{ "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." } ] }