C6-C7, central disc protrusion and bilateral facet arthropathy cause\nmoderate to severe spinal canal and severe bilateral neural foraminal\nstenosis.\n\nAt C7-T1, bilateral facet arthropathy and central disc extrusion with superior\nmigration flattens and deforms the thecal sac, causing moderate spinal canal\nstenosis. There is no neural foraminal stenosis.\n\nTHORACIC:\nThe alignment of the thoracic spine is normal. There is focal fatty marrow\ndeposition throughout the thoracic spine. No abnormal enhancement is\nidentified within the bone marrow. The height of the vertebral bodies are\nmaintained. The central spinal canal is prominent throughout the thoracic\nspine. No abnormal enhancement is identified in the spinal cord. No epidural\nfluid collections or masses are identified. The paraspinal muscles are\nnormal.\n\nThere are multilevel degenerative changes of the thoracic spine.\n\nAt T2-T3, central disc protrusion and right facet arthropathy flattens and\ndeforms the thecal sac, causing moderate spinal canal stenosis.\n\nAt T3-T4, central disc protrusion bilateral facet arthropathy flat and an\ndeformed thecal sac, causing mild spinal canal stenosis.\n\nAt T9-T10 and T10-T11, bilateral facet arthropathy cause mild spinal canal\nstenosis.\n\nLUMBAR:\nThe patient is status post left L2-L3 hemilaminectomy with linear, ill-defined\nsoft tissue edema and enhancement along the left paraspinal soft tissues and\nleft L2-3 facet at this level, related to the recent surgery. No discrete\nfluid collection is identified. T1 hyperintense and T2/STIR hyperintense\nsignal at the endplates of L2-L3 demonstrate minimal enhancement. There is T2\nhyperintense signal within the L2-L3 intervertebral disc, but no definite\nenhancement within the intervertebral disc. There are no epidural fluid\ncollections. The alignment of the lumbar spine is normal. The spinal cord is\nnormal in signal. The conus medullaris terminates at T12-L1. There is no\nenhancement within the spinal cord or nerve roots of the cauda equina.\n\nAt L1-L2, disc bulge, ligamentum flavum thickening, and bilateral facet\narthropathy cause moderate spinal canal and mild bilateral neural foraminal\nstenosis.\n\nAt L2-L3, bilateral facet arthropathy cause mild right neural foraminal and\nsevere left neural foraminal stenosis.\n\nAt L3-L4, disc bulge, ligamentum flavum thickening, and bilateral facet\narthropathy cause mild spinal canal and moderate bilateral neural foraminal\nstenosis.\n\nAt L4-5, disc bulge, ligamentum flavum thickening, and bilateral facet\narthropathy cause severe right and moderate left neural foraminal stenosis. \nThere is no spinal canal stenosis.\n\nAt L5-S1, bilateral facet arthropathy cause mild left neural foraminal\nstenosis. There is no spinal canal stenosis.\n\nOTHER: A rounded T2 hyperintense lesion in the right hepatic lobe is partially\nvisualized on 17:13.", "output": "1. Postsurgical changes status post left L2-L3 hemilaminectomy with\nill-defined soft tissue edema and enhancement along the left paraspinal soft\ntissues and left L2-L3 facet, likely postoperative. No discrete fluid\ncollection.\n2. T2 hyperintense, mildly enhancing signal at the endplates of L2-L3 and T2\nhyperintense, nonenhancing signal within the intervertebral disc at L2-L3,\nwhich likely represents postsurgical changes and less likely\ndiscitis/osteomyelitis.\n3. Multilevel degenerative changes of the cervical, thoracic, and lumbar spine\nas detailed above.\n4. Incomplete characterization of a T2 hyperintense lesion within the right\nhepatic lobe. Dedicated MRI or ultrasound of the liver may be obtained for\nfurther evaluation if clinically indicated." }, { "input": "There been no significant changes since the prior studies. Again seen is mild\nretrolisthesis of L1 on L2 with otherwise normal alignment. Again seen are\nextensive changes of degenerative disc disease. There is increased signal of\nthe vertebral endplates on the STIR images at L2-3. The endplates enhance\nafter contrast administration, but there is no evidence of enhancement of the\nintervertebral disc. These findings suggest degenerative disease rather than\ninfection.\n\nAt T12-L1, there is no encroachment on the spinal canal or neural foramina.\n\nAt L1-2, there is moderate spinal canal stenosis due to a combination of\nretrolisthesis, bulging of the disc, ligamentum flavum thickening and facet\nfacet osteophytes. The neural foramina appear normal.\n\nAt L2-3, intervertebral osteophytes, disc bulge, ligamentum flavum thickening\nand facet osteophytes produce severe spinal canal stenosis. There is severe\nnarrowing of the left neural foramen. There are postoperative changes at this\nlevel with epidural scarring extending along the lateral and left anterior\naspect of the thecal sac.\n\nAt L3-4, bulging of the disc produces moderate spinal canal narrowing. There\nis moderate narrowing of the neural foramina bilaterally.\n\nAt L4-5, there is a broad-based bulge of the disc along with a tiny midline\nprotrusion. The disc does not compromise the cauda equina. Facet osteophytes\nproduce severe right and moderate left neural foraminal narrowing. There are\npostoperative changes at this level after laminectomy.\n\nAt L5-S1, there are mild changes of degenerative disc disease and\npostoperative changes involving the left lamina. There is no evidence of\nthecal sac or nerve root compromise.\n\n\n\nThe spinal cord appears normal in caliber and configuration. There is no\nevidence of infection or neoplasm.", "output": "1. Degenerative disc disease status post laminectomy.\n2. Postoperative epidural scarring" }, { "input": "The patient is status post L2-3 laminectomy and posterior spinal fusion with\nbilateral posterior rods and transpedicular screws. Hardware itself is\nsuboptimally evaluated on this study but appears without complication on gross\nassessment.\n\nAside from unchanged grade 1 L1-2 retrolisthesis, alignment is normal in the\nlumbar spine. There is no evidence of an fracture or new vertebral body\nheight loss. Re-identified is high T2/STIR and T1 hypointense endplate signal\nat L2-3 with evidence of mild enhancement following contrast administration;\nhowever, the intervening L2-3 disc, aside from mild signal loss, demonstrates\nnormal signal intensity without evidence of enhancement, suggestive of\ndegenerative change, similar to prior exam (for exam see series 7, 6, and 10,\nimage 16 for all). Similar but less conspicuous findings are also seen\nposteriorly at L1-2. No concerning foci of abnormal marrow signal are\nidentified. Areas of focal fat are seen within S2 and S3. Multilevel\nintervertebral disc signal and height loss is consistent with degeneration,\nmost pronounced at L1-2, L2-3, L3-4, and L4-5. The distal spinal cord and\nconus medullaris is within normal limits, and terminates at T12-L1.\n\nAgain seen is marked multilevel, multifactorial lumbar spine degenerative\nchange. Specifically:\n\nAt T12-L1, there is ligamentum flavum and facet hypertrophy without spinal\ncanal or neural foraminal narrowing.\n\nAt L1-2, a combination of a posterior disc bulge (8, 20 as well as 11, 20), in\nconjunction with ligamentum flavum and facet hypertrophy, causes moderate\nspinal canal narrowing with mild crowding of the cauda equina nerve roots (8,\n20). There is moderate left neural foraminal narrowing (6, 14 and 6,\nrespectively), unchanged.\n\nAt L2-3, enhancing postsurgical scar tissue surrounds the thecal sac,\nincluding extending to the left ___ lateral margin of the thecal sac at\nthis level (series 11, image 26), and extending to the right anterolateral\naspect of the thecal sac and into the right L2-3 neural foramen at the site of\nthe prior L2-3 foraminotomy (series 11, image 25). There is no spinal canal\nnarrowing, markedly improved in comparison to the prior study status post L2-3\nlaminectomies (see series 8, image 26, and 11, 26). Previously severe right\nneural foraminal narrowing is improved, however enhancing postsurgical scar\ntissue surrounds the exiting right L2 nerve at this level (6, 15). Previously\nmoderate left neural foraminal narrowing is now severe (6, 7).\n\nAt L3-4, a posterior disc bulge in combination with facet hypertrophy causes\nsevere spinal canal narrowing (series 8, image 13), not appreciably changed\nfrom prior exam, with crowding of the cauda equina nerve roots. There is\nsevere bilateral neural foraminal narrowing, probably with compression of the\nexiting L3 nerve roots (see series 6 images 16 and 6, respectively). \nEnhancing postsurgical scar seen posterior to the spinal canal at this level\n(11, 33).\n\nAt L4-5, a posterior disc bulge and facet joint hypertrophy causes mild to\nmoderate spinal canal narrowing, possibly with disc minimally contacting the\ntraversing right L5 nerve root (series 8, image 38). There is severe\nbilateral neural foraminal narrowing at this level (6, 15 and 6).\n\nAt L5-S1, there is a posterior disc bulge (8, 43) without spinal canal\nnarrowing. There is at least moderate left (6, 6) neural foraminal narrowing.\nThere is mild right (6, 15) neural foraminal narrowing.\n\nA nonenhancing circumscribed T2 hyperintense 9 mm focus is seen within the\nposterior left interpolar renal cortex, unchanged from prior, incompletely\nevaluated but most likely a simple renal cyst. A similar, smaller 3-4 mm\nfocus is seen in the lateral right kidney interpolar cortex, not seen on the\nprior study but also most likely a simple renal cyst. Postsurgical changes\nalong the subcutaneous and deep soft tissues in the midline back overlying\nL2-3 are noted, including postsurgical enhancing scar tissue at these levels,\nsurrounding the thecal sac at L2-3, as detailed above. No evidence of focal\nfluid collection. Atrophy of the paraspinal lumbar musculature is noted, right\nmore than left.", "output": "1. Postsurgical improvement in previously severe spinal canal stenosis at\nL2-3.\n2. Improvement in right L2-3 neural foraminal stenosis status post\nforaminotomy, however now with enhancing postsurgical scar tissue surrounding\nthe exiting right L2 nerve root within the foramen. Interval worsening of\npreviously moderate, now severe left L2-3 neural foraminal narrowing.\n3. Persistent multilevel spinal canal and neural foraminal stenosis due to the\nsevere multifactorial degenerative changes at other levels. Specifically,\nspinal stenosis is worst (severe) at L3-4. Neural foraminal stenosis is\nsevere at multiple levels, including on the left at L1-2, L2-3 (as mentioned\nabove), L3-4, and bilaterally at L4-5.\n4. Postsurgical changes at L2-3. No focal fluid collection." }, { "input": "At T12-L1 and L1-2 levels disc degenerative changes identified with mild\nbulging.\n\nAt L1-2 level, above the level of the spinal fusion there is disc bulging and\nmild spinal stenosis identified no significantly changed from the previous\nstudy. However, compared to the prior study there are slightly increased\nendplate changes seen at this level indicative of progression of degenerative\nendplate disease.\n\nAt L2-3 and L3-4 levels, the patient has undergone laminectomy. Pedicle\nscrews are identified at L2 and L3 level. The spinal canal at L2-3 level is\npatent. Evaluation of foramina is limited but there do not appear different\nthan the previous study.\n\nAt L3-4 level, diffuse disc bulge central protrusion and thickening of the\nligaments identified below the level of laminectomy resulting in\nmoderate-to-severe spinal stenosis which appears to have increased since the\nprevious MRI study. There is moderate-to-severe bilateral foraminal narrowing\nalso slightly increased from the previous study.\n\nAt L4-5 level, diffuse disc bulging and facet degenerative changes identified.\nThere is severe right and moderate-to-severe left foraminal narrowing\nunchanged from the prior study.\n\nAt L5-S1 level disc and facet degenerative changes seen with moderate to\nsevere left foraminal narrowing unchanged from the previous study.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. No\nabnormal enhancement is seen.", "output": "1. Spinal fusion at L2 and L3 level with laminectomy.\n2. Moderate-to-severe spinal stenosis at L3-4 level below the level of fusion\nhas increased since the previous MRI of ___. 3 foraminal narrowing at L4-5\nand L5-S1 levels unchanged from previous study." }, { "input": "There is hardware related to posterior instrumented L2-3 fusion and L2-3\nlaminectomy. There is mild enhancement within the posterior paraspinal\nmuscles, likely postsurgical in nature. No fluid collection is identified.\n\nVertebral body height and alignment appear preserved. There is abnormal low\nsignal within the bone marrow on T1 weighted images, similar to ___. There is no abnormal bone marrow enhancement.\n\nThe cauda equina terminates at the T12-L1 level. The conus medullaris and\ncauda equina appear normal in signal intensity and morphology. There is no\nabnormal intradural enhancement.\n\nAt L1-2, there is a disc bulge ligamentum flavum thickening, prominent dorsal\nepidural adipose tissue, and facet hypertrophy that result in moderate spinal\ncanal narrowing. The disc bulge and appears to contact the traversing L2\nnerve roots, however does not displace them. Facet hypertrophy results in\nmild right and moderate left neural foraminal narrowing.\n\nAt L2-3, the spinal canal is widely patent status post laminectomy. There are\nsmall posterior endplate spurs that indent the ventral thecal sac. Facet\nhypertrophy results in mild right and moderate to severe left neural foraminal\nnarrowing.\n\nAt L3-4, there is a disc bulge, ligamentum flavum thickening, and facet\nhypertrophy that result in moderate spinal canal narrowing. The disc bulge\nand facet hypertrophy contacts, and may impinge on the traversing bilateral L4\nnerve roots. Facet hypertrophy results in severe bilateral neural foraminal\nnarrowing.\n\nAt L4-5, there is a disc bulge and facet hypertrophy that result in mild\nspinal canal and severe bilateral neural foraminal narrowing.\n\nAt L5-S1, facet hypertrophy results in mild bilateral neural foraminal\nnarrowing. There is no spinal canal narrowing.\n\nThere is mild edema within the dorsal subcutaneous adipose tissue and\nposterior paraspinal muscles, similar to the prior study. There is a small\nleft renal cyst. The prevertebral and paraspinal soft tissues are otherwise\nunremarkable.", "output": "1. Posterior instrumented L2-3 fusion and laminectomy, without findings to\nsuggest infection.\n2. Moderate spinal canal narrowing at the L1-2 and L3-4 levels, and multilevel\nsevere neural foraminal narrowing as detailed above. These findings appear\nsimilar to ___.\n3. Abnormal bone marrow signal intensity. This may be related to anemia,\nsmoking, metabolic disease, or less likely marrow infiltration. This abnormal\nsignal intensity appears similar to ___." }, { "input": "Please note the study is limited by motion degradation.\n\nThere is retrolisthesis of C4 on C5 and C5 on C6. There is T2/STIR signal\nhyperintensity within the C4, C5, and C6 vertebral bodies which is potentially\non the basis ___ type 1 degenerative endplate changes, as there is\nsignificant spondylosis at this level. There is no loss of vertebral body\nheight and no clear evidence of fracture. There may be a tiny prevertebral\nfluid collection at the C4-C5 level. There is no evidence of ligamentous\ninjury.\n\nWithin the limits of this motion degraded examination, the cervical spinal\ncord is grossly preserved in signal and morphology. There is no cerebellar\ntonsillar ectopia. There is no abnormality within the spinal cord on\ndiffusion-weighted imaging.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the C2-C3 level, the spinal canal and neural foramina are normal.\n\nAt the C3-C4 level, the spinal canal and neural foramina are normal.\n\nAt the C4-C5 level, there is a broad-based posterior disc protrusion causing\nmoderate to severe spinal canal narrowing with remodeling of the ventral\nsurface of the spinal cord. Additionally, uncovertebral and facet arthropathy\ncause severe bilateral neural foraminal narrowing.\n\nAt the C5-C6 level, there is a broad-based posterior disc protrusion which\ncauses moderate to severe spinal canal narrowing with remodeling of the\nventral surface of the spinal cord. Uncovertebral and facet arthropathy cause\nsevere bilateral neural foraminal narrowing.\n\nAt the C7-T1 level, the spinal canal and neural foramina appear normal.", "output": "1. Please note study is degraded by motion artifact.\n2. Nonspecific marrow edema within the C4, C5, and superior C6 vertebral\nbodies.\n3. No clear evidence of fracture or loss of vertebral body height.\n4. Possible tiny prevertebral fluid collection at the C4-C5 level. Recommend\nclinical correlation.\n5. Multilevel degenerative changes as described, greatest at the C4-C5 and\nC5-C6 levels where there is moderate to severe spinal canal narrowing and\nsevere bilateral neural foraminal narrowing without definite cord signal\nabnormality.\n6. C4 on C5 and C5 on C6 minimal retrolisthesis." }, { "input": "The patient is status post interval revision of the cervical spinal fusion\nwith interval C5-T1 corpectomy and posterior spinal fusion of the upper\nthoracic spine. Hardware susceptibility artifact obscures visualization of\nadjacent structures.\n\nIn comparison with prior study dated ___, there is interval\nresolution of epidural abscess that was previously seen at C6-C7 and upper\nthoracic spine. There is no evidence of new or residual abnormal fluid\ncollection or abscess.\n\nThe spinal cord at C4-T3 levels demonstrates cord expansion with diffuse\nhyperintense T2 signal with suggestion of a cystic component at C6 level\nmeasuring 0.9 cm (6:8). In comparison with the prior study from ___, there is overall increase in spinal cord T2 hyperintensity at these\nlevels, possibly related to syringomyelia.\n\nThere is interval reduction in caliber of the spinal cord suggesting cord\natrophy with anterior displacement of the spinal cord within the upper\nthoracic spine. There previously seen spinal cord edema at C3-C4 and T3-T5\nhas resolved in the interim.\n\nThere is stable 4 mm C3-C4 and 2 mm C4-C5 anterolisthesis, unchanged from ___. There is osseous fusion posteriorly at C3-C4 and C6-C7\nvertebral bodies.\n\nC2-C3: No spinal canal or neural foraminal stenosis.\n\nC3-C4: No spinal canal stenosis. Facet and uncovertebral joint osteophyte\ncauses mild left neural foraminal narrowing and no right neural foraminal\nnarrowing.\n\nC4-C5: There is progression of a disc bulge with asymmetric left foraminal\ncomponent and annular fissure not previously seen causing mild spinal canal\nstenosis. In conjunction with facet and uncovertebral joint osteophytes,\nthere is severe left and mild right neural foraminal narrowing, compressing\nthe left exiting nerve root.\n\nC5-C6: Endplate osteophyte cause mild spinal canal stenosis with flattening of\nthe left ventral spinal cord. In conjunction with facet and uncovertebral\njoint osteophyte, there is mild bilateral neural foraminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal stenosis.\n\nA left C7-T1 perineural cyst is again seen measuring 6 mm, unchanged in size.", "output": "1. Resolution of previously seen epidural abscess. No evidence of new\nabnormal fluid collection or abscess.\n2. Interval increase in hyperintense T2 signal within the C4-T3 spinal cord\nwith spinal cord expansion. This may represent a combination of myelomalacia\nand cyst formation.\n3. New spinal cord atrophy at the remaining levels of the upper cervical and\nthoracic spine.\n4. Progression of C4-C5 disc bulge with mild spinal canal stenosis and severe\nleft and mild right neural foraminal narrowing, as above.\n5. Stable left C7-T1 perineural cyst." }, { "input": "CERVICAL:\nEvidence of posterior spinal decompression and spinal fusion with pedicular\nscrews and rods extending from the C5 to T3 levels. Interbody spacer device\nin situ extending from the C5-6 to the T1-T2 level. No evidence for epidural\ncollection. No evidence for diskitis/osteomyelitis.\n\nThe imaged posterior fossa appears unremarkable. The cerebellar tonsils are\nnormally positioned. Spinal cord syrinx extends from this C5 - T3 levels,\nunchanged. No epidural collection.\n\nBroad-based disc protrusion effacing the CSF space anterior to cord at the\nC4-5 level appears similar compared to prior. Right T1-2 perineural cysts\nappear similar compared to prior.\n\nTHORACIC:\nThere is T2 and STIR hyperintense changes of the left erector spinae muscles\nextending from the T8-9 level to the T12 level with associated T1\nhypointensity demonstrating rim enhancement post contrast. This nonenhancing\narea measures 53 x 19 x 91 (TV by AP by CC) best seen series 16 image 20 and\nseries 19, image 11. The nonenhancing central component still demonstrates\nmuscular fibrillation characteristics on imaging suggesting that it is\nmyositis/phlegmon and not yet a liquified/necrotic abscess.\n\nNo evidence for diskitis, osteomyelitis, or epidural collection. Preserved T3\nthrough T12 vertebral body heights. No spinal canal narrowing.\n\nLUMBAR:\n\nThe conus terminates at the L1 level. No conus masses. There is no\ncompromise of the cauda equina nerve roots in the spinal canal or neural\nforamina. Mild neural foraminal narrowing is present at L4-L5 and L5-S1. No\nacute vertebral body fractures. Hemangiomas noted in the L2, L4 and T12\nvertebral bodies. No epidural collections. No abnormal enhancement of the\nnerve roots. No evidence of spondylitis or discitis. Spinal curvature in the\ncoronal plane.\n\nOTHER:\nT2 bright lesion in the right vallecula measuring 10 mm in diameter which may\nrepresent retained secretions or a mucosal retention cyst. Mild dependent\natelectasis in the left lung base. Small left renal cortical cyst.", "output": "1. T2 and STIR hyperintense and T1 hypointense changes in the left erector\nspinae muscles extending from the T8-9 to T12 levels measuring 53 x 19 x 91 mm\nas described above. This nonenhancing central component still demonstrates\nmuscular fibrillation characteristics on imaging suggesting that it is\nmyositis/phlegmon and not yet a liquified/necrotic abscess.\n2. Postsurgical changes noted in the lower cervical and upper thoracic spine\nas described above. Syrinx extending from the C5-T3 levels, unchanged since\nthe prior MRI. No compromise of the cord in the central canal.\n3. No evidence of osteomyelitis, discitis, or epidural collection.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 10:25 am, 10 minutes after\ndiscovery of the findings." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is millimetric anterolisthesis of C4 on C5, C5 on C6, C6 on C7, and C7\non T1, likely degenerative.\n\nThere is mild vertebral body height loss with associated T2/STIR\nhyperintensity suggesting an acute versus early subacute process of the T2\nvertebral body. No evidence for bony retropulsion. Minimal nonspecific fluid\nis noted anterior to the C6 and T2 vertebral bodies. Within limits of study,\nno definite evidence of ligamentous disruption identified. Nonspecific T2 and\nSTIR hyperintensity are noted in the C5 through T3 right paraspinous muscles.\n\nOsseous fusion along the posterior aspects of the C3-4 vertebral bodies is\nnoted.\n\nC2-C3: No definite vertebral canal stenosis. Uncovertebral joint osteophytes\nresult in mild right neural foraminal narrowing.\n\nC3-C4: Patent vertebral canal, with mild right neural foraminal narrowing\nsecondary to joint osteophytes.\n\nC4-C5: Posterior disc bulging flattens the ventral thecal sac without definite\ncanal narrowing. Uncovertebral joint osteophytes result in moderate right and\nmild left neural foraminal narrowing.\n\nC5-C6: Posterior disc bulging with rightward asymmetry indents the ventral\nthecal sac with mild canal narrowing but no definite neural foraminal\nnarrowing.\n\nC6-C7: Posterior disc bulging with a superimposed central disc protrusion\nindents the ventral thecal sac and marginates the ventral cord with mild canal\nnarrowing, with no definite abnormal cord signal abnormality. Uncovertebral\njoint osteophytes result in moderate bilateral neural foraminal narrowing at\nthis level.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nWithin limits of this noncontrast examination, there is no definite evidence\nof paravertebral or paraspinal mass.", "output": "1. Study is moderately degraded by motion.\n2. Acute to subacute compression deformity involving the T2 vertebral body\nwith mild loss of height and no definite bony retropulsion.\n3. No evidence for bony retropulsion or ligamentous injury.\n4. Nonspecific right C5 through T3 paraspinal muscle edema.\n5. Multilevel cervical spondylosis as described, with C6-7 mild vertebral\ncanal narrowing with deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality.\n6. C4-5 moderate right and C6-7 moderate bilateral neural foraminal narrowing." }, { "input": "Study is mildly degraded by motion.\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nMinimal L5 on S1 retrolisthesis is noted, progressed compared to ___ prior\nexam. Vertebral body heights are preserved. Multiple grossly stable\nSchmorl's nodes are again noted throughout the thoracolumbar spine. L2\nvertebral body probable hemangioma is again noted. L5-S1 endplate type 2\n___ changes are again noted.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nGrossly stable loss of intervertebral disc height and signal at the L5-S1\nintervertebral disc is again noted. Intervertebral disc heights and signal\nare preserved.\n\nT9-10, T10-11 and T11-12 disc bulges with mild vertebral canal and no neural\nforaminal narrowing are noted.\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 no vertebral canal or neural foraminal narrowing.\n\nAt L3-4 there is disc bulge, prominent epidural fat, facet joint hypertrophy,\nligamentum flavum hypertrophy, mildvertebral canal and no neural foraminal\nnarrowing. Right facet joint probable synovial cyst is noted. Nonspecific\nbilateral facet joint fluid is noted.\n\nAt L4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canal and no neural foraminal narrowing. Left\nfacet joint probable synovial cyst is noted. Nonspecific bilateral facet\njoint fluid is noted.\n\nAt L5-S1 there is disc bulge, central disc protrusion which contacts the\ntransiting left S1 nerve root (see 05:34), hypertrophy, ligamentum flavum\nhypertrophy, mildvertebral canaland mild leftneural foraminal narrowing.\nNonspecific bilateral facet joint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.", "output": "1. Study is mildly degraded by motion.\n2. Minimal progression of L5 on S1 retrolisthesis compared to ___ prior exam.\n3. Otherwise, grossly stable multilevel lumbar spondylosis as described, most\npronounced at L5-S1, where disc protrusion contacts transiting left S1 nerve\nroot, with mild vertebral canal and mild left neural foraminal narrowing.\n4. Within limits of study, no definite evidence of moderate or severe\nvertebral canal or neural foraminal narrowing." }, { "input": "The visualized elements of the posterior fossa and craniocervical junction are\nunremarkable. Vertebral body heights are preserved. Minimal retrolisthesis\nof C5 on C6 is unchanged. No concerning bone marrow signal abnormalities are\nidentified.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa appears unremarkable.\n\nMultilevel degenerative disease is unchanged compared to ___, as\ndetailed below. These findings include multiple levels of disc desiccation\nand varying degrees of disc height loss.\n\nThe craniocervical junction and the C1-C2 level appear unremarkable.\n\nAt C2-3: No foraminal narrowing. There is mild left facet arthropathy.\n\nAt C3-4, there is a tiny central disc protrusion without spinal canal\nnarrowing. There is mild, left greater than right facet arthropathy without\nneural foraminal narrowing.\n\nAt C4-5, there is a tiny shallow central/ left paracentral disc protrusion\nwithout spinal canal narrowing. There is mild to moderate left neural\nforaminal narrowing by uncovertebral and facet osteophytes. There is also\nmild right uncovertebral and facet arthropathy without significant neural\nforaminal narrowing.\n\nAt C5-6, there is a mild retrolisthesis and a broad-based sent disc osteophyte\ncomplex flattening the spinal cord with moderate spinal canal stenosis, but no\nevidence for cord signal abnormalities. There is moderate right and severe\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C6-7, there is a broad-based central disc osteophyte complex slightly\nremodeling the ventral spinal cord with mild to moderate spinal canal\nstenosis. There is no evidence for cord signal abnormalities. There is mild\nleft neural foraminal narrowing by primarily uncovertebral osteophytes.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.", "output": "1. Multilevel degenerative disease appears unchanged compared to ___.\n2. Moderate spinal canal stenosis at C5-6 with spinal cord flattening, and\nmild to moderate spinal canal stenosis at C6-7 with mild ventral spinal cord\nremodeling, but no evidence for cord signal abnormalities.\n3. Mild right and mild to moderate left neural foraminal narrowing at C4-5. \nModerate right and severe left neural foraminal narrowing at C5-6." }, { "input": "The patient is status post anterior cervical spinal fusion at C5-C7. \nSusceptibility artifact from the orthopedic hardware limits evaluation of the\nadjacent structures. Allowing for this, the remainder of the vertebral bodies\nappear normal in height and signal intensity.\n\nThere is apparent 2 mm anterolisthesis of C4 on C5 and 2-3 mm retrolisthesis\nC5 on C6. The remainder of the spinal sagittal alignment is grossly\nmaintained.\n\nC2-C3: There is no spinal canal stenosis. Uncovertebral and facet joint\narthropathy results in mild left neural foraminal narrowing.\n\nC3-C4: Mild posterior disc bulging indents the ventral thecal sac with minimal\ncanal stenosis, combining with uncovertebral joint hypertrophy result in\nminimal left neural foraminal narrowing.\n\nC4-C5: There is a posterior disc bulge with leftward asymmetry contributing to\nmild-to-moderate canal stenosis and combining with uncovertebral joint\nhypertrophy to result in moderate right and moderate severe left neural\nforaminal narrowing.\n\nC5-C6: A posterior disc bulge with leftward asymmetry indents the ventral\nthecal sac, contacts the ventral cord, resulting in moderate to severe canal\nstenosis. This combines with uncovertebral joint hypertrophy to result in\nmoderate severe right and severe left neural foraminal narrowing.\n\nC6-C7: Posterior disc bulging is noted flattening the ventral thecal sac\nwithout significant canal stenosis at this level. This combines with\nuncovertebral joint hypertrophy to result in moderate left neural foraminal\nnarrowing.\n\nC7-T1: There is no definite spinal canal stenosis or neural foraminal\nnarrowing.\n\nThe prevertebral and paraspinal soft tissues are grossly within normal limits.", "output": "1. Status post anterior discectomy and cervical fusion at C5-C7.\n2. Multilevel spondylosis of the cervical spine, as detailed above. Findings\nare most notable at the level of C5-6 with moderate to severe canal stenosis,\nmoderate to severe right and severe left neural foraminal narrowing.\n3. Multilevel spondylolisthesis, also detailed above." }, { "input": "Axial gradient echo images are limited by motion, but axial T2 weighted images\nprovide good diagnostic quality.\n\nVertebral body heights are preserved. Minimal retrolisthesis of C5 on C6 is\nunchanged. No concerning bone marrow signal abnormalities are identified.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa appears unremarkable.\n\nMultilevel degenerative disease is unchanged compared to ___, as\ndetailed below.\n\nThe craniocervical junction and the C1-C2 level appear unremarkable.\n\nAt C2-3 or neural foraminal narrowing. There is mild left facet arthropathy.\n\nAt C3-4, there is a tiny central disc protrusion without spinal canal\nnarrowing. There is mild, left greater than right facet arthropathy without\nneural foraminal narrowing.\n\nAt C4-5, there is a tiny shallow central/ left paracentral disc protrusion\nwithout spinal canal narrowing. There is mild to moderate left neural\nforaminal narrowing by uncovertebral and facet osteophytes. There is also\nmild right uncovertebral and facet arthropathy without significant neural\nforaminal narrowing.\n\nAt C5-6, there is a mild retrolisthesis and a broad-based sent disc osteophyte\ncomplex flattening the spinal cord with moderate spinal canal stenosis, but no\nevidence for cord signal abnormalities. There is moderate right and severe\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nAt C6-7, there is a broad-based central disc osteophyte complex slightly\nremodeling the ventral spinal cord with mild to moderate spinal canal\nstenosis. There is no evidence for cord signal abnormalities. There is mild\nleft neural foraminal narrowing by primarily uncovertebral osteophytes.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.", "output": "1. Multilevel degenerative disease appears unchanged compared to ___.\n2. Moderate spinal canal stenosis at C5-6 with spinal cord flattening, and\nmild to moderate spinal canal stenosis at C6-7 with mild ventral spinal cord\nremodeling, but no evidence for cord signal abnormalities.\n3. Mild right and mild to moderate left neural foraminal narrowing at C4-5. \nModerate right and severe left neural foraminal narrowing at C5-6." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \nRight hemilaminectomy changes are seen at L4. A T1 and T2 hypointense lesion\nL3 vertebral body is stable compared to prior exam and is compatible with a\nbone island as demonstrated on CT. There is no other marrow signal\nabnormality. The visualized portion of the spinal cord is preserved in signal\nand caliber. There is loss of intervertebral disc height and signal at\nmultiple levels, most notably at L5-S1, similar compared to prior exam. There\nis no paravertebral or paraspinal mass identified and there is no evidence of\ninfection or neoplasm. The visualized portion of the sacroiliac joints are\npreserved.\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there has been interval increase in size of a disc bulge with an\nannular fissure and superimposed central disc protrusion resulting in\nmild-to-moderate spinal canal stenosis and no significant neural foraminal\nstenosis. Mild facet arthropathy and ligamentum flavum thickening is also\nseen at this level.\n\nAt L2-3 there is a progressive disc bulge, facet arthropathy and ligamentum\nflavum thickening with dorsal epidural fat resulting in moderate spinal canal\nstenosis and mild right neural foraminal stenosis.\n\nAt L3-4 there is progressive severe spinal canal stenosis secondary to disc\nbulge and dorsal epidural lipomatosis with facet arthropathy and ligamentum\nflavum thickening. In addition, mild bilateral neural foraminal stenosis is\nseen, worse compared to prior.\n\nAt L4-5 there is mild disc bulge with facet arthropathy with no significant\nspinal canal or neural foraminal stenosis. An annular fissure is seen at this\nlevel.\n\nAt L5-S1 there is facet arthropathy with no significant spinal canal and mild\nbilateral neural foraminal stenosis.\n\nRight renal scarring is seen.", "output": "Progressive degenerative changes throughout the lumbar spine, as described\nabove, with moderate spinal canal stenosis at L2-3 and and severe spinal canal\nstenosis at L3-4 which has progressed since prior." }, { "input": "Alignment is normal. There are minimal degenerate endplate marrow signal\nchanges at the L5-S1 level, and there are scattered hemangiomas, largest at\nthe L4 level. There is disc desiccation and mild loss of intervertebral disc\nheight at the L2-L3 through L5-S1 levels. The remaining intervertebral discs\nare normal in height and signal. Vertebral body and intervertebral disc\nsignal intensity otherwise appear normal.\n\nThe visualized distal spinal cord appears normal in caliber and configuration.\nThe conus medullaris is normal and terminates at L1.\n\nThe spinal canal is congenitally narrow due to short pedicles, particularly\nfrom L3 and below. There is also prominent epidural fat contributing to\neffacement of the thecal sac.\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 a diffuse disc bulge eccentric towards the left with\nligamentum flavum infolding and mild facet arthropathy causing mild narrowing\nof the spinal canal. There is a superimposed left paracentral disc protrusion\ncomponent which contacts and slightly displaces the traversing left L3 nerve\nroots in the subarticular recess. There is moderate left and no right neural\nforaminal narrowing due to a foraminal disc protrusion. The foraminal\ncomponent of the disc protrusion has an annular fissure.\n\nAt L3-L4, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy including a right facet joint effusion. Superimposed on a\ncongenitally narrowed spinal canal and in combination with prominent posterior\nepidural fat, there is moderate spinal canal stenosis. There is mild\nbilateral neural foraminal narrowing.\n\nAt L4-L5, there is a diffuse disc bulge with small central protrusion\ncomponent, ligamentum flavum infolding, and facet arthrosis with superimposed\non a congenitally narrowed spinal canal resulting in moderate spinal canal\nstenosis. There is narrowing of the subarticular recesses with crowding of\nthe bilateral traversing L5 nerve roots. There is mild bilateral neural\nforaminal narrowing.\n\nAt L5-S1, there is a diffuse disc bulge with central protrusion component and\nfacet arthropathy including a small right facet joint effusion. There is\nmoderate narrowing of the spinal canal. There is narrowing of the\nsubarticular recesses with compression of the bilateral traversing S1 nerve\nroots. There is mild left and mild-to-moderate right neural foraminal\nnarrowing.\n\nThere is no evidence of infection or neoplasm.", "output": "1. Multilevel degenerative changes of the lumbar spine as described above,\nwhich are overall similar to previous examination. There is slight\ndisplacement of the traversing left L3 nerve roots due to a left paracentral\ndisc protrusion at L2-L3, moderate spinal canal stenosis at L3-L4, moderate\nspinal canal stenosis at L4-L5 with crowding of the bilateral traversing L5\nnerve roots due to subarticular recess narrowing, and bilateral subarticular\nrecess narrowing at L5-S1 with compression of the bilateral traversing S1\nnerve roots.\n2. No cauda equina compression." }, { "input": "There is a transitional vertebra at the lumbosacral junction. Rudimentary disk\nis seen between S1 and S2.\n\nFrom T10-11 through L3- levels idusk degenerative changes are identified. At\nL4-5 there is mild anterolisthesis due to facet degenerative changes. No\nspinal stenosis seen. There is no foraminal narrowing.\n\nAt L5-S1 level, disk bulging and a broad-based central protrusion identified\nwith facet degenerative changes. There is moderate bilateral subarticular\nrecess narrowing seen. There is mild foraminal narrowing. There is also mild\nspinal stenosis.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable. \nIncidental hemangioma is seen in the L1 vertebra.", "output": "Transitional vertebra at the lumbosacral junction with rudimentary disc\nbetween S1 and S2.\n\nDisk bulging and central protrusion at L5-S1 level with moderate bilateral\nsubarticular recess narrowing. Mild multilevel degenerative changes at other\nlevels as described above." }, { "input": "C1-C2: Mild intervertebral disc height loss and desiccation. No significant\nspinal canal or neural foraminal narrowing.\n\nC2-C3: Mild intervertebral disc height loss and desiccation. A combination of\nsmall posterior disc bulge and osteophytes result in minimal spinal canal\nnarrowing.\n\nC3-C4: Mild intervertebral disc height loss and desiccation. A combination of\nsmall posterior disc bulge and osteophytes results in mild spinal canal\nnarrowing. Mild right neural foraminal narrowing.\n\nC4-C5; C5-C6: Probably complete or near complete replacement of the C5\nvertebral body by an osseous metastasis, better assessed on recent PET-CT, now\nincompletely assessed in the absence of intravenous contrast. There is a\nsevere pathologic compression fracture of C5 with severe focal kyphosis and 6\nmm of retropulsion/protrusion into the spinal canal, severe spinal canal\nnarrowing, and mass effect on the spinal cord. Despite posterior displacement\nof the cord, there is no definite cord compression and no focal cord signal\nabnormality. The osseous metastasis extends laterally and obliterates both\nneural foramen. There is mild paravertebral fluid as well as edema in the\ninterspinous ligaments.\n\nC6-C7: Mild intervertebral disc height loss and desiccation. A combination of\nsmall posterior disc bulge and osteophytes result in mild spinal canal\nnarrowing. Mild left neural foraminal narrowing.\n\nC7-T1: Mild intervertebral disc height loss and desiccation. No significant\nspinal canal or neural foraminal narrowing. No significant neural foraminal\nnarrowing.\n\nLimited assessment for additional osseous lesions in the absence of\nintravenous contrast. Intravenous contrast was not administered given\npatient's insistence that she has allergies to both iodine and gadolinium\nbased contrast agents. Incidental T5 vertebral body hemangioma is noted.\n\nOTHER: Enlarged, heterogeneous thyroid gland. The left thyroid lobe is\npreviously very FDG avid, concerning for the patient's primary malignancy.", "output": "Severe C5 pathologic compression fracture with severe focal kyphosis,\nretropulsion/protrusion into the spinal canal, severe spinal canal narrowing,\nand posterior displacement of the cord, but no definite cord compression or\nfocal cord signal abnormality.\n\nNOTIFICATION: The findings were discussed with ___, Medical Student by\n___, M.D. on the telephone on ___ at 2:03 pm, less than 5\nminutes after discovery of the findings." }, { "input": "There is transitional anatomy at the lumbosacral junction with lumbarization\nof S1 vertebral body. The lowest well-formed intervertebral disc is\ndesignated as S1-2.\n\nThe FDG avid lesion within transverse process of the T10 (not the T9 vertebral\nbody as mentioned in the PET-CT report from ___ is again noted. \nThere is no bone marrow lesion to correspond with a mildly elevated uptake\nidentified within the T9 vertebral body (described as T8 on the PET\ndictation).\n\nThere are benign intraosseous hemangiomas within the T5, T8, and L1 vertebral\nbodies.\n\nThere is a large dominant lesion within the L4 vertebral body is smaller\nmetastatic lesion within the L4 pedicle. There is also metastatic lesion\nwithin the L5 vertebral body.\n\nThere is a large perineural root sleeve cyst at S2-3.\n\nThe thoracic spinal cord appears normal in morphology and signal intensity. \nThe conus medullaris terminates at the T12-L1 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nThere is mild thoracic degenerative disc disease without spinal canal or\nneural foraminal narrowing.\n\nThere is mild lumbar degenerative disc disease with narrowing of the right\nsubarticular zone at L5-S1. There is no lumbar spinal canal narrowing.\n\nThe left iliac wing and innumerable hepatic metastasis are noted.", "output": "1. Transitional anatomy at the lumbosacral junction, with lumbarization of the\nS1 vertebral body. The lowest well-formed intervertebral disc is designated\nas S1-2. Please note that this vertebral body assignment is different from\nthe PET-CT dictation on ___.\n2. Small metastatic lesion within the posterior elements of the T10 vertebral\nbody as identified on the prior PET. No other thoracic metastasis are\nidentified. Several benign intraosseous hemangiomas are noted as above.\n3. Lumbar metastasis L4 and L5 vertebral bodies as identified on the prior\nPET. No new lumbar metastasis are identified.\n4. Left iliac wing innumerable hepatic metastatic lesions are noted.\n5. Mild thoracic and lumbar degenerative disc disease." }, { "input": "Images are mildly limited by motion artifact.\n\nSince the prior cervical spine MRI, there has been suboccipital craniectomy\nwith decompression of the Chiari 1 malformation. There is no residual mass\neffect on the cerebellar tonsils. Angulation of the cervicomedullary junction\npersists. Concurrent brain MRI is reported separately.\n\nThe previously noted syrinx extends from C1 through T1, unchanged in\ncraniocaudad extent. On axial images, the syrinx measures up to 7 mm\ntransverse by up to 3.5 mm AP, compared to 8 x 4 mm previously.\n\nVertebral body heights are preserved. No concerning bone marrow signal\nabnormalities are seen. Alignment is normal.\n\nC2-C3: Small right paracentral disc protrusion with endplate osteophytes is\nagain seen, unchanged. No significant spinal canal or neural foraminal\nnarrowing.\n\nC3-C4: Right paracentral disc protrusion with endplate osteophytes indent the\nventral thecal sac and mildly narrow the spinal canal, but do not contact the\nspinal cord. Severe right and moderate left neural foraminal narrowing by\nuncovertebral and facet osteophytes. No interval change.\n\nC4-C5: No spinal canal narrowing. Mild bilateral neural foraminal narrowing\nby uncovertebral and facet osteophytes. No interval change.\n\nC5-C6: Broad-based shallow central disc protrusion with endplate osteophytes\nindent the ventral thecal sac but do not contact the spinal cord or\nsignificantly narrow the spinal canal. There is mild right and mild to\nmoderate left neural foraminal narrowing by uncovertebral osteophytes. No\ninterval change.\n\nC6-C7: Broad-based shallow central disc protrusion with endplate osteophytes\nindent the ventral thecal sac but do not contact the spinal cord or\nsignificantly narrow the spinal canal. The left neural foramen is moderately\nnarrowed by uncovertebral and facet osteophytes. No interval change.\n\nC7-T1: Mild disc bulge without spinal canal or neural foraminal narrowing. \nNo interval change.", "output": "1. The syrinx from C1 through T1 appears unchanged in craniocaudad extent, but\nhas slightly decreased in maximal axial cross-section, now 7 x 3.5 mm compared\nto 8 x 4 mm previously.\n2. Status post suboccipital craniectomy. Concurrent brain MRI is reported\nseparately.\n3. Unchanged multilevel degenerative disease. No mass effect on the spinal\ncord. Mild to moderate neural foraminal narrowing, as detailed above." }, { "input": "There are 5 lumbar-type vertebrae with transitional configuration of L1\ntransverse processes. The numbering is documented on image 2:10.\n\nNo concerning bone marrow signal abnormalities seen. Several small\nhemangiomas are again seen within the T12 and L1 vertebral bodies. Vertebral\nbody heights are preserved.\n\nThe distal spinal cord demonstrates normal morphology and signal intensity,\nwith the conus medullaris terminating at L1.\n\nFrom T11-T12 through L4-L5, intervertebral discs maintain normal heights and\nnormal signal intensities. There is no spinal canal or neural foraminal\nnarrowing.\n\nAt L5-S1, there is minimal retrolisthesis, a disc bulge, and a central disc\nherniation, extending further to the right than left. The herniation measures\n15 mm transverse, 5 mm AP, 8 mm craniocaudad compared to 15 x 8 x 13 mm in\n___. Mild right facet arthropathy is also present. The traversing\nright S1 nerve root appears impinged and deformed in the subarticular zone. \nThe traversing left S1 nerve root is contacted by the disc herniation without\ndefinite impingement. The thecal sac is moderately narrowed, less than in\n___, and the intrathecal nerve roots are no longer crowded. There is\nno significant neural foraminal narrowing.", "output": "1. The previously noted central L5-S1 disc herniation, extending further to\nthe right than left, has decreased in size since ___. It continues to\nimpinge the traversing right S1 nerve root in the subarticular zone, and it\ncontinues to contact the traversing left S1 nerve root without definite\nimpingement. The thecal sac is moderately narrowed, less than in ___,\nwith resolution of intrathecal nerve root crowding. Minimal retrolisthesis of\nL5 on S1 is unchanged.\n2. No new abnormalities are seen in the lumbar spine. From T11-T12 through\nL4-L5, there is no spinal canal narrowing, neural foraminal narrowing, or\nevidence for neural impingement." }, { "input": "Motion artifact limits evaluation.\n\nVertebral body heights are preserved. Alignment is normal. No concerning\nbone marrow signal abnormalities are seen. No evidence for an enhancing mass.\n\nThere is a tiny syrinx from C6-C7 through C7-T1 level, up to 1.3 mm in\ndiameter, without contrast enhancement. No cord expansion at this level. No\nother cord signal abnormalities.\n\nThe cerebellar tonsils are normally positioned. Visualized portion of the\nposterior fossa appears unremarkable.\n\nC2-C3: No spinal canal or neural foraminal narrowing. Mild right and\nmild-to-moderate left facet arthropathy.\n\nC3-C4: No spinal canal narrowing. Mild left neural foraminal narrowing by\nuncovertebral osteophytes.\n\nC4-C5: No spinal canal narrowing. Mild left neural foraminal narrowing by\nuncovertebral and facet osteophytes. Mild right facet arthropathy without\nsignificant neural foraminal narrowing.\n\nC5-C6: No spinal canal narrowing. Mild-to-moderate left neural foraminal\nnarrowing by uncovertebral and facet osteophytes. Mild right facet\narthropathy without significant neural foraminal narrowing.\n\nC6-C7: No spinal canal narrowing. Small bilateral uncovertebral osteophytes\nand mild facet arthropathy with minimal bilateral neural foraminal narrowing.\n\nC7-T1: No spinal canal or neural foraminal narrowing.", "output": "1. Tiny syrinx from C6-C7 through C7-T1 levels, up to 1.3 mm in diameter,\nwithout associated cord expansion or contrast enhancement.\n2. Mild-to-moderate left neural foraminal narrowing at C2-C3 and at C5-C6. \nMild neural foraminal narrowing at several other levels, as described above." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nVertebral body heights and alignment are maintained. There is minimal edema\nwithin the right inferior L3 and right superior L4 vertebral body endplates.\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThere is loss of intervertebral disc height and signal at the L3-4, and L5-S1\nlevels.\n\nAt T12-L1, L1-2 at L2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt L3-4 within the right neural foramen there is a T2, stir, and T1\nhypointense soft tissue structure measuring up to 5 x 9 mm involving the right\nL3 nerve roots (see series 5 images ___ and series 2, 3, and 6 images ___. \nThere is also at this level, a disc bulge resulting in mild spinal canal and\nmoderate bilateral neural foraminal stenosis.\n\nAt L4-5 there a disc bulge with facet joint arthropathy and ligamentum flavum\nhypertrophy resulting in moderate spinal canal and moderate bilateral neural\nforaminal stenosis.\n\nAt L5-S1 there is a central disc protrusion with ligamentum flavum hypertrophy\nand facet joint arthropathy resulting in mild spinal canal and moderate\nbilateral neural foraminal stenosis.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.\n\n Within the limits of this noncontrast study there is no evidence of infection\nor neoplasm. The visualized portion of the sacroiliac joints are preserved.", "output": "1. Approximately 5 x 9 mm nonspecific right L3 neural foraminal nerve root\nsoft tissue mass. While differential considerations include schwannoma, other\netiologies cannot be excluded on the basis of this noncontrast examination.\nRecommend clinical correlation and correlation with dedicated\ncontrast-enhanced lumbar MRI.\n2. Multilevel degenerative changes as described, that include L3-4, L4-5, and\nL5-S1 moderate bilateral neural foraminal stenosis.\n3. L4-5 level moderate spinal canal stenosis.\n\nRECOMMENDATION(S): Recommend clinical correlation and correlation with\ndedicated contrast-enhanced lumbar MRI." }, { "input": "The previously seen small soft tissue abnormality within the right lateral\nrecess of L4 is again identified and appears slightly smaller than the\nprevious study. There is peripheral enhancement identified. These findings are\nconsistent with disc herniation at L3-4 level and extending inferiorly with\nsurrounding epidural enhancement.\n\nDegenerative changes at other levels are again identified and essentially\nunchanged.", "output": "The soft tissue abnormality in the right lateral recess of L4 extending\ntowards right L3-4 neural foramen does not demonstrate any intrinsic\nenhancement but shows peripheral enhancement consistent with a disk herniation\nwith surrounding granulation tissue. The disk herniation appears slightly\nsmaller than the previous study. The appearance is not typical for a\nschwannoma. Otherwise the examination is unchanged." }, { "input": "Study is mildly degraded by motion. For the purposes of numbering, the lowest\nrib bearing vertebral body was designated the T12 level.\n\n There is approximately 4 mm L5 on S1 grade 1 retrolisthesis. There is\ntransitional anatomy with partial lumbarization of S1. Vertebral body heights\nare preserved. L4-5 and L5-S1 endplate Schmorl's nodes are seen. L5-S1 type\n___ ___ changes are present. And L2 through L5 vertebral bodies are suggested\ncongenitally short pedicles.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of intervertebral disc height and signal at L4-5 and L5-S1. \nOtherwise, intervertebral discheightsandsignalare preserved.\n\nAt T12-L1 there is with no vertebral canal and no neural foraminal narrowing.\n\nAt L1-2 there is suggested congenitally short pedicles, epidural fat, with\nmild vertebral canal and no neural foraminal narrowing.\n\nAt L2-3 there is suggested congenitally short pedicles, epidural fat, with\nmild vertebral canal and no neural foraminal narrowing.\n\nAt L3-4 there is suggested congenitally short pedicles, epidural fat, with\nmild vertebral canal and no neural foraminal narrowing.\n\nAt L4-5 there is suggested congenitally short pedicles, disc bulge with\nannular fissure, facet hypertrophy, epidural fat, with\nmild-to-moderatevertebral canal and no neural foraminal narrowing. Nonspecific\nbilateral facet joint fluid is noted.\n\nAt L5-S1 there is suggested congenitally short pedicles, disc bulge which\ncontacts exiting right L5 and descending right S1 nerve roots, right\nparacentral disc protrusion at position of previously noted right paracentral\ndisc extrusion (see 5: 35-37 on current study and ___ on prior lumbar\nspine MRI), Facet joint hypertrophy, with moderate to severevertebral canal\nand mild bilateral neural foraminal narrowing. Nonspecific bilateral facet\njoint fluid is noted.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is mildly degraded by motion.\n2. Transitional anatomy with partial lumbarization of S1.\n3. Suggested congenitally short pedicles at L2 through L5 levels contributing\nto vertebral canal narrowing at L1-2 through L5-S1 as described.\n4. Multilevel lumbar spondylosis as described, most pronounced at L5-S1, where\nthere is disc bulge which contacts the exiting right L5 and descending right\nS1 nerve roots, with moderate to severe vertebral canal and mild bilateral\nneural foraminal narrowing.\n5. L5-S1 right paracentral disc protrusion in position of previously noted\nL5-S1 right paracentral disc extrusion." }, { "input": "Alignment is normal. There is T1/T2 hypointense signal in the L4 and L5\nvertebral bodies, consistent with vertebroplasty changes. Interval increased\nSTIR signal is noted at the inferior endplate of L2 and L3, consistent with\n___ type 1 endplate changes. There is diffuse hypo intense signal\nthroughout the discs, consistent with degeneration. The spinal cord appears\nnormal in caliber and configuration. L2-L5 laminectomy changes are seen. \nSTIR Hyperintense signal is noted in the lumbar paraspinal musculature, likely\nrelated to prior surgery.\n\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is no spinal canal or neural foraminal stenosis.\n\nAt L2-3 there is a stable disc bulge resulting in mild spinal canal stenosis\nand no significant neural foraminal stenosis.\n\nAt L3-4 there is a stable disc bulge and facet arthropathy resulting in mild\nspinal canal stenosis, severe right and moderate left neural foraminal\nstenosis.\n\nAt L4-5 there is a stabledisc bulge and facet arthropathy resulting in mild\nspinal canal stenosis and severe left, moderate right neural foraminal\nstenosis.\n\nAt L5-S1 there is a stable disc bulge and facet arthropathy resulting in mild\nspinal canal stenosis and moderate bilateral neural foraminal stenosis.\n\nThere is no abnormal enhancement after contrast min", "output": "1. Postlaminectomy changes from L2-L5 and vertebroplasty changes at L4-L5.\n2. Stable mild spinal canal stenosis, severe right neuroforaminal stenosis and\nmoderate left neural foraminal stenosis at L3-L4 secondary to a disc bulge and\nfacet arthropathy.\n3. Stable mild spinal canal stenosis, severe left and moderate right neural\nforaminal stenosis at L4-L5 secondary to disc bulge and facet arthropathy.\n4. Stable mild spinal canal stenosis, moderate right and severe left neural\nforaminal stenosis at L5-S1 secondary to disc bulge and facet arthropathy.\n5. STIR hyperintense signal in the lumbar paraspinal muscular, likely related\nto prior surgery." }, { "input": "Spine labeling has been provided on series 3, image 8. There is mild\nstraightening of the normal cervical lordosis. No acute fracture or traumatic\nsubluxation is seen. There is no prevertebral soft tissue swelling. Vertebral\nbody and intervertebral disc signal intensity appear normal. The spinal cord\nappears normal in caliber and configuration. Moderate degenerative changes\nare seen throughout the cervical spine.\n\nC2/C3: No significant degenerative changes are seen at this level. There is\nno neural foraminal narrowing.\n\nC3/C4: There is minimal intervertebral disc bulge however no significant\nthecal sac or neural foraminal narrowing.\n\nC4/C5: There is mild right paracentral disc bulge, with mild spinal canal\nnarrowing and slight mass effect on the ventral cord. No definite underlying\ncord signal abnormality is identified. There is mild right neural foraminal\nnarrowing.\n\nC5/C6: There is mild left paracentral disc bulge, with minimal thecal sac\nnarrowing and mild left neural foraminal narrowing. No underlying cord signal\nabnormalities identified.\n\nC6/C7: There is moderate broad-based intervertebral disc bulge, with thecal\nsac narrowing and mass effect on the ventral cord. No underlying cord signal\nabnormality is seen. There is moderate right and mild left neural foraminal\nnarrowing.\n\nC7/T1: No significant degenerative changes are seen at this level.\n\nThe visualized base of the brain is unremarkable.", "output": "1. No acute fracture or traumatic subluxation.\n\n2. Moderate degenerative changes throughout the cervical spine worst at C6/C7\nwith moderate broad-based intervertebral disc bulge and mass effect on the\nventral cord. Moderate right and mild left neural foraminal narrowing at this\nlevel." }, { "input": "There are 7 cervical and 12 rib-bearing thoracic type vertebrae, as seen on\nthe prior studies.\n\nCERVICAL:\nStatus post ACDF from C4 through C7. The hardware is not assessed by MRI;\nplease refer to the concurrent CT report. Hardware related artifact limits\nevaluation of bone marrow signal and vertebral body heights at surgical\nlevels. C3 vertebral body height is preserved. Visualized bone marrow signal\nis unremarkable. Allowing for posterior endplate osteophytes at C6-C7, there\nis no evidence for spondylolisthesis.\n\nThe cerebellar tonsils are normally positioned. Visualized posterior fossa is\nunremarkable.\n\nAllowing for hardware related artifacts and some motion artifact, no evidence\nfor spinal cord signal abnormalities is seen.\n\nC2-C3: Small central disc protrusion indents the ventral thecal sac without\nspinal cord contact. Mild right neural foraminal narrowing by uncovertebral\nand facet osteophytes. No change since the ___ MRI.\n\nC3-C4: Left paracentral disc protrusion moderately narrows the spinal canal\nand mildly remodels the left ventral spinal cord, increased compared to ___. Moderate bilateral neural foraminal narrowing by uncovertebral and\nfacet osteophytes, not significantly changed.\n\nC4-C5: Right greater than left posterior endplate osteophytes mildly narrow\nthe spinal canal without evidence for spinal cord contact, compared to spinal\ncord remodeling on the ___ MRI. Moderate bilateral neural foraminal\nnarrowing by uncovertebral and facet osteophytes, unchanged.\n\nC5-C6: Left paracentral osteophytes moderately narrow the spinal canal with\nventral cord remodeling. Moderate to severe, left greater than right neural\nforaminal narrowing by uncovertebral and facet osteophytes. No change since\nthe ___ MRI.\n\nC6-C7: Posterior endplate osteophytes moderately to severely narrow the spinal\ncanal with spinal cord remodeling, compared to severe narrowing on the ___ MRI. Moderate to severe right and severe left neural foraminal narrowing\nby uncovertebral and facet osteophytes, unchanged.\n\nC7-T1: No spinal canal narrowing. Moderate right and mild-to-moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes, unchanged.\n\nTHORACIC:\nStatus post laminectomies at T7, T8, and T9, and instrumented posterior fusion\nwith bilateral screws at T7 and T9. The hardware is not assessed by MRI;\nplease refer to the concurrent thoracic spine CT for further detail. Mild\nanterior wedging of T7 and T8 has slightly progressed compared to the ___ MRI. Mild T11 superior endplate deformity, in part related to or\nSchmorl's node, is unchanged. Where not obscured by hardware related\nartifact, no suspicious bone marrow signal abnormalities are seen. Scattered\nhemangiomas are again seen, for example within T3 and T12 vertebral bodies. \nNo subluxation.\n\nEvaluation of spinal cord signal is limited by artifacts related to the\nhardware, motion, and the large field of view. Faintly elevated T2 signal\nwithin the cord at the level of T7-T8 cannot be excluded, similar to the ___ MRI. The conus medullaris terminates at T12. No pathologic contrast\nenhancement is seen.\n\nT1-T2: Central/left paracentral disc herniation indents the ventral thecal sac\nwithout spinal cord contact, similar to the ___ MRI.\n\nT2-T3: Central disc herniation indents the ventral thecal sac without spinal\ncord contact, similar to the ___ MRI.\n\nT5-T6: Central disc herniation indents the ventral thecal sac without spinal\ncord contact, similar to the ___ MRI.\n\nT6-T7: Hardware related artifacts limit evaluation. A disc bulge appears\npresent without evidence for significant spinal canal narrowing, similar to\nthe ___ MRI.\n\nT7-T8: There are large left paracentral endplate osteophytes, causing mild to\nmoderate narrowing of the thecal sac and slight rightward displacement of the\nspinal cord, with mild left ventrolateral cord deformity. Faintly elevated T2\nsignal within the cord at this level cannot be excluded, though evaluation is\nlimited by artifacts, similar to ___, as stated above. On the prior\nMRI, there was a broad-based, rather than left paracentral endplate osteophyte\nridge compressing the cord at this level.\n\nT9-T10, T10-T11: Mild disc bulge without significant spinal canal narrowing.\nNo change since the prior MRI.\n\nT11-T12: Mild disc bulge plus/minus shallow left paracentral disc protrusion. \nNo significant spinal canal narrowing. No change since the prior MRI.\n\nT12-L1: Left paracentral disc protrusion contacts the traversing left L1 nerve\nroot in the subarticular zone, slightly more conspicuous than on the ___ MRI. No significant thecal sac narrowing.\n\nL1-L2: Mild disc bulge and facet arthropathy without significant spinal canal\nor neural foraminal narrowing. This level was not included on the ___\nthoracic spine MRI.\n\nL2-L3: Disc bulge and facet arthropathy cause narrowing of the subarticular\nzones with contact of bilateral traversing L3 nerve roots, as well as minimal\nbilateral neural foraminal narrowing. This level was not included on the\n___ thoracic spine MRI.\n\nOTHER:\nSubcentimeter T2 hyperintense, T1 hypointense focus in the left kidney on\nimages 15:24 and 18:22 is not fully characterized but statistically likely a\ncyst.", "output": "CERVICAL SPINE:\n\n1. Status post ACDF at C4-C7.\n2. C3-C4: Moderate spinal canal narrowing with mild remodeling of the left\nventral spinal cord, increased compared to the ___ MRI.\n3. C4-C5: Mild spinal canal narrowing without evidence for spinal cord\ncontact, compared to prior spinal cord remodeling on the ___ MRI.\n4. C5-C6: Moderate spinal canal narrowing with ventral cord remodeling,\nunchanged.\n5. Moderate to severe spinal canal narrowing with spinal cord remodeling,\ncompared to prior severe narrowing on the ___ MRI.\n6. No evidence for cervical spinal cord signal abnormalities.\n7. Multilevel neural foraminal narrowing is unchanged.\nTHORACIC SPINE:\n\n1. S/p laminectomies and posterior fusion of T7-T9.\n2. Large left paracentral endplate osteophytes cause mild to moderate\nnarrowing of the thecal sac and slight rightward displacement of the spinal\ncord, with mild left ventrolateral cord deformity. Faintly elevated T2 signal\nwithin the cord at this level cannot be excluded, though evaluation is limited\nby artifacts, similar to ___. On the prior MRI, there was a\nbroad-based, rather than left paracentral endplate osteophyte ridge\ncompressing the cord at this level.\n3. Mild spinal canal narrowing by disc protrusions and disc bulges without\nspinal cord contact at several other thoracic levels, unchanged. Also\ndegenerative changes in the included upper lumbar spine, not imaged\npreviously." }, { "input": "There is a mild levoconvex lumbar scoliosis. Vertebral body alignment is\notherwise preserved.\n\nThere is transitional anatomy at the lumbosacral junction with lumbarization\nof S1. The lowest well-formed intervertebral disc is designated as S1-2.\n\nThere are chronic compression deformities of the L5 and S1 vertebral bodies.\n\nThere is an acute to subacute compression deformity of the superior endplate\nof the L1 vertebral body, with minimal loss of height.\n\nThere may is mild reactive change at the right T12 costovertebral junction\n(series 4, image 17).\n\nNo suspicious bone marrow signal abnormality is identified.\n\nThe conus medullaris terminates at the L1 level. The conus medullaris and\ncauda equina appear normal in morphology and signal intensity.\n\nThere is multilevel degenerative disc disease, without spinal canal narrowing.\n\nAt L4-5, there is right subarticular zone narrowing due to a disc bulge and\nhypertrophied facet, without impingement on the traversing right L5 nerve\nroot. There is mild right neural foraminal narrowing.\n\nAt L5-S1, there is right subarticular zone narrowing due to a disc bulge and\nhypertrophied facet, without impingement on the traversing right S1 nerve\nroot. There is mild bilateral neural foraminal narrowing.\n\nAt S1-2, there is mild right neural foraminal narrowing due to facet\nhypertrophy.\n\nThere is a simple exophytic right renal cyst. The prevertebral and paraspinal\nsoft tissues are otherwise unremarkable.", "output": "1. Probable acute to subacute compression fracture of the superior endplate of\nL1, with minimal loss of height.\n2. Mild cervical degenerative disc disease, without spinal canal narrowing or\ndefinite nerve root impingement.\n3. Chronic compression deformities of the L5 and S1 vertebral bodies. Please\nnote that there is transitional anatomy at the lumbosacral junction. The\nlowest well-formed intervertebral disc is designated as S1-2." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThere is no marrow signal abnormality. The visualized portion of the spinal\ncord is preserved in signal and caliber. There is mild degenerative disc\nsignal in the lower cervical and upper thoracic spine. Within the limits of\nthis noncontrast study there is no evidence of infection or neoplasm. There is\nno prevertebral soft tissue swelling.. The visualized portion of the are\nunremarkable.\n\n\nAt C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is there is a mild disc bulge with a superimposed central\nprotrusion with slight indentation of the anterior surface of the spinal cord.\nThere is no neural foraminal stenosis.\n\nAt C4-5 there is no spinal canal or neural foraminal stenosis.\n\nAt C5-6 there is no spinal canal or neural foraminal stenosis.\n\nAt 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": "Mild multilevel degenerative changes, with a midline disc protrusion slightly\nindenting the spinal cord at C3-4. No other neural foraminal or spinal canal\nstenosis." }, { "input": "Alignment is normal. There are ___ type 2 signal intensity changes of the\nvertebral endplates at L5-S1. There is loss of signal of the intervertebral\ndiscs on the T2 weighted images due to degenerative disease. This is most\nmarked at L3-4 and at L5-S1. There is loss of height of the intervertebral\ndiscs at L3-4 and L5-S1. No intradural lesions are detected. The spinal cord\nappears normal in caliber and configuration and ends at L1. Axial imaging\nfrom T11-L3 demonstrates facet osteophytes but no encroachment on the spinal\ncanal or neural foramina.\nAt L3-4, bulging of the disc, intervertebral osteophytes, ligamentum flavum\nthickening and facet osteophytes produce moderate spinal canal narrowing. The\ntraversing L4 nerve roots may be compressed between the disc and the superior\nfacet osteophytes. There is mild bilateral neural foraminal narrowing.\nAt L4-5, minimal bulging of the disc along with facet osteophytes and\nligamentum flavum thickening produces mild spinal canal narrowing. The\ntraversing L5 roots may be compressed between the superior facet osteophytes\nand the disc bulge. There is mild neural foraminal narrowing. There is a\nright-sided foraminal and extraforaminal annular fissure peer\nAt L5-S1, loss of disc height and facet osteophytes produce bilateral neural\nforaminal narrowing. There is no spinal canal narrowing and no evidence of\nnerve root compression.\nAn 8 mm apparently cystic structure in the upper portion of the right kidney\nis incompletely visualized but may represent a simple cyst.", "output": "1. Degenerative disc disease most marked at L3-4 where there is moderate\nspinal canal narrowing and likely compromise of the traversing L4 nerve roots\nbilaterally." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is grade 1 L5 on S1 retrolisthesis. Vertebral body heights are\npreserved. Type ___ ___ changes are noted at the endplates of L5-S1 with\nSchmorl's nodes in the L5 inferior endplate. Allowing for differences in\ntechnique, finding is grossly stable the slightly increased compared to prior\nCT abdomen and pelvis exam. The visualized portion of the spinal cord is\npreserved in signal and caliber.\n\nThere is near complete loss of intervertebral disc height and signal at L5-S1,\nwith a annular fissure noted.\n\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal stenosis.\n\nAt L1-2 there is no vertebral canal or neural foraminal stenosis.\n\nAt L2-3 there is no vertebral canal or neural foraminal stenosis.\n\nAt L3-4 there is no vertebral canal or neural foraminal stenosis.\n\nAt L4-5 there is no vertebral canal or neural foraminal stenosis.\n\nAt L5-S1 there is disc bulge and facet joint arthropathy resulting in moderate\nright and severe left neural foraminal stenosis withno vertebral canal\nstenosis.", "output": "Degenerative changes at L5-S1 level as described, including disc bulge, and\ngrade 1 retrolisthesis of L5 on S1, moderate right and severe left neural\nforaminal stenosis." }, { "input": "Cervical spine alignment is maintained. Vertebral body heights are preserved.\nThere is diffuse cervical disc degeneration. Bone marrow signal is\nheterogeneous without focal suspicious abnormality.\n\nThe cervical cord is normal in signal intensity. There is no evidence for\nligamentous injury.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing present.\n\nC3-C4: There is a broad-based disc protrusion which minimally effaces the\nventral subarachnoid space. There is mild left neural foraminal narrowing\nsecondary to uncovertebral and facet osteophytes. The right neural foramen is\npatent.\n\nC4-C5: A broad-based disc protrusion effaces the ventral subarachnoid space\ncausing mild narrowing of the spinal canal along with ligamentum flavum\nthickening. There is mild left neural foraminal narrowing secondary to\nuncovertebral and facet osteophytes. The right neural foramen is patent.\n\nC5-C6: A broad-based disc protrusion effaces the ventral subarachnoid space\nwithout significant narrowing of the spinal canal. There is mild to moderate\nleft neural foraminal narrowing secondary to uncovertebral and facet\nosteophytes, and the right neural foramen is mildly narrowed.\n\nC6-C7: A shallow disc protrusion is present without significant spinal canal\nor neural foraminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nThere is soft tissue prominence at the tongue base.", "output": "1. No evidence for acute cervical spine injury.\n2. Multilevel cervical spine degenerative changes without high-grade spinal\ncanal or neural foraminal narrowing. No cord compression or signal abnormality\nis present.\n3. Soft tissue prominence at the tongue base. Direct inspection is\nrecommended." }, { "input": "The patient is status post right sacroiliac joint fixation with cannulated\nscrews. Metallic artifact results in suboptimal evaluation of the adjacent\nstructures.\n\nThere is dextroconvex curvature of the lumbar spine with apex at L1-L2. 2 mm\nretrolisthesis of L1 on L2 and 3 mm retrolisthesis of L2 on L3 is identified. \nProminent ___ type 2 L1-L2 endplate changes are identified. The remainder\nof the marrow signal is grossly unremarkable. No suspicious marrow lesions\nare noted. L1 and L4 superior endplate Schmorl's nodes are identified. \nDegenerative loss of disc height and signal is severe at L1-L2, moderate to\nsevere at L2-L3 and L3-L4. The conus medullaris terminates at the L1 level,\nwithin expected limits. There is no signal abnormality of the visualized\nterminal cord or conus medullaris.\n\nT11-T12: Unremarkable.\n\nT12-L1: A left central to foraminal zone protrusion does not narrow the\nspinal canal. The this results in mild left and no significant right neural\nforaminal narrowing.\n\nL2-L3: A disc bulge and retrolisthesis does not significantly narrow the\nspinal canal. In conjunction with facet arthropathy, there is moderate right\nand mild left neural foraminal narrowing. Moderate left facet joint effusion\nis identified.\n\nL3-L4: A small disc bulge does not significantly narrow the spinal canal. \nThere is mild right and no significant left neural foraminal narrowing.\n\nL4-L5: A central to left foraminal zone disc protrusion in combination with\nepidural fat results in mild spinal canal narrowing. The degenerative changes\nincluding facet arthropathy results in mild left neural foraminal narrowing. \nA large 1 cm cystic structure in the right foraminal to extraforaminal zone\nappears to be closely associated with the right facet, potentially\nrepresenting a synovial cyst, which exerts mass effect and impinges on the\nexiting right L4 nerve root (series 7, image 8 ; series 5, image 14). There\nare large bilateral facet joint effusions.\n\nL5-S1: Allowing for metallic artifact, no significant spinal canal or neural\nforaminal narrowing.\n\n\nThe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Multilevel degenerative changes as described above. The findings are most\nprominent at L4-L5 where a 1 cm cystic structure at the right foraminal to\nextraforaminal zone appears to be closely associated with the right facet. \nThe cystic structure likely impinges on the exiting right L4 nerve root\n(series 7, image 8).\n2. This is felt to most likely represent a synovial cyst from adjacent facet\narthropathy. Alternatively this could represent a perineural cyst although\nconsidered much less likely.\n3. Additional findings as described above." }, { "input": "The coronal scout images re-demonstrated moderate, mid-lumbar levo- scoliotic\ncurvature of the mid-lumbar spine.\n\nComparison with the prior lumbar spine MRI scan re-demonstrates extensive\nmultilevel degenerative changes involving the lower thoracic and lumbar spine.\nPlease refer to Dr. ___ prior report for these observations. \nHowever, I believe that the degenerative endplate changes on either side of\nthe L1-2 disc are of the type 1 variety.\n\nRegarding the suspected cyst within the region of the right L4-5 neural\nforamen, this finding is difficult to identify on the present study. There is\ncontinued demonstration of extensive bilateral facet joint degenerative\ndisease at this interspace, with accompanying moderate right and milder\nleft-sided thickening of the ligamentum flavum.\n\nOnce again, evaluation of the L5-S1 region is hampered by extensive metallic\nartifacts which arise from two, large, right-sided screws. The screws are\ndepicted on the AP scout radiograph of an abdominal/pelvic CT scan from ___. There is no definite new abnormality identified at this\ninterspace, or involving the distal spinal cord, conus medullaris, cauda\nequina or limited lumbar paraspinal soft tissue imaging, either.", "output": "Probable interval regression of previously suspected cyst of degenerative\norigin within the right L4-5 neural foramen. Please see above report for\nadditional observations." }, { "input": "CERVICAL:\nThere is 2 mm retrolisthesis of C4 on C5. Sagittal alignment is otherwise\nmaintained. There are post radiation marrow signal changes with striking high\nsignal intensity on the T1 weighted images. There is multilevel disc\ndesiccation with loss of intervertebral disc height primarily at C4-C5 and\nC5-C6. There are degenerative marrow signal changes along the endplates at\nC4-C5.The spinal cord appears normal in caliber and signal intensity.There is\nleptomeningeal enhancement.\n\nC2-C3: No spinal canal or neural foraminal stenosis.\nC3-C4: Intervertebral osteophytes produce minimal flattening of the ventral\nspinal cord. Uncovertebral and facet joint osteophytes result in moderate\nleft neural foraminal narrowing.\nC4-C5: Subluxation, posterior disc protrusion, endplate osteophytes and\nligamentum flavum thickening results in severe narrowing of the spinal canal\nwith complete effacement of the CSF space and associated cord deformity\nwithout definite spinal cord signal abnormality. Uncovertebral and facet\njoint osteophytes contribute to severe right and moderate to severe left\nneural foraminal narrowing.\nC5-C6: Right paracentral disc protrusion, endplate osteophytes and ligamentum\nflavum thickening results in moderate to severe narrowing of the spinal canal\nwith associated flattening of the spinal cord. Uncovertebral and facet joint\nosteophytes contribute to severe right and moderate left neural foraminal\nstenosis.\nC6-C7: Posterior disc bulge and ligamentum flavum thickening results in\nmoderate narrowing of the spinal canal with mild flattening of the spinal\ncord. Uncovertebral and facet joint osteophytes contribute to severe left and\nmoderate right neural foraminal stenosis.\nC7-T1: No significant spinal canal or neural foraminal stenosis.\n\nTHORACIC:\nThere is nodular leptomeningeal enhancement along the margins of the lower\nspinal cord.\n\nAlignment is normal. There are post radiation marrow signal changes a\nstriking high-signal intensity on the T1 weighted images. There is diffuse\ndisc desiccation with loss of intervertebral disc height.The spinal cord\nappears normal in caliber and configuration. There is a small posterior disc\nbulge and ligamentum flavum thickening at T10-T11, T11-T12 and T12-L1 without\nspinal canal or neural foraminal stenosis. There is no evidence of spinal\ncanal or neural foraminal narrowing at the remaining levels.\n\nLUMBAR:\nThere is nodular leptomeningeal enhancement along the roots of the cauda\nequina and the margins of the spinal cord.\n\nThere is transitional lumbosacral anatomy with lumbarization of S1. There is\n2 mm retrolisthesis of T12 on L1 and 2 mm anterolisthesis of L4 on L5. \nSagittal alignment is otherwise maintained.There is diffuse disc desiccation\nand loss of intervertebral disc height.The spinal cord appears normal in\ncaliber and configuration.There is nodular leptomeningeal enhancement along\nthe conus medullaris and cauda equina nerve roots.\n\nL1-L2, L2-L3 and L3-L4: Diffuse disc bulge, ligamentum flavum thickening and\nfacet joint hypertrophy without spinal canal or neural foraminal stenosis.\nL4-L5: Diffuse disc bulge contacting the traversing nerve roots, ligamentum\nflavum thickening and facet joint hypertrophy results in mild bilateral neural\nforaminal narrowing without spinal canal stenosis.\nL5-S1: No spinal canal or neural foraminal stenosis.\n\nOTHER: There is redemonstration of a loculated right-sided pleural effusion\nand partially visualized right lung lesion, better characterized on the prior\nCT chest. There is diffuse esophageal wall thickening. An aberrant right\nsubclavian artery is noted. Multiple cystic and solid thyroid nodules are\npartially visualized. Cystic lesions are noted in the kidneys.", "output": "1. Diffuse nodular leptomeningeal enhancement along the spinal cord and cauda\nequina nerve roots concerning for metastatic disease.\n2. Multilevel spondylosis, most pronounced in the cervical spine where there\nis severe spinal canal stenosis at C4-C5 and C5-C6 resulting in cord deformity\nand severe neural foraminal stenosis as detailed above. No cord signal\nabnormality.\n3. Partially visualized loculated right pleural effusion and right lung\nlesions, better evaluated on the dedicated CT chest from ___.\n4. Diffuse esophageal wall thickening and multiple large thyroid nodules\nmeasuring up to 3 cm along the left thyroid lobe.\n5. Bilateral renal cystic lesions.\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):115___\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 9:24 am, 10 minutes after\ndiscovery of the findings." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n For 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. there is levoscoliosis of the\nlumbar spine.\n\n Vertebral body heights are preserved. There are type ___ ___ changes at\nL4-5. Schmorl's nodes are seen at multiple levels of the visualized\nthoracolumbar spine.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThe conus medullaris terminates at L1-2.\n\nThere is loss of the normal intervertebral disc height and signal intensity\nthroughout the lumbar spine, most pronounced at L1-2, L3-4 and L4-5.\nNonspecific facet joint fluid is noted at multiple levels of the lumbar spine.\n\nAt T12-L1 there is facet joint hypertrophy, ligamentum flavum thickening, with\nno vertebral canaland no neural foraminal narrowing.\n\nAt L1-2 there is left paracentral disc protrusion, facet joint hypertrophy,\nligamentum flavum thickening, epidural fat, with mild vertebral canaland no \nneural foraminal narrowing.\n\nAt L2-3 there is facet joint hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild vertebral canaland mild bilateral neural foraminal\nnarrowing.\n\nAt L3-4 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, with severe vertebral canaland moderate bilateral neural\nforaminal narrowing. Overall, this appears progressed compared to ___ but\nsimilar to ___ given the differences in modality. Question\nminimal nonspecific epidural enhancing tissue adjacent to the left facet joint\nand left lateral epidural space versus artifact (see 5, 6, 08:23; 201:22; 3,\n4, 07:11).\n\nAt L4-5 there is grade 1 L4 on L5 anterolisthesis, facet joint hypertrophy,\nligamentum flavum thickening, epidural fat, with severe vertebral canal, mild\nleft and severe right neural foraminal narrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with moderate vertebral canal and mild bilateral neural\nforaminal narrowing.\n\nOTHER:\nThe left kidney is atrophic, as before.\n\nNonspecific soft tissue in the retroperitoneum is redemonstrated, better\nevaluated on ___ CT abdomen and pelvis.\n\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.\n\nOn limited imaging of pelvis, question nonspecific edema of left iliac bone\nversus artifact (see 21:18; 3, 4:8).", "output": "1. Study is moderately degraded by motion.\n2. Interval progression of multilevel lumbar spondylosis and epidural fat\ncompared to ___ prior abdomen MRI, allowing for difference in technique, as\ndescribed, most pronounced at L3-4, where there is severe vertebral canal and\nmoderate bilateral neural foraminal narrowing.\n3. L4-5 severe vertebral canal, mild left and severe right neural foraminal\nnarrowing.\n4. Question minimal nonspecific epidural enhancing tissue adjacent to the left\nfacet joint and left lateral epidural space versus artifact. While findings\nmay be degenerative, neoplastic etiologies not excluded on the basis of this\nexamination. Recommend attention on follow-up imaging.\n5. Soft tissue in the retroperitoneum, compatible with provided history of\nlymphoma, better demonstrated on ___ CT abdomen and pelvis.\n6. On limited imaging of pelvis, question nonspecific edema of left iliac bone\nversus artifact. If concern for nondisplaced sacral fracture, consider\ndedicated sacral MRI for further evaluation.\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 preliminary read findings were discussed with ___\n___, N.P. by ___, M.D. on the telephone on ___ at 8:54 am, 5\nminutes after discovery of the findings.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 12:55 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Grade 1 anterolisthesis of L4 on L5 is unchanged. Type ___ ___ changes are\nsimilar at L4-5. Similar extent of degenerative intervertebral disc signal is\npresent throughout the lumbar spine, most pronounced at L4-5. The image\nspinal cord is normal in caliber and configuration, and the conus medullaris\nterminates at L1-2.\n\nT12-L1: Facet and ligamentum flavum thickening. No canal or neural foraminal\nnarrowing.\n\nL1-2: Small left-sided disc protrusion, facet osteophytes and ligamentum\nflavum thickening resulting in mild canal narrowing. Disc likely contacts the\ntraversing left L2 nerve root. There is no neural foraminal narrowing. \nUnchanged.\n\nL2-3: Facet and ligamentum flavum thickening resulting in mild canal\nnarrowing. Mild left and no right neural foraminal narrowing. Unchanged.\n\nL3-4: Disc bulge, with a protrusion extending superiorly along the posterior\nmargin of the L3 vertebral body, facet osteophytes, and ligamentum flavum\nthickening result in severe canal narrowing, unchanged from prior. There is\nalso severe bilateral neural foraminal narrowing, unchanged. Previously seen\nepidural enhancing tissue adjacent to the facet joint is not as well\nappreciated given the absence of intravenous contrast. There is trace fluid\nin the left greater than right facet joint, likely related to degenerative\ndisease.\n\nL4-5: Grade 1 anterolisthesis, disc bulge, facet osteophytes and ligamentum\nflavum thickening resulting in severe canal narrowing is unchanged. Severe\nright and mild left neural foraminal narrowing unchanged.\n\nL5-S1: Disc bulge, facet hypertrophy and ligamentum flavum thickening\nresulting in an mild canal narrowing and mild bilateral neural foraminal\nnarrowing.\n\nOther: The left kidney remains atrophic. Similar retroperitoneal soft tissue,\nbetter evaluated on CT abdomen and pelvis ___. Increased\nprobable dependent edema in the dorsal soft tissues. The left sacral T1\nhypointense, at T2 and water ideal hyperintense enhancing focus appears\nunchanged on the current examination, although no contrast was administered\nthis study. Given the history of lymphoma, this may represent a sign of bone\nmarrow involvement.", "output": "1. No interval change in multilevel lumbar spine degenerative disease compared\nto ___, including severe canal narrowing at L3-4 and L4-5.\n2. Unchanged severe neural foraminal narrowing bilaterally at L3-4 and on the\nright at L4-5.\n3. Question of soft tissue adjacent to the left L3-4 facet joint is not as\nwell appreciated on this study, given the absence of intravenous contrast. \nTrace fluid in the left greater than right facet joint is likely related to\ndegenerative disease.\n4. Unchanged retroperitoneal soft tissue, better assessed on CT abdomen and\npelvis dated ___.\n5. Unchanged increased T2/stir signal in the left hemi sacrum, perhaps\nreflecting bone marrow involvement with lymphoma.\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": "Evaluation is limited by motion artifact.\n\nTHORACIC:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and\nconfiguration.There is no evidence of spinal canal narrowing. There is\nmoderate right T8-T9 neural foraminal stenosis secondary to foraminal zone\ndisc protrusion and facet hypertrophy (7:26).There is no evidence of infection\nor neoplasm. There is no abnormal enhancement after contrast administration.\n\nLUMBAR:\nThere is grade 1 anterolisthesis of L4 on L5, with ___ type 2 endplate\nchanges and loss of intervertebral disc space height. Otherwise, vertebral\nbody and intervertebral disc signal intensity appear normal.There is no\nabnormal enhancement after contrast administration. Remarkable level specific\nfindings include:\n\nT12-L1: Left facet hypertrophy results in mild left neural foraminal stenosis\n(12:5).\n\nL1-L2: Mild disc bulge results in mild bilateral neural foraminal stenosis.\n\nL2-L3: Mild disc bulge results in mild bilateral neural foraminal stenosis.\n\nL3-L4: Moderate disc bulge results in moderate bilateral neural foraminal\nstenosis and severe spinal canal narrowing (12:22).\n\nL4-L5: Moderate disc bulge and ligamentum flavum hypertrophy results in\nmoderate to severe bilateral neural foraminal stenosis and severe spinal canal\nstenosis.\n\nL5-S1: Mild disc bulge results in mild bilateral neural foraminal stenosis.\n\nOTHER: Visualized portions of the cervical spine are unremarkable. \nRetroperitoneal soft tissue is better evaluated on CT abdomen pelvis ___.", "output": "1. Study is moderately degraded by motion artifact.\n2. Moderate disc bulge at L3-L4 and L4-L5 result in severe spinal canal\nstenosis and moderate to severe neural foraminal stenosis, similar to prior\nrecent studies..\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": "Study is moderately degraded by motion. Within these confines:\n\nThere is minimal anterolisthesis of C4 on C5, C5 on C6 and C6 on C7. \nVertebral body heights are preserved. There is no definite focal marrow signal\nabnormality.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber, without definite abnormal enhancement.\n\nThere is loss of intervertebral disc height and signal throughout the cervical\nspine.\n\nAt C2-C3, there is no spinal canal narrowing and there is no neural foraminal\nnarrowing.\n\nAt C3-C4, minimal posterior disc bulge and bilateral uncovertebral and facet\nhypertrophy are noted without spinal canal narrowing. There is mild bilateral\nneural foraminal narrowing.\n\nAt C4-C5, there is trace anterolisthesis of C4 on C5. There is no spinal\ncanal narrowing. Uncovertebral and facet hypertrophy result in mild bilateral\nneural foraminal narrowing.\n\nAt C5-C6, there is minimal anterolisthesis of C5 on C6. There is no spinal\ncanal narrowing or neural foraminal narrowing.\n\nAt C6-C7, trace anterolisthesis of C6 on C7, mild posterior disc bulge\nresulting in mild spinal canal narrowing. Mild uncovertebral facet\nhypertrophy and facet osteophytes result in mild bilateral neural foraminal\nnarrowing.\n\nAt C7-T1, there is no spinal canal narrowing or neural foraminal narrowing.\n\n OTHER:\n\nThere is no definite evidence of enhancing epidural, paravertebral or\nparaspinal mass identified.\n\nLimited imaging of thoracic spine demonstrates multilevel thoracic spondylosis\nwithout definite evidence of moderate or severe vertebral canal or neural\nforaminal narrowing, better demonstrated on ___ thoracic and\nlumbar spine contrast MRI.", "output": "1. Study is moderately degraded by motion.\n2. Multilevel cervical spondylosis as described, without definite evidence of\nmoderate or severe vertebral canal or neural foraminal narrowing.\n3. Within limits of study, no definite evidence of cervical spinal cord\nlesion or abnormal enhancement.\n4. Within limits of study, no definite evidence of enhancing epidural,\nparavertebral or paraspinal mass.\n5. Multilevel thoracic spondylosis as described, better demonstrated on ___ thoracic and lumbar spine contrast MRI." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and signal. No\nabnormal enhancement after contrast administration.\n\nThere is no evidence of significant spinal canal or neural foraminal narrowing\nin the lumbar spine. Mild disc bulging at L4-L5 causes mild right greater\nthan left neural foraminal narrowing without significant spinal canal\nnarrowing.\n\nLeft pelvic cystic structure measures 3.8 cm, partially visualized (series\n200, image 81). Trace retroperitoneal fluid and stranding along the left\ncommon iliac artery and left pelvic wall, also partially visualized, may be\ndue to postoperative status, incompletely assessed.", "output": "1. No evidence of cord or nerve root compression.\n2. No abnormal enhancement after contrast administration.\n3. Partially visualized left pelvic cystic structure measures 3.8 cm.\n4. Trace retroperitoneal fluid and stranding along the left common iliac\nartery and left pelvic wall may be due to postoperative status, incompletely\nassessed.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:32 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "2 mm retrolisthesis of C6 on C7 is identified. Otherwise cervical alignment\nis unremarkable. Loss of T2 signal is seen throughout the intervertebral\ndiscs of the cervical spine, likely degenerative in etiology, most prominent\nat C5-C6 and C6-C7. No cord signal abnormalities are identified. No bone\nmarrow signal abnormalities are seen.\n\nC2-C3: There is no spinal canal or neural foraminal narrowing.\n\nC3-C4: There is no spinal canal or neural foraminal narrowing.\n\nC4-C5: Minimal central protrusion does not result in spinal canal narrowing. \nThere is no neural foraminal narrowing.\n\nC5-C6: There is no spinal canal or neural foraminal narrowing.\n\nC6-C7: Small left eccentric central protrusion results in mild spinal canal\nnarrowing. Uncovertebral and facet arthropathy results in mild to moderate\nleft and mild right neural foraminal narrowing..\n\nC7-T1: There is no spinal canal or neural foraminal narrowing.\n\n2.1 cm (SI) STIR hyperintense focus in the expected location of the posterior\nedge of the right lobe of the thyroid (series 3, image 4) is partially\nvisualized. Otherwise, no paraspinal or paravertebral soft tissue\nabnormalities are identified.", "output": "1. Mild cervical spondylosis most pronounced at C6-C7 with mild spinal canal\nand mild-to-moderate left neural foraminal narrowing and mild right neural\nforaminal narrowing.\n2. No cord signal abnormalities identified.\n3. Incompletely characterized apparent 2 cm T2/STIR hyperintense signal in the\nexpected location of the posterior edge of the right lobe of the thyroid. \nFurther evaluation with thyroid ultrasound is recommended.\n\nRECOMMENDATION(S): Further evaluation with thyroid ultrasound is recommended\nfor impression 3." }, { "input": "From T11-12 through L3-4 levels minimal degenerative disc disease seen without\nsignificant disc bulge or disc herniation.\n\nAt L4-5 level mild bulging disc and facet degenerative changes seen without\nspinal stenosis or focal disc herniation. There is no evidence of compression\nor displacement of nerve roots. There is no foraminal narrowing.\n\nAt L5-S1 level degenerative disc disease and minimal bulging seen without\nspinal stenosis or foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative disc disease and mild facet degenerative changes without\nspinal stenosis or high-grade foraminal narrowing.\n2. No focal disc herniation, nerve root displacement or compression.\n3. No significant change since the previous MRI examination of ___.\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": "There is no evidence of bony injury or ligamentous disruption. At the\ncraniocervical junction and C2-3 no abnormalities are seen. At C3-4 mild disk\nbulging seen without spinal stenosis or foraminal narrowing. At C4-5 level\nlumbar disc bulging and mild to moderate left-sided and mild right-sided\nforaminal narrowing seen. At C5-6 level cord disk bulging and mild-to-moderate\nleft foraminal narrowing seen.\n\nAt C6-7 through T3-4 and abnormalities are identified.\n\nThe spinal cord shows normal intrinsic signal and compression. .", "output": "No evidence of bony or ligamentous injury. Degenerative disc disease bulging\nand mild to moderate foraminal changes from C3-4 through C5-6 levels." }, { "input": "CERVICAL SPINE:\n\nAcute fractures through the spinous processes of C6, C7 and T1 are better\ndemonstrated on the recent CT. There is extensive adjacent edematous changes\nin the posterior paraspinal soft tissues, with evidence of injury to the\nligamentum nuchae and the interspinous ligaments at these levels. There is\nmild straightening of cervical lordosis which may be positional. There is\nsevere underlying degenerative disc greater than facet disease. The vertebral\nbody height is maintained. Facet alignment is anatomic. There is mild likely\ndegenerative irregularity of the ALL and PLL with no evidence of focal tear.\n\nAt C3-C4, disc osteophyte complex, most prominent on the right, moderately\nnarrows the spinal canal with remodeling of the ventral spinal cord. This\nalso mildly narrows the right neural foramen.\n\nAt C4-C5, posterior disc osteophyte complex, most prominent right paracentral,\nmoderately narrows the spinal canal with remodeling of the right ventral and\ndorsal spinal cord.\n\nAt C5-C6, large disc bulge with ridging osteophytes severely narrows the\nspinal canal with moderate flattening of the spinal cord and near complete\neffacement of cerebrospinal fluid. There is moderate right and severe left\nforaminal narrowing as well.\n\nAt C6-C7, a left paracentral disc extrusion with underlying osteophytes\nseverely narrows the spinal canal with marked flattening and deformity of the\nspinal cord, particularly of the left anterior aspect. In addition, there is\nmoderate right and severe left foraminal narrowing.\n\nAt C7-T1, there is diffuse disc bulge, the largest on the left, with mild\nligamentous thickening. This mildly narrows the spinal canal and the left\nneural foramen.\n\nThere is no evidence of epidural hematoma and the spinal cord while markedly\ndeformed at multiple levels, has no definite signal abnormality.\n\nTHORACIC SPINE: Fracture of the T1 spinous process is better seen on the\nrecent CT and described above. There is mild dextroconvex curvature of the\nthoracic spine, apex of the curve at T11. Alignment is otherwise anatomic. \nThere is no increased STIR signal within the vertebral bodies to suggest acute\nfracture. There is mild anterior wedging of T12, and multilevel disc\ndesiccation with degenerative endplate irregularity and scattered Schmorl's\nnodes, most prominent at the endplates of T12 as well. There is no other\nsuspicious osseous abnormality.\n\nUnderlying degenerative changes include numerous disc protrusions. The\nlargest is at T5-T6 where a left paracentral disc extrusion is slightly\nmigrates inferiorly. This moderately narrows the spinal canal with remodeling\nof the ventral spinal cord. Smaller protrusions are present at T3-T4, T4-T5,\nT10-T11, T11-T12, and T12-L1. There is no evidence of epidural hematoma and\nthe spinal cord while deformed by disc protrusions, shows no definite signal\nabnormality. The conus medullaris terminates at the level of the T12-L1 disc\nspace with normal contour and signal. There is mild likely degenerative\nirregularity of the ALL and PLL with no evidence of focal tear.\n\nLUMBAR SPINE:\n\nCorrelating with the recent CT, there is no evidence of acute fracture of the\nlumbar spine. 2-mm likely degenerative retrolisthesis of L3 on L4 and L2 on L3\nis similar to prior. There is also mild levoconvex curvature of the lumbar\nspine. There is mild anterior wedging of L3 with a small osseous fragment\nadjacent to the anterior/superior vertebral endplate. There is no increased\nSTIR signal to suggest acute injury. This most likely represents a chronic\ndegenerative ossification or congenital \"limbus\" vertebra.\n\nThere is diffuse disc desiccation with degenerative endplate irregularity and\nsmall Schmorl's nodes, most prominent at L1-L2 and L2-L3.\n\nAt T12-L1, there is moderate facet arthropathy but no significant narrowing.\n\nAt L1-L2, there is diffuse disc bulge and mild facet arthropathy but no\nsignificant narrowing.\n\nAt L2-L3, there is mild retrolisthesis, moderate diffuse disc bulge and\nmoderate facet arthropathy with small facet effusions. There is mild spinal\ncanal narrowing, particularly the subarticular zones, but no definite nerve\nroot impingement.\n\nAt L3-L4, there are similar findings. In addition, the disc bulge mildly\nnarrows the foramina bilaterally with abutment of exiting L3 nerve root in the\nforaminal zone. \n\nAt L4-L5, there is disc bulge and moderate facet arthropathy with small facet\neffusions. Overall, these changes are similar to the level above with mild\nforaminal narrowing particularly on the left.\n\nL5-S1 is not well evaluated secondary to artifact and field of view. There is\na disc bulge and no high-grade spinal canal narrowing. There is probably mild\nleft foraminal narrowing.\n\nThere is no epidural hematoma.\n\nThe spleen is borderline in size (14 cm in length). Otherwise, the visualized\nparaspinal soft tissues are unremarkable.", "output": "1. Acute fractures of the spinous processes of C6, C7, and T1. No other\nfractures. Please note that the initial wet read mislabelled the fractured\nvertebrae.\n2. Severe degenerative disc disease within the cervical spine with high-grade\nspinal canal at C5-C6 and particularly C6-C7. The actuity of the disc\nherniations is difficult to determine.\n3. Less severe degenerative changes in the thoracic and lumbar spine." }, { "input": "Edema superior L1 endplate, horizontal band of decreased T1 and T2 signal\nalong the superior margin of the endplate, mild vertebral body height loss,\nfindings consistent with acute/subacute compression fracture, similar. 5 mm\nretropulsion L1, probably similar. Mild edema inferior T12 vertebral body,\nconsistent with acute/subacute compression fracture/Schmorl's node, similar. \nMild paravertebral edema at this level. T12-L1 disc space is normal, no\nendplate destructive changes, vacuum disc phenomenon\n\nDegenerative changes lumbar spine. Lumbar curve convex to the left. Few\nendplate Schmorl's nodes. Multilevel disc space narrowing. Lumbar facet\narthritis. No worrisome osseous lesions. Normal visualized cord. Multilevel\ndiffuse disc bulges, endplate hypertrophic changes.\n\nAt T12-L1, moderate central canal narrowing, preserved CSF about conus and\nproximal cauda equina. 5 mm L1 retropulsion. Mild left, moderate right\nforaminal narrowing.\n\nAt L1-L2 mild central canal narrowing. Mild-to-moderate left, moderate right\nforaminal narrowing.\n\nAt L2-L3, mild central canal narrowing.. Mild bilateral foraminal narrowing.\n\nAt L3-L4, patent central canal. Mild-to-moderate right, mild left foraminal\nnarrowing.\n\nAt L4-5, patent central canal. Moderate bilateral foraminal narrowing.\n\nAt L5-S1, patent central canal. Patent right foramen. Moderate left\nforaminal narrowing.\n\nMild infrarenal aortic ectasia, 2.3 cm in diameter. Few benign perineural\ncysts S 2, S3 level.", "output": "1. Mild T12, L1 compression fractures, similar appearance of vertebral bodies\nsince ___. Mild vertebral body, paraspinal edema.Moderate central\ncanal narrowing T12-L1, 5 mm L1 retropulsion.\n2. Degenerative changes lumbar spine.\n3. Foraminal narrowing, as above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:29 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nLevoscoliosis of lumbar spine is again noted. There is transitional anatomy\nwith partial sacralization of L5.\n\nRedemonstration of a compression fracture involving the L1 vertebral body with\napproximately 30% height loss. There is redemonstration of WATER IDEAL and T2\nhyperintense, T1 hypointense signal abnormality throughout the L1 vertebral\nbody. There is approximately 7-8 mm of retropulsion of the posterior cortex\nof L1 with indentation and effacement of the ventral thecal sac. The degree\nof retropulsion appears minimally increased from prior exam. Unchanged\nendplate irregularity and signal alterations of the inferior T12 endplate with\nmild height loss.\n\nNo additional compression fractures are identified. The remaining visualized\nvertebral body heights are maintained. There are probable ___ type 2\nendplate changes involving multiple levels, predominately at L2-L3.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. The conus medullaris terminates at L1-L2.\n\nMultilevel intervertebral disc height loss and desiccation, most pronounced\nfrom T12-L1 through L2-L3. Nonspecific facet joint fluid is noted at multiple\nlevels of the lumbar spine.\n\nAt T12-L1 there is disc bulge, ligamentum flavum thickening, moderate\nvertebral canaland mild-to-moderate left and moderate rightneural foraminal\nnarrowing, unchanged from prior.\n\nAt L1-2 there is diffuse disc bulge, ligamentum flavum thickening,\nmildvertebral canal, mild-to-moderate left and moderate right neural foraminal\nnarrowing, unchanged.\n\nAt L2-3 there is disc bulge, ligamentum flavum thickening, mildvertebral canal\nand mild bilateral neural foraminal narrowing, unchanged.\n\nAt L3-4 there is disc bulge, ligamentum flavum thickening, facet osteophytes,\nnovertebral canal, mild to moderate right, and mild left neural foraminal\nnarrowing, unchanged.\n\nAt L4-5 there is disc bulge, ligamentum flavum thickening, facet osteophytes,\nno vertebral canal, and moderate bilateral neural foraminal narrowing,\nunchanged.\n\nAt L5-S1 there is disc bulge, ligamentum flavum thickening, facet osteophytes,\nno vertebral canal, moderate left and mild right neural foraminal narrowing. \nFindings are unchanged from prior exam.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. There is mild fatty atrophy of the paraspinal\nmuscles.\n\nThere is an incompletely characterized T2 hyperintense lesion emanating from\nthe anterior interpolar region of the left kidney, statistically likely a\nparapelvic cyst versus an extrarenal pelvis.\n\nLimited imaging of the sacrum again demonstrates probable Tarlov cysts.", "output": "1. Study is moderately degraded by motion.\n2. Minimally increased retropulsion of the L1 cortex measuring up to 8 mm of\notherwise grossly stable L1 superior endplate compression deformity, now\nresulting in moderate spinal canal narrowing. Within limits of study, no\ndefinite associated epidural collection identified.\n3. No evidence of new acute or subacute additional compression fracture\ndeformities.\n4. Grossly stable multilevel lumbar spondylosis compared to ___\nprior exam, as described." }, { "input": "There is unchanged levoscoliosis of the lumbar spine, transitional anatomy\nwith partial sacralization of L5. There is a grossly unchanged compression\nfracture at L1 vertebral body with persistent bone edema at the endplates of\nT12 and L1, loss of height and unchanged retropulsion of the superior endplate\nof L1, causing anterior thecal sac deformity, contacting the ventral aspect of\nthe conus medullaris which terminates at the level of L1, however, there is no\nevidence of focal diffuse lesions within the lower spinal cord or conus\nmedullaris to indicate myelomalacia. Multilevel, multifactorial degenerative\nchanges throughout the lumbar spine remain as follows:\n\nAt T12-L1, there is unchanged irregular contour of the intervertebral disc\nspace, posterior disc protrusion with compression fracture of L1 as described\nabove, no significantly changed the prior exam, with retropulsion causing\nanterior thecal sac deformity, moderate spinal canal stenosis, there is\nbilateral neural foraminal narrowing impinging the exiting nerve roots\nbilaterally. There is mild articular joint facet hypertrophy bilaterally.\n\nAt L1-L2 level, there is diffuse disc bulge causing mild anterior thecal sac\ndeformity and mild to moderate bilateral neural foraminal narrowing, there is\nno evidence of central spinal canal stenosis, there is articular joint facet\nhypertrophy.\n\nAt L2-L3 level, there is diffuse disc bulge causing moderate bilateral neural\nforaminal narrowing, slightly more pronounced on the right, contacting the\ntraversing nerve roots towards the subarticular zones, as well as the exiting\nnerve root of L2 on the right.\n\nAt L3-L4 level, there is diffuse disc bulge, causing mild left and moderate\nright neural foraminal narrowing, contacting the traversing nerve roots\ntowards the subarticular zones as well as the exiting nerve root of L3 on the\nright. There is mild bilateral articular joint facet hypertrophy, there is no\nevidence of central spinal canal stenosis.\n\nAt L4-5 level, there is diffuse disc bulge causing mild-to-moderate bilateral\nneural foraminal narrowing, contacting the traversing nerve roots towards the\nsubarticular zones bilaterally, there is no evidence of central spinal canal\nstenosis, there is mild bilateral articular joint facet hypertrophy and\nligamentum flavum thickening.\n\nAt L5-S1 level, there is mild diffuse disc bulge with no evidence of nerve\nroot compression or spinal canal stenosis, there is mild to moderate bilateral\narticular joint facet hypertrophy which is more pronounced on the left (series\n200, image 65). In the sacrum, unchanged subcentimeter perineural cysts are\nvisualized at the level of S2 and S3 levels (___ cysts).\n\nThe sacroiliac joints and the visualized paravertebral structures are grossly\nunremarkable.\n\nThe previously described T2 hyperintense lesion at the anterior interpolar\nregion of the left kidney is not clearly seen in the current exam.", "output": "1. Grossly unchanged compression fracture deformity at L1 vertebral body with\nretropulsion of the superior endplate, and persistent bone edema at the\nendplates of T12 and L1 as described detail above, causing anterior thecal sac\ndeformity and resulting in moderate spinal canal stenosis.\n\n2. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine remain relatively stable from L1-L2 through L5-S1 levels." }, { "input": "From T11-12 through L1-2 levels, mild degenerative changes are identified. \nThere is no spinal stenosis or foraminal narrowing.\n\nAt L2-3 level, there is diffuse disc bulge and facet degenerative changes. \nThere is thickening of the ligaments. There is moderate-to-severe spinal\nstenosis with moderate bilateral foraminal narrowing.\n\nAt L3-4, L4-5 levels, there is laminectomy. At L3-4 level, facet degenerative\nchanges seen. Minimal anterolisthesis of L3 over L4 seen. There is mild\nnarrowing of the foramina.\n\nAt L4-5 diffuse disc bulging and a central protrusion identified. There is\nmoderate to severe right and moderate left subarticular recess and mild\nnarrowing of the foramina. There is no central canal narrowing.\n\nAt L5-S1 level, disc bulging is identified. There appear to be posterior\nspinal fusion at this level. There is moderate right-sided and\nmoderate-to-severe left-sided foraminal narrowing.\n\nThe distal spinal cord and paraspinal soft tissues are unremarkable.", "output": "1. Lower lumbar laminectomies.\n2. Moderate-to-severe spinal stenosis at L2-3 level above the level of\nlaminectomies.\n3. moderate-to-severe right and moderate left subarticular recess narrowing at\nL4-5 level due to central protrusion.\n4. Moderate to severe left and moderate right foraminal narrowing at L5-S1\nlevel." }, { "input": "There is no evidence of bony or ligamentous injury in the cervical region. No\nsigns of ligamentous disruption. At the craniocervical junction no\nsignificant abnormalities are seen.\n\nAt C2-3, C3-4 and C4-5 mild degenerative changes seen without spinal stenosis\nor foraminal narrowing.\n\nAt C5-6 and C6-7 mild disc bulging identified with mild narrowing of the\nforamina at C5-6 and mild narrowing of the left foramen at C6-7.\n\nFrom C7-T1 to T3-4 minimal degenerative change seen.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression.", "output": "No evidence of ligamentous or bony injury. Mild degenerative changes without\nhigh-grade spinal stenosis or foraminal narrowing." }, { "input": "The patient again could not complete the MRI exam as he experienced shortness\nof breath and dizziness.\n\nSequences obtained include a sagittal T2 and STIR sequence. The evaluation\nfor metastatic lesions is significantly limited however, no obvious osseous\ndestructive process is identified.\n\nVertebral body height and alignment appears grossly preserved. There is\nsignificant degenerative disc disease throughout the cervical spine, most\npronounced at C3-C4 and C5-C6 with severe disc space height loss.\n\nThere are multilevel posterior disc herniations resulting in remodeling of the\nventral cord and with questionable cord signal abnormality on the STIR\nsequence posteriorly to C4-C5.", "output": "1. Significantly limited exam as only sagittal T2 and STIR sequences could be\nobtained because the patient again experienced shortness of breath and\ndizziness.\n2. Allowing for this limitation, no obvious osseous destructive process\nidentified.\n3. Multilevel degenerative changes throughout the cervical spine with\nposterior disc herniations resulting in remodeling of the ventral cord with\nquestionable cord signal abnormality posteriorly to the C4-C5 level on the\nSTIR sequence.\nRECOMMENDATIONS: Recommend completion of the full cervical spine protocol when\npatient is better able to tolerate the exam." }, { "input": "Essentially nondiagnostic study as only scout images were obtained.", "output": "Only limited MR scout images were obtained only as the patient experienced\ndifficulty breathing.\nA second attempt, possibly limited to a certain spine region, can be obtained\nonce the patient has recovered." }, { "input": "The alignment is normal. The bone marrow signal is within normal limits. A\nsubcentimeter old infarct is seen in the right cerebellar hemisphere. \nOtherwise, the visualized posterior fossa and cord are unremarkable. The\nintervertebral discs are normal in signal intensity and height.\n\nC2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Small central disc protrusion, abutting the ventral cord, no spinal\ncanal or foraminal narrowing.\n\nC4-C5: Small central disc protrusion, effacement of the ventral thecal sac,\nbilateral facet and uncovertebral osteophytes, no spinal canal narrowing, mild\nbilateral foraminal narrowing.\n\nC5-C6: Disc bulge, right paracentral disc protrusion, distortion of the\nventral cord without cord signal abnormality, bilateral facet and\nuncovertebral osteophytes, moderate spinal canal narrowing, mild bilateral\nforaminal narrowing.\n\nC6-C7: Bilateral facet and uncovertebral osteophytes, no spinal canal\nnarrowing, mild bilateral foraminal narrowing.\n\nC7-T1: Disc bulge, no spinal canal or foraminal narrowing.\n\nThere is no spinal canal or foraminal narrowing involving the visualized upper\nthoracic spine. The visualized paraspinal soft tissues are unremarkable.", "output": "1. Cervical spondylosis, worst at C5-6 with moderate spinal canal narrowing\nand distortion of the ventral cord without cord signal abnormality." }, { "input": "Again seen is anterior subluxation of L5 on S1 due to bilateral pars defects. \nOtherwise, alignment is normal. Vertebral body signal intensity appears\nnormal except for ___ type 1 and type 2 signal intensity changes at L5-S1. \nThere is mild loss of signal of the intervertebral disc at ___ the T2\nweighted images. This is a manifestation of degenerative disc disease. There\nis severe loss of height of the intervertebral disc at L5-S1 and loss of\nsignal of the intervertebral disc. Again, these findings are due to\ndegenerative disc disease.\nThere is lumbar scoliosis convex to the left.\n\nThere are small anterior osteophytes at L1-2.\n\nAxial images from T12 to L4 demonstrate no canal or neural foraminal\nencroachment.\n\nAt L4-5, there is minimal bulging of the disc with no encroachment on the\nnerve roots. The neural foramina appear normal. There small bilateral facet\nosteophytes.\n\nAt L5-S1, there is a minimal encroachment on the thecal sac due to\nsubluxation. There is diffuse bulging of the disc that extends into the\nneural foramina bilaterally. This, +facet osteophytes and anterior\nsubluxation of L5 on S1 produces severe bilateral neural foraminal narrowing\nand compromise of the exiting L5 nerve roots bilaterally.\n\nThe spinal cord appears normal in caliber and configuration. There is no\nabnormal enhancement after contrast administration. There is no evidence of\ninfection or neoplasm.", "output": "1. Mild degenerative disc disease at ___. Anterior subluxation of L5 on S1 due to bilateral pars defects. Severe\nbilateral neural foraminal narrowing at this level." }, { "input": "Study is moderately degraded by motion.\n\nTHORACIC SPINE:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nare grossly preserved. T8-9 probable type ___ ___ changes without definite\nepidural collection are noted. T8-9 and T11 Schmorl's nodes are noted. The\nvisualized portion of the spinal cord is grossly preserved in signal and\ncaliber. Mild central disc bulge is seen at T12-L1, otherwise there is no\nevidence of spinal canal or neural foraminal narrowing throughout the thoracic\nspine. There is no evidence of infection or neoplasm. No concerning\nenhancement is seen.\n\nLUMBAR SPINE:\nGrade 1 retrolisthesis is seen involving L5 on S1, otherwise the alignment is\nnormal. Type ___ ___ changes are seen along the endplates of L4-L5. Left\npsoas lipoma extending from L2 through L4 is suggested (see 13: 4- 17). \nQuestion dermal defect overlying left L2-3 level dorsal subcutaneous tissues\n(see 10: 1- 14).\n\nSubtle increased STIR signal abnormality and enhancement is seen involving the\nright facet joint, pedicles, and spinous processes of L3 and L4, as well as\nadjacent soft tissues. A small right facet joint effusion is seen. Subtle\nincreased STIR signal abnormality is also seen involving the left facet joint,\nand pedicles of L3-L4\n\nThe conus terminates at L1-L2. No terminal cord signal abnormalities are\nidentified. Degenerative disc desiccation is seen throughout the lumbar\nspine.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: Facet joint osteophytes are seen however there is no spinal canal or\nneural foraminal narrowing.\n\nL3-L4: Disc bulge, facet joint osteophytes and ligamentum flavum hypertrophy\ncontribute to mild spinal canal narrowing. A small right facet joint effusion\nis seen. Facet joint osteophytes and ligamentum flavum hypertrophy contribute\nto mild bilateral neural foraminal narrowing.\n\nL4-L5: Disc bulge is seen resulting in bilateral subarticular zone narrowing.\nFacet joint osteophytes and ligamentum flavum hypertrophy contributes to mild\nspinal canal narrowing. Note is made of a annular fissure along the posterior\naspect of the intervertebral disc. Facet joint osteophytes contribute to\nmoderate bilateral neural foraminal narrowing.\n\nL5-S1: Left disc bulge is seen however there is no spinal canal narrowing. \nFacet joint osteophytes and ligamentum flavum hypertrophy contribute to mild\nleft neural foraminal narrowing. The right neural foramen is patent.\n\nA 1.3 cm cystic lesion is incidentally seen within the upper pole of the left\nkidney, series 13, image 1. A bilobed cystic lesion is seen within the\nmidpole of the left kidney, series 13, image 5.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no epidural fluid collection or evidence of cord\ncompression within the thoracic or lumbar spine.\n3. Bilateral increased STIR signal abnormality involving the facet joint and\npedicles of L3-L4, right greater than left is likely secondary to degenerative\nchanges.\n4. Right paraspinal soft tissue edema and enhancement at the level of L3/L4. \nWhile this may represent sequelae of degenerative changes, soft tissue\nphlegmonous changes cannot be excluded. No definite abscess is seen. \nAttention on follow up imaging is recommended.\n5. Mild-to-moderate lumbar spondylosis, most pronounced at L4-L5 with moderate\nto severe bilateral neural foraminal narrowing.\n6. Suggested left psoas muscle lipoma versus nonspecific atrophy.\n7. Suggested focal dermal defect of subcutaneous tissues overlying L2-3\nwithout definite associated edema, versus artifact.\n\nRECOMMENDATION(S): Right paraspinal soft tissue edema and enhancement at the\nlevel of L3/L4. While this may represent sequelae of degenerative changes,\nsoft tissue phlegmonous changes cannot be excluded. No definite abscess is\nseen. Attention on follow up imaging is recommended.\n\nNOTIFICATION: Updated findings were emailed to the EDQA nurse group by Dr. ___.\n___ on the day of the exam." }, { "input": "From T12-L1 through L4-5 levels, minimal degenerative changes identified. \nThere is no spinal stenosis or foraminal narrowing.\n\nAt L5-S1 level, disc bulging seen. There is a small disc herniation extending\ninferiorly to the left lateral recess of S1 and displacing and compressing the\nleft S1 nerve root. This could result in irritation of this nerve root.\n\nThe conus is at a normal level. The paraspinal soft tissues are unremarkable.", "output": "Small left-sided disc herniation at L5-S1 level extending inferiorly to the\nleft lateral recess of S1 and displacing the left S1 nerve root which could\nresult in irritation of this nerve root. This finding is new since the\nprevious MRI." }, { "input": "Cervical alignment is anatomic. Vertebral body heights are preserved. There\nis no suspicious marrow signal. Mild disc desiccation and minimal loss of\ndisc height spanning C3-C4 through the C5-C6 is identified. The visualized\nposterior fossa is unremarkable. There is no abnormal enhancement or signal\nof the cord.\n\nThere is borderline spinal canal narrowing at baseline secondary to congenital\nshortening of the pedicles.\n\nC2-C3: There is a small disc protrusion which results in mild spinal canal\nnarrowing. There is no significant neural foraminal narrowing.\n\nC3-C4: A disc protrusion and thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing, mildly remodeling the ventral aspect of the\ncord. Bilateral uncovertebral facet arthropathy results in mild bilateral\nneural foraminal narrowing.\n\nC4-C5: A disc protrusion and thickening of ligamentum flavum results in mild\nspinal canal narrowing. Uncovertebral facet arthropathy results in left\ngreater than right moderate neural foraminal narrowing.\n\nC5-C6: A disc protrusion contacts and minimally remodels the ventral aspect\nof the cord and results in mild spinal canal narrowing. Uncovertebral facet\narthropathy results in moderate bilateral neural foraminal narrowing.\n\nC6-C7: A disc protrusion and thickening of ligamentum flavum results in\nmoderate spinal canal narrowing. There is no significant neural foraminal\nnarrowing.\n\nC7-T1: A small disc protrusion does not result in significant spinal canal\nnarrowing. There is no significant neural foraminal narrowing.\n\nT1-T2 through T4-T5: On sagittal images, there are small disc herniations in\nmild facet arthropathy which does not result in significant spinal canal or\nneural foraminal narrowing.\n\nThere is a 9 mm right inferior thyroid lobe nodule. Median sternotomy wires\nare partially visualized. A small vallecular cyst is noted. Otherwise,\nprevertebral paraspinal soft tissues are unremarkable.", "output": "1. Mild degenerative changes as described above, most prominent at C3-C4 where\na disc protrusion results in moderate spinal canal narrowing, moderately\nremodeling ventral aspect of the cord.\n2. At C4-C5, there is left greater than right moderate neural foraminal\nnarrowing.\n3. There is no underlying cord signal change. No abnormal enhancement or\nmasses." }, { "input": "There is grade 1 anterolisthesis of L4 on L5 which has progressed as compared\nto prior lumbar spine MR examination from ___. Alignment is\notherwise normal. Vertebral body and intervertebral disc signal intensity\nappear normal. Bone marrow signal is normal. The spinal cord appears normal\nin caliber and configuration. There is no evidence of fracture, infection or\nneoplasm.\n\nAt the T12-L1 level, there is minimal disc bulge with no spinal canal or\nneural foraminal stenosis.\n\nAt the L1-L2 level, there is minimal disc bulge with no spinal canal or neural\nforaminal stenosis.\n\nAt the L2-L3 level, there is minimal disc bulge. There is no spinal canal\nstenosis or neural foraminal narrowing.\n\nAt the L3-L4 level, there is mild disc bulge causing mild effacement of the\nanterior thecal sac. There is no spinal canal stenosis or neural foraminal\nnarrowing.\n\nAt the L4-L5 level, there is severe facet arthropathy, mild disc bulge and\nthickening of the ligamentum flavum causing severe spinal canal stenosis,\nwhich is progressed since prior MR examination. There is moderate bilateral\nneural foraminal narrowing.\n\nAt the L5-S1 level, there is mild disc protrusion causing minimal effacement\nof the anterior thecal sac. There is moderate facet arthropathy and\nthickening of the ligamentum flavum causing moderate bilateral neural\nforaminal narrowing with focal impingement of the left exiting nerve root.\n\nThere are bilateral T2 hyperintense structures in the posterior paravertebral\nsoft tissues at the L5 level measuring approximately 5 x 4 mm on the left and\n10 x 7 mm on the right (series 5, image 30, image 31) which likely reflect\nsynovial cyst arising from the facet joints. The synovial cyst on the right\nshows peripheral enhancement on the postcontrast images (series 8, image 31). \nThere is a 6 mm T2 bright, nonenhancing lesion in the left kidney which likely\nreflects a simple cyst. There is a 1 cm T2 bright nonenhancing cyst in the\npancreatic tail which is stable since at least prior MRCP from ___.", "output": "1. No acute cervical fracture or metastatic lesion.\n2. Severe facet arthropathy and thickening of the ligamentum flavum at the\nL4-L5 level causing severe spinal canal stenosis and moderate bilateral neural\nforaminal narrowing, progressed since prior MR examination.\n3. Moderate bilateral neural foraminal narrowing at the L5-S1 level with focal\nimpingement of the left exiting nerve root.\n4. New small bilateral L5 synovial cysts .\n5. Grade 1 anterolisthesis of L4 on L5, progressed since prior examination.\n6. Additional findings as described above." }, { "input": "Alignment is anatomic. Vertebral body and intervertebral disc signal\nintensity appear overall normal. The conus terminates at L1 vertebral body. \nCompared to prior exam on ___, there is persistent mild enhancement\nof the anterior and posterior aspect of the distal conus. There is also\npersistent mild enhancement of the proximal cauda equina, slightly out of\nproportion to the expected amount. Subcentimeter nonenhancing cystic spaces\nposterior to the L4-5 interspinous ligament are again noted.\n\nAt T12-L1, disc bulge and loss of disc height results in mild narrowing of the\nbilateral neural foramina and no significant narrowing of the spinal canal.\nAt L1-L 2, there is asymmetric disc bulge into the left neural foramina,\nnarrowing the neural foramina moderately on the left and mildly on the right. \nNo significant spinal canal narrowing is seen.\nAt L2-3, mild disc bulge results in mild narrowing of the spinal canal without\nsignificant neural foraminal narrowing.\nAt L3-4, there is mild asymmetric disc bulge into the left neural foramina\nresulting in mild narrowing of the spinal canal and moderate left and mild\nright neural foramina.\nAt L4-5, there is stable mild disc bulge, bilateral facet arthropathy and\ninfolding of the ligamentum flavum at the level the, resulting in severe\nnarrowing of the spinal canal with near complete effacement of the CSF space\nwith moderate to severe narrowing of the neural foramina bilaterally.\nAt L5-S1, mild disc bulge, loss of disc height and facet arthropathy results\nin mild narrowing of the spinal canal, as well as moderate right and moderate\nto severe left neural foraminal narrowing.\n\nThere is fatty atrophy of the pancreatic head and neck, unchanged. 1.2 cm\ncystic mass in the tail of the pancreas with no internal enhancement is\noverall unchanged.", "output": "1. Persistent mild enhancement of the anterior and posterior aspect of the\ndistal conus with mild persistent enhancement of the proximal cauda equina,\noverall grossly similar compared to ___. Given the patient's\nhistory of lymphoma, lymphangitic spread cannot be excluded. Correlation with\nCSF is recommended.\n2. Stable severe spinal canal narrowing at L4-5 with moderate to severe\nnarrowing of the neural foramina as noted above.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 11:30 am, 10 minutes after discovery of\nthe findings." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere has been a slight progression in the 2-3 mm anterolisthesis at L4-L5,\nlikely degenerative. Alignment is otherwise anatomic. Vertebral body heights\nare preserved. There is no marrow signal abnormality.\n\nThe visualized portion of the spinal cord is preserved in signal and caliber. \nThe conus medullaris terminates at the level of L1-L2.\n\nDiffusely reduced T2 signal within the intervertebral discs is likely on a\ndegenerative basis.\n\nThe previously described mild enhancement of the anterior and posterior\naspects of the distal conus and proximal cauda equina appears decreased\ncompared to ___.\n\nAt T12-L1 there is mild symmetric disc bulging without significant spinal\ncanal or neural foraminal narrowing.\n\nAt L1-2 there is mild symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes with minimal spinal canal narrowing and moderate bilateral\nneural foraminal narrowing.\n\nAt L2-3 there is mild symmetric disc bulging, ligamentum flavum thickening\nand facet osteophytes with mild spinal canal narrowing and mild-to-moderate\nbilateral neural foraminal narrowing.\n\nAt L3-4 there is symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes resulting in mild spinal canal narrowing and moderate left\nneural foraminal narrowing.\n\nAt L4-5 there is symmetric disc bulging, prominent ligamentum flavum\nthickening and facet osteophytes resulting in severe spinal canal narrowing\nwith crowding of the cauda equina nerve roots. There is mild right and\nmoderate left neural foraminal narrowing.\n\nAt L5-S1 there is symmetric disc bulging, ligamentum flavum thickening and\nfacet osteophytes with mild spinal canal narrowing, moderate right and\nmoderate to severe left neural foraminal narrowing.\n\nOverall, findings are not significantly changed from ___.", "output": "1. Previously described mild enhancement of the anterior and posterior aspects\nof the distal conus and proximal cauda equina appears less apparent compared\nto ___.\n2. Stable degenerative changes of the lumbar spine most significant at L4-L5\nwhere there is severe spinal canal narrowing resulting in crowding of the\ncauda equina nerve roots. Findings are not significantly changed since ___.\n3. Slight progression in 2-3 mm anterolisthesis at L4-L5, likely degenerative." }, { "input": "Grade 1 anterolisthesis of L4 on L5 is overall similar to examination of ___. The remainder of the lumbar alignment is anatomic. Vertebral\nbody heights are preserved.\n\nThere is no suspicious marrow lesion. Degenerative loss of disc height is\nmild to moderate diffusely. The conus medullaris terminates at the L1-L2\nlevel, within expected limits. There is no signal abnormality of the terminal\ncord.\n\nT11-T12: A small disc bulge and thickening ligamentum flavum results in mild\nspinal canal narrowing. There is mild bilateral neural foraminal narrowing\nsecondary to facet arthropathy.\n\nT12-L1 through L2-L3: Small disc bulges do not significantly narrow the spinal\ncanal. In conjunction with facet arthropathy, there is mild bilateral L1-L2\nnarrowing. There is no significant neural foraminal narrowing at T12-L1 and\nL2-L3.\n\nL3-L4: A small disc bulge results in mild crowding of the\nleft-greater-than-right subarticular zone with minimal displacement of the\ntraversing right L4 nerve root (series 5, image 23). There is no significant\nneural foraminal narrowing.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in severe\nspinal canal narrowing, progressed from prior exam. There is buckling of the\ncauda equina superiorly, greater when compared to prior exam. There is\nbilateral facet arthropathy with small facet joint effusions and posteriorly\nprojecting synovial cysts. Loss of disc height and facet arthropathy results\nin mild-to-moderate bilateral neural foraminal narrowing, slightly progressed\nfrom prior exam.\n\nL5-S1: A disc bulge does not significantly narrow the spinal canal. There is\ncrowding of the bilateral cervical is own switch contacts but does not\ndefinitively posteriorly displace traversing nerve roots. In conjunction with\nfacet arthropathy, there is at least moderate to severe right and severe left\nneural foraminal narrowing, with impingement of the exiting left L5 nerve\nroot. These findings are similar to prior exam.\n\n\nA 8 mm cystic lesion in the pancreatic tail likely represents in IPMN,\nunchanged from prior exam. T2 hyperintense cystic lesion of the inferior left\nrenal pole measuring 6 mm is statistically most likely a simple cyst. Minimal\ninfrarenal abdominal aortic ectasia measuring 2.1 cm, unchanged from prior\nexam. The remainder the visualized prevertebral paraspinal soft tissues are\ngrossly unremarkable.", "output": "1. Multilevel multifactorial lumbar spondylosis most prominent at L4-L5 where\nthere is severe spinal canal narrowing, worsened from prior exam. This\ncompresses the cauda equina with buckling of the cauda equina nerve roots\nsuperiorly, which is not seen on prior exam.\n2. Please note, imaging appearance of cauda equina compression does not equate\ncauda equina syndrome, which is a clinical diagnosis.\n3. Additional degenerative changes including severe left L5-S1 neural\nforaminal narrowing with likely impingement of the exiting left L5 nerve root\nis overall similar to prior exam.\n4. Additional findings 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": "There is trace anterolisthesis of L4 on L5. The lumbar vertebral body heights\nand alignment are otherwise well preserved without fracture. The prevertebral\nsoft tissue is unremarkable. Bone marrow signal is normal. The the terminal\ncord is normal in morphology and signal characteristics. The conus medullaris\nterminates at the L1/L2 level. There is no epidural collection.\n\nThere are mild degenerative changes of the imaged distal thoracic spine. At\nthe T9-T10 level, there is mild intervertebral disk space narrowing with\nmoderate posterior disk protrusion causing mild canal stenosis, though there\nis no contact with the spinal cord. There is a minimal disk space narrowing at\nthe T11-T12 and T12-L1 levels with a small posterior disc protrusion which\ndoes not cause significant canal stenosis. The imaged retroperitoneum is\ngrossly unremarkable.\n\nL1-L2: The disk space is well preserved. There is no significant disc\nprotrusion. The neural foramina are patent.\n\nL2-L3: The intervertebral disc space is well-preserved without significant\nprotrusion. The neural foramina are patent.\n\nL3-L4: The intervertebral disc space is preserved. There is a small posterior\ndisc bulge which does not cause significant canal stenosis. The right neural\nforamen is patent. There is mild narrowing of the left neural foramen at the\nlevel of the subarticular recess with the disc bulge focally contacting the\nnerve root.\n\nL4-L5: The intervertebral disc spaces well preserved. There is no significant\nprotrusion. The neural foramina are mildly narrowed bilaterally. A combination\nof large facet osteophytes and ligamentum flavum hypertrophy causes moderate\ncanal stenosis.\n\nL5-S1: There is mild narrowing of the intervertebral disc space. A\ncombination of a broad-based posterior disc bulge along with hypertrophy of\nthe ligamentum flavum causes moderate narrowing of the left neural foramen\nwith focal impingement of the exiting nerve root as well as moderate narrowing\nof the right neural foramen with focal contact of the exiting nerve root.", "output": "Degenerative changes, as above, most prominent at the level of L5-S1 with\nmoderate narrowing of the bilateral neural foramina with focal impingement of\nthe exiting nerve root." }, { "input": "There is slight reversal of the cervical lordosis. The vertebral body and\nintervertebral disc signal intensity appear normal. The spinal cord appears\nnormal in caliber and configuration. There is no evidence of infection or\nneoplasm. The spinous processes extending from C3 through C5 appear\nhypoplastic, likely congenital.\n\nC2-C3: Facet osteophytes with mild left neural foraminal narrowing.\n\nC3-C4: Uncovertebral osteophytes the results in moderate left neural foraminal\nnarrowing.\n\nC4-C5: Uncovertebral osteophytes with moderate left neural foraminal\nnarrowing.\n\nC5-C6: Slight disc bulging and uncovertebral osteophytes with mild spinal\ncanal stenosis, mild right and moderate left neural foraminal narrowing.\n\nC6-C7: Patent canal and neural foramina.\n\nC7-T1: Patent canal and neural foramina.", "output": "1. Multilevel degenerative changes of the cervical spine most significant at\nC5-C6 where there is mild spinal canal stenosis.\n2. Multilevel moderate left neural foraminal narrowing extending from C3-C4\nthrough C5-C6." }, { "input": "The cervical vertebral body heights are maintained. There is mild\nanterolisthesis of C7 on T1. There is multilevel loss of disc signal on the\nT2 weighted images due to degenerative disease. The spinal cord signal\nappears maintained. There is no evidence of infection or neoplasm.\n\nC2-C3: Mild central disc protrusion with indentation of the spinal cord in the\nmidline. Spinal canal and neural foramina are patent.\n\nC3-C4: Mild disc bulge with effacement of the anterior subarachnoid space and\nabutment of the anterior aspect of the spinal cord. Moderate right and mild\nleft neural foraminal stenosis.\n\nC4-C5: Moderate disc bulge with effacement of the anterior and posterior\nsubarachnoid space and indentation along the anterior aspect of the cord\nresulting in moderate spinal canal stenosis. Mild right neural foraminal\nstenosis.\n\nC5-C6: Moderate disc bulge with effacement of the anterior subarachnoid space\nand abutment of the anterior aspect of the cord. Mild right neural foraminal\nstenosis.\n\nC6-C7: There is spinal canal narrowing due to intervertebral osteophytes and\nbulging of the disc. There is severe right and moderate left neural foraminal\nnarrowing.\n\nC7-T1: Mild disc bulge. Spinal canal and neural foramina are patent.", "output": "Moderate to severe multilevel degenerative disc disease, most severe at C4-C5\nwith effacement of the anterior and posterior subarachnoid space and\nindentation along the anterior aspect of the cord." }, { "input": "There is 2 mm posterior subluxation of C5 on C6. Minimal STIR hyperintense\nsignal is seen between the bilateral C1 and C2 lateral masses. There is\nprevertebral fluid spanning from C3-4 to C5-6. ___ anterior or middle spinal\ncolumn ligamentous injury is ___. STIR hyperintense signal is seen in the\nposterior muscles with minimal STIR hyperintense signal within the\ninterspinous ligaments of C2-3 and C3-4. ___ fracture is seen. The C5 laminar\nfractures displayed on the CT scan are not demonstrated on this MR study. The\nbone marrow signal is within normal limits.\n\nThe visualized cord is unremarkable. Multilevel disc desiccation loss of disc\nheight are seen:\n\nC2-C3: Disc bulge, bilateral facet uncovertebral osteophytes, ___ spinal canal\nor foraminal narrowing.\n\nC3-C4: Bilateral facet and uncovertebral osteophytes, ___ spinal canal\nnarrowing, moderate right and mild left foraminal narrowing.\n\nC4-C5: Posterior and bilateral facet uncovertebral osteophytes, ___ spinal\ncanal or foraminal narrowing.\n\nC5-C6: Posterior subluxation, disc bulge, posterior and bilateral facet and\nuncovertebral osteophytes, ___ spinal canal narrowing, mild right and moderate\nleft foraminal narrowing.\n\nC6-C7: Disc bulge, posterior and bilateral facet uncovertebral osteophytes, ___\nspinal canal or foraminal narrowing.\n\nC7-T1: ___ spinal canal or foraminal narrowing.\n\nThere is ___ spinal canal or foraminal narrowing involving the visualized upper\nthoracic spine.\n\nThere is left posterior neck subcutaneous edema.", "output": "1. Fluid between the bilateral C1 and C2 lateral masses, within the posterior\nmuscles and minimally within the C2-3 and C3-4 interspinous ligaments.\n2. ___ anterior or middle spinal column ligamentous injury.\n3. The C5 laminar fractures demonstrated on the cervical spine CT are not\ndetected on the MR. ___ fracture identified.\n4. Normal appearance of the spinal cord.\n5. Cervical degenerative disease, worst at C3-4 and C5-6, with moderate right\nand moderate left foraminal narrowing, respectively." }, { "input": "Vertebrae are normal in height. There have been bilateral laminectomies at L3\nthrough L5 with osseous fusion of the L4 and L5 vertebral bodies. There is\nbone graft material at the L3-L5 laminectomy sites. There is thin epidural\nenhancement consistent with postoperative granulation tissue at L3-L5. There\nis an approximately 2.4 x 1.2 cm pocket of fluid without rim enhancement\nwithin the laminectomy bed, likely a seroma. There is grade ___\nanterolisthesis at L4-5 with type ___ ___ endplate changes. There is\nill-defined T1 hypointensity, T2 hyperintensity, and contrast enhancement\nwithin the L1 vertebral body. There is a similar pattern of abnormal\nenhancement involving the L2-3 endplates. The conus is normal in appearance\nand position, terminating at L1.\n\nT12-L1: No significant disc pathology. No significant spinal canal or\nforaminal stenosis.\n\nL1-L2: There is a mild disc bulge. There is no significant spinal canal or\nforaminal stenosis.\n\nL2-L3: There is a disc bulge extending into the right foramen and causing\nmild right foraminal stenosis. There is no significant spinal canal or left\nforaminal stenosis.\n\nL3-L4: There is a mild disc bulge causing mild bilateral foraminal stenosis.\nThere is no significant spinal canal stenosis.\n\nL4-L5: There is grade ___ anterolisthesis causing severe left foraminal\nstenosis. There is an approximately 0.8 x 0.5 cm T1 hypointense, nonenhancing\nstructure in the left neural foramen (series 7, image 24). This may be a\nswollen nerve root or disc material. There is no significant spinal canal or\nright foraminal stenosis.\n\nL5-S1: There is a disc bulge. There is no significant spinal canal or\nforaminal stenosis.", "output": "1. Approximately 0.8 x 0.5 cm structure within the left L4-5 neural foramen,\neither a swollen nerve root or less likely disc material. This is\nsuperimposed on severe left L4-5 foraminal stenosis due to grade I-II\nanterolisthesis.\n2. Focal signal abnormality within the L1 vertebral body, possibly a\nmetastasis. Correlation with noncontrast CT of the lumbar spine is recommended\nfor further evaluation.\n3. Abnormal signal within the L2-3 endplates, either due to degenerative\ndisease, compression fractures, or metastasis. Correlation with noncontrast CT\nof the lumbar spine is recommended for clarification.\n4. Postsurgical changes of L3-L5 laminectomy and fusion.\n\nFindings discussed with Dr. ___ at approximately 12:00 ___." }, { "input": "At T10-T11, T11-T12 and T12-L1 disc bulging is identified.\n\nAt L1-2 level there is disc bulging and a broad-based right-sided protrusion\nare seen mildly indenting the thecal sac with moderate right subarticular\nrecess and foraminal narrowing.\n\nThere is lumbar spine scoliosis identified convex to the right in the lower\nlumbar and to the left in the upper lumbar region.\n\nAt L2-3 the previously seen endplate changes have resolved. There is narrowing\nof this disc space noted with disk bulging. There is moderate spinal stenosis\nseen which is not significantly changed.\n\nAt L3-4 level, disc bulging and moderate spinal stenosis identified as before.\nAll\n\nAt L4-5 there is grade 1 spondylolisthesis of L4 on L5. Severe spinal stenosis\nseen. There is severe narrowing of both foramina left greater than right with\ncompression of the exiting nerve roots. Overall there has been no significant\ninterval change at this level.\n\nAt L5-S1 level disk bulging and severe bilateral foraminal narrowing right\ngreater than left side is noted which appears to have increased from the prior\nstudy.\n\nDistal spinal cord and paraspinal soft tissues are unremarkable. Following\ngadolinium no abnormal enhancement is seen. There is no intraspinal or\nparaspinal fluid collection identified. Simple appearing renal cysts are\nincidentally noted.", "output": "There has been progression of degenerative changes at L5-S1 level there is\nbilateral severe foraminal narrowing identified right impressions and\nleft-sided. Spinal stenosis from L2-3 L3-4 and L4-5 level with most pronounced\nchanges at L4-5 level are again noted with severe foraminal narrowing at this\nlevel as before." }, { "input": "Nondiagnostic study with only localizer imaging obtained.", "output": "Aborted exam due to patient refusal. If clinically indicated, consider repeat\nexamination when patient can tolerate study." }, { "input": "There are multilevel degenerate changes of the visualized cervical spine with\ndisc bulges most prominent at C3-C4 through C6-C7 levels resulting in moderate\nto severe spinal canal stenosis, but cannot be properly characterized on this\nseverely motion degraded study. The multilevel disc protrusions within the\nvisualized lower thoracic spine. The spinal cord cannot be properly evaluated\non this study. Incidental note is made of multiple hyperintense T2 lesions\nwithin the kidneys, likely renal cysts. A hiatal hernia and a tortuous\ndescending aorta is identified. Proper evaluation for epidural abscess is not\npossible on this study.", "output": "Only limited MR images were obtained only as the patient could not tolerate\nthe entirety of the examination; this is a second attempt today. Provided\nimages are severely degraded by patient motion artifact. This is an\nincomplete study.\n\nProvided images demonstrate multilevel degenerative changes of the cervical\nspine, most prominent from C3-C4 through C6-C7 levels with multilevel disc\nprotrusions of the visualized thoracic spine." }, { "input": "There is 6 mm anterolisthesis of L4 on L5, and 2 mm retrolisthesis of L5 on\nS1, unchanged compared with prior. Alignment is otherwise anatomic. With the\nexception of the T11-T12 intervertebral disc, there is reduced intervertebral\ndisc height and loss of disc hydration from T10-S1, with adjacent multilevel\nendplate degenerative change. There is a T1 and T2 hyperintense lesion in the\nT11 vertebral body, likely representing a vertebral hemangioma. Marked\nanterior osteophytes are noted at L2-L3 level.. Vertebral body and\nintervertebral disc signal intensity appear otherwise normal.\n\nT10-T11: There is a posterior disc bulge and ligamentum flavum thickening,\ncausing moderate spinal canal narrowing. There is severe bilateral neural\nforaminal narrowing, with possible impingement of the exiting T10 nerve roots\nbilaterally.\n\nT11-T12: There is prominent posterior epidural fat and ligamentum flavum\nthickening, causing moderate spinal canal narrowing. There is no significant\nneural foraminal narrowing.\n\nT12-L1: There is a posterior disc bulge, ligamentum flavum thickening and\nbilateral facet joint arthropathy, causing mild spinal canal narrowing. There\nis no significant neural foraminal narrowing.\n\nL1-L2: There is a posterior disc bulge, ligamentum flavum thickening,\nprominent posterior epidural fat and bilateral facet joint arthropathy,\ncausing severe spinal canal narrowing. Minimal CSF is identified around the\ncauda equina at this level. There is mild bilateral neural foraminal\nnarrowing.\n\nL2-L3: There is a posterior disc bulge, ligamentum flavum thickening and\nbilateral facet joint arthropathy, causing severe spinal canal narrowing. No\nCSF is identified around the cauda equina at this level, with possible cauda\nequina impingement. There is severe right and mild left neural foraminal\nnarrowing, with possible impingement of the exiting right L2 nerve root.\n\nL3-L4: There is a posterior disc bulge, ligamentum flavum thickening and\nbilateral facet joint arthropathy, causing severe spinal canal narrowing, with\nno CSF identified around the cauda equina at this level, with possible cauda\nequina impingement. There is severe bilateral neural foraminal narrowing,\nwith possible impingement of the exiting L3 nerve roots bilaterally.\n\nL4-L5: There is a posterior disc bulge, ligamentum flavum thickening and\nbilateral facet joint arthropathy, causing moderate to severe spinal canal\nnarrowing. There is narrowing of the lateral recesses bilaterally and\npossible impingement of the descending L5 nerve roots bilaterally. There is\nsevere bilateral neural foraminal narrowing, with possible impingement of the\nexiting L4 nerve roots bilaterally.\n\nL5-S1: There is a posterior disc bulge, ligamentum flavum thickening and\nbilateral facet joint arthropathy, causing moderate to severe spinal canal\nnarrowing. There is narrowing of the lateral recesses bilaterally and\npossible impingement of the descending S1 nerve roots bilaterally. There is\nsevere right and moderate to severe left neural foraminal narrowing, with\npossible impingement of the exiting right L5 nerve root.\n\nThe terminal cord is within expected limits. The conus ends at T12-L1 level.\n\nMultiple likely simple renal cysts are noted.", "output": "1. Multilevel severe lumbar spondylosis, unchanged compared with prior.\n2. Severe spinal canal narrowing from L1 to L4 levels, with possible cauda\nequina impingement.\n3. Moderate to severe spinal canal narrowing from L4-S1 levels, with possible\nimpingement of the descending L5 and S1 nerve roots in the lateral recesses\nbilaterally.\n4. Severe right neural foraminal narrowing at L2-L3 and L5-S1 levels and\nsevere bilateral neural foraminal narrowing at L3-L4 and L4-L5 levels, with\npossible impingement of the respective exiting nerve roots.\n5. Overall the findings appear mildly progressed from examination of ___.\n6. Multiple bilateral likely simple renal cysts.\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 vertebral body height and alignment is maintained. There is a normal\ncurvature. The bone marrow has a normal signal intensity. The intervertebral\ndisc have normal height and signal intensities.\n\nC2-C3: No disk herniation, or spinal canal or neural foraminal narrowing.\n\nC3-C4: No disk herniation, or spinal canal or left neural foraminal\nnarrowing. Uncovertebral hypertrophy and facet arthrosis cause mild to\nmoderate right neural foraminal narrowing.\n\nC4-C5: No disk herniation or spinal canal narrowing. Uncovertebral\nhypertrophy and facet arthrosis cause mild to moderate left-greater-than-right\nneural foraminal narrowing.\n\nC5-C6: No disk herniation, or spinal canal or left neural foraminal\nnarrowing. Uncovertebral hypertrophy and facet arthrosis cause mild right\nneural foraminal narrowing.\n\nC6-C7: No disk herniation, or spinal canal or neural foraminal narrowing.\n\nC7-T1: No disc herniation, or spinal canal or neural foraminal narrowing.\n\nThe cervical and included upper thoracic spinal cord demonstrate normal signal\nintensity and morphology. No abnormal flow voids are identified within the\ncervical included upper thoracic spinal canal. No abnormal cord signal or\nenhancement is appreciated. The vertebral and carotid vessels appear\nunremarkable. The included posterior fossa appears unremarkable as visualized.\nThe paraspinal soft tissues are normal.", "output": "1. No evidence of cervical vascular malformation.\n2. Mild multilevel cervical spondylosis as detailed above." }, { "input": "There has been no change since comparison exam. Alignment is anatomic with\nloss of cervical lordosis. There is minimal loss height superior T2 vertebral\nbody, likely from Schmorl's node, there is no associated vertebral body or\nparavertebral edema. Vertebral body heights are preserved. Vertebral body\nsignal intensity appear normal. There are multilevel degenerative changes\nwith loss of disc height, loss of intervertebral disc signal intensity,\nintervertebral osteophyte formation, hypertrophy of ligamentum flavum, and\nfacet hypertrophy. There is no evidence of abnormal enhancement post contrast\nadministration. There are postoperative changes at the right lung apex there\nis no cord T2 signal abnormality.\n\nAt C2-C3 level, central canal, right foramen are patent. There is mild left\nforaminal narrowing.\nAt C3-C4 level, there is fusion of vertebral bodies across disc space. There\nis moderate central canal narrowing, with minimal flattening of the ventral\ncord secondary to prominent disc osteophyte complex. A there is moderate\nsevere left, and moderate right foraminal narrowing.\nAt C4-C5 level there is mild-to-moderate central canal narrowing. There is\nsevere left, and mild-to-moderate right foraminal narrowing.\nAt C5-C6 level there prominent endplate hypertrophic changes, diffuse disc\nbulge causing moderate to severe central canal narrowing, mild flattening of\nthe cord, and nearly complete effacement of CSF. There is severe right, and\nmoderate left foraminal narrowing.\nAt C6-C7 level there is mild central canal narrowing. There is moderate\nbilateral foraminal narrowing.\nAt C7-T1 level, central canal is patent. There is mild bilateral foraminal\nnarrowing.", "output": "1. Multilevel advanced degenerative changes in the cervical spine.\n2. Multilevel central canal narrowing, most prominent and moderate to severe\nat C5-C6 level.\n3. There is multilevel significant foraminal narrowing.\n4. No evidence of metastases." }, { "input": "Slightly evaluation due to motion degradation.\n\nAlignment is normal. Again seen is straightening of cervical spine. Vertebral\nbody and intervertebral disc signal intensity appear normal. The spinal cord\nappears normal in caliber and configuration.\n\nC1-C2: Within normal limits\nC2-C3: Within normal limits\nC3-C4: Stable mild left uncovertebral hypertrophy without neural foraminal\nnarrowing.\nC4-C5: Stable small posterior disc bulge mildly narrowing the thecal sac. No\nabnormal cord signal. Mild bilateral uncovertebral hypertrophy without neural\nforaminal narrowing.\nC5-C6: Within normal limits.\nC6-C7: Mild posterior disk bulge causing mild anterior thecal sac deformity,\nunchanged from previous examination. No abnormal cord signal. Bilateral\nuncovertebral hypertrophy causing severe left and moderate right neural\nforaminal narrowing and possible contact of exiting left nerve root, which is\nunchanged in appearance.\nC7-T1: Mild bilateral uncovertebral hypertrophy causing mild left neural\nforaminal narrowing.", "output": "1. Straightening of cervical spine, unchanged from ___.\n2. Mild multilevel degenerative changes most prominent C6-C7 with mild\nposterior disc bulge causing mild anterior thecal sac deformity with severe\nleft and moderate right neural foraminal narrowing with possible contact of\nexiting left C6 nerve root, unchanged from ___." }, { "input": "Cervical spine:\n\nThere is no evidence of cord compression or abnormal signal within the spinal\ncord. At C6-7 level there is disc bulging indenting the thecal sac with\nmoderate to severe left-sided and moderate right-sided foraminal narrowing\nunchanged from the previous study mild degenerative changes also seen at other\nlevels.\n\nLumbar spine:\n\nThere is no evidence of thecal sac compression seen there is no disc\nherniation. Mild disk bulging at L5-S1 level. There is no foraminal\nnarrowing. There is no compression fracture. The distal spinal cord shows\nnormal signal intensities.", "output": "No evidence of cord compression or high-grade thecal sac compression. \nDegenerative changes in the cervical spine with mild bulging at C6-7 levels\nand foraminal narrowing unchanged from previous MRI. Mild degenerative\nchanges at L5-S1 level in the lumbar region without evidence of spinal\nstenosis foraminal narrowing or nerve root displacement." }, { "input": "Study is mildly degraded by motion.\n\n Minimal reversal of the cervical lordosis is grossly unchanged. Vertebral\nbody heights are preserved. C2-3, C3-4, and C4-5 type ___ ___ changes are\nnoted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nGrossly stable loss of intervertebral disc height and signal are again noted\nat C3-4, C4-5, C5-6 and C6-7.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nThe visualized portion of the posterior fossa and cervicomedullary junction\nare preserved. Bilateral maxillary sinus mucosal thickening is present.\n\nAt C2-3 there is no vertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy and facet joint\nhypertrophy resulting mild vertebral canal and moderate bilateral neural\nforaminal narrowing.\n\nAt C4-5 there is disc bulge, uncovertebral hypertrophy and facet joint\nhypertrophy which deforms the ventral thecal sac without definite associated\ncord signal abnormality, resulting in mild vertebral canal, moderate left and\nmild right neural foraminal narrowing.\n\nAt C5-6 there is disc bulge and uncovertebral hypertrophy which deforms the\nventral thecal sac without definite associated cord deformation or cord signal\nabnormality, resulting in mild vertebral canal and no neural foraminal\nnarrowing.\n\nAt C6-7 there is disc bulge and uncovertebral hypertrophy resulting in mild\nvertebral canal and no neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.", "output": "1. Study is mildly degraded by motion.\n2. Grossly stable multilevel cervical spondylosis as described, most\npronounced at C3-4, where there is mild vertebral canal and moderate bilateral\nneural foraminal narrowing.\n3. Paranasal sinus disease , as described." }, { "input": "Alignment is normal. Again seen are regions of focal fat accumulation in the\nT11 and L3 vertebral bodies, unchanged since the prior study there are\nSchmorl's nodes in the inferior endplates of the T11 and T12 vertebral bodies,\nunchanged. There is loss of signal of the intervertebral discs at T11-12,\nL3-4, L4-5 and L5-S1. These are manifestations of degenerative disc disease.\nAxial imaging demonstrates a small right-sided disc protrusion at T11-12 that\ndoes not contact the spinal cord.\nThere is disc bulging at L3-4 and L4-5 with no compromise of the spinal canal.\nThere are facet osteophytes at each level from L3 through S1 with no neural\nforaminal compromise. The spinal cord appears normal in caliber and\nconfiguration. There is no evidence of infection or neoplasm.", "output": "1. Mild changes of degenerative disc disease." }, { "input": "Alignment is normal. There is a region of focal fat deposition in the T1\nvertebral body and a small atypical hemangioma in the T2 body. ___ type 2\ndegenerative endplate changes are seen at the C4-5 level. There is mild disc\nheight loss and loss of disc signal intensity at C3-4, C4-5, and C5-6. \nOtherwise, vertebral body and intervertebral disc signal intensity appear\nnormal. The spinal cord appears normal in caliber and configuration. There\nare mild multilevel degenerative changes of the cervical spine.\nC2-3: No significant spinal canal or neural foraminal narrowing.\nC3-4: Broad-based disc bulge causes mild canal and moderate bilateral neural\nforaminal narrowing.\nC4-5: Broad-based disc bulge causes mild canal and moderate bilateral neural\nforaminal narrowing.\nC5-6: Disc bulge cause mild canal narrowing. No significant neural foraminal\nnarrowing.\nC6-7: Disc bulge causes minimal canal narrowing. No significant neural\nforaminal narrowing.\nC7-T1: No significant spinal canal or neural foraminal narrowing .\nLimited evaluation of the visualized intracranial structures is unremarkable.", "output": "No significant change in mild degenerative changes of the cervical spine as\ndescribed above with mild canal narrowing at several levels and moderate\nbilateral neural foraminal narrowing at C3-4 and C4-5." }, { "input": "Study is moderately degraded by motion. Thoracic spine diffusion images are\nnondiagnostic. Within these confines:\n\nCERVICAL:\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno definite slowed diffusion of the cervical spinal cord.\n\nTHORACIC and LUMBAR:\nAlignment is normal. T12 superior endplate Schmorl's node is noted. \nVertebral body and intervertebral disc signal intensity appear\nnormal.Increased T2 and water signal in the gray matter, including anterior\nand posterior horns, throughout the entire thoracic and lumbar spinal cord is\npresent (see series 11 and series 12). The conus medullaris terminates at the\nlevel of L2. There is no epidural collection or evidence of hemorrhage. There\nis no evidence of spinal canal or neural foraminal narrowing.\n\nOTHER: Incidental note of a punctate T2 hyperintense focus in the interpolar\nleft kidney (12:31), which is incompletely characterize but may represent a\nmillimetric cyst. Small amount of fluid signal in the lumbar soft tissues is\nincidentally noted (15:14).", "output": "1. Study is moderately degraded by motion, and further limited by\nnondiagnostic thoracic spine diffusion imaging.\n2. Signal abnormality in the anterior and posterior columns of the entire\nthoracic and lumbar spinal gray matter, concerning for cord infarction with\ndifferential considerations of transverse myelitis.\n3. Within limits of study, no definite evidence of fracture, epidural\nhemorrhage, or cervical spinal cord infarction.\n4. Nonspecific lumbosacral soft tissue edema.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 13:43 on ___, 5 min after discovery. \nAdditionally, findings were communicated via telephone by Dr. ___ to Dr.\n___ at 14:00 on ___, 20 min after discovery." }, { "input": "Again seen is hyperintensity in the thoracic spinal cord. This appears more\nextensive than on the prior examination, now involving the spinal cord at the\nC7-T1 level and inferiorly to the conus. The upper thoracic spinal cord\nappears enlarged, a new finding since the prior study. Axial T2 weighted\nimages demonstrate more extensive involvement of the central spinal cord. \nAlthough in some locations the gray matter predominant pattern persist, and\nothers there is more uniform involvement of the central white matter as well\nas gray matter. There is no abnormal enhancement after contrast\nadministration.\n\nThe findings are most suspicious for infarction, given the gray matter\npredominance. This pattern would not be typical for other inflammatory\ncauses.\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration.\nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.", "output": "1. Progression of spinal cord swelling and signal intensity abnormality since\nthe study of ___. The gray matter predominant pattern continues\nto suggest infarction as the most likely etiology." }, { "input": "Study is severely degraded by motion. Within these confines:\n\n Vertebral body alignment is grossly preserved. Chronic minimal C6 and C7\nanterior compression deformity fractures are again noted. There is no\ndefinite focal marrow signal abnormality.\n\nThe visualized portion of the spinal cord is grossly preserved in signal.\n\nThere is loss of intervertebral disc height and signal throughout cervical\nspine.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling..\n\nAt C2-3 there is no definitevertebral canal or neural foraminal narrowing.\n\nAt C3-4 there is disc bulge, uncovertebral hypertrophy, facet joint\nhypertrophy, deformation of ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality, mild to moderatevertebral canal\nand severe bilateral neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nhypertrophy, uncovertebral hypertrophy, deformation of ventral thecal sac and\nspinal cord without definite associated cord signal abnormality,\nmoderatevertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is uncovertebral hypertrophy, disc bulge, and facet joint\nhypertrophy, mildvertebral canaland mild leftneural foraminal narrowing.\n\nAt C6-7 there is disc bulge, ligamentum flavum hypertrophy, mildvertebral\ncanal and no neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.", "output": "1. Study is severely degraded by motion.\n2. C6 and C7 chronic minimal anterior vertebral body compression fractures.\n3. Multilevel cervical spondylosis as described, most pronounced at C4-5,\nwhere there is moderate vertebral canal and moderate bilateral neural\nforaminal narrowing with deformation of the ventral thecal sac and spinal cord\nwithout definite associated cord signal abnormality.\n4. C3-4 mild-to-moderate vertebral canal and severe bilateral neural foraminal\nnarrowing with deformation of ventral thecal sac and spinal cord without\ndefinite associated cord signal abnormality." }, { "input": "Axial images are limited by motion artifacts.\n\nThe preceding CT demonstrates slightly displaced fractures of the right C6\ntransverse process and left C5 transverse process. These are not adequately\nreassessed on the MRI.\n\nThere is widening of the C6-7 disc with associated edema, as well as edema in\nthe adjacent endplates, without loss of C6 or C7 vertebral body heights. The\nleft C6-7 facet joint is widened. There is fluid in bilateral C6-7 facet\njoints. There is no spondylolisthesis at C6-7.\n\nThe anterior longitudinal ligament at C6-7 is disrupted. There is prevertebral\nedema from the craniocervical junction through the image upper thoracic\nlevels. Focal disruption of the posterior longitudinal ligament at C6-7 is\nalso suspected, series 4, images ___. Ligamentum flavum at C6-7 is disrupted\nand edematous. Interspinous ligaments are edematous at C6-7 and possibly also\nat C5-6. There is extensive posterior paravertebral muscle and other soft\ntissue edema from the craniocervical junction through the imaged upper\nthoracic levels. There is also edema in the visualized portion of the left\ntrapezius extending towards left shoulder.\n\nThere is a small anterior epidural signal abnormality extending from the C6-7\ndisc space superiorly along the C6 vertebral body, most likely a small\nepidural hematoma measuring 3.5 mm in maximal depth on image 5:11. In\ncombination with posterior endplate osteophytes, this results in spinal cord\ncompression at C6-7 with questionable minimal high T2 signal, image 3:11.\nEvaluation of spinal cord signal on axial T2 weighted images is limited by\nmotion artifact.\n\nThe cerebellar tonsils are normally positioned, and the visualized portion of\nthe posterior fossa appears unremarkable.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, a central disc protrusion abuts and slightly indents the ventral\nspinal cord with moderate spinal canal narrowing. There is moderate to severe\nright and severe left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nAt C4-5, a disc osteophyte complex and thickening of the ligamentum flavum\nresult in severe spinal canal stenosis with spinal cord deformation and likely\ncompression. There is questionable faint high T2 signal in the cord at this\nlevel on image 3:10. Evaluation of spinal cord signal on axial T2 weighted\nimages is limited by motion artifact.\n\nAt C5-6, a left paracentral disc protrusion flattens the ventral spinal cord\nwith moderate spinal canal narrowing. There is moderate or severe right neural\nforaminal narrowing by uncovertebral and facet osteophytes, difficult to\nevaluate due to motion on axial images. There is mild left neural foraminal\nnarrowing by uncovertebral osteophytes.\n\nAt C7-T1, there is a mild anterolisthesis without spinal canal narrowing. The\nneural foramina are mildly foreshortened.", "output": "1. Unstable 3 column injury at C6-7 including disruption of the anterior\nlongitudinal ligament, disc space, posterior longitudinal ligament, and\nligamentum flavum, as well as fluid in bilateral facet joints and widening of\nthe left facet joint. Also interspinous ligament edema at C5-6 and C6-7.\n2. Edema in the C6-7 endplates without loss of vertebral body height or\nevidence of fracture on preceding CT.\n3. Right C6 transverse process fracture and left C5 transverse process\nfracture, seen on the preceding CT, are not adequately redemonstrated by MRI.\n4. Extensive prevertebral edema and posterior paravertebral muscle/ soft\ntissue edema from the craniocervical junction through the visualized upper\nthoracic levels. Visualized left trapezius is also edematous with edema\nextending to the left shoulder.\n5. Small anterior epidural hematoma at C5 and C5-6. In combination with\nposterior endplate osteophytes, this results in spinal cord compression at\nC5-6 with questionable faint cord signal abnormality.\n6. Multilevel degenerative disease with severe spinal canal stenosis and cord\ncompression at C4-5, with questionable faint cord signal abnormality.\n\nNOTIFICATION: Results were discussed over the telephone by Dr. ___ with\nDr. ___ at 10:15 on ___." }, { "input": "Prior thoracic spine radiographs demonstrate 11 rib-bearing vertebrae. Prior\nabdominal/pelvic CT demonstrates two transitional vertebrae caudal to the most\ninferior rib-bearing vertebra and 3 lumbar-type vertebrae. The most caudal\nlumbar type vertebra attached is the iliolumbar ligament and is, therefore,\nlabeled L5. The two transitional vertebrae are labeled L1 and L2. The\nnumbering is documented on image 2:9.\n\nThere is bone graft mediated posterior fusion of L4 through the upper sacrum.\n\nVertebral body heights are preserved. Alignment is within normal limits. There\nis no evidence for osseous, epidural, or leptomeningeal metastatic disease.\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating at L1-2.\n\nSagittal images through the T9-10 level demonstrate a mild disc bulge without\nspinal canal or neural foraminal narrowing. There are no axial images through\nthis level.\n\nAt T10-11, there is a small left paracentral disc protrusion without spinal\ncanal or neural foraminal narrowing.\n\nAt T11-L1, there is a mild disc bulge and mild right facet arthropathy with\nfluid in the right facet joint. There is no spinal canal or neural foraminal\nnarrowing. There is no interval change compared to the ___ MRI.\n\nAt L1-2, there is a mild disc bulge and mild bilateral facet arthropathy with\nfluid in the facet joints. There is no spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing. There is no interval change compared to\nthe ___ MRI.\n\nAt L2-3, there is mild bilateral facet arthropathy with fluid in the facet\njoints, and a minimal disc bulge. There is mild bilateral neural foraminal\nnarrowing. These findings are unchanged compared to the ___ MRI.\n\nAt L3-4, there is a disc bulge which is larger than on the ___ MRI,\nthickening of the ligamentum flavum which has increased since the prior MRI,\nand advanced bilateral facet arthropathy with fluid in the facet joints,\nsimilar to the prior MRI. These findings result in moderate to severe spinal\ncanal stenosis with crowding of the intrathecal nerve roots and compression of\nbilateral traversing L4 nerve roots in the subarticular zones, progressed\nsince the prior MRI. There is also moderate bilateral neural foraminal\nnarrowing with abutment of the exiting L3 nerve roots, progressed on the right\nbut not significantly changed on the left.\n\nAt L4-5, there is a mild disc bulge and moderate bilateral facet arthropathy.\nThere is no significant spinal canal or neural foraminal narrowing.\n\nAt L5-S1, there is evidence of laminectomies. There is moderate bilateral\nfacet arthropathy. There is no significant disc bulge. There is no significant\nspinal canal or neural foraminal narrowing.\n\nThere are cystic lesions in the left kidney and cortical defects in the middle\nand lower thirds of the right kidney, similar to the prior CT.", "output": "1. 11 rib-bearing vertebrae, transitional anatomy of L1 and L2, and\nconventional anatomy of L3 through L5, with the iliolumbar ligament attaching\nat the vertebra labeled L5, as detailed above.\n2. S/p L5-S1 laminectomies and bone graft mediated posterior fusion of L4\nthrough the upper sacrum. No significant spinal canal or neural foraminal\nnarrowing at L4-5 or L5-S1.\n3. At L3-4, there is an increase disk bulge and thickening of the ligamentum\nflavum compared to the ___ MRI, and unchanged advanced bilateral facet\narthropathy. There is associated moderate to severe spinal canal stenosis with\ncrowding of the intrathecal nerve roots and compression of bilateral\ntraversing L4 nerve roots, progressed since the prior MRI. There is also\nmoderate bilateral neural foraminal narrowing with abutment of the exiting L3\nnerve roots, progressed on the right but stable on the left.\n4. Mild degenerative changes from T10-11 through L2-3 are similar to the ___\nMRI.\n5. No evidence for metastatic disease." }, { "input": "There is minimal anterior wedging of T4 and T7 vertebral bodies without\nabnormal signal indicative of mild chronic compressions. Disc degenerative\nsignal is seen in the upper and mid thoracic intervertebral discs without\nsignificant bulge or herniation. There is no spinal stenosis seen. Spinal\ncord shows normal intrinsic signal without extrinsic compression. An\nincidental hemangioma is seen in the ___ vertebral body.", "output": "Minimal to mild chronic compressions of T4-T7 vertebral bodies. No acute\ncompression fracture. Minimal disc degenerative disease without significant\ndisc bulge, herniation or spinal stenosis." }, { "input": "There is extensive lumbar spondylosis and scoliosis.\n\nThe conus terminates at the L1-2 level. No conus masses.\n\nThere is a longitudinal extensive T2 hyperintense, T1 hypointense collection\nnot demonstrating enhancement postcontrast spanning L2 through L4 measuring a\nmaximum of 65 mm in craniocaudal ___, which occupies almost the entire\nspinal canal with displacement and compression of the surrounding nerve roots.\nThis intraspinal lesion is difficult to place as intra or extradural due to\nits large size. This is most compatible with a large arachnoid cyst, in the\ndifferential diagnosis consider a liquified hematoma, but is less likely\nconsidering there is no intrinsically T1 hyperintense components. There is a\nnonenhancing T1 Iso and T2 iso to hypointense soft tissue component in its\nposterior aspect at the L3 level which does not enhance postcontrast.\nThere are no surrounding inflammatory signs to suggest infection or epidural\nabscess.\n\nThere is marked multilevel spondylotic changes in the form of disc\ndesiccation, broad-based disc bulge, facet joint arthropathy as well as again\nmentum flavum hypertrophy as described below:\n\nT12-L1: No cord or nerve root compromise.\n\nL1-2: No cord compromise in the spinal canal. Moderate right and moderate\nsevere left neural foraminal narrowing.\n\nL2-3: Marked spinal canal narrowing due to the lesion described above. Mild\nmoderate right and moderate severe left neural foraminal narrowing.\n\nL3-4: Marked spinal canal narrowing due to the lesion described above. \nModerate severe right and severe left neural foraminal narrowing.\n\nL4-5: Moderate severe spinal canal narrowing secondary to degenerative changes\nwith marked ligamentum flavum hypertrophy. Moderate severe and severe neural\nforaminal narrowing bilateral.\n\nL5-S1: Grade 2 spondylolytic spondylolisthesis of L5 on S1. This with\nassociated degenerative changes results in severe spinal canal stenosis. \nThere is also severe neural foraminal narrowing bilateral. Fluid present\nbetween the L5-S1 spinous processes suggesting arthropathy between the spinous\nprocess (possible Baastrup's disease), but no edema in the spinous processes.\n\nA couple of vertebral body hemangiomas are incidental findings.\n\nExtra-spinal: Distended bladder which may lead to fullness of the kidneys\nbilaterally, right greater than left. Moderate dilatation of the CBD\nmeasuring 10 mm in a dedicated ultrasound may be performed if clinically\nindicated.", "output": "1. Large T2 hyperintense, T1 hypointense collection in the spinal canal\nextending from L2 through L4 resulting in marked displacement and compression\nof the surrounding nerve roots. Differential considerations include an\narachnoid cyst vs a liquified hematoma. Nonenhancing soft tissue in this\nlesion is nonspecific but is most likely felt to represent associated\nthickened dura/meninges in the setting of a arachnoid cyst or retracted clot\nin the setting of a liquified hematoma.There is no surrounding inflammatory\nsigns to suggest infection or epidural abscess.\n2. There is marked multilevel spondylotic changes which results in moderate to\nsevere spinal canal narrowing at the L4-5 as well as grade 2 spondylolytic\nspondylolisthesis of L5 on S1 which results in severe spinal canal narrowing\nat this level.\n3. Multilevel severe neural foraminal narrowing as described above.\n4. Moderate dilatation of the CBD measuring 10 mm and a dedicated ultrasound\nmay be performed if clinically indicated.\n5. Distended bladder - which may lead to fullness of the kidneys - right\ngreater than left.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:22 am, 5 minutes\nafter discovery of the findings." }, { "input": "Alignment is anatomic. There is focal increased STIR/T2 signal\nwithin the superior aspect and anterior cortex of the C7 vertebral body. \nVertebral body height is maintained. There is minimal-mild loss of normal low\nT1-T2 signal within the adjacent anterior longitudinal ligament. There is no\nprevertebral fluid/swelling. The spinal cord has normal contour. There is no\nsignificant spinal canal or foraminal narrowing. The posterior longitudinal\nligament, ligamenta flava and facet capsular ligaments appear unremarkable.", "output": "Focal increased STIR/T2 signal within the superior aspect of the\nC7 vertebral body and the anterior cortex compatible with a bony contusion. \nNo obvious fracture is demonstrated on the prior CT except for some subtle\nvague lucency. While there is no evidence of full-thickness tear of the\nanterior longitudinal ligament at this level, the adjacent anterior\nlongitudinal ligament has minimal-mild loss of the normal low T1 and T2 signal\nwhich most likely represents a sprain. The posterior longitudinal ligaments\nand ligamenta flava are intact. Spine conslt can be helpful." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThere is mild levoscoliosis of the lumbar spine. Vertebral body heights are\npreserved. There are degenerative changes at the inferior endplate of L4 and\nthe superior endplate of L5. Otherwise, there is no marrow signal abnormality.\nThe visualized portion of the spinal cord is preserved in signal and caliber.\nThere is loss of intervertebral disc height and signal atL5-S1. There is\nadditional loss of intervertebral disc signal at L3-4 and L4-5.\n\n At T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is no spinal canal or neural foraminal stenosis.\n\nAt L2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt L3-4 there is a disc bulge with ligamentum flavum hypertrophy and facet\njoint arthropathy, with no spinal canal or neural foraminal stenosis.\n\nAt L4-5 there is postsurgical changes related to prior right hemilaminectomy,\nwith disc bulge, ligamentum flavum hypertrophy and facet joint arthropathy,\nwith no spinal canal and moderate right neural foraminal stenosis.\n\nAt L5-S1 there is a disc bulge with facet joint arthropathy with no spinal\ncanal and moderate bilateral neural foraminal stenosis.\n\nThere are 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. Partial visualization the kidneys suggest an\napproximately 8 mm left renal cystic structure (see series 6, image 5).\nAdditionally, within the right kidney there is a 2 mm hypointense lesion (see\nseries 5, image 4), which is not imaged on postcontrast images.", "output": "1. Multilevel degenerative changes as described, most pronounced at the L5-S1\nlevels where there is moderate bilateral neural foraminal stenosis. \nAdditional to moderate right neural foraminal stenosis at L4-5 level.\n2. Approximately 8 mm left renal at least partially cystic lesion, and\napproximately 2 mm right renal nonspecific lesion.\n3. Postsurgical changes related to prior right L4-5 hemilaminectomy.\n\nRECOMMENDATION(S): RE 2: Recommend clinical correlation and correlation\nwith renal ultrasound." }, { "input": "Limited examination due to patient motion, within this limitation, the\nthoracic spine alignment is normal, there is a T1 hypointense and T2\nhyperintense enhancing lesion along the inferior endplate of the T6 vertebral\nbody measuring 8 mm (2:7, 3:9), correlating to the area of increased FDG\nuptake on prior PET-CT dated ___. In the setting of known\npulmonary malignancy, findings are concerning for a lytic metastatic lesion.\nArticular joint facet hypertrophy and ligamentum flavum thickening are\nvisualized at T2-T3 level, causing posterior thecal sac deformity on the left\nand causing mild left-sided neural foraminal narrowing (series 5, image 10)\notherwise, vertebral body and intervertebral disc signal intensity appear\nnormal. The spinal cord appears normal in caliber and configuration. There\nare bilateral pleural effusions, more significant on the left, new since the\nprior PET-CT exam. Small renal cystic formations are identified in the left\nkidney, measuring approximately 4 x 5 mm (minutes series 7, image 31, and\nimage 34), partially evaluated in this exam.", "output": "1. Likely metastatic osseous lesion in the T6 vertebral body measuring 8 mm,\ncorrelating to the area of increased FDG uptake on prior PET-CT dated ___.\n\n2. Limited examination due to patient motion, within this limitation, no\nfocal or diffuse lesions are visualized throughout the thoracic spinal cord.\n\n3. Degenerative changes are seen at ___ level consistent with articular\njoint facet hypertrophy causing moderate left-sided neural foraminal\nnarrowing.\n\n4. Bilateral pleural effusion more significant on the left, and new since the\nprior PET-CT exam." }, { "input": "The vertebral body height, alignment, and marrow signal within the lumbar\nspine are normal. There is minimal loss of disc signal at the L2-L3 and L3-L4\nlevels.\n\nThe conus is normal in position and morphology and terminates at the L1-L2\nlevel.\n\nThe paraspinal and prevertebral soft tissues are unremarkable.\n\nAt the L3-L4 level, there is mild bilateral facet arthropathy. The spinal\ncanal and neural foramina appear normal.\n\nAt the L4-L5 level, there is mild bilateral facet arthropathy, ligamentum\nflavum thickening, and a mild diffuse disc bulge. The spinal canal and neural\nforamina appear normal.\n\nAt the L5-S1 level, there is bilateral facet arthropathy and a diffuse disc\nbulge which cause mild bilateral neural foraminal narrowing.\n\nWhen compared to prior exam, these degenerative changes appear similar.", "output": "1. Degenerative lumbar spondylosis, greatest at the L5-S1 level where there is\nmild bilateral neural foraminal narrowing." }, { "input": "Cervical spine: Cervical vertebral bodies are maintained in height and\nalignment. There is mind old intervertebral disc height loss at C5-6 and\nC6-7. Remaining discs are preserved in height. The spinal cord is preserved\nin signal and caliber. Included portion of posterior fossa is unremarkable. \nPost-contrast images demonstrate no abnormal enhancement.\n\nCraniocervical junction is unremarkable.\n\nAt C2-3 through C3-4, there is no significant canal or foraminal narrowing.\n\nAt C4-5, and C5-C6 there disc protrusions which partially efface the ventral\nCSF but without significant canal or foraminal narrowing.\n\nAt C6-7, there is a disc protrusion and uncovertebral joint hypertrophy which\nresults in partial effacement of ventral CSF and moderate bilateral foraminal\nnarrowing.\n\nAt C7-T1, there is no significant canal or foraminal narrowing.\n\nThere is a 1.5 x 1.2 cm T2 hyperintense lesion in association with the right\nlobe of the thyroid which is incompletely characterized. Other included\nparaspinal soft tissues are unremarkable.\n\nThoracic spine: Thoracic vertebral bodies are maintained in height and\nalignment. No focal suspicious marrow lesion identified. Intervertebral\ndiscs are preserved in height.\n\nThere is no cord signal abnormality. Post-contrast images demonstrate no\nabnormal enhancement.\n\nThere is no significant canal or foraminal narrowing throughout the thoracic\nspine. Included paraspinal soft tissues are unremarkable.\n\nLumbar spine: There are 5 lumbar-type vertebral bodies which are maintained\nin height and alignment. No focal suspicious marrow lesions identified. \nThere is mild disc desiccation at the L2-3 and L3-4 levels. Intervertebral\ndiscs are preserved in height. Conus terminates at the L1-2 level, in normal\nanatomic position. Post-contrast images demonstrate no abnormal enhancement\nof the cauda equina nerve roots.\n\nAt T12-L1 through L3-4, there is no significant canal or foraminal narrowing.\n\nAt L4-5, there is a mild diffuse disc bulge and facet joint hypertrophy which\ncause narrowing of the subarticular recesses, crowding the traversing L5 nerve\nroots. There is also mild bilateral foraminal narrowing.\n\nAt L5-S1, there is facet joint hypertrophy and mild bilateral foraminal\nnarrowing but no significant canal narrowing.\n\nIncluded paraspinal soft tissues are unremarkable.", "output": "1. No findings to explain patient's symptoms. Mild degenerative changes in\nthe cervical and lumbar spine without significant canal or foraminal\nnarrowing. No evidence of cord signal abnormality.\n2. Right-sided thyroid nodule for which dedicated nonurgent thyroid ultrasound\nis suggested.\n\nRECOMMENDATIONS: Nonurgent thyroid ultrasound." }, { "input": "There is no evidence of an acute compression fracture. No marrow edema is\nseen. The distal spinal cord shows normal signal intensities. The paraspinal\nsoft tissues are unremarkable.\n\nFrom T10-T11 through L3-4 levels mild disc degenerative changes seen. There\nis no significant bulge or herniation.\n\nAt L4-5 level, disc bulging and thickening of the ligaments resulting in mild\nspinal stenosis and subarticular recess narrowing with mild narrowing of the\nforamina unchanged from prior study.\n\nAt L5-S1 level, disc bulging is seen without spinal stenosis. There is\nminimal narrowing of the foramina.", "output": "Mild multilevel disc degenerative changes in the lumbar region. Mild spinal\nstenosis at L4-5 level. No significant change since the previous MRI of\n___. No evidence of high-grade thecal sac compression. No\ncompression fracture. No evidence of abnormal signal or compression of the\nspinal cord distal to T10 vertebra to conus level." }, { "input": "THORACIC:\nDegenerative changes are seen in the lower cervical spine, with probably mild\ncentral canal narrowing C7-T1 level. Mild left and probably moderate right\nC7-T1 foraminal narrowing.\n\nWithin the thoracic spine, vertebral body heights and alignment are\nmaintained. No suspicious bone marrow lesion is identified. Minimal\nposterior disc bulging seen at multiple levels. The thoracic spinal cord is\nnormal in morphology and signal intensity.\nNo significant central canal narrowing in the thoracic spine.\nNo significant foraminal narrowing in the thoracic spine.\n\n\nLUMBAR:\n Vertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation. There is no concerning focal\nbone marrow signal abnormality. The conus medullaris terminates at the level\nof L1. There is multilevel loss of intervertebral disc height and intrinsic T2\nsignal.\n\nMultilevel spondylosis is seen within the lumbar spine including posterior\ndisc bulging, facet arthropathy, and mild thickening of ligamentum flavum.\n\nMild central canal narrowing L2-L3, L3-L4 levels. Central canal otherwise\npatent.\n\nMild-to-moderate right foraminal narrowing L3-L4 level, with broad-based\nforaminal, extraforaminal disc bulge contacting exiting right L3 nerve.\n\nModerate to severe left L4-5 foraminal narrowing with small disc protrusion. \nMild right L4-5 foraminal narrowing.\n\nRemaining foramina lumbar spine are patent.\n\nThe visualized portions of the paraspinal soft tissues are grossly within\nnormal limits.", "output": "1. Mild degenerative change thoracic spine.\n2. Degenerative changes lumbar spine, mild central canal narrowing. Moderate\nto severe left L4-5 foraminal narrowing with small disc protrusion." }, { "input": "Alignment is normal. No worrisome lesions. Mild diffuse disc bulges lower\nlumbar spine. Normal visualized cord. Annular disc tear at L5-S1 level. \nPosterior element hypertrophic changes.\n\nAt L1-L 2, L2-L3, L3-L4 level central canal, foramina are patent.\n\nAt L5-S1 level there is minimal central canal narrowing. Small inferior left\nforaminal disc protrusion, it is of increased T2 signal, suggesting acute to\nsubacute protrusion. Severe left foraminal narrowing. Moderate right\nforaminal narrowing\n\nAt L5-S1 level there is minimal central canal narrowing.. Mild-to-moderate\nbilateral foraminal narrowing.", "output": "1. Left L4-5 foraminal disc protrusion, severe left foraminal narrowing.\n2. Degenerative changes elsewhere, as above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:58 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Alignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. There is minimal bulging of the C5-6 and C6-7 disks,\ncontacting the cervical spinal cord. The spinal cord appears normal in caliber\nand configuration. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm.", "output": "Mild cervical degenerative disk disease. Otherwise normal study." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of lumbar spine. L1 minimal chronic anterior\ncompression deformities seen. Transitional anatomy with partial sacralization\nof L5 is noted. Schmorl's nodes are seen at multiple levels throughout the\nvisualized thoracolumbar spine. Otherwise, vertebral body heights are\npreserved. L2 and L4 probable hemangiomas are again seen.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. L3-4 level question clumping of lumbar nerve roots versus volume\naveraging (see 101:37).\n\nThere is loss of intervertebral disc height and signal at L1-2 through L4-5. \nThere is loss of intervertebral disc signal at L5-S1. Nonspecific facet joint\nfluid is noted at multiple levels of the lumbar spine.\n\nAt T12-L1 there is facet joint hypertrophy, epidural fat, with no vertebral\ncanaland no neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, facet joint hypertrophy, ligamentum flavum\nthickening, epidural fat, with mild vertebral canaland mild bilateral neural\nforaminal narrowing.\n\nAt L2-3 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild-to-moderate vertebral canaland moderate bilateral \nneural foraminal narrowing.\n\nAt L3-4 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with mild-to-moderate vertebral canaland moderate bilateral \nneural foraminal narrowing.\n\nAt L4-5 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nepidural fat, with moderate vertebral canaland moderate bilateral neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge, facet hypertrophy, ligamentum flavum thickening,\nwith mild vertebral canal , moderate right and severe left neural foraminal\nnarrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. Interval progression of multilevel lumbar spondylosis and epidural fat\ncompared to ___ prior exam as described, most pronounced at L4-5, where there\nis moderate vertebral canal and moderate bilateral neural foraminal narrowing.\n3. L2-3, L3-4 and L4-5 moderate bilateral, L5-S1 moderate right and severe\nleft neural foraminal narrowing.\n4. Question focal nerve root clumping at L3-4 versus volume averaging\nartifact. If not artifactual, findings may represent arachnoiditis." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is reversal of the cervical lordosis. Approximately 3 mm C7 on T1\nanterolisthesis is again seen. Vertebral body heights are grossly preserved. \nT2 vertebral body probable hemangioma is again seen. C3-4 and C6 inferior\nendplate probable type ___ ___ changes are seen. C4-5 through C6-7 type 2\n___ changes seen. There is no prevertebral soft tissue swelling.\n\nThere is interval progression of deformation of the cervical spinal cord at\nthe C3-4 level with question overall volume loss and question minimal\nbilateral lateral cord gray matter signal hyperintensity versus artifact,\nwithout definite associated enhancement of the cervical spinal cord at C3-4\nlevel (see 06:11, 05:14 on current study and 6,8:11 on 2 day prior exam)\n\nOtherwise, the visualized portion of the spinal cord is preserved in signal,\nwith no definite abnormal enhancement on postcontrast imaging\n\nThere is loss of intervertebral disc height and signal throughout the\ncervicothoracic spine.\n\nAt C2-3 there is central disc protrusion, facet hypertrophy, ligamentum flavum\nthickening, with mild vertebral canaland mild bilateral neural foraminal\nnarrowing.\n\nAt C3-4 there is disc bulge, central disc protrusion, deformation of the\nventral thecal sac and spinal cord, facet joint hypertrophy, question minimal\nbilateral lateral cord gray matter signal hyperintensity versus artifact,\nwithout definite associated enhancement (see 06:11, 05:14 on current study and\n6,8:11 on 2 day prior exam) with moderate vertebral canal, severe left and\nmoderate right neural foraminal narrowing.\n\nAt C4-5 there is disc bulge, central disc protrusion, deformation of the\nventral thecal sac and spinal cord without definite associated cord signal\nabnormality, facet joint hypertrophy, with mild vertebral canaland mild\nbilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, right paracentral disc protrusion, deformation of\nthe ventral thecal sac and spinal cord without definite associated cord signal\nabnormality, facet joint hypertrophy, with mild-to-moderate vertebral canal,\nsevere right and mild left neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy,\nwith no vertebral canaland mild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is asymmetric right disc bulge, facet hypertrophy,\nuncovertebral hypertrophy, with mild vertebral canaland severe right neural\nforaminal narrowing.\n\nOTHER:\n There is no paravertebral or paraspinal mass identified. Limited imaging of\nthe atlantooccipital joints again demonstrate nonspecific asymmetric\nleft-sided atlantooccipital joint fluid.", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable multilevel cervical spondylosis as described compared to 2\nday prior noncontrast cervical spine MRI.\n3. Grossly stable C3-4 level spinal cord focal suggested volume loss and\nquestion lesion versus artifact as described. There is no definite\nenhancement of this finding on current examination, within limits of study. \nFindings are again suggestive of myelomalacia, with posttraumatic cord signal\nabnormality not excluded on the basis of this motion degraded examination." }, { "input": "There is mild anterior subluxation of C7 on T1. Alignment otherwise is\nnormal. There is hypointensity on the T1 weighted images in the T2 vertebral\nbody on the T1 weighted images with hyperintensity on the water ideal and T2\nweighted images. This demonstrated classic findings of a hemangioma on the\nCTA of ___. This suggests an atypical hemangioma. There are ___\ntype 1 signal intensity abnormalities at T6-7. There is a mild bulge of the\ndisc at this location that slightly encroaches on the spinal canal but does\nnot contact the spinal cord.\nImaging of the remainder of the thoracic spine demonstrates no other spinal\ncanal compromise.\nThe spinal cord appears normal in caliber and configuration.", "output": "1. Mild changes of degenerative disease without spinal cord deformity.\n2. Likely atypical hemangioma in the T2 vertebral body." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is reversal of the cervical lordosis. Approximately 3 mm C7 on T1\nanterolisthesis is again seen. Is approximately 1 mm C4 on C5\nanterolisthesis. Vertebral body heights are grossly preserved.\n\nT2 vertebral body probable hemangioma is again seen. C3-4 and C5 inferior\nendplate probable type ___ ___ changes are seen. C4-5 through C6-7 type 2\n___ changes seen.\n\nC4 left pedicle and inferior articular facet T2, water ideal hyperintense, T1\nhypointense, faintly enhancing approximately 6 mm structure is noted (see 2,\n4, 5, 10: 16; 6, 09:15; 07:20) is noted. Allowing for difference technique,\nfinding may correspond to approximately 1 mm T2 and STIR hyperintense\nstructure on ___ prior exam, without definite correlate on earlier\ncervical spine MRI exams as listed in priors list. Question minimal bilateral\nC3 inferior articular facet and C4 superior articular facet edema versus\nartifact (see 5: 3, 16).\n\nThere is no prevertebral soft tissue swelling.\n\nThere is grossly stable moderate spinal canal stenosis with underlying\ndeformation of the cervical spinal cord at the C3-4 level with unchanged\nintramedullary T2 hyperintensity at the same level.\n\nOtherwise, the visualized portion of the spinal cord is grossly preserved in\nsignal, with no definite abnormal enhancement on postcontrast imaging.\n\nThere is loss of intervertebral disc height and signal throughout the\ncervicothoracic spine.\n\nAt C2-3 there is central disc protrusion, facet hypertrophy, ligamentum flavum\nthickening, with mild vertebral canal and mild bilateral neural foraminal\nnarrowing. Nonspecific right facet joint fluid is noted.\n\nAt C3-4 there is disc bulge, central disc protrusion, deformation of the\nventral thecal sac and spinal cord, facet joint hypertrophy, abnormal\nintramedullary T2 hyperintensity with moderate vertebral canal, severe left\nand moderate right neural foraminal narrowing. Nonspecific bilateral facet\njoint fluid is noted.\n\nAt C4-5 there is disc bulge, central disc protrusion, deformation of the\nventral thecal sac and spinal cord without definite associated cord signal\nabnormality, facet joint hypertrophy, with mild vertebral canal and mild\nbilateral neural foraminal narrowing.\n\nAt C5-6 there is disc bulge, right paracentral disc protrusion, deformation of\nthe ventral thecal sac and spinal cord without definite associated cord signal\nabnormality, facet joint hypertrophy, with vertebral canal, severe right and\nmild left neural foraminal narrowing.\n\nAt C6-7 there is disc bulge, uncovertebral hypertrophy, facet hypertrophy,\nwith no vertebral canal and mild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is asymmetric right disc bulge, facet hypertrophy,\nuncovertebral hypertrophy, with mild vertebral canal and severe right neural\nforaminal narrowing.\n\nOTHER:\nThere is no paravertebral or paraspinal mass identified. Limited imaging of\nthe atlantooccipital joints again demonstrate nonspecific asymmetric\nleft-sided atlantooccipital joint fluid.\n\n Scattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by size criteria. The largest of\nthese is a left supraclavicular approximately 9 mm lymph node (see 09:23).", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable moderate C3-C4 vertebral canal stenosis and nonenhancing\ncord lesion compared to ___ prior exam.\n3. Within limits of study, no definite evidence of abnormal cervical spine\nparavertebral, paraspinal, or epidural enhancing mass.\n4. Approximately 6 mm left C4 inferior articular facet faintly enhancing\ncystic structure as described. While findings are suggestive of degenerative\nchange such as subchondral or synovial cyst, if concern for cystic metastatic\nlesion, consider cervical spine CT for further evaluation.\n5. Question minimal bilateral C3 inferior articular facet and C4 superior\narticular facet edema versus artifact.\n6. Additional multilevel cervical spondylosis, as described.\n7. Nonspecific subcentimeter cervical lymph nodes as described." }, { "input": "There is extensive susceptibility artifact related to 2 threaded screws\ntraversing bilateral sacroiliac joints. There is partial visualization of the\nperipherally enhancing 5.4 cm x 3.7 cm centrally necrotic mass along the\nanterior margin of the right sacroiliac joint (8:37). There is possible\nsubtle enhancement along the right iliac bone at the right sacroiliac joint\n(8:42).\n\nThere is a 5 mm T2/STIR hyperintense and T1 hypointense lesion in the right\nsuperior articular facet of T12 (3:15 and 5:15) with associated enhancement. \nThere is a subtle 9 mm T2/stir hyperintense lesion in the L3 vertebral body\n(2:96 and 3:13) which appears isointense on the T1 and postcontrast images,\nnonspecific and may represent a atypical hemangioma.\n\nAlignment is normal. There is mild disc desiccation and mild loss of\nintervertebral disc height at L4-L5. Vertebral body and intervertebral disc\nsignal intensity otherwise appear normal. The spinal cord appears normal in\ncaliber and configuration. There is no normal intraspinal enhancement.\n\nL1-L2: No significant spinal canal or neural foraminal stenosis.\nL2-L3: No significant spinal canal or neural foraminal stenosis.\nL3-L4: Diffuse disc bulge with a small annular fissure, ligamentum flavum\nthickening and facet joint arthropathy results in mild narrowing of the\nsubarticular zones and mild-to-moderate right and mild left neural foraminal\nnarrowing without significant spinal canal stenosis.\nL4-L5: Diffuse disc bulge and facet joint arthropathy results in mild\nnarrowing of the left subarticular zone with contact of the traversing left L5\nnerve root and mild bilateral neural foraminal narrowing.\nL5-S1: Mild disc bulge and facet joint arthropathy results in mild left neural\nforaminal narrowing.\n\nThere is redemonstration of bilateral left hydroureteronephrosis, better\nevaluated on the dedicated CT abdomen pelvis.", "output": "1. Postsurgical changes with 2 threaded screws traversing the bilateral\nsacroiliac joints results in regional susceptibility artifact and suboptimal\nevaluation of the regional structures. Within these confines:\n2. Similar peripherally enhancing, centrally necrotic mass along the anterior\nright sacroiliac joint with possible involvement of the adjacent right iliac\nbone and right sacral ala compatible with the known neoplasm.\n3. 5 mm enhancing T2 hyperintense and T1 hypointense lesion in the right\nsuperior facet of T12, nonspecific. Metastatic disease not excluded.\n4. Otherwise no evidence of abnormal osseous or intraspinal enhancement in the\nlumbar spine.\n5. Mild multilevel degenerative changes of the lumbar spine without high-grade\nspinal canal stenosis and mild-to-moderate multilevel neural foraminal\nnarrowing as well as mild narrowing of the left subarticular zone at L4-L5\nwith the contact of the traversing left L5 nerve root.\n6. Partially visualized left hydroureteronephrosis, better evaluated on the\ndedicated CT abdomen pelvis.\nPREVALENCE: Prevalence of lumbar deg" }, { "input": "Study is mildly degraded by motion.\n\nTHORACIC AND LUMBAR SPINE:\n\nLevels were established by counting down from the C2 level using series 3,\nimage 2.\n\nVertebral body alignment is preserved. Vertebral body heights are preserved.\nT8 and L1 probable hemangiomas are noted.\n\nThe visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\nIntervertebral discheightsandsignalare preserved. Nonspecific facet joint\nfluid is noted at multiple levels of the lumbar spine.\n\nDisc bulges and facet joint hypertrophy are noted at multiple levels of the\nthoracic and lumbar spine without definite evidence of moderate or severe\nvertebral canal or neural foraminal narrowing.\n\nOTHER:\n\nAt the level of T4 through T6, arising from the posterior mediastinum,\nposterior to the aorta, there is a 2.4 x 2.1 x 3.5 cm cystic lesion, without\ndefinite scalloping of adjacent vertebral bodies, and with no definite\nevidence of communication with thecal sac (4:5; 07:25). There are T2\nhyperintense lesions in the right kidney and liver, incompletely\ncharacterized. Partially visualized cystic focus in the left pelvis is likely\nfollicular activity in the left adnexa (11:17).\n\nFluid signal at S3-S4 level is seen only on STIR sagittal images, with no\ndefinite adjacent soft tissue edema.\n\n Nonspecific probable dependent edema is noted in the dorsal lumbar soft\ntissues.\n\nLimited imaging of cervical spine suggests right paracentral disc protrusion\nat C6-7 with least mild vertebral canal and mild right neural foraminal\nnarrowing.\n\nLimited imaging of the pelvis suggests an at least 1.9 cm at least partially\ncystic left adnexal structure (see 100:7; 11, 12:17). Additionally,\nnonspecific fluid within the uterus is noted.", "output": "1. Study is mildly degraded by motion.\n2. Mild multilevel thoracic and lumbar spondylosis as described without\ndefinite evidence of moderate or severe vertebral canal or neural foraminal\nnarrowing.\n3. Probable artifact S3-4 level, with differential consideration of edema as\ndescribed. If concern for nondisplaced sacral fracture, consider dedicated\nsacral MRI for further evaluation.\n4. Approximately 2.4 x 2 x 1 x 3.5 cm cystic lesion in the posterior\nmediastinum as described, without definite scalloping of adjacent vertebral\nbodies, suggestive of congenital bronchogenic cyst.\n5. Limited imaging of cervical spine suggests spondylosis as described. If\nclinically indicated, consider dedicated cervical spine MRI for further\nevaluation.\n6. Limited imaging of the kidneys and liver suggests at least partially cystic\nstructures, incompletely characterized. If clinically indicated, consider\nabdominal ultrasound for further evaluation.\n7. Limited imaging of the pelvis suggests an at least 1.9 cm at least\npartially cystic left adnexal structure, and nonspecific uterine fluid. If\nclinically indicated, consider dedicated pelvic ultrasound for further\nevaluation." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Please note that this method is\ninappropriate for surgical planning and that prior to any intervention\nappropriate levels must be established.\n\nThere is levoscoliosis with the apex at L2 level. Otherwise, vertebral body\nheights and alignment are maintained.\n\n The visualized portion of the spinal cord is preserved in signal and caliber,\nwith the conus noted at L2-3.\n\nIntervertebral disc heights and signal are preserved.\n\nAt T12-L1 there is spinal canal or neural foraminal stenosis.\n\nAt L1-2 there is ligamentum flavum hypertrophy with no spinal canal or neural\nforaminal stenosis.\n\nAt L2-3 there is a disc bulge which contacts the exiting left L2 nerve root.\n\nAt L3-4 there is ligamentum flavum hypertrophy and facet joint hypertrophy\nwith no spinal canal or neural foraminal stenosis.\n\nAt L4-5 there is ligamentum flavum hypertrophy and facet joint hypertrophy and\na disc bulge resulting in moderate left neural foraminal and mild spinal canal\nstenosis with no right neural foramina stenosis.\n\nAt L5-S1 there is a disc bulge with severe left neural foraminal stenosis and\nno spinal canal or right neural foraminal stenosis.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified and there is no evidence of infection or neoplasm.\nThe visualized portion of the sacroiliac joints are preserved. Partial imaging\nof the kidneys suggest at least 2 left renal T2 hyperintense structure\nmeasuring up to 7 mm (series 6 images 9 and 17).", "output": "1. Levoscoliosis with apex at L2 level.\n2. Multilevel degenerative changes most pronounced at L5-S1 level where there\nis severe left-sided neural foraminal stenosis.\n3. Moderate left neural foraminal and mild spinal canal stenosis at L4-5\nlevel.\n4. Partial imaging of kidneys suggests at least two 7mm left renal structures\nthat may be cysts. However other etiologies can't be excluded on the basis of\nthis noncontrast examination. Recommend clinical correlation. If clinically\nindicated, consider dedicated renal imaging.\n5. Conus noted at L2-3 level." }, { "input": "There are 7 cervical vertebrae with fusion of C6 and C7 vertebral bodies in\nposterior elements, 12 rib-bearing vertebrae, L1 with transitional anatomy, L2\nthrough L5 with conventional anatomy, and ad largely lumbarized S1.\n\nCERVICAL:\nThere is fusion of C6 and C7 vertebral bodies and posterior elements, as\nstated above. Vertebral body heights are preserved. No suspicious bone\nmarrow signal abnormalities are seen. Alignment is normal. No abnormal\ncontrast enhancement is seen. The cerebellar tonsils are normally positioned.\nVisualized posterior fossa appears unremarkable. The cervical spinal cord\ndemonstrates normal morphology and signal intensity.\n\nMultilevel degenerative disease is present. Evaluation of the neural foramina\non axial T2 weighted images is limited by motion artifact.\n\nC2-C3: No spinal canal narrowing. Some degree of neural foraminal narrowing\nby facet osteophytes appears present.\n\nC3-C4: Shallow posterior endplate osteophytes without significant spinal canal\nnarrowing. Some degree of left neural foraminal narrowing by facet\nosteophytes.\n\nC4-C5: Shallow posterior endplate osteophytes without significant spinal canal\nnarrowing. Some degree of neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Broad-based posterior endplate osteophytes, larger on the left, and\ninfolding of the ligamentum flavum cause mild, left greater than right, spinal\ncanal narrowing. Some degree of bilateral neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nC6-C7: No spinal canal narrowing. No evidence for significant neural\nforaminal narrowing.\n\nC7-T1: Small central disc protrusion indents the ventral thecal sac without\nsignificant spinal canal narrowing. Some degree of neural foraminal narrowing\nby facet osteophytes, left worse than right.\n\nTHORACIC:\nT7 vertebral body demonstrates moderate loss of height with anterior wedging\nand partial fatty marrow replacement, but no edema. There is kyphotic\nangulation at T6-T7. T12 vertebral body demonstrates mild loss of height with\npartial fatty marrow replacement, but no edema. There is minimal superior\nretropulsion of T12, indenting the ventral thecal sac without significant\nspinal canal narrowing. No suspicious marrow signal abnormalities are seen. \nScattered hemangiomas are present. The thoracic spinal cord demonstrates\nnormal morphology and signal intensity. No pathologic contrast enhancement is\nseen.\n\nThere are multiple small disc bulges and disc protrusions, most notable at\nT2-T3, T6-T7, and T11-T12, without significant spinal canal narrowing. Disc\nbulge and facet arthropathy at T11-T12 cause mild bilateral neural foraminal\nnarrowing.\n\nLUMBAR:\nThere is transitional anatomy of L1 and near complete lumbarization of S1, as\nstated above. Vertebral body heights are preserved. Alignment is normal. \nThere are extensive discogenic bone marrow changes in the endplates at L4-L5\nand L5-S1. No suspicious bone marrow signal abnormalities are seen. The\nconus medullaris demonstrates normal morphology and signal intensity,\nterminating at L2-L3. No pathologic contrast enhancement is seen.\n\nL1-L2: Mild disc bulge and facet arthropathy without significant spinal canal\nor neural foraminal narrowing.\n\nL2-L3: Minimal disc bulge and facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL3-L4: Minimal disc bulge and facet arthropathy without spinal canal or neural\nforaminal narrowing.\n\nL4-L5: Disc bulge and facet arthropathy cause mild narrowing of the\nsubarticular zones without frank compression of the traversing L5 nerve roots.\nThe ventral thecal sac is mildly indented without mass effect on the\nintrathecal nerve roots. Mild bilateral neural foraminal narrowing.\n\nL5-S1: There is a disc bulge and a left paracentral rim enhancing disc\nherniation, displacing the traversing left L5 nerve root in the subarticular\nzone. There is also mild facet arthropathy. There is no mass effect on the\nintrathecal nerve roots. There is mild to moderate right and mild left neural\nforaminal narrowing, with a disc bulge and endplate osteophytes contacting the\nexiting bilateral L5 nerve roots in the neural foramina.\n\nS1-S2: Mild right and moderate left facet arthropathy. Prominent left\nanterior epidural fat. No mass effect on the intrathecal nerve roots. Left\nendplate osteophytes and left facet osteophytes contact the exiting left S1\nnerve root in the moderately narrowed left neural foramen.\n\nOTHER:\nT2 hyperintense foci in the visualized kidneys are compatible with cysts.", "output": "1. There are 7 cervical vertebrae with fusion of C6 and C7 anterior and\nposterior elements, 12 rib-bearing vertebrae, L1 with transitional anatomy, L2\nthrough L5 with conventional anatomy, and a nearly completely lumbarized S1.\n2. Normal appearance of the spinal cord. No pathologic contrast enhancement.\n3. Mild chronic compression of T7 and T12 vertebral bodies.\n4. Multilevel cervical, thoracic, and lumbar degenerative disease, as detailed\nabove. No mass effect on the spinal cord or intrathecal nerve roots." }, { "input": "THORACIC SPINE:\n\nAlignment is normal. Vertebral body and intervertebral disc signal intensity\nappear normal. The spinal cord appears normal in caliber and configuration. \nThere is no evidence of spinal canal or neural foraminal narrowing. There is\nno evidence of infection or neoplasm.\n\nLUMBAR SPINE:\n\nAlignment is normal. Vertebral body and intervertebral disc signal is normal.\nThe spinal cord is normal in configuration and terminates at L1/L2. There is\nno evidence of spinal cord edema or abnormal enhancement. Degenerative\nchanges of the lumbar spine are mild as follows:\n\nFrom T12-L3, there is no significant spinal canal or neural foraminal\nnarrowing.\n\nAt L4-5, a small posterior disc bulge does not cause significant spinal canal\nnarrowing, and mild bilateral neural foraminal narrowing.\n\nAt L5-S1, a posterior disc bulge does not cause significant spinal canal\nnarrowing, and mild bilateral neural foraminal narrowing.\n\nThere is no prevertebral or paravertebral edema.", "output": "1. No evidence of infection orspinal cord compression in the thoracic or\nlumbar spine.\n2. Minimal degenerative changes of the lumbar spine as described above." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is normal lumbar alignment. Vertebral body heights are preserved. There\nis no marrow signal abnormality. There is no disc signal at L4-L5 without\nsignificant loss of height. The conus demonstrates normal signal and\nmorphology terminating appropriately at the T12-L1 level.\n\nAt L4-L5 there is a right central disc extrusion causing moderate vertebral\ncanal stenosis which compresses the traversing right L5 nerve root within the\nsubarticular zone and contacts the traversing left L5 nerve root (05:27). \nThere is no significant neural foraminal stenosis.\n\nThere are no significant degenerative changes at the other levels without\nspinal canal or neuroforaminal stenoses. The paravertebral soft tissues are\nunremarkable. There is no evidence of infection or neoplasm.", "output": "L4-L5 right central disc extrusion causing moderate vertebral canal stenosis,\ncompressing bilateral traversing L5 nerve roots." }, { "input": "The lumbar vertebral bodies are normally aligned. Vertebral body heights are\npreserved. Re-identified are T2/ STIR signal hyperintense foci compatible\nwith known bone lesions as seen on prior studies. Specifically, hyperintense\nT2/STIR signal is seen predominantly involving the posterior elements of L3\nand L4. At L3, on the left, there is involvement of the pedicle, pars\ninterarticularis (3, 8 and 9), lamina (3, 11), spinous process (3, 12), as\nwell as the right lamina (3, 14) and pedicle (3, 16) as well as likely the\nproximal right transverse process (3, 18). The changes are somewhat more\nextensive than on the prior exam. At L4, on the right, there is involvement\nof the lamina (3, 13), inferior articular process/pars interarticularis and\npedicle (3, ___, as well as likely the right superior articular process (3,\n18). This is also somewhat more prominent that on the prior exam.\n\nThe lesion in the inferior endplate of L2 is no longer identified. The\ndiscrete lesion in the spinous process of L1 is no longer seen. These lesions\ndemonstrate mild T1 hypointensity and mild enhancement following\nadministration of contrast (for example see series 6 and 10, images 3 and 8\nfor both, for right-sided L3 and L4 lesions). There are no definite new\nlesions identified. No evidence of fracture.\n\nThe distal spinal cord and conus medullaris is normal common terminates at\nL1-L2.\n\nDiffuse signal loss of the lumbar intervertebral discs is consistent with\ndegenerative change. Disc height loss is seen at multiple levels, mild,\nprobably posteriorly, most pronounced at T12-L1, L1-L2, L2-L3, and L3-4.\n\nAt T12-L1 there may be a small annular fissure. There is no spinal canal or\nneural foraminal narrowing.\n\nAt L1-2, there is a mild posterior disc bulge, and ligamentum flavum and facet\nhypertrophy, which causes mild spinal canal narrowing (7, 12). There is no\nneural foraminal narrowing.\n\nAt L2-3, the posterior distal which as well as facet hypertrophy (7 common 19)\ncauses moderate spinal canal narrowing without contact of the traversing nerve\nroots. There is mild left and minimal right neural foraminal narrowing at\nthis level.\n\nAt L3-4, there is a posterior disc bulge and facet hypertrophy which causes at\nleast moderate spinal canal stenosis, most likely with contact of the\ntraversing bilateral L4 nerve roots by a combination of disc bulge and facet,\nalthough this is not discretely visualized. Canal narrowing causes crowding\nof the cauda equina nerve roots. There is right moderate to severe (4, 16)\nand left moderate (for, 6) neural foraminal narrowing. This bulge appears to\nminimally abut the exiting right L3 nerve root (5, 6).\n\nAt L4-5, there is a posterior disc bulge, ligamentum flavum and facet\nhypertrophy which causes moderate spinal canal narrowing. There is mild right\nand mild-to-moderate left neural foraminal narrowing (for, 16 and 6 seconds,\nrespectively).\n\nAt L5-S1, there is a posterior disc bulge which mildly narrows the canal. \nThere is no significant neural foraminal narrowing at this level.\n\nSmall facet joint effusions are seen at multiple levels on the left, most\nconspicuous at L3-4 (series 3, image 8). No other abnormal foci of\nenhancement are identified.", "output": "1. Multifocal T2/STIR hyperintense, mildly enhancing lumbar spine osseous\nlesions. Specifically, the majority lesions are seen involving the posterior\nelements at L3-4, and these appear mildly more pronounced/conspicuous in\ncomparison to the prior study from ___. Scattered lesions previously\nseen elsewhere have resolved in the interim (e.g., the lesions seen in the\ninferior endplate of L2 in the spinous process of L1 are no longer seen).\n2. No new lesions identified.\n3. Overall unchanged multilevel, multifactorial lumbar spine degenerative\nchange worst at L3-4 where there is moderate spinal canal and moderate to\nsevere right and moderate left neural foraminal narrowing; other details\nabove." }, { "input": "There is mild anterior subluxation of L4 on L5, likely degenerative in similar\nto prior exam. Vertebral body heights are preserved.\n\nThere are multiple new enhancing T1 hypointense lesions within the lumbar\nspine vertebral bodies, the largest is noted in L3 measuring 1.2 x 1.8 x 2.4\ncm (2; 10). In addition, there is a new 8 mm lesion anteriorly within the L3\nvertebral body (300; 9). New additional lesions are noted in the left L1\ntransverse process measuring 1.2 x 0.9 cm (6; 12). New enhancing T1\nhypointense lesion in the L4 left transverse process measuring 1.0 cm is also\nnoted (6; 30) as well as abutting the inferior endplate of L4 (300; 10). In\nthe anterior vertebra body of L5, there is a 0.8 cm lesion that is new since\nprior (6; 38).\n\nAdjacent to the bilateral facet joints of L3-L4 and L4-L5, are areas of soft\ntissue enhancement, similar to prior, and most likely soft tissue inflammation\nassociated with degenerative changes given involvement of bilateral facets and\nless likely to be metastatic disease (8; 27) (8; 30). The enhancement has\nminimally increased since ___, which also supports noted changes. No\nepidural soft tissue mass.\n\nThe conus medullaris terminates at L1-L2 and appears normal in caliber and\nconfiguration. No signal abnormality was noted in the conus medullaris or\nnerve roots.\n\nMultilevel degenerative changes are again noted including diffuse loss of\nsignal in the intervertebral discs, facet hypertrophy, ligamentum flavum\nthickening, and posterior disc protrusion.\n\nAt T12-L1, there is minimal posterior disc bulge without significant spinal\ncanal or neural foraminal narrowing.\nAt L1-L2, minimal posterior disc bulge and bilateral facet osteophytes result\nin mild spinal canal narrowing and mild bilateral neural foraminal narrowing.\nAt L2-L3, facet hypertrophy, ligamentum flavum thickening, and posterior disc\nbulge results in mild to moderate spinal canal narrowing and bilateral mild\nneural foraminal narrowing.\nAt L3-L4, facet osteophytes, posterior disc bulge, and ligamentum flavum\nthickening results in moderate to severe narrowing of the spinal canal and\nbilateral severe neural foraminal narrowing.\nAt L4-L5, posterior disc bulge, facet osteophytes, and ligamentum flavum\nthickening result in mild-to-moderate spinal canal stenosis and no significant\nneural foraminal narrowing.\nAt L5-S1, there are large facet osteophytes without significant spinal canal\nstenosis or neural foraminal narrowing.", "output": "1. Multiple new enhancing metastases within the lumbar spine, the largest in\nL3 vertebral body measuring up to 2.4 cm.\n2. No evidence of neoplastic encroahment on the spinal canal." }, { "input": "Minimal anterolisthesis of L4 on L5, similar to prior study, likely\ndegenerative. Vertebral body heights are preserved. Conus medullaris\nterminates at L1. The visualized spinal cord appears normal in caliber and\nconfiguration.\n\nMultiple enhancing T1 hypointense STIR hyperintense lesions are noted\nthroughout the lumbar spine, the largest in L3 vertebral body measures 1.7 x\n1.6 x 2.4 cm, slightly increased in size compared to prior when it measured\n1.2 x 1.6 x 2.4 cm (7; 10). 1.1 x 1.0 cm enhancing lesion in the left L1\ntransverse process is similar to prior (11; 13). There is a 1.4 x 1.6 cm\nlesion in the left L2 superior articular process (7; 6), which appears more\nconspicuous than prior. 1.0 x 1.4 cm L4 left transverse process enhancing\nlesion is similar to prior. 0.9 cm enhancing lesion abutting the superior\nendplate in the L5 vertebral body is similar to prior (7; 10). Another 0.6 cm\nlesion abutting the superior endplate of S1 is also similar to prior (7; 11). \nA 0.5 cm lesion in S2 is unchanged (7; 17). There are no new enhancing\nlesions.\n\nAdjacent to the bilateral facet joints of L3-L4 and L4-L5 are again noted\nareas of soft tissue enhancement similar to prior, most likely soft tissue\ninflammation associated with degenerative changes. There is no epidural\ncollection or lesion.\n\nMultilevel degenerative changes are again noted with loss of disc signal and\nheight, facet hypertrophy, and posterior disc protrusion.\n\nT12-L1: There is minimal posterior disc bulge without significant spinal canal\nor neural foraminal narrowing.\nL1-L2: Minimal posterior disc bulge and bilateral facet hypertrophy results in\nminimal spinal canal narrowing and no significant neural foraminal narrowing.\nL2-L3: Mild posterior disc bulge and facet hypertrophy results in mild spinal\ncanal stenosis and mild bilateral neural foraminal narrowing.\nL3-L4: Broad posterior disc bulge and facet hypertrophy and ligamentum flavum\nthickening result in moderate spinal canal stenosis and mild left and moderate\nright neural foraminal narrowing. A facet osteophyte appears to contact the\nexiting right L L3 nerve root.\nL4-L5: Minimal posterior disc bulge does not result in significant spinal\ncanal stenosis nor neural foraminal narrowing.\nL5-S1: Mild posterior disc bulge and bilateral facet hypertrophy results in\nmild spinal canal narrowing and no significant neural foraminal narrowing.\n\nNo evidence of fracture in visualized portions of the sacrum and ilium,\nhowever please 2 concurrent MRI pelvis for additional details..", "output": "1. Multiple enhancing lesions throughout the lumbar spine as well as in the\nsacrum, the largest measuring 2.4 cm in the L3 vertebral body minimally\nincreased in size from prior. No new lesions are identified.\n2. Degenerative changes are most prominent at L3-L4 where there is moderate\nspinal canal narrowing and moderate right neural foraminal narrowing, with an\nosteophyte which appears to contact the exiting right L3 nerve root.\n3. No evidence to suggest acute fracture within the lumbar spine and\nvisualized portions of the sacrum.\n4. Please refer to concurrent MRI pelvis for additional details.\n5. Additional findings as described above." }, { "input": "THORACIC: Thoracic vertebral bodies are maintained in height and alignment. \nThere is no fracture. There are T1 hypointense, T2 hyperintense enhancing\nlesions compatible with patient's myeloma involving the T7 and T8 vertebral\nbodies. Schmorl's nodes seen at the superior endplate of T6 and inferior\nendplate of T8. There is a similar lesion involving the right sixth rib\nposteriorly. In the left seventh rib adjacent to the costovertebral junction.\n\nIntervertebral disc height loss is seen spanning T5-6 through T8-9. There is\na small disc bulge at T6-T7. There is no canal or foraminal narrowing at this\nlevel nor elsewhere in the thoracic spine.\n\nThe spinal cord is preserved in signal and caliber throughout. Post-contrast\nimages demonstrate no abnormal enhancement.\n\nLUMBAR:\nThere are five lumbar-type vertebral bodies which are maintained in height. \nGrade 1 anterolisthesis of L4 on L5 is similar compared to prior. Remaining\nvertebral bodies are maintained in alignment. There is a T2 hyperintense T1\nhypointense enhancing lesion within the L3 vertebral body which is seen on\nprior MRI from ___ though is less bulging posteriorly. Previously,\nthe lesion had measured 1.9 by 1.7 cm. It currently measures 1.5 by 1.4 cm. \nSmaller but similar lesion seen adjacent to the superior endplate of the L5\nvertebral body. Additionally, smaller similar lesions seen at the right\nlateral aspect of the inferior endplate of T12, unchanged. The left L1 and\nthe left L4 transverse process lesions are again noted.\n\nNo new focal suspicious marrow lesion identified. Intervertebral disc\ndesiccation with mild associated height loss seen throughout the lumbar spine\nsomewhat sparing L5-S1. Conus terminates at L1, in normal anatomic position. \nPost-contrast images demonstrate no abnormal enhancement.\n\nAt T12-L1 and L1-L2, there are disc bulges and facet joint hypertrophy without\nsignificant canal foraminal narrowing.\n\nAt L2-3, there is a disc bulge with a left subarticular annular fissure. \nFacet joint hypertrophy contributes to subarticular recess narrowing\nbilaterally and there is mild left worse than right foraminal narrowing.\n\nAt L3-4, there is a disc bulge and extensive facet joint hypertrophy with\nthickening of the ligamentum flavum. Secondary mild to moderate canal\nnarrowing is similar to prior as is mild left and moderate right foraminal\nnarrowing. Facet joint effusion is noted on the left with a small synovial\ncyst in the posterior paraspinal soft tissues.\n\nAt L4-5, there is uncovering of the disc with a superimposed disc bulge. \nExtensive facet joint hypertrophy. No secondary canal narrowing nor\nsignificant foraminal narrowing.\n\nAt L5-S1, there is extensive facet joint hypertrophy without canal or\nforaminal narrowing.\n\nIncluded paraspinal and retroperitoneal soft tissue structures are\nunremarkable.", "output": "1. No fracture or new malalignment in the thoracic or lumbar spine.\n2. Enhancing lesions within thoracic and lumbar vertebrae and ribs. \nPreviously visualized lesions in the lumbar spine have decreased in size. \nThere is no prior to evaluate for change in size of thoracic lesions.\n3. Degenerative changes in the lumbar spine as detailed above, unchanged since\nprior." }, { "input": "The previously seen infiltrative lesion in T7 and T8 vertebral bodies have\nslightly increased in size. Left-sided soft tissue prominence (09: 32-33)\nextending to the left neural foramen (09:32) has also increased. There is\nminimal extension to the left side of the spinal canal seen best visualized on\n09:33. However, there is no spinal cord compression or deformity seen. There\nis associated involvement of the adjacent rib. There remains a Schmorl's node\nat the inferior endplate of T8 without significant change in the height of T8\nvertebral body. There is no retropulsion. A Schmorl's node in the superior\nendplate of T6 is unchanged. No definite new foci of signal abnormalities are\nseen within the thoracic vertebral bodies.\n\nThe spinal cord shows normal intrinsic signal without extrinsic compression. \nOther focal abnormalities within the ribs are unchanged accounting for\ndifferences in slice selection.", "output": "1. Foci of signal abnormalities within the T7 and T8 vertebral bodies have\nslightly increased in size compared to the previous MRI of ___.\n2. Increase in soft tissue changes seen in the left paraspinal region at T7\nlevel extending to left T7-8 neural foramen but without cord compression.\n3. No new foci of signal abnormalities or pathologic fractures seen." }, { "input": "Study is mildly degraded by motion.\n\nLevels were established by counting down from the C2 level using series 2.\n\nThe alignment of the thoracic spine appears maintained. Vertebral body\nheights are preserved. The previously identified lesions in the T2, T7, T8,\nand L1 vertebral bodies appear similar in size compared to prior exam dated ___. The 1.5 x 1.2 cm lesion in the posterior left T7 vertebral body\nextending into the left pedicle is similar in size compared to prior exam. \nThe soft tissue component at the T7 level is also similar and demonstrates\nsevere narrowing of the left T7-T8 neural foramina. Otherwise, there is no\ndefinite evidence of vertebral canal neural foraminal narrowing of the\nthoracic spine.\n\n Within limits of study, no definite new foci of signal abnormalities are\ndemonstrated in the thoracic vertebral bodies.\n\nGrossly stable Schmorl's nodes in the superior T6 and inferior T8 endplates\nare again noted.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\n\nGrossly stable loss of intervertebral disc height and signal is again noted.\n\nOther:\nPatulous esophagus with secretion is noted (see 6:19).", "output": "1. Study is mildly degraded by motion.\n2. Grossly stable multifocal thoracic lesions compatible with patient's\nprovided history of multiple myeloma.\n3. Within limits of study, no new lesions identified in the thoracic spine.\n4. Within limits of study, no definite evidence of acute thoracic spine\nfracture.\n5. Grossly stable soft tissue component at the level of T7 again associated\nwith severe left T7-T8 neural foraminal narrowing." }, { "input": "Corresponding to the FDG avid lesions seen L3 on the recent PET-CT, the mildly\nSTIR hyperintense, T1 hypointense, homogeneously enhancing mass in the\nposterior aspect of L3 has enlarged compared with the prior MRI lumbar spine\nof ___. Specifically, the mass now measures 2.8 x 2.5 x 2.6 cm (SI by\nAP by TV) (4:11 and 300:56), with new posteriorly convex expansion and\nreplacement of the posterior cortex, causing mild-to-moderate spinal canal\nnarrowing at this level which is new (see series 6 and 8 image 21 for both). \nThere is no fracture line or vertebral body height loss at this level, or at\nother levels, on this exam. STIR hyperintense enhancing signal abnormality\ncontiguous with the lesion extends into the right pedicle and posterior\nelements, seen to involve the inferior aspect of the L3 spinous process (see\nseries 4, 5, 7 images 14 and 10 for all).\n\nThere is an additional 1.8 x 1.4 x 1.4 cm (AP by TV by SI) (7:5 and 6:8, 8:8)\nsmaller but otherwise identical lesion within the left L1 pedicle, and extends\ninto the lamina, inferior articular facet, and transverse process (see series\n6 and 8, image 9). This lesion is also larger compared with prior exam of\n___, previously up to 10 mm.\n\nCentered in the left L4 pedicle, there is an 11 mm identical lesion (series 4,\n5, 7 image 1, as well as series 6 and 8:27). This is slightly larger since\nprior. Centered in the right T11 pedicle, not seen on axial images, a 16 mm\nSTIR hyperintense enhancing lesion appears slightly enlarged more conspicuous\ncompared prior.\n\nThere is 4 mm of L4-5 anterolisthesis, unchanged. Alignment is otherwise\nnormal. The distal spinal cord and conus medullaris is unremarkable and\nterminates at L1-2. The cauda equina nerve roots are normal. There is\nmultilevel disc signal and height loss in the lumbar spine consistent with\ndegenerative change. More specifically:\n\n T12-L1: Mild posterior disc bulge. No spinal canal or neural foraminal\nnarrowing.\nL1-2: Mild posterior disc bulge, ligamentum flavum thickening facet\nosteophytes without spinal canal or neural foraminal narrowing.\nL2-3: Posterior disc bulge, ligamentum flavum thickening facet osteophytes and\ntrace bilateral facet joint effusions, unchanged, causing mild spinal canal\nnarrowing. There is mild bilateral neural foraminal narrowing, unchanged.\nL3-4: As detailed above, at the level of the L3 laminae, there is overall mild\nspinal canal narrowing due to posterior extension of the L3 enhancing mass\ninto the spinal canal, with narrowing seen centrally, left paracentral, and\nworst in the right paracentral region with obliteration of the right lateral\nrecess (300:56). The cauda equina are posteriorly displaced but not\ncompressed. There is resultant now severe right neural foraminal stenosis,\nlikely with impingement of the exiting right L3 nerve root (05:14), new from\nprior. Moderate left neural foraminal narrowing is unchanged.\nInferior to this at the level of the L3-4 intervertebral disc, there is a\nposterior disc bulge, ligamentum flavum thickening facet osteophytes causing\nmoderate to severe spinal canal with crowding of the cauda equina nerve roots,\nunchanged from prior (300:62).\nL4-5: There is a posterior disc bulge, ligamentum flavum thickening and facet\nosteophytes without spinal canal narrowing. There is mild bilateral neural\nforaminal narrowing, unchanged.\nL5-S1: Mild posterior disc bulge without spinal canal narrowing. There is no\nneural foraminal narrowing. There is a trace right facet joint effusion.\n\nThe imaged prevertebral and paraspinal soft tissues are grossly unremarkable\non limited evaluation.", "output": "1. Interval enlargement of the now 2.8 cm enhancing mass in L3 compatible with\na lesion of multiple myeloma, with involvement of right pedicle and spinous\nprocess. The mass has newly replaced most of the posterior cortex of this\nvertebral body and has expanded into and mildly narrows the central and right\nparacentral spinal canal. Note, this lesion corresponds to the FDG avid\nlesion seen on the recent PET-CT.\n2. No pathologic fracture or vertebral body height loss identified on the\ncurrent exam.\n3. Numerous additional lesions also likely representing myelomatous lesions\ninvolving T11, L1, and L4, are larger since ___.\n4. L3 mass causes new severe right L3-4 neural foraminal narrowing with likely\nimpingement of the exiting right L3 nerve root.\n5. Unchanged background mild-to-moderate lumbar spondylosis which causes\nmoderate to severe spinal canal narrowing at L3-4 with crowding of the cauda\nequina nerve roots, unchanged since ___." }, { "input": "CERVICAL:\nThe cervical vertebral body heights and alignment are grossly maintained. \nCervical bone marrow signal intensity appears normal. There are multilevel\ndisc bulges in the cervical spine from C3-C4 through C6-C7, most pronounced at\nC4-C5 with moderate spinal canal narrowing. There is no evidence of abnormal\ncontrast enhancement.\n\nTHORACIC:\nThe thoracic vertebral body heights and alignment are maintained. There are\nmultiple T2 hyperintense, T1 hypointense lesions throughout the thoracic spine\nwhich demonstrate enhancement. The largest measures 3 cm AP x 2 cm TV x 1.8\ncm SI in the left aspect of the T8 vertebral body. The lesions are consistent\nwith the clinical history of multiple myeloma.\n\nThe spinal cord appears normal in caliber and configuration without evidence\nof edema. There is no evidence of spinal canal or neural foraminal narrowing.\n\nLUMBAR:\nThere are 5 non-rib-bearing lumbar type vertebral bodies. There is grade 1\nanterolisthesis of L4 on L5. Otherwise, sagittal alignment of the lumbar\nspine is maintained. There are T2 hyperintense, T1 hypointense lesions in the\nleft pedicle at L1 posterior, posterior L3 vertebral body, and right iliac\nbone, which demonstrate heterogeneous enhancement. The lesion in the\nposterior L3 vertebral body appear smaller in size compared to prior exam and\ncurrently measures 2.2 x 2.1 cm (image 11 of series 4), previously 2.7 x 2.3\ncm. Previously, there was a soft tissue component of the L3 vertebral body\nlesion, which appears to have resolved. Additionally, a lesion in the L3\nspinous process appears decreased in size compared to prior exam.\n\nThe visualized spinal cord is normal in caliber and configuration with no\nevidence of edema. The conus medullaris terminates at the level of L1.\n\nSagittal postcontrast images demonstrate linear areas of subtle enhancement of\nthe cauda equina nerve roots on the left at the level of L2, new compared to\nprior exam. This is much less conspicuous on the axial T1 postcontrast\nimages.\n\nFrom T12-L1 through L2-L3, there are mild disc bulges without significant\nspinal canal or neural foraminal narrowing. There is minimal nonspecific\nfacet joint fluid on the left at T12-L1, bilaterally at L1-L2, and left\ngreater than right at L2-L3.\n\nL3-L4: There is mild diffuse disc bulge and ligamentum flavum thickening\nresulting in moderate spinal canal narrowing. Moderate right and mild left\nneural foraminal narrowing due to facet osteophytes. Mild nonspecific facet\njoint fluid is present.\n\nL4-L5: There is mild disc bulge and ligamentum flavum thickening without\nsignificant spinal canal narrowing. There is mild bilateral neural foraminal\nnarrowing with the L4 exiting nerve root contacting the disc. Mild\nnonspecific left facet joint fluid is present.\n\nL5-S1: There is minimal disc bulge without significant spinal canal narrowing.\nThere is mild bilateral neural foraminal narrowing. Minimal nonspecific right\nfacet joint fluid is present.\n\nOTHER: There are small bilateral pleural effusions. There are consolidations\nin the dependent portions of the visualized lungs, which have increased\ncompared to CT chest dated ___.", "output": "1. Multiple T2 hyperintense, T1 hypointense enhancing lesions throughout the\nthoracic and lumbar spine are consistent with clinical history of multiple\nmyeloma. Dominant lesion in the L3 vertebral body has slightly decreased in\nsize compared to prior exam with resolution of the soft tissue component.\n2. Subtle enhancement of the cauda equina nerve roots on the left at the level\nof L2 are new compared to prior exam concerning for leptomeningeal metastatic\ninfiltration.\n3. Multilevel degenerative disc disease in the cervical spine, most pronounced\nat C4-C5 with moderate spinal canal narrowing.\n4. Multilevel degenerative disc disease in the lumbar spine, most pronounced\nat L3-L4 with moderate spinal canal narrowing and moderate right spinal canal\nnarrowing.\n5. Small bilateral pleural effusions with consolidations in the dependent\nportions of the lungs are consistent with worsening pleural-parenchymal\ndisease." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. Grade 1\nanterolisthesis of L4 on L5 persists. Otherwise, the sagittal alignment of\nthe lumbar vertebral bodies is maintained. Multiple T2 hyperintense, T1\nhypointense lesions throughout the lumbar spine and right iliac bone are again\nidentified, which demonstrate heterogeneous enhancement.\n\nThe largest lesion is located in the posterior L3 vertebral body and measures\n2.2 x 2.1 cm, unchanged.\n\nThe visualized spinal cord is normal in caliber and configuration. The conus\nmedullaris terminates at the level of L1.\n\nIn comparison to prior exams, there is increasing subtle enhancement of the\ncauda equina nerve roots.\n\nModerate to severe spinal canal narrowing at L3-L4 appears minimally\nprogressed compared to prior exam. Mild-to-moderate bilateral neural\nforaminal narrowing persists at L3-L4 and mild at L4-L5 and L5-S1.\n\nThere is redemonstration of small facet joint effusions from L1-L2 through\nL5-S1, unchanged compared to prior exam. Small posteriorly projecting\nsynovial cysts are seen at L3-L4 and L4-L5.\n\nThe paraspinal and paravertebral muscles are unremarkable.", "output": "1. Multiple T2 hyperintense, T1 hypointense enhancing lesions throughout the\nlumbar spine are consistent with clinical history of multiple myeloma, similar\ncompared to prior exam.\n2. Increasing subtle enhancement of the cauda equina nerve roots are\nconcerning for worsening leptomeningeal metastatic infiltration.\n3. Moderate to severe spinal canal narrowing at L3-L4 appears minimally\nprogressed." }, { "input": "THORACIC SPINE:\nAlignment is normal. No evidence of fracture. Multiple T1 hypointense, T2\nhyperintense, enhancing vertebral body and posterior element lesions are\nunchanged since 2 months prior. Dominant lesions at T2 and T8 measure 1.4 x\n1.2 cm and 2.8 x 1.8 cm, respectively. No evidence of extension into the\nspinal canal. The spinal cord is normal in caliber and signal intensity. A\nsmall disc bulge at T6-T7 and small right subarticular disc protrusion at\nT11-T12 result in mild spinal canal narrowing.\n\nLUMBAR SPINE:\nGrade 1 anterolisthesis of L4 on L5 is unchanged. No evidence of fracture. \nMultiple T1 hypointense, T2 hyperintense, enhancing lesions are unchanged\nsince 2 months prior. A dominant lesion at L3 measures 2.2 x 2.0 cm. No\nevidence of extension into the spinal canal. The spinal cord is normal in\ncaliber and signal intensity. Mild enhancement of the cauda equina nerve\nroots is unchanged.\n\n T12-L1: A small disc bulge results in mild spinal canal narrowing.\n\nL1-L2: A small disc bulge and ligamentum flavum thickening result in mild\nspinal canal and neural foraminal narrowing.\n\nL2-L3: A small disc bulge and ligamentum flavum thickening result in mild\nspinal canal narrowing and moderate left and mild right neural foraminal\nnarrowing.\n\nL3-L4: A disc bulge and ligamentum flavum thickening result in\nmild-to-moderate spinal canal narrowing, less conspicuous than on the prior\nexamination. There is moderate left neural foraminal narrowing and severe\nright neural foraminal narrowing with abutment of the exiting right L3 nerve\nroots.\n\nL4-L5: Grade 1 anterolisthesis, a disc bulge, and ligamentum flavum thickening\nresult in mild spinal canal narrowing mild left neural foraminal narrowing,\nand moderate right neural foraminal narrowing.\n\nL5-S1: A disc bulge result in mild spinal canal narrowing.\n\nOther: A disc bulge at C6-C7 result in mild spinal canal narrowing. The\nremainder of the cervical spine is incompletely assessed. A T1 hypointense,\nT2 hyperintense, enhancing lesion in the right iliac bone is unchanged and\nmeasures 1.6 x 1.5 cm.", "output": "1. No evidence of fracture.\n2. Scattered myelomatous lesions are unchanged. No new or enlarging lesions.\n3. Unchanged mild enhancement of the cauda equina nerve roots.\n4. Mild thoracic and lumbar spondylosis." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\n Levels were established by counting down from the C2 level using series 3,\nimage 4.\n\nTHORACIC:\nAlignment is normal. No evidence of fracture. Multiple T1 hypointense, T2\nhyperintense, enhancing vertebral body and posterior element lesions are\nunchanged since less than 1 month prior. Dominant lesions at T2 and T8\nmeasure 1.4 and 2.8 cm, respectively. No evidence of extension into the\nspinal canal. The spinal cord is normal in caliber and signal intensity. \nThere is mild multilevel intervertebral disc height loss and desiccation and\nT6 superior endplate and T8 inferior endplate Schmorl's nodes. A small disc\nbulge at T6-T7 and small right subarticular disc protrusion at T11-T12 result\nin mild spinal canal narrowing.\n\nLUMBAR:\nGrade 1 anterolisthesis of L4 on L5 is unchanged. No evidence of fracture. \nMultiple T1 hypointense, T2 hyperintense, enhancing lesions are unchanged\nsince less than 1 month prior. A dominant lesion at L3 measures 2.2 cm. No\nevidence of extension into the spinal canal. The spinal cord is normal in\ncaliber and signal intensity. Previously seen enhancement of the cauda equina\nnerve roots is less conspicuous.\n\n T12-L1: A small disc bulge and ligamentum flavum thickening result in mild\nspinal canal narrowing.\n\nL1-L2: A small disc bulge and ligamentum flavum thickening result in mild\nspinal canal narrowing.\n\nL2-L3: A disc bulge and ligamentum flavum thickening result in mild spinal\ncanal narrowing and mild right and moderate left neural foraminal narrowing.\n\nL3-L4: A disc bulge, ligamentum flavum thickening, and facet hypertrophy\nresult in mild-to-moderate spinal canal narrowing, moderate left neural\nforaminal narrowing, and severe right neural foraminal narrowing with abutment\nof the exiting right L3 nerve roots. Nonspecific bilateral facet joint fluid\nis noted.\n\nL4-L5: Grade 1 anterolisthesis, a disc bulge, and ligamentum flavum thickening\nresult in mild spinal canal narrowing and mild left and moderate right neural\nforaminal narrowing.\n\nL5-S1: A disc bulge results in mild spinal canal and bilateral neural\nforaminal narrowing.\n\nOTHER: A T1 hypointense, T2 hyperintense, enhancing lesion in the right iliac\nbone is unchanged and measures 1.6 cm. Limited imaging of the lungs suggests\nbilateral scarring and probable dependent atelectasis.", "output": "1. Study is moderately degraded by motion.\n2. No definite evidence of fracture.\n3. Scattered myelomatous lesions are unchanged.\n4. Within limits of study, no definite new or enlarging myomatous lesions\nidentified.\n5. Previously seen enhancement of the cauda equina nerve roots is less\nconspicuous.\n6. Grossly stable multilevel thoracic and lumbar spondylosis compared to 3\nweeks prior thoracic and lumbar spine contrast MRI as described, again most\npronounced at L3-4 where there is mild-to-moderate vertebral canal, moderate\nleft and severe right neural foraminal narrowing.\n7. Limited imaging of the lungs suggests bilateral scarring and probable\ndependent atelectasis. If concern for lung opacities, consider dedicated\nchest imaging for further evaluation." }, { "input": "CERVICAL SPINE: No focal bony abnormalities are identified. There is no cord\ncompression or abnormal signal within the spinal cord. No intraspinal\nenhancement is identified. Mild degenerative changes are seen with disc\nbulging from C3-4 to C6-7 with mild spinal stenosis at C4-5 level.\n\nTHORACIC SPINE: New mild compressions of superior endplate of T2 and T4\nvertebral bodies (5:8) demonstrate no increased signal and are likely late\nsubacute to chronic since the previous MRI examination. Previously noted\nlesion within the T2 vertebra might have minimally increased but the lesion\nwithin the T8 vertebra is unchanged. The previously noted lesion within the\nT6 superior aspect now demonstrates a chronic Schmorl's node. Otherwise, no\ndefinite new focal lesions are identified within the thoracic vertebral\nbodies. There is no cord compression, abnormal spinal cord signal or abnormal\nintraspinal enhancement.\n\nBilateral small pleural effusions are noted.\n\nLUMBAR SPINE: A focal hypointense T1 lesion in the L3 vertebral bodies\nunchanged. No definite new bony abnormalities are identified.\n\nAt L1-2 and L2-3 levels mild degenerative disc disease seen without spinal\nstenosis.\n\nAt L3-4 level disc and facet degenerative changes and disc bulging result in\nmild-to-moderate spinal stenosis. There is mild narrowing of the foramina.\n\nAt L4-5 and L5-S1 levels disc and facet degenerative changes seen without\nspinal stenosis or foraminal narrowing.\n\nWithin the lumbar thecal sac there is mild clumping of the nerve roots\nidentified but no abnormal enhancement on the postcontrast images noted. \nThere is a focal bony signal abnormality with low signal at the posterior\naspect of the right iliac crest (16:43) which demonstrates slightly increased\nsize compared to MRI of ___ and shows different signal\ncharacteristics.", "output": "1. Focal bony abnormalities within the T2 vertebral body and posterior right\nilium have minimally increased in size but other focal lesions are unchanged\ncompared to the previous MRI of ___.\n2. Mild chronic appearing compression of superior endplate of T2 and T4\nvertebral bodies are new since the previous study.\n3. No evidence of spinal cord compression or abnormal signal within the spinal\ncord.\n4. Previously noted enhancement of the lumbar cauda equina nerve roots is not\nvisible but there is some clumping of the nerve roots identified indicative of\narachnoiditis." }, { "input": "There is grade 1 anterolisthesis of L4 over L5; unchanged. Otherwise the\nsagittal alignment is normal. Vertebral body and intervertebral disc heights\nappear normal. There is redemonstration of focal enhancing T2 STIR\nhyperintense and T1 hypointense osseous abnormalities in the posterior element\nof T11, posterior element of L1 and L3 vertebral body; unchanged. No new\nlesions are detected. There is diffuse fatty infiltration of the included\nosseous marrow structures.\n\nThere are multilevel disc degenerative disease evidenced by disc desiccation,\ndisc osteophytosis, facet arthropathy ligamentum flavum thickening.\n\nThe conus medullaris and cauda equina fibers show normal shape and signal\nintensity. There is no abnormal intradural or intraspinal enhancement.\n\nT12-L1: There is disc bulge with associated facet arthropathy ligamentum\nflavum thickening resulting in mild spinal canal stenosis. There are\nbilateral mild neural foraminal narrowing.\n\nL1-L2: There is disc bulge with associated facet arthropathy ligamentum flavum\nthickening resulting in mild spinal canal stenosis. There are bilateral mild\nneural foraminal narrowing; more on the left side.\n\nL2-L3: There is disc bulge with associated facet arthropathy ligamentum flavum\nthickening resulting in mild spinal canal stenosis. There are encroachment of\nbilateral subarticular zones which may affect the descending L3 nerve roots. \nThere are bilateral mild neural foraminal narrowing; more on the left side. \nThere are bilateral facet effusions.\n\nL3-L4: There is disc bulge with associated facet arthropathy and ligamentum\nflavum thickening resulting in moderate spinal canal stenosis. There is a\nposterior thecal sac cystic structure within the right ligamentum flavum. \nThere are bilateral mild-to-moderate neural foraminal narrowing; more on the\nright-side. There are bilateral mild facet effusions.\n\nL4-L5: There is disc bulge with associated facet arthropathy and ligamentum\nflavum thickening resulting in mild spinal canal stenosis. There are\nbilateral mild neural foraminal narrowing.\n\nL5-S1: There is no significant disc bulge or spinal canal stenosis. There are\nbilateral mild neural foraminal narrowing.\n\nThere are partially included multifocal T2 and T1 hypointense intraosseous\nsignal abnormalities largest on the right iliac bone (series 7, image 36)\nwhich may be related to known multiple myeloma; grossly unchanged since ___ examination.", "output": "1. Unchanged multilevel degenerative changes of the lumbar spine.\n2. Unchanged degree of spondylitic moderate spinal stenosis at L3-L4 level.\n3. No abnormal intradural enhancement.\n4. Unchanged multifocal intraosseous abnormality is in the lumbar and included\nsacroiliac osseous structures due to myeloma.\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" }, { "input": "At the craniocervical junction degenerative changes assessed with thickening\nof the transverse ligament.\n\nAt C2-3 level, there is disc bulging and thickening of the ligaments resulting\nin mild-to-moderate spinal stenosis and moderate left foraminal narrowing\nincreased from prior study.\n\nAt C3-4 level, there is disc bulging resulting in mild spinal stenosis with\nmoderate right-sided and mild left-sided foraminal narrowing.\n\nAt C4-5 level, there is posterior disc osteophyte resulting in mild spinal\nstenosis and mild foraminal narrowing.\n\nAt C5-6 level, there is spinal fusion. The intervertebral disc is\nobliterated. The foramina are patent.\n\nAt C6-7 level, disc bulging and uncovertebral degenerative changes are seen\nwith mild-to-moderate spinal stenosis and mild deformity of the spinal cord. \nThere is moderate-to-severe left-sided and mild right-sided foraminal\nnarrowing.\n\nAt C7-T1 moderate right-sided and moderate-to-severe left-sided foraminal\nnarrowing seen due to disc bulging and uncovertebral degenerative change.\n\nAt T1-2, T2-3 and T3-4 levels disc bulging is identified.\n\nThere is mild deformity of the spinal cord seen due to spinal canal narrowing\nis at C2-3, C3-4, C4-5 and C6-7 levels. There is no abnormal signal within\nthe spinal cord.", "output": "Progression of degenerative changes since ___. Intervertebral fusion is seen\nsince the previous study at C5-6 level. Mild extrinsic deformity of the\nspinal cord is seen at C2-3, C3-4, C4-5 and C6-7 without abnormal signal\nwithin the spinal cord. Foraminal changes as above." }, { "input": "There are 5 non rib-bearing lumbar type vertebral bodies. Vertebral body\nheights are maintained. There is anterolisthesis of L4 on L5, unchanged since\n___. Patient is status post posterior fusion at L4-L5 with pedicle screws\nand interbody spacers. At the right spinal canal posterior to the vertebral\nbody there is T1 hypointense material which demonstrates homogeneous\nenhancement following contrast administration compatible with scar tissue. \nThere is no epidural collection or other areas of abnormal enhancement. The\nconus terminates at the level of L1/L2, within normal limits. The distal\nspinal cord is normal in caliber and signal intensity.\n\nThere is no significant spinal canal stenosis or neural foraminal narrowing\nfrom the T12-L1 through L3-L4 levels.\n\nAt L4-L5, the right neural foramen is not well evaluated secondary to artifact\nfrom spinal hardware but appears patent due to postoperative appearance of the\nfacet. The left neural foramen is mildly narrowed, as before.\n\nAt L5-S1, there is a diffuse disc bulge without spinal canal stenosis or\nneural foraminal narrowing.\n\nLimited assessment of the paraspinal soft tissues are grossly unremarkable.", "output": "1. Postoperative changes status post L4-L5 posterior fusion with mild\nanterolisthesis of L4 on L5, unchanged.\n2. Mild left neural foraminal narrowing at L4-L5. The right neural foramen is\nlikely patent." }, { "input": "Images were degraded by motion artifact.\n\nCERVICAL:\nAlignment is normal. Vertebral body heights and signal intensity appear\nunremarkable. There are multilevel degenerative changes evidenced by disc\ndesiccation, disc osteophytosis, facet arthropathy and ligamentum flavum\nthickening. There is no underlying high-grade spinal canal stenosis. \nUncovertebral arthropathy resulting in multilevel mild neural foraminal\nnarrowing more pronounced at right C4-C5 and bilateral C5-C6 neural foramina.\n\nThe spinal cord appears normal in caliber and configuration.There is no\nevidence of infection or neoplasm. There is no abnormal enhancement after\ncontrast administration.\n\nTHORACIC:\nAlignment is normal.There is superior endplate central compression deformity\nat T11 vertebral body with associated 50% vertebral body height loss with no\nunderlying edematous changes; suggest chronicity. Vertebral body heights and\nsignal intensity otherwise appear unremarkable.\n\nThere are questionable confluent intramedullary T2 STIR hyperintensity more\npronounced at upper thoracic cord with no correlate on axial or sagittal T2\nsequences. This is likely artifactual. There is no underlying thoracic cord\nexpansion or abnormal enhancement.\n\nThere is no evidence of high-grade spinal canal or neural foraminal narrowing.\nThere is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nLUMBAR:\nAlignment is normal. Vertebral body heights and disc signal intensity appear\nunremarkable the conus medullaris and cauda equina fibers show normal shape\nand signal intensity. There is no evidence of high-grade spinal canal\nstenosis.There is no evidence of infection or neoplasm. There is no abnormal\nenhancement after contrast administration.\n\nT12-L1 and L1-L2: No significant disc bulge, spinal canal stenosis or neural\nforaminal narrowing.\n\nL2-L3: Small disc bulge with facet arthropathy and ligamentum flavum\nthickening without spinal canal stenosis. Unremarkable bilateral neural\nforamina.\n\nL3-L4: Disc bulge with facet arthropathy ligamentum flavum thickening\nresulting in mild to moderate spinal canal stenosis. Mild left neural\nforaminal narrowing. Unremarkable right neural foramina.\n\nL4-L5: Disc bulge with facet arthropathy and ligamentum flavum thickening\nresulting in mild spinal canal stenosis. Mild right and moderate left\nforaminal narrowing.\n\nL5-S1: No disc bulge or spinal canal stenosis. Mild-to-moderate bilateral\nneural foraminal narrowing.\n\nOTHER: Bilateral renal cysts largest on the right side measuring up to 16 mm.", "output": "1. No definite metastatic spinal lesions.\n2. No abnormal intradural enhancement.\n3. No definite signal abnormality within the spinal cord.\n4. No cord compression or cauda equina compression.\n5. No underlying high-grade spinal canal stenosis.\n6. T11 superior endplate compression deformity with no underlying edematous\nchanges; suggests chronicity.\n7. Mild-to-moderate spinal stenosis at L3-4 level. Foraminal narrowing in the\nlumbar region 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%\n___" }, { "input": "CERVICAL:\nThere is motion artifact which limits spatial resolution.\n\nThere is normal cervical alignment. The vertebral body heights and marrow\nsignal are preserved. The intervertebral disc spaces demonstrate normal\nsignal height. There are mild degenerative changes without significant neural\nforaminal stenosis. There is diffuse thin leptomeningeal postcontrast\nenhancement consistent with carcinomatosis. There is more nodular enhancing\ndisease as follows: There is a 0.8 AP by 1.1 TV by 1.1 SI cm enhancing mass\nat the left lateral aspect of the nodule cervical junction at the foramen\nmagnum which mildly deforms the traversing cord.\nThere is a large 2.0 TV by 1.1 AP by 1.1 SI cm enhancing mass centered at the\nleft lateral aspect of the spinal canal at the C3 level which severely narrows\nthe spinal canal compressing and displacing the traversing cord to the right\nwith associated underlying cord T2 signal hyperintensity extending from C1-C2\nto the C4 levels (15:19).\n\nTHORACIC:\nThere is a normal thoracic alignment the vertebral body heights and marrow\nsignal are preserved. The intervertebral disc spaces demonstrate preserved\nheight. There are mild degenerative changes without significant neural\nforaminal stenosis. There is nodular enhancing intradural extramedullary\ndisease at the right lateral aspect of the thoracic spinal canal centered at\nthe T8 level measuring 1.0 AP by 0.5 T the by 2.1 SI cm which mildly deforms\nand leftward displaces the traversing cord. There is no definitive intrinsic\ncord signal T2 hyperintensity on sagittal T2 and STIR sequences. There is\ndiffuse trace leptomeningeal enhancement throughout the remainder of the\nthoracic spinal canal.\n\nLUMBAR:\nThere is normal lumbar alignment. The vertebral body heights are preserved. \nThere is a T1 hypointense, T2 hyperintense, enhancing circumscribed lesion\nwithin the anterior aspect of the S2 vertebral body measuring 8 mm (12:13). \nThere is there is low signal within the T12-L1, L4-L5, and L5-S1\nintervertebral disc spaces. The conus terminates appropriately at the L1\nlevel. There is diffuse nodular enhancing leptomeningeal disease throughout\nthe visualized conus and cauda equina without definitive cord or nerve root\ncompression.\n\nThere are mild degenerative changes without significant neural foraminal\nstenosis. There are prominent bilateral iliac chain lymph nodes measuring up\nto 7 mm in short axis on the right (17:34) and 9 mm in short axis on the left\n(17:41).", "output": "1. Motion artifact which limits space resolution of this study.\n2. Diffuse total spine leptomeningeal carcinomatosis consistent with lymphoma.\n3. More focal areas of nodular masslike enhancing disease, as described, with\nlarge 2 cm lesion at the C3 level severely compressing the traversing cervical\ncord causing intrinsic cord edema.\n4. Enhancing lesion within the S2 vertebral body which may represent\nmetastatic osseous disease.\n5. Prominent bilateral iliac chain lymph nodes, as described.\n\nNOTIFICATION: Results discussed with Dr. ___ by Dr. ___ at ___ on ___ via telephone 5 minute after discovery." }, { "input": "CERVICAL SPINE: Cervical alignment is anatomic. Vertebral body heights are\npreserved. There is no suspicious T1 marrow signal. Disc heights are\npreserved.\n\nThere is mild residual leptomeningeal enhancement and thickening of the\nbrainstem and upper cervical spine extending to the C4 level, improved from\nprior examination.\n\nThere is significant decrease size of left sided extramedullary nodular\nenhancing lesions at the cervical medullary junction now measuring\napproximately 4 mm (series 6, image 3) and at posterior C3 level (series 6,\nimage 12). There is significant decreased mass effect on the adjacent\ncervical spine. No new enhancing nodules are identified.\n\nThere are mild degenerative changes without significant neural foraminal\nnarrowing. Allowing for mild spinal canal narrowing at the C3 level secondary\nto the 4 mm extramedullary lesion, there is no significant spinal canal\nnarrowing.\n\nTHORACIC SPINE: Thoracic alignment is anatomic. Vertebral body heights are\npreserved. There is no signal abnormality on T1 postcontrast sequences. \nVertebral body heights are preserved.\n\nThere is significant decrease size of a left T8 extramedullary mass now\nmeasuring approximately 7 x 5 x 17 mm (AP, TRV, SI), resulting in moderate\nspinal canal narrowing at this level effacing the right ventral aspect of the\ncord.\n\nThere remains in nodular enhancement along the lower thoracic cord to the\nlevel of the conus medullaris, also significantly improved from prior\nexamination.\n\nThe remainder of the thoracic spine demonstrates no significant spinal canal\nor neural foraminal narrowing.", "output": "1. Significant improvement in the degree of cervical leptomeningeal nodular\nenhancement. Interval decrease size of two dominant left-sided craniocervical\njunction and C3 extramedullary nodules. There is significant decreased mass\neffect on the C3 cord.\n2. Significant decrease size of a T8 right extramedullary lesion and decreased\nprominence of nodular leptomeningeal enhancement of the lower thoracolumbar\ncord and conus medullaris\n3. Changes in cord signal abnormality seen on the prior exam cannot be\nassessed on the current exam as T2 and water sensitive sequences were not\nperformed. The patient has been entered into the MRI callback system for\nadditional T2 and water sensitive sequences at no cost to the patient.\n\nRECOMMENDATION(S): The patient has been entered into the MRI callback system\nfor additional T2 and water sensitive sequences at no cost to the patient. \nThis has been discussed with Dr. ___ provider.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 5:15 ___, 10 minutes after discovery of\nthe findings." }, { "input": "CERVICAL:\nAgain seen are extensive changes of leptomeningeal disease presenting as\nnodules and masses along the surface of the cord. The largest of these is at\nC3 and indents the posterior margin of the spinal cord. The noncontrast\ntechnique employed in this follow-up study does not demonstrate the full\nextent of leptomeningeal disease.\n\nTHORACIC:\nAgain seen are multiple nodules involving the thoracic spine, similar and size\nand distribution to the enhancing abnormalities demonstrated on the study of\n___. The largest of these is at the T8 level. Incompletely\nimaged is an appearance of extensive nodular involvement of the roots of the\ncauda equina. .", "output": "1. Noncontrast examination demonstrates extensive leptomeningeal disease\ninvolving the cervical and thoracic spine with the largest masses at C3 and T8\nindenting the spinal cord. The size of the lesions appears similar to the\nrecent contrast-enhanced examination of ___" }, { "input": "Vertebral alignment is anatomic. The cervical vertebral body heights are\npreserved. Not seen on prior examination of ___ were ___ are new subacute superior endplate compression fractures of T5 and T6,\ndemonstrating mild STIR hyperintense signal with minimal loss of vertebral\nbody height (series 5, image 7). Known T8 anterior wedge compression fracture\nis not within the field of view of diagnostic sequences, but is visualized on\nscout sequences, similar in appearance to prior examination\n\nAgain identified are two T2 hypo intense posterior intradural nodules abutting\nthe spinal cord at the level of C3 measuring approximately 5 x 4 x 7 mm (7:11,\n4:9), and 4 x 3 x 5 mm (4:7, 7:12), unchanged compared to the prior\nexamination. There is no evidence of intra medullary lesion and there remains\nonly a trace rim of surrounding increased T2 signal within the adjacent cord,\nsimilar to the prior examination (07:11). Previous examinations demonstrated\nwidespread leptomeningeal enhancement, which is not well evaluated given\nnoncontrast technique. Another nodule adjacent to the left aspect of the cord\nat the cervicomedullary junction measures 3 x 2 x 6 mm, minimally decreased in\nconspicuity compared to the prior examination. The remainder of the\nvisualized portion of the spinal cord is preserved in signal and caliber.\n\nThere is loss of T2 signal within all visualized intervertebral discs. The\nintervertebral disc heights are otherwise relatively well preserved.\n\nThere is no prevertebral soft tissue swelling..\n\n At C2-3 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4 there is minimal disc bulge without significant spinal canal or neural\nforaminal narrowingno vertebral canal or neural foraminal stenosis.\n\nAt C4-5 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6 there is disc bulge indenting the ventral thecal sac without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt C6-7 there is disc protrusion indenting the ventral thecal sac without\nsignificant spinal canal or neural foraminal narrowing.\n\nAt C7-T1 there is disc protrusion indenting the ventral thecal sac without\nsignificant spinal canal or neural foraminal narrowing.\n\nLimited sagittal view of the visualized upper thoracic spine demonstrates tiny\ndisc protrusions without significant spinal canal or neural foraminal\nnarrowing.", "output": "1. Mild superior endplate fracture deformities of T4 and T5, likely subacute\nin nature, new from examination of ___ with very minimal loss of\nvertebral body height.\n2. Please note that this is an incomplete examination and neither images of\nthe thoracic spine nor postcontrast images were obtained as the patient\ncomplained of warmth at the pacemaker site during the examination and the\nelectrophysiology cardiology fellow deemed the examination unsafe to proceed.\n3. Overall unchanged extra medullary, intradural nodules at the\ncervicomedullary junction and level of C3 with unchanged trace edema in the\nadjacent cord consistent with history of neurosarcoidosis. No definite new\nlesion. Note that this noncontrast examination underestimates the degree of\nleptomeningeal involvement.\n4. Cervical degenerative disc disease and additional findings, as described.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Study is mildly degraded by motion.\n\n Levels were established by counting down from the C2 level using series 3,\nimage 1.\n\nS shaped thoracic spine scoliosis is noted.\n\nCentral compression fracture is identified at T1 vertebral body with central\nloss of vertebral body height less than 50%. Associated STIR hyperintensity\nin T1 superior endplate is suggestive of acute fracture. STIR hyperintensity\nin bilateral T1 pedicles are mild.\n\nSevere T6 burst fracture is identified with greater than 50% vertebral height\nloss and retropulsion of the fracture which mildly narrows the spinal canal\nand contacts the anterior surface of the spinal cord. There is no evidence\nof cord compression or signal abnormality. There is more anterior height loss\nthan posterior, resulting in kyphotic angle of spine. Significant STIR\nhyperintensity is identified at the T6 vertebral body which extends to\nbilateral pedicles. The vertebral retropulsion causes mild bilateral T6-7\nneural foraminal narrowing.\n\nOtherwise, there is no vertebral canal or neural foraminal narrowing of the\nthoracic spine.\n\nSchmorl's nodes are noted at T12 and L1 superior endplates.\n\nSTIR hyperintensity is identified at T6-7 interspinous ligament, suspicious\nfor ligamentous injury. Supraspinous ligament is intact. Mild STIR\nhyperintensity is also identified at the C7 spinous process, suggestive of\nbone contusion.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber.\n\n Intervertebral discheightsandsignalare grossly preserved.\n\nOTHER:\nSTIR hyperintensity is identified at the manubrium.\nHiatal hernia is noted. Bilateral posterior lung atelectasis is mild.", "output": "1. Study is mildly degraded by motion.\n2. Acute severe T6 burst fracture with greater than 50% height loss\ndemonstrate retropulsion into the spinal canal which contacts the anterior\nsurface of the spinal cord, without causing cord compression. Abnormal signal\nextends from the vertebral body to bilateral pedicles, suspicious for fracture\nextension to bilateral pedicles. While findings may be related to patient's\nknown history of osteopenia, underlying tumor is not excluded on the basis\nexamination. If clinically indicated, consider follow-up imaging to\nresolution.\n3. Acute T1 central compression fracture demonstrates less than 50% height\nloss. Mild signal abnormality in bilateral pedicles may reflect bone\ncontusion.\n4. T6-7 interspinous ligament signal abnormality concerning for ligamentous\ninjury.\n5. Signal abnormality in the T7 spinous process suggestive of bone contusion.\n6. Signal abnormality at the manubrium is concerning for acute fracture.\n7. Hiatal hernia and bilateral probable atelectasis. If clinically indicated,\nconsider correlation with dedicated chest imaging." }, { "input": "There are 5 lumbar type vertebral bodies. Anterolisthesis of L3 on L4 and L4\non L5 is similar compared to prior. Elsewhere, vertebral bodies are maintained\nin alignment. There is no focal suspicious marrow lesion identified. Disc\ndesiccation with mild associated disc height loss seen at L3-4, L4-5, and\nL5-S1, similar to prior.\n\nThe conus terminates at the L1 level, in normal anatomic position. There is\nredundancy of the cauda equina nerve roots secondary to severe canal narrowing\nas detailed below, present on prior.\n\nAt T12-L1, and L1-L2, there is facet joint hypertrophy without significant\ncanal or foraminal narrowing.\n\nAt L2-3 there is moderate facet joint hypertrophy causing narrowing of the\nsubarticular recesses and mild bilateral foraminal narrowing. No overall canal\nnarrowing. This is unchanged from prior\n\nAt L3-4 there is a diffuse disc bulge with a central disc protrusion with an\nannular fissure. Previously seen superiorly extending left paracentral disc\nextrusion has resolved. Extensive bilateral facet joint hypertrophy with facet\njoint effusions and thickening of the ligamentum flavum is also seen. There is\nsubsequent severe canal narrowing, similar compared to prior and persistent\nsevere bilateral foraminal narrowing. Small synovial cyst seen anterior to\nthe right facet (8:8, 9) contributes to canal narrowing below the level of the\ndisc.\n\nAt L4-5 there is uncovering of the disc and a superimposed disc bulge. In\ncombination with severe bilateral facet joint hypertrophy and ligamentum\nflavum thickening there is severe canal narrowing similar to prior. There is\nsignificant narrowing of the subarticular recesses likely impinging the\ntraversing nerve roots. Severe bilateral foraminal narrowing is again noted.\n\nAt L5-S1, there is a diffuse disc bulge and moderate facet joint hypertrophy\nwhich result in mild canal narrowing and significant narrowing of the\nsubarticular recesses, right greater than left, contacting the traversing S1\nnerve roots. There is moderate bilateral foraminal narrowing. Both exiting L5\nnerve roots are contacted by the disc bulge in the neural foramina.\n\nMultiple T2 hyperintense lesions in the kidneys bilaterally, incompletely\ncharacterized but likely cysts, the largest at the upper pole of the left\nkidney measuring 5.7 by 4.4 cm", "output": "Extensive degenerative changes most notable for severe canal narrowing at L3-4\nand L4-5 with secondary redundancy of the cauda equina nerve roots superiorly.\n\nAlthough there has been reduction in size of the left paracentral disc\nextrusion at L3-4, degree of canal narrowing has not significantly changed and\nthere is persistent bilateral severe foraminal narrowing both at L3-4 and\nL4-5.\n\nOther degenerative changes as detailed above." }, { "input": "L2 and L3 vertebral bodies demonstrate edema and contrast enhancement, as well\nas minimal loss of height, not significantly changed compared to ___\nand ___. Anterior fusion of L2-3 and L3-4 with intervertebral\nspacers is new compared to ___. Compared to ___, the\nintervertebral spacer at L2-3 is displaced anteriorly and slightly rotated.\nThe L2-3 disc space is narrowed posteriorly. There is enhancing material in\nthe L2-3 disc space, surrounding the displaced spacer device and extending\nanteriorly into the prevertebral soft tissues along the margins of the spacer\ndevice.\n\nThere is also enhancing material in the anterior epidural space at L2 and L3.\nWhile it continues to indents the ventral thecal sac at the level of L2 and\nL2-3 disc space, its maximal AP dimension has decreased compared to ___. Mild associated mass effect on the ventral thecal sac is less\nthan on prior exams. The enhancing epidural material also extends into\nbilateral neural foramina encasing the exiting L2 nerve roots. There is no\nresidual epidural fluid collection.\n\nThe L3-4 spacer device remains well positioned, similar to ___.\nMild anterolisthesis of L3 on L4 is unchanged compared to ___. Edema and contrast enhancement along the L4 superior endplate a new\ncompared to ___, but the edema was present on ___\npostsurgical noncontrast MRI.\n\nAnterior fusion of L4-5 and L5-S1 with intervertebral spacer devices appears\nunchanged compared to the ___ MRI and ___\nradiographs. Laminectomies from L2 through S1, and instrumented posterior\nfusion of L4 through S1 with left-sided screws, have been present since ___.\n\nThe distal spinal cord appears unremarkable, with the conus medullaris\nterminating at L1-2.\n\nAt L1-2 disc bulge and facet arthropathy without significant spinal canal or\nneural foraminal narrowing.\n\nL2-3 level is discussed above.\n\nAt L3-4, there is a disc bulge and facet arthropathy with narrowing of the\nsubarticular zones and moderate bilateral neural foraminal narrowing,\nunchanged.\n\nAt L4-5, there is bilateral facet arthropathy with minimal bilateral neural\nforaminal narrowing, unchanged. There is no spinal canal narrowing.\n\nAt L5-S1, there is bilateral facet arthropathy with moderate right neural\nforaminal narrowing. The left neural foramen also appears at least moderately\nnarrowed, but it is suboptimally assessed due to hardware related artifacts.\n\nThe right psoas muscle demonstrates mild residual contrast enhancement,\nwithout evidence for residual abscess. The left psoas muscle also demonstrates\nmild residual contrast enhancement, as well as an area of central high signal\nand peripheral low signal on all sequences which may represent postsurgical\nchange, but no evidence for a residual abscess.\n\nA right renal cystic lesion is partially visualized.", "output": "1. Compared to ___, intervertebral spacer at L2-3 is displaced\nanteriorly and slightly rotated, with loss of posterior L2-3 disc space\nheight. Enhancing material in the L2-3 disc space, surrounding the displaced\nspacer device and extending anteriorly into the prevertebral soft tissues\nalong the spacer device, may be inflammatory, but infection cannot be excluded\nby MRI.\n2. Anterior epidural enhancing material at L2 and L3 has decreased in extent\ncompared to ___, with decreased mass effect on the\nventral thecal sac. It continues to extend into the neural foramina, encasing\nbilateral L2 nerve roots. This may represent post infectious granulation\ntissue, there residual infection cannot be excluded by MRI. There is no\nresidual epidural abscess.\n3. Persistent edema and contrast enhancement in L2 and L3 vertebral bodies may\nrepresent inflammatory sequela, but residual infection cannot be excluded by\nMRI. Edema and contrast enhancement along the L4 superior endplate, new\ncompared to ___ but similar to ___, which may represent\npostsurgical change given the interim L3-4 anterior fusion.\n4. Mild residual contrast enhancement in bilateral psoas muscles and\npostsurgical changes in the left psoas muscle, without evidence for a residual\npsoas abscess.\n\nRECOMMENDATION(S): Recommend lumbar spine CT for better assessment of the\ndisplaced L2-3 intervertebral spacer and neurosurgical consultation.\n\nNOTIFICATION: The item 1 of the impression and recommendations above were\nentered by Dr. ___ on ___ at approximately 15:40 into the\nDepartment of Radiology critical communications system for direct\ncommunication to the referring provider." }, { "input": "Again seen are postsurgical changes related to laminectomy at L2, L3, right\nhemilaminectomy at L4 and L5 and laminectomy at S1 with interbody graft at\nL2-L3, L3-L4, L4-L5 and L5-S1 and uni pedicle left screw and rod device at\nL4-S1. The interbody graft at L2-L3 is anteriorly displaced with compression\ndeformity along the anterior aspect of the inferior endplate of L2, unchanged\ncompared to the prior MRI from ___.\n\nAgain seen is enhancing soft tissue material in the anterior epidural space at\nthe level of L2-L3 vertebrae which indents the ventral thecal sac measuring\napproximately 4 mm in the AP dimension on image 12:9, previously 7 mm. There\nis mild associated mass effect on the ventral thecal sac, decreased compared\nto the prior study. The enhancing soft tissue material extends into the\nneural foramen bilaterally at the level of L2 encasing the exiting L2 nerve\nroots. Linear enhancement along the course of the cauda equina likely\nrepresents venous enhancement rather than arachnoiditis.\n\nThe previously seen enhancing material within the L2-L3 intervertebral disc\nspace is again seen, decreased compared to the prior study. Also seen is\nanterior extension of this enhancing soft tissue into the prevertebral space\nalong the margins of the spacer device, decreased compared to the prior study.\n\nAgain seen is 2 mm anterolisthesis of L3 on L4. Again seen is edema within\nthe L2 vertebral body and along the superior endplate of L4 with enhancement\non the postcontrast images, slightly decreased compared to the prior study.\n\nThe distal spinal cord appears unremarkable with the conus terminating at the\nlevel of L1.\n\nAt at T12-L1, there is loss of disc height and signal with diffuse disc bulge\nand bilateral facet arthropathy. Bilateral neural foramen and spinal canal\nare patent.\n\nAt L1-L2, there is diffuse disc bulge with bilateral facet arthropathy and\nligamentum flavum thickening resulting and moderate spinal canal and moderate\nbilateral neural foramen narrowing.\n\nAt L2-L3, there is disc bulge with facet arthropathy and enhancing epidural\nsoft tissue resulting in severe bilateral neural foramen narrowing and\nnarrowing of bilateral subarticular zones displacing the traversing L3 nerve\nroots.\n\nAt L3-L4, there is diffuse disc bulge, bilateral facet arthropathy resulting\nin moderate to severe bilateral neural foramen narrowing and narrowing of\nbilateral subarticular zones contacting the traversing L4 nerve roots. No\nspinal canal stenosis is seen secondary to posterior decompression.\n\nAt L4-L5, there is diffuse disc bulge and bilateral facet arthropathy\nresulting in mild bilateral neural foramen narrowing. The spinal canal is\npatent secondary to posterior decompression.\n\nAt L5-S1, there is disc bulge with bilateral facet arthropathy and spinal\nfusion resulting in mild bilateral neural foramen narrowing. The spinal canal\nis patent secondary to posterior decompression.\n\nNonenhancing T2 hyperintense cystic lesion of the right kidney is identified,\ncompatible with a simple cyst. Near complete resolution of previously\ndescribed enhancement of the right psoas muscle.", "output": "1. Stable postoperative changes related to laminectomy and posterior spinal\nfusion of L2-S1 with interbody grafts at L2-L3 to L5-S1 as described above. \nStable anteriorly positioned interbody graft at L2-L3.\n2. Mild interval decrease in the enhancing soft tissue in the interbody graft\nat L2-L3 extending anteriorly into the prevertebral space and posteriorly into\nthe epidural space with interval decrease in the edema and enhanced involving\nthe adjacent vertebral bodies. This is favored to be post surgical\ngranulation tissue. However, residual superimposed infection is not\ncompletely excluded and clinical correlation is recommended.\n3. Soft tissue granulation tissue is extending into the neural foramen at\nL2-L3 causing severe bilateral neural foramen narrowing.\n4. Moderate spinal canal stenosis at L1-L2 with moderate bilateral neural\nforamen narrowing. The spinal canal is patent at all other levels secondary\nto posterior decompression." }, { "input": "Study is degraded by motion and by lumbar spinal fusion hardware artifact. \nWithin these confines:\n\nCERVICAL:\nThere is 2 mm spondylolisthesis of C7 on T1, likely degenerative.\n\nMild loss of cervical vertebral body height without definite associated\nincreased STIR signal are likely degenerative. Low signal intensity within\nthe right lamina of the C3-C6 vertebral bodies on T1 and T2 weighted images\nlikely reflects postoperative change.\n\n The visualized portion of the spinal cord is grossly preserved in signal and\ncaliber. There is no definite abnormal enhancement.\n\nAt C2-3, uncovertebral and facet joint hypertrophy result in mild left neural\nforaminal narrowing. There is no spinal canal or right neural foraminal\nnarrowing.\n\nAt C3-4, a disc osteophyte complex, uncovertebral and facet joint hypertrophy\nresult in mild spinal canal narrowing. There is moderate left and severe\nright neural foraminal narrowing.\n\nAt C4-5, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy\nresult in mild spinal canal narrowing. There is severe bilateral neural\nforaminal narrowing.\n\nAt C5-6, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy\nresult in mild-to-moderate spinal canal narrowing. There is severe bilateral\nneural foraminal narrowing.\n\nAt C6-7, a disc osteophyte complex, uncovertebral, and facet joint hypertrophy\nresult in mild spinal canal narrowing. There is severe bilateral neural\nforaminal narrowing.\n\nAt C7-T1 a disc osteophyte complex, uncovertebral, and facet joint hypertrophy\nresult in mild spinal canal narrowing. There is mild-to-moderate bilateral\nneural foraminal narrowing.\n\nTHORACIC:\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nT8 vertebral body probable hemangioma is noted.\n\n The visualized portion of the spinal cord is preserved in signal and caliber.\nThere is no abnormal enhancement.\n\nThere is mild degenerative disc disease, without moderate or severe spinal\ncanal or neural foraminal narrowing.\n\nLUMBAR:\nThere postoperative changes for posterior instrumented fusion with\ntranspedicular screws at the L4-S1 level and anterior fixation screws at right\nL4 and S1. There is solid osseous fusion of the L2-3, partial osseous fusion\nof L3-4, L4-5, and L5-S1. Laminectomy changes are detailed below.\n\nThere is an oblique fracture of the superior endplate of L2 with lateral\nextension through the lateral margin of the vertebral body. This is likely\nsubacute to chronic, however is a new finding from the ___ MRI. \nVertebral body height is otherwise preserved without evidence of an acute\nfracture. Vertebral body alignment is preserved.\n\nThe conus medullaris terminates at the L1 level. There is no definite signal\nabnormality within the conus or cauda equina. There is no abnormal\nenhancement.\n\nAt T12-L1 there is no spinal canal or neural foraminal narrowing.\n\nAt L1-2, there is advanced degenerative endplate change with bone marrow\nreactive change and associated vacuum disc phenomenon. There is a disc bulge\nwith superimposed central disc extrusion with superior migration, ligamentum\nflavum thickening, and facet hypertrophy with bilateral synovial cysts that\nresult in severe spinal canal narrowing. There is probable impingement on the\ntraversing bilateral L2 and possibly other nerve roots. There is there is\nmoderate left and severe right neural foraminal narrowing. There is a right\nfacet joint effusion.\n\nAt L2-3, there is ossification of a residual L2-3 intervertebral disc versus\nendplate spurs. There are bilateral laminectomy changes with decompression of\nthe spinal canal narrowing. Facet hypertrophy results in severe bilateral\nneural foraminal narrowing, left worse than right.\n\nAt L3-4, there is a small disc bulge. There are bilateral laminectomy changes\nwith decompression of the spinal canal. Facet hypertrophy results in moderate\nbilateral neural foraminal narrowing.\n\nAt L4-5, facet hypertrophy results in mild bilateral neural foraminal\nnarrowing. There are bilateral laminectomy changes with decompression of the\nspinal canal.\n\nAt L5-S1, there are bilateral laminectomy changes with decompression of the\nspinal canal. Facet hypertrophy results in and moderate left neural foraminal\nnarrowing.\n\nOTHER:\nThere is a 5 mm nodule within the left lobe of the thyroid.\n\nThere is a moderate size loculated right pleural effusion. Signal abnormality\nwithin the basilar right lower lobe could reflect atelectasis and/or\npneumonia.\n\nThere is a gastric fundal diverticulum (series 18, image 22).", "output": "1. Study is degraded by motion and by lumbar spinal fusion hardware artifact.\n2. Cervical degenerative disc disease as detailed above, without high-grade\nspinal canal narrowing or cord signal abnormality. There is severe neural\nforaminal narrowing at multiple levels.\n3. Mild thoracic degenerative disc disease, without high-grade spinal canal or\nneural foraminal narrowing.\n4. Loculated right pleural effusion basilar right lower lobe could reflect\natelectasis, however pneumonia cannot be excluded. Chest CT is suggested.\n5. Instrumented lumbar fusion at L4-S1, interbody fusion graft at L3-4 with\npartial osseous fusion, and solid osseous fusion of the L2-3 level as detailed\nabove.\n6. L1-2 disc extrusion with superior migration results in severe spinal canal\nnarrowing. There is probable impingement of the traversing L2 and possibly\nother nerve roots. Allowing for difference technique, finding may be slightly\nprogressed compared to ___ prior exam.\n7. Within limits of study, no definite evidence of discitis-osteomyelitis, or\nepidural abscess.\n8. Probable subacute to chronic oblique fracture of the superior endplate of\nL2 with lateral extension through the lateral vertebral body.\n9. Right L1-2 and bilateral L2-3 Severe neural foraminal narrowing." }, { "input": "The examination is incomplete secondary to patient's inability to continue.\nSagittal T1, T2, STIR, and axial T2 images contain significant artifact\nsecondary to patient motion.\n\nThere have been interval postoperative changes of new intervertebral spacers\nat the L2-L3 and L3-L4 levels. There are postoperative changes of\nintervertebral spacers at the L4-5 and L5-S1 levels with trans pedicle screws\non the left and posterior stabilization rods from L4 through S1.\n\nThe conus medullaris is normal and signal and morphology and terminates at the\nL1-L2 level. There is persistent T1 hypointensity within the inferior and\nsuperior endplate of the and L3, respectively.. The previously seen fluid\ncollection at the posterior margin of L2-3 disc is less apparent on the\ncurrent study. There remains deformity of the thecal sac at this level.\n\nThere is persistent edema and some fluid collections within the bilateral\npsoas musculature, extending from the L2-L3 level inferiorly to the L5-S1\nlevel compatible with a psoas edema and residual fluid/ abscesses. The fluid\ncollection within the right psoas muscle may be slightly increased although\ncomparison is difficult secondary to artifact. There is additional edema\nwithin the posterior paraspinous musculature.\n\nDegenerative lumbar spondylosis at the L3-L4 through L5-S1 levels causes\nneural foraminal narrowing, greatest at the L5-S1 level, and some degree of\nspinal canal narrowing although evaluation is difficult secondary to motion\nartifact.", "output": "1. Incomplete examination secondary to patient's inability continue. Obtained\nsequences contain motion artifact.\n2. Interval postoperative changes of intervertebral spacers at L2-L3 and\nL3-L4. Tip subdural fluid collection is less apparent on the current study but\nevaluation is incomplete. There remains some deformity of the thecal sac.\n3. Bilateral fluid collections within the psoas musculature, consistent with\nresidual thyroid/ abscesses. One of these fluid collections within the right\npsoas muscle may be increased when compared to prior exam although comparison\nis difficult secondary to motion artifact.\n4. Degenerative lumbar spondylosis and other postoperative changes, as\ndescribed." }, { "input": "The lumbar spine alignment appears maintained, the vertebral body signal\nintensity appears normal. The visualized aspect of the lower spinal cord\nappears normal in signal and configuration, the conus medullaris terminates at\nthe level of T12/L1 and is unremarkable.\n\nFrom T12-L3 levels, there is no disc bulge or spinal canal or neural foraminal\nnarrowing.\n\nAt L3-4, there is mild unchanged diffuse disc bulge without spinal canal or\nneural foraminal narrowing. Mild bilateral articular joint facet hypertrophy\nappears unchanged.\n\nAt L4-5, there is diffuse disc bulge causing mild right and moderate left\nneural foraminal narrowing, contacting the traversing nerve root on the left\nat the level of the subarticular zone (image 11, series 5), however slightly\nless pronounced since the prior exam.\n\nAt L5-S1, there is persistent disc bulging and right paracentral disc\nprotrusion causing moderate to severe right neural foraminal narrowing,\ndisplacing the S1 nerve root on the right and contacting the right exiting\nnerve root of L5 (image 18, series 5), similar to prior, the degree of right\nanterolateral thecal sac deformity is significantly improved since the prior\nexamination.\n\nThe sacroiliac joint and the visualized paravertebral structures are grossly\nunremarkable.", "output": "1. In comparison with the prior examination, there is interval improvement in\nthe previously seen left paracentral disc protrusion causing anterior thecal\nsac deformity and right-sided neural foraminal narrowing, the amount of disc\nprotrusion appears slightly less conspicuous, however the degree of\nright-sided neural foraminal narrowing abutting the right S1 nerve root and\nthe right L5 exiting nerve root remain unchanged.\n\n2. Diffuse disc bulging identified at L4-L5 level, with mild right and\nmoderate left neural foraminal narrowing, contacting the traversing nerve root\non the left, however slightly less pronounced since the prior exam." }, { "input": "There are 5 lumbar-type vertebrae. There is normal lordosis without\nspondylolisthesis. There is no compression fracture, marrow edema or\naggressive osseous lesion.\n\nThe conus medullaris terminates at L1 and is normal in both caliber and signal\nintensity.\n\nT12-L1: No disc bulge or protrusion. No spinal canal stenosis or neural\nforaminal narrowing.\n\nL1-2: No disc bulge or protrusion. No spinal canal stenosis or neural\nforaminal narrowing.\n\nL2-3: Minimal, diffuse disc bulge. No spinal canal stenosis or impingement of\nthe traversing nerve roots. No neural foraminal narrowing.\n\nL3-4: Minimal, diffuse disc bulge. No spinal canal stenosis or impingement of\nthe traversing nerve roots. No neural foraminal narrowing.\n\nL4-5: Mild, diffuse disc bulge with bilateral facet joint hypertrophy and\nthickening of the ligamentum flavum. There is mild narrowing of the right\nsubarticular recess (8:30).\n\n\nL5-S1: Minimal disc bulge without spinal stenosis and mild foraminal\nnarrowing.\n\nThere is no suspicious paraspinal mass.", "output": "1. Mild multilevel degenerative changes without high-grade spinal stenosis or\nforaminal narrowing. Minimal to mild foraminal narrowing as described in the\nlower lumbar region.\n2. No focal disc herniation or nerve root displacement.\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": "There is slight reversal of the cervical lordosis. There is mild multilevel\nvertebral body height loss extending from C3 through C7, likely degenerative. \nDiffuse signal heterogeneity of the vertebral bodies is likely on a\ndegenerative basis. Although multilevel patchy cervical vertebral body T1\nhypointensity relative to the intervertebral discs with possible minimal\npostcontrast enhancement raises concern for a potential marrow infiltrative\nprocess if there is a history of malignancy.\n\nC2-C3: Facet osteophytes result in severe right neural foraminal narrowing.\n\nC3-C4: Disc bulging and endplate/uncovertebral osteophytes results in mild\nspinal canal stenosis with mild cord flattening without evidence of abnormal\ncord signal. There is moderate to severe left and moderate right neural\nforaminal narrowing.\n\nC4-C5: Disc bulging and endplate/uncovertebral osteophytes with mild spinal\ncanal stenosis and mild flattening of the cord without evidence of abnormal\ncord signal. There is severe left and moderate right neural foraminal\nnarrowing.\n\nC5-C6: Endplate and uncovertebral osteophytes result in moderate spinal canal\nstenosis with flattening of the cord without abnormal cord signal. There is\nsevere bilateral neural foraminal narrowing.\n\nC6-C7: Disc bulging and endplate/uncovertebral osteophytes with moderate left\nand mild right neural foraminal narrowing.\n\nC7-T1: Facet osteophytes with mild left neural foraminal narrowing.\n\nFor the visualized portions of the brain, please refer to the report for the\nconcurrently performed MRI brain study.", "output": "1. Multilevel degenerative changes of the cervical spine with multilevel mild\nflattening of the cord without of evidence of abnormal cord signal. \nDegenerative changes are most significant at C5-C6 where there is moderate\nspinal canal stenosis and severe bilateral neural foraminal narrowing.\n2. Multilevel patchy cervical vertebral body T1 hypointensity relative to the\nintervertebral discs with possible minimal postcontrast enhancement raises\nconcern for a potential marrow infiltrative process if there is a history of\nmalignancy. Alternatively, findings may also represent sequela of\ndegenerative change." }, { "input": "The visualized portions of the distal spinal cord demonstrate mild expansion\nand T2/STIR hyperintensity, particularly at the level of T12-L1. Differential\nconsiderations include inflammatory etiologies such as transverse myelitis,\ndemyelinating disease, or intramedullary neoplasm.\n\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nThe lumbar spine bone marrow is diffusely T1 and T2 hypointense. Otherwise,\nthere is no concerning focal bone marrow signal abnormality. The conus\nmedullaris terminates at the level of L1-L2.\n\nThere is loss of intervertebral disc height and signal in multiple levels,\nmost prominent at L4-L5. There are multilevel degenerative changes as\nfollows:\n\nT12-L1: Unremarkable.\n\nL1-L2: There is a mild posterior disc bulge with superimposed left sided disc\nprotrusion resulting in minimal canal narrowing without neural foraminal\nnarrowing. Of note, the disc bulge at this level nearly contacts the\ndescending left L2 nerve root.\n\nL2-L3: Mild posterior disc bulging is noted without canal stenosis or neural\nforaminal narrowing.\n\nL3-L4: A mild posterior disc bulge flattens the ventral thecal sac and\ncombines with thickening of the ligamentum flavum and prominent dorsal\nepidural fat to result in minimal canal narrowing with minimal neural\nforaminal narrowing bilaterally. The disc bulge at this level abuts the\ndescending left L4 nerve root.\n\nL4-L5: A posterior disc bulge flattens the ventral thecal sac without canal\nnarrowing, but causing bilateral subarticular recess narrowing and minimally\ncontacting the bilateral descending L5 nerve roots. There is mild-to-moderate\nleft and mild right neural foraminal narrowing. The disc bulge at this level\nalso contacts the exiting left L4 nerve root.\n\nL5-S1: There is a posterior disc bulge with slightly left sided superimposed\nprotrusion which narrows the left subarticular recess and minimally abuts the\ndescending left S1 nerve root. Otherwise, there is no canal stenosis or\nsignificant neural foraminal narrowing.\n\nSeveral small T2 hyperintense renal cysts are noted. The remainder of the\nvisualized paraspinal soft tissues are grossly unremarkable.", "output": "1. Mild expansion and T2/STIR hyperintensity of the distal lumbar spinal cord.\nDifferential considerations include inflammatory etiologies such as transverse\nmyelitis, demyelinating disease, or intramedullary neoplasm. If there is\nongoing clinical concern, consider repeat thoracic/lumbar spine MRI evaluation\nwith intravenous contrast.\n2. Multilevel spondylosis of the lumbar spine, as detailed above, with L3-L4\ndisc bulge abutting the descending left L4 nerve root and L4-L5 disc bulge\ncontacting the exiting left L4 nerve root.\n3. Mild, diffusely T1/T2 hypointense bone marrow signal, similar to findings\nfat were previously noted in the cervical spine. Although this finding can be\nseen in the setting of chronic anemia or smoking, an marrow infiltrative\nprocess is not excluded." }, { "input": "THORACIC:\nThere is mild S shaped scoliosis of the thoracic spine. The thoracic\nvertebral body heights are grossly maintained. Sagittal spinal alignment is\nmaintained.\n\nThe bone marrow signal is mildly heterogeneous, but without focal suspicious\nlesion. The upper and mid thoracic spinal cord is normal in morphology and\nsignal intensity, without evidence of abnormal enhancement. The known signal\nabnormality in the distal thoracic and lumbar spinal cord is discussed below.\n\nMultilevel disc bulges are seen throughout the thoracic spine, most notable at\nT3-4, T6-7, T7-8, and T8-9, all of which result in minimal to no spinal canal\nstenosis. There is no significant neural foraminal narrowing.\n\n\nLUMBAR:\nVertebral body heights are maintained. Vertebral body alignment is within\nnormal limits, without evidence for subluxation.\n\nWithin the distal spinal cord, at the level of T12-L1, there is a enhancing\nlesion within the slightly left and ventral of center cord which measures\napproximately 1.5 x 0.6 x 0.5 cm (SI by AP by TV). There is both superior and\ninferior extension of this abnormal enhancement, which involves the\nleptomeningeal surface and extends inferiorly to the level of L2 (13:8). \nPosterior leptomeningeal extension is also noted (13:10, with potential\ninvolvement of the adjacent nerve roots.\n\nAgain, there is associated with cord expansion and surrounding T2/STIR signal\nabnormality which extends from the superior endplate of T12 to the superior\nendplate of L2\n\nBackground spondylosis of the lumbar spine are again noted, previously\ndetailed in a level by level description on the recent noncontrast MR lumbar\nspine examination performed earlier on the same day.", "output": "1. 1.5 x 0.6 x 0.5 cm T12-L1 intramedullary enhancing focus with surrounding\nSTIR/T2 signal abnormality and associated cord expansion. Notably, there is\nextensive leptomeningeal involvement which extends both superiorly and\ninferiorly beyond the margins of the intramedullary lesion, with possible\ninvolvement of the adjacent nerve roots. Differential considerations include\ninflammatory processes such as sarcoid, infection, or leptomeningeal seeding\nfrom metastatic disease. Lymphoma is a is a possibility. A primary spinal\nneoplasm is less likely given the extent of the leptomeningeal component.\n2. No additional areas of abnormal cord signal or contrast enhancement.\n3. Unremarkable examination of the thoracic spine with minimal spondylosis.\n4. Multilevel degenerative changes of the lumbar spine are again noted,\npreviously detailed in a level by level description on the recent noncontrast\nMR lumbar spine examination performed earlier on the same day." }, { "input": "Study is moderately degraded by motion. Within these confines:\n\nThe conus mass which is T1 isointense, T2 hyperintense and demonstrates\nhomogeneous enhancement postcontrast in the central aspect of the cord (intra\nmedullary) extending to the left anterior lateral aspect of the cord involving\nthe adjacent left anterior nerve roots. This enhancing intramedullary\ncomponent measures 7 x 6 x 19 (TV by AP by CC) previously measuring 6 x 6 by\n17 mm suggesting that the lesion have increased in size or it may also be\nsecondary to difference in technique.\n\n2 additional foci of abnormal enhancement is seen in relation a nerve root\nright posterior lateral to the conus (series 8, image 18) as well as in\nrelation to the nerve roots in the thecal sac at the lower L4 level (series 8,\nimage 38).\nThere is nonspecific enhancement also in relation to the left anterior lateral\ndura best seen on sagittal imaging at the L1-2 levels/level of the conus.\n\nMultilevel lumbar spondylosis is grossly unchanged compared to ___ prior exam.\n\n Right renal cortical cyst is noted. Nonspecific sclerotic lesion in the left\niliac bone which does not demonstrate surrounding edema or enhancement\npostcontrast, with corresponding to sclerotic lesion on recent abdomen CT (see\n2:90 on prior CT exam and 5, 6, 08:47 on current study).", "output": "1. Study is moderately degraded by motion.\n2. Slight interval increase of enhancement and size of conus mass with\nexpansion of the conus and extension into adjacent nerve roots, with at least\n2 areas of leptomeningeal dissemination. Nonspecific thickening and\nenhancement of the dura also noted left anterolateral adjacent to the conus. \nDifferential considerations include primary spinal tumor with drop metastasis\nsuch as ependymoma (Myxopapillary) or astrocytoma, metastatic lesions from an\nextra-spinal primary or infective/inflammatory etiology such as sarcoidosis. \nIf clinically indicated, consider correlation with CSF.\n3. Grossly stable lumbar spondylosis as described.\n4. Right renal cyst.\n5. Nonspecific left iliac sclerotic lesion, which may be degenerative. If\nclinically indicated, consider bone scan for further evaluation." }, { "input": "There have been no significant changes since the prior study. Alignment is\nnormal. Vertebral body signal intensity inhomogeneity with marked\nhypointensity on the T1 weighted images is unchanged. With the presence of\ncontrast administration on this examination there is no evidence of abnormal\nenhancement within the areas of T1 hypointensity in the vertebral bodies. \nThis argues against a neoplastic etiology, suggesting that degenerative\ndisease and sclerosis are more likely. There are ___ type 2 signal\nintensity changes in the inferior endplate of the C4 vertebral body. There is\nloss of signal of the intervertebral discs on the T2 weighted images, a\nmanifestation of degenerative disc disease. Intervertebral osteophytes at\nevery level from C3-4 through C7 again demonstrate spinal canal narrowing and\nflattening of the spinal cord, unchanged since the prior study. Unchanged are\nmultiple areas of neural foraminal narrowing due to degenerative disease.\nThe spinal cord signal intensity appears normal.\nThere is no abnormal enhancement after contrast administration.", "output": "1. Unchanged appearance of degenerative disease with spinal canal and neural\nforaminal narrowing.\n2. No evidence of spinal cord signal intensity abnormality or enhancement" }, { "input": "Again seen is enhancing mass involving conus, with mild worsening of the\nfinding since ___. Enhancing component of the intramedullary\ntumor has slightly increased, measuring 2.2 cm x 0.68 cm x 0.74 cm today,\ncompared with 1.8 cm x 0.60 cm x 0.69 cm on prior. Mildly worsened\nsurrounding edema nodule thickening and enhancement of predominantly the\nproximal cauda equina roots ventrally and dorsally is similar. Cord is more\nexpanded today.\nDifferential considerations include lymphoma, metastasis, either systemic or\nprimary CNS drop metastasis, primary cord malignancy, potentially myxo\npapillary ependymoma, granulomatous process including sarcoidosis, less likely\nsubacute infectious process.\nHeterogeneous T1 signal of the ___ be from infiltrative process or red\nmarrow conversion.\nMultilevel degenerative changes, with diffuse disc bulges, lumbar facet\narthritis, multilevel mild central canal narrowing, and multilevel foraminal\nnarrowing, most prominent and probably mild-to-moderate at L4-5 level, similar\nto prior.\nNo incidental new findings.", "output": "1. Enhancing mass at the conus has mildly increased in size, with mildly\nworsened cord expansion and adjacent edema, compared with ___.. \nSimilar nodular thickening and enhancement of the roots of the cauda equina. \nDifferential considerations include metastasis, lymphoma, primary cord\nneoplasm, granulomatous process such as sarcoid, less likely subacute\ninfection.\n2. Areas of inhomogeneous marrow signal, indeterminate, may represent marrow\ninfiltrative process, including lymphoproliferative disease, metastases, or\nreactive changes." }, { "input": "The T2 hyperintense and enhancing conus lesion is decreased in size compared\nto prior imaging currently measuring 21 x 5 mm in the sagittal plane,\npreviously measuring 25 x 7 mm. The enhancement along the nerve roots is\nslightly increased compared to prior.\n\nThere is mild dependent clumping of the nerve roots in the posterior aspect of\nthe thecal sac at the L4-5 level which is nonspecific and may be related to\npostsurgical arachnoiditis or possibly due to CSF leak.\n\nThe patient is status post L2-3 through L5-S1 posterior laminectomy. There is\na fluid intensity collection immediately posterior to the thecal sac measuring\n29 x 97 mm (AP by CC). This collection demonstrates rim enhancement. There\nis presumed surgical sponge within this collection. The collection extends\ninto the subcutaneous soft tissue of the lower back at the L3 level (series 2,\nimage 7) and communicates with a small fistulous tract in the midline at the\nL3 level (series 5, image 18) which appears to open up on the skin. There\nappears to be a small defect in the dura at the L4 level (series 8, image 27),\nbut this is difficult to state with certainty due to the limited spatial\nresolution of MR. ___ edema in the lower back subcutaneous tissue\nappears fairly similar compared to prior CT.\n\n\nMild moderate lumbar spine degenerative changes, but no compromise of the\nconus or nerve roots in the spinal canal or high-grade neural foraminal\nstenosis.\n\nFairly diffuse decrease in T1 bone marrow signal intensity appears fairly\nsimilar compared to prior.\n\nExtra-spinal: Small simple right renal cortical cyst.", "output": "1. The T2 hyperintense enhancing conus lesion is decreased in size compared to\nprior. The enhancement along the nerve root is slightly increased compared to\nprior.\n2. There is mild dependent clumping of the nerve roots in the posterior aspect\nof the thecal sac at the L4-5 level which is nonspecific and may be related to\nprior surgery/arachnoiditis or possibly due to CSF leak.\n3. The patent is status post L2-L3 through L5-S1 posterior laminectomy with a\nfluid collection in the soft tissues immediately posterior to the thecal sac. \nThis collection demonstrates enhancement postcontrast.\n4. There is a possible small discontinuity in the dura as described above at\nthe L4 level, but this is difficult to state with certainty due to the limited\nspatial resolution of MR.\n5. The fluid collection appears to communicate with a small fistulous tract\nopening up on the skin at the L3 level.\n6. Fairly diffuse decrease in T1 bone marrow signal intensity appears fairly\nsimilar compared to prior and may represent hemopoietic active red marrow or\nbone marrow infiltration." }, { "input": "5 lumbar-type vertebrae are again demonstrated. Vertebral body heights are\npreserved. Alignment is normal. Bone marrow signal on precontrast T1\nweighted images remains relatively low, likely secondary to the known lymphoma\nand/or sequela of treatment. No suspicious focal bone marrow signal\nabnormalities are seen.\n\nThere are partial laminectomies at L3, and bilateral laminectomies at L4 and\nL5. There is a persistent fluid collection extending into the midline\nposterior paravertebral soft tissues from the laminectomy beds, spanning mid\nL3 through S1-S2 levels, which measures 9.3 cm craniocaudad on sagittal image\n201:21, and 1.7 cm transverse by 1.6 cm AP in maximal axial cross-section near\nthe upper endplate of L4 on axial image 7:25. Previously, it measured 9.4 x\n2.0 x 2.1 cm when measured in the same fashion. The fluid collection is\nsurrounded by granulation tissue. A track from the collection to the skin is\nagain seen at the level of L4, for example axial image 7:26. This collection\ndoes not exert mass effect on the thecal sac.\n\nMild clumping of the intrathecal nerve roots from L3-L4 through L5-S1, without\ncontrast enhancement, appear stable and may be secondary to postsurgical\narachnoiditis.\n\nFaint T2 hyperintensity in the central and left ventral spinal cord near the\nupper aspect of L1 appears stable to slightly decreased in extent. Previously\nseen mild residual contrast enhancement along the left ventral cord in this\nlevel appears slightly less conspicuous, faintly visible on sagittal image 6:9\nand axial images ___, though the decreased conspicuity may be secondary to\nmotion artifact on axial postcontrast T1 weighted images. The conus\nmedullaris terminates at L2, as seen previously\n\nL1-L2: Left paracentral disc protrusion indents the ventral thecal sac without\ncontact of the conus medullaris, unchanged. No narrowing of the subarticular\nzones or neural foramina.\n\nL2-L3: Mild disc bulge and facet arthropathy without significant spinal canal\nor neural foraminal narrowing, unchanged.\n\nL3-L4: Mild disc bulge. Mild-to-moderate facet arthropathy. The ventral\nthecal sac is minimally indented without mass effect on the intrathecal nerve\nroots. Subarticular zones are mildly narrowed without compression of the\ntraversing L4 nerve roots. Neural foramina minimally narrowed without mass\neffect on the exiting L3 nerve roots. No interval change.\n\nL4-L5: Mild disc bulge and mild-to-moderate facet arthropathy. Subarticular\nzones are moderately narrowed with contact of the traversing L5 nerve roots. \nThe ventral thecal sac is mildly indented. There is moderate bilateral neural\nforaminal narrowing with contact of the exiting L4 nerve roots. No interval\nchange.\n\nL5-S1: There is a mild disc bulge, larger on the left than right, and moderate\nfacet arthropathy. The left subarticular zone is mildly narrowed. No mass\neffect on the thecal sac. Mild right and moderate left neural foraminal\nnarrowing, with a disc bulge and endplate osteophytes contacting the exiting\nleft L5 nerve root, unchanged.", "output": "1. Persistent, slightly decreased fluid collection extending from the\nlaminectomy beds into the posterior paravertebral soft tissues from mid L3\nthrough S1-S2 levels, without mass effect on the thecal sac. Persistent\nprobable fistulous tract to the skin at the level of L4.\n2. Persistent mild clumping of the intrathecal nerve roots from L3-L4 through\nL5-S1, without contrast enhancement, compatible with sequela of arachnoiditis.\n3. Faint T2 hyperintensity in the central and left ventral spinal cord near\nthe upper aspect of L1 appear stable to slightly decreased in extent compared\nto ___. Previously seen mild residual contrast enhancement along\nthe left ventral cord at this level appears slightly less conspicuous, though\nthe decreased conspicuity may be secondary to motion artifact.\n4. Multilevel degenerative disease appears similar to the ___ MRI." }, { "input": "The increased T2 signal within the distal spinal cord and focus of enhancement\nat T12-L1 level seen on the MRI of ___ has resolved with minimal\nsubtle T2 abnormalities remaining in the region. The previously noted\nexpansion of the spinal cord has also resolved.\n\nAt L1-2 small disc protrusion minimally indents the thecal sac without spinal\nstenosis or foraminal narrowing. At L2-3 and L3-4 levels mild disc bulging\nseen without spinal stenosis or foraminal narrowing.\n\nAt L4-5 the patient has undergone laminectomy with small amount of fluid at\nthe laminectomy site which has considerably decreased since ___. \nSpinal canal remains patent. There is unchanged mild left foraminal\nnarrowing.\n\nAt L5-S1 level, mild disc bulging seen without spinal stenosis or foraminal\nnarrowing.\n\nClumping of the nerve roots in the lower lumbar region indicating\narachnoiditis is unchanged.", "output": "1. Hyperintensities, cord expansion and enhancement in the distal spinal cord\nseen on the MRI of ___ has resolved with subtle T2\nhyperintensities remaining in the region. No new areas of enhancement or new\nT2 abnormalities within the distal spinal cord.\n2. Laminectomy at L4-5 level with decreased fluid at the laminectomy site.\n3. Mild degenerative changes stable from the previous study.\n4. Unchanged clumping of the lower lumbar nerve roots within the thecal sac\nsecondary to arachnoiditis." }, { "input": "There is been no significant interval change. Increased signal within the\ndistal spinal cord and enhancement previously identified have resolved. No\nabnormal signal now seen within the distal spinal cord or abnormal enhancement\nidentified.\n\nFrom L1-2 to L5-S1 levels disc degenerative changes and minimal bulging seen\nas before. Mild narrowing of the left foramen is seen at L4-5 level.\n\nThere is clumping of the nerve roots within the lower lumbar region indicative\nof arachnoiditis. Lower lumbar laminectomy is again seen.", "output": "1. No significant change since the previous MRI study.\n2. No abnormal enhancement or signal within the distal spinal cord or abnormal\nintraspinal enhancement.\n3. Mild degenerative changes and lumbar laminectomy as before.\n4. Dumping of the nerve roots in the lower lumbar region indicating\narachnoiditis." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. The\npatient is status post remote L4 and L5 laminectomy, with unchanged\npostsurgical scar tissue and enhancement within the laminectomy bed. No\nsuspicious marrow signal. Degenerative loss of disc height is mild to\nmoderate spanning L1-L2 through L5-S1, similar to prior exam.\n\nThe conus medullaris terminates at the L2 level, within expected limits. \nThere is no definitive abnormal signal or enhancement of the terminal cord or\nconus medullaris. There is clumping and peripheral distribution of the nerve\nroots at the L4 and L5 levels, without worsening enhancement, unchanged from\nprior exam, compatible with arachnoiditis.\n\nL1-L2: A left central to foraminal zone disc protrusion has progressed from\nprior examination, which results in mild-to-moderate spinal canal narrowing,\nremodeling the undersurface of the exiting left L1 nerve root (series 6, image\n10). There is mild spinal canal narrowing along the left aspect of the spinal\ncanal. There is no significant right neural foraminal narrowing.\n\nL2-L3 through L5-S1: Small disc bulges does not significantly narrow the\nspinal canal. In combination with loss of disc height and facet arthropathy\nthere is mild bilateral neural foraminal narrowing.\n\nAllowing for postoperative changes, visualized prevertebral and paraspinal\nsoft tissues are grossly unremarkable.", "output": "1. No significant interval change since prior MRI lumbar spine of ___. There is no new abnormal signal or enhancement associated with the\nterminal cord, conus medullaris or cauda equina.\n2. Clumping of the nerve roots no lower lumbar spine, compatible with\narachnoiditis. The patient is status post L4 and L5 laminectomy.\n3. Interval progression of L1-L2 left central to foraminal zone disc disease,\nwhich results in mild-to-moderate left neural foraminal narrowing remodeling\nthe undersurface of the exiting left L1 nerve root.\n4. Additional findings as described above." }, { "input": "Examination is moderately degraded by motion. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nDextroscoliosis of the lumbar spine is noted. Vertebral body heights are\npreserved.\n\nThere are postsurgical changes of prior L4 and L5 laminectomies with unchanged\npostsurgical scar tissue and enhancement in the laminectomy surgical bed.\n\nThe visualized terminal portion of the spinal cord is preserved in signal\nintensity without evidence of abnormal enhancement. Similar to prior exams,\nthere is peripheral distribution of clumping of the cauda equina nerve roots\nat the L4-L5 levels, again concerning for arachnoiditis. Within limits of\nstudy, there is no definite evidence of abnormal enhancement.\n\nThere is loss of intervertebral disc height and signal throughout lumbar\nspine. Nonspecific facet joint fluid is noted at multiple levels of the\nlumbar spine.\n\nAt T12-L1 there is disc bulge novertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is disc bulge with superimposed left central/left foraminal disc\nprotrusion, dural fat mild-to-moderate vertebral canal, and mild left neural\nforaminal narrowing. No right neural foraminal narrowing.\n\nAt L2-3 there is disc bulge, epidural fat, ligamentum flavum thickening,\nnovertebral canal, and mild bilateral neural foraminal narrowing.\n\nAt L3-4 there is disc bulge, ligamentum flavum thickening, facet osteophytes,\nepidural fat, novertebral canal or neural foraminal narrowing.\n\nAt L4-5 there is disc bulge, facet osteophytes, novertebral canal or neural\nforaminal narrowing.\n\nAt L5-S1 there is disc bulge, facet osteophytes, novertebral canal or neural\nforaminal narrowing.\n\nOTHER:\nWithin limits of this motion degraded study, there is no paravertebral or\nparaspinal mass identified.", "output": "1. Study is moderately degraded by motion.\n2. Grossly stable MRI appearance of the lumbar spine status post L4-L5\nlaminectomies with no evidence of new abnormal signal or enhancement of the\nterminal cord or cauda equina.\n3. Grossly stable peripheral clumping of the cauda equina nerve roots at L4-L5\nlevels, compatible with arachnoiditis.\n4. Grossly stable multilevel degenerative changes of the lumbar spine compared\nto ___ prior exam, again most pronounced at L1-L2, where there is\nmild-to-moderate spinal canal narrowing." }, { "input": "Comparison with the prior lumbar spine examination reveals no new lumbar disc\nor vertebral abnormality. Please refer to the prior report, authored by Drs. \n___ for complete details. There are no new areas of\nabnormal enhancement seen within the lumbar spine. The postoperative changes\nnoted within the distal lumbar spine, including evidence for probable\npostsurgical arachnoiditis are again identified, as well. There does not\nappear to be evidence for new lumbar paraspinal soft tissue pathology.", "output": "No signs to suggest the presence of tumor recurrence. Please see above report\nfor additional observations, as well as the preceding report from ___." }, { "input": "The vertebral bodies are normal in height and sagittal alignment. A mild\ndextroconvex curvature is noted. There are multilevel degenerative endplate\nmarrow signal changes and endplate osteophytes along with diffuse mild loss of\nintervertebral disc height and T2 signal.\n\nThe visualized distal spinal cord and conus medullaris appear normal. The\nconus medullaris terminates L2.\n\nThere is again clumping of the cauda equina or nerve roots at L4-L5 level\nsuggesting arachnoiditis. There is no new abnormal enhancement, thickening,\nor nodularity of the nerve roots.\n\nThere are postsurgical changes in the posterior paraspinal soft tissues from\nprevious laminectomy at the L4-L5 level including enhancing scar tissue at the\nsurgical site.\n\nMultiple renal cysts are noted, 1 of the largest a left parapelvic cyst\nmeasuring approximately 8 mm. No further imaging is needed. T12-L1: No\nspinal canal or neural foraminal stenosis.\n\nL1-L2: Minimal disc bulge. No significant narrowing of the spinal canal or\nneural foramina.\n\nL2-L3: Diffuse disc bulge with facet arthropathy causing no significant\nnarrowing of the spinal canal or neural foramina.\n\nAt L3-L4, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy causing no significant narrowing of spinal canal or right\nneural foramen. There is mild left neural foraminal narrowing.\n\nAt L4-L5, there is postsurgical change laminectomy. Endplate osteophytes and\nfacet arthropathy cause no significant narrowing of spinal canal. There is\nmild left and no right neural foraminal narrowing.\n\nAt L5-S1, there is a minimal disc bulge facet arthropathy. There is no\nsignificant narrowing of spinal canal or right neural foramen. There is mild\nleft neural foraminal narrowing.", "output": "1. No findings to suggest recurrence or progressive tumor.\n2. Findings again suggest arachnoiditis at the L4-L5 level.\n3. Postoperative and degenerative changes of the lumbar spine as described\nabove.\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": "Alignment is anatomic. Vertebral body signal again appears mildly\nheterogenous, which may be secondary to fatty replacement of the bone marrow. \nPatient is status post L4-5 laminectomies. Again seen is posterior\ndisplacement of the nerve roots which appeared adherent to the thecal sac\nsuggestive of arachnoiditis, likely postsurgical. Mild soft tissue\nenhancement posterior to the thecal sac is suggestive of granulation tissue\nand is unchanged. Mild disc desiccation is noted. The terminal cord appears\nunremarkable in caliber and configuration. The conus terminates at L2. There\nis no evidence of neoplasm.\n\nAt T12-L1: No spinal canal or neural foraminal narrowing.\nAt L1-2: There is a posterior disc bulge and ligamentum flavum hypertrophy\nwith no spinal canal or neural foraminal narrowing.\nAt L2-3: There is a posterior disc bulge and bilateral facet joint effusions\nwith no spinal canal or neural foraminal narrowing.\nAt L3-4: There is a posterior disc bulge, facet arthropathy and bilateral\nfacet joint effusions with no spinal canal or neural foraminal narrowing. The\nbulging disc contacts the bilateral exiting L3 nerve root.\nAt L4-5: There is a posterior disc bulge, facet arthropathy and bilateral\nfacet joint effusions with no spinal canal and mild right and mild-to-moderate\nleft neural foraminal narrowing with the disc contacting the left exiting L4\nnerve root.\nAt L5-S1: There is a posterior disc bulge, facet arthropathy and bilateral\nfacet joint effusions with no spinal canal and mild left neural foraminal\nnarrowing.\n\nA 6 mm right renal cortical cyst and multiple left parapelvic cysts are noted.\nThere is colonic diverticulosis. Degenerative changes are noted along\nbilateral SI joints.", "output": "1. No evidence of residual or recurrent tumor.\n2. Grossly stable mild lumbar spondylosis.\n3. Stable postsurgical changes following L4-5 laminectomies.\n4. Additional findings 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." } ] }