Text_summarization/task92_mimic_mri_abdomen_summarization.json

{
    "Contributors": "MIMIC",
    "Source": "MIMIC-IV",
    "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/",
    "Categories": [
        "Summarization"
    ],
    "Definition": [
        "Summarize the MRI imaging diagnostics' detailed findings for the Abdomen into a concise conclusion."
    ],
    "Reasoning": [],
    "Input_language": [
        "English"
    ],
    "Output_language": [
        "English"
    ],
    "Instruction_language": [
        "English"
    ],
    "Domains": [
        "Medicine",
        "Clinical Reports",
        "MRI",
        "Abdomen"
    ],
    "Positive Examples": [],
    "Negative Examples": [],
    "Instances": [
        {
            "input": "Lower Thorax: Visualized lung bases are clear.  There is no pleural effusion. \nHeart size is enlarged.\n\nHepatobiliary: The liver is cirrhotic in morphology.  There is intrahepatic\nbiliary ductal dilatation in segment VII, likely secondary to a focal\nobstruction at the level of the TIPS stent, with associated progressive\nenhancement of the surrounding hepatic parenchyma, compatible with fibrosis,\nstable.  A 3.0 cm focus of subcapsular progressive enhancement in the left\nhepatic dome (series 1104, image 23) is also compatible with fibrosis, stable.\nThere is no focal lesion meeting OPTN 5 criteria for hepatocellular carcinoma.\nThere are no focal hepatic lesions meeting OPTN 5 criteria for hepatocellular\ncarcinoma.\n\nThere are stones in the gallbladder. There is no extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity.  There is no\nfocal lesion or ductal dilatation.\n\nSpleen: The spleen is top-normal in size, measuring 13.0 cm in length, and\nnormal in signal intensity.\n\nAdrenal Glands: Bilateral adrenal glands are normal in contour.\n\nKidneys: The kidneys are normal and symmetric in size.  There is no\nhydronephrosis.  There are no focal renal lesions.\n\nGastrointestinal Tract:  Visualized small and large bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is a patent TIPS extending from the main portal vein to the\nintrahepatic IVC.  Main, right and left portal veins are patent.  Hepatic\nveins are patent.  Hepatic arterial anatomy is conventional.  There is a\nrecanalized paraumbilical vein.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nSoft tissue structures of the abdominal wall are unremarkable.",
            "output": "1.  Cirrhotic morphology of the liver.  No focal lesions meeting OPTN 5\ncriteria for hepatocellular carcinoma.\n2.  Patent TIPS.\n\nRECOMMENDATION(S):  2.  Patent TIPS."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious lesion\nseen. The portal vein and hepatic veins are patent. No free fluid.\n\nBiliary: The common bile duct measures up to 9 mm, similar to previously. \nThere is minimal opening at one point.  No obstructing mass is visualized.\nThis is likely due to sphincter of Oddi dysfunction.\n\nThe gallbladder is unremarkable. T2 feathery, probably duodenum.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A few small cortical cysts are seen in both kidneys, the largest in\nthe upper pole of the left kidney measuring 2.5 cm in diameter.  No\nhydronephrosis.\n\nGastrointestinal Tract:  Unremarkable.\n\nLymph Nodes: No size significant lymph nodes.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Nonspecific enhancing lesion in L1\nvertebral body, too small to characterize, but statistically likely\nhemangioma.  This was not seen on the previous examination, possibly due to\ntechnique.",
            "output": "1.The common bile duct measures up to 9 mm, similar to previously. There is\nminimal opening at one point.  No obstructing mass is visualized. This is\nlikely due to sphincter of Oddi dysfunction.\n\n2. Nonspecific enhancing lesion in L1 vertebral body, too small to\ncharacterize, but statistically likely hemangioma.  Dedicated lumbar spine MRI\ncan be performed for further characterization if clinically indicated."
        },
        {
            "input": "Lower Thorax: There is a small right pleural effusion.  There is scattered\nlinear subsegmental atelectasis of the bilateral lung bases.\n\nLiver: The liver is enlarged, with the right hepatic lobe measuring 20.5 cm in\nlength, and smooth in contour.  There is severe diffuse hepatic steatosis with\ncalculated fat fraction of 36%.  There are a few hepatic cysts versus biliary\nhamartomas, measuring 2.3 x 1.9 cm in segment III (series 10, image 29), 1.0 x\n0.9 cm in segment II (series 10, image 18), and subcentimeter in segment VIII\n(series 10, image 20 and 21).  No suspicious hepatic lesion is identified. \nThere is mild diffuse periportal edema.  There is a small amount of\nperihepatic ascites.  Taken together, these findings are concerning for\nhepatitis.\n\nThe portal and hepatic veins are patent.\n\nBiliary: The gallbladder is collapsed and demonstrates mural edema, likely\nreactive to the underlying hepatic process.  There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity.  There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size and low in signal intensity.  The signal\nintensity increases on the out-of-phase images, compatible with iron overload.\nThere is a small cystic lesion in the inferior spleen (series 9, image 20).\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size.  There is a 1.8 x 1.6 cm cyst in\nthe lower pole of the left kidney with a thin septation (series 3, image 27). \nThere is also a tiny cyst in the lower pole of the left kidney.  There is no\nsolid renal mass or hydronephrosis.  There is nonspecific bilateral\nperinephric stranding.\n\nGastrointestinal Tract: The stomach is collapsed and grossly unremarkable. \nVisualized upper abdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures:  Note is made of multiple osseous\nhemangiomas.  No suspicious osseous lesion is identified.  There are midline\nincisional changes of the lower abdominal wall.  There is diffuse subcutaneous\nedema of the abdomen.",
            "output": "1.  Enlarged liver with mild diffuse periportal edema and a small amount of\nperihepatic ascites, concerning for hepatitis.  Severe diffuse hepatic\nsteatosis, with calculated fat fraction of 36%.\n\n2.  Collapsed gallbladder with mural edema, likely reactive to the underlying\nhepatic process.\n\n3.  Findings of iron overload in the spleen.\n\n4.  Small right pleural effusion."
        },
        {
            "input": "Lower Thorax: Minimal dependent left lower lobe atelectasis appear similar\ncompared to prior.\n\nLiver/biliary: The patient is status post orthotopic liver trans plant\ncomplicated by recurrent primary sclerosing cholangitis.  Hepaticojejunostomy\nis unremarkable.  The previously noted abnormal T2 signal in the anterior\nlower aspect of the liver (series 8, image 55) is improved compared to prior. \nPreviously noted abnormal T2 signal in the posterior aspect of the liver\n(series 8, image 48) is similar to slightly increased compared to prior. \nThere is persistent increased peribiliary signal which may be due to\ninfectious or inflammatory cholangitis.  No focal fluid collection.\n\nPancreas: Evaluation of the pancreas is notable for several cystic lesions,\nthe largest measuring up to 19 mm in the pancreatic tail (series 3, image 28).\nThese lesions likely represent side branch IPMNs and unchanged.  No main\npancreatic duct dilatation.\n\nSpleen: Splenomegaly appear similar compared to prior.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Simple appearing renal cysts measuring up to 15 mm in the kidneys are\nunchanged.\n\nGastrointestinal Tract:  There is no bowel obstruction.  Small volume ascites.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Thoracoabdominal aortic dissection is again noted and appears\nfairly similar compared to most recent MR. ___ upper abdominal varices\nand splenorenal shunt in keeping with portal hypertension.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.",
            "output": "Overall cholangitis appears fairly similar with abnormal T2 signal in the\nanterior aspect of the liver appearing slightly improved, and in the posterior\naspect of the liver appear similar to slightly worse.\nRecurrent primary sclerosing cholangitis within the transplant liver, with\nunchanged degree of biliary ductal dilatation and stricturing.\nThere is no drainable fluid collection.\n\nSequela of portal hypertension, with splenomegaly, varices and small volume\nascites are unchanged.\n\nProbable side-branch IPMNs measuring up to 19 mm in diameter are unchanged.\n\nUnchanged thoracoabdominal aortic dissection as noted above."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: The transplanted hepatic parenchyma is homogeneous with a smooth\ncontour. No suspicious lesion seen. The portal vein and hepatic veins are\npatent. No free fluid.  A 5 mm cyst is seen in segment 5.\n\nThere are a few very vague small subcentimeter subcapsular arterial enhancing\nfoci of doubtful significance.  In the dome of the right lobe, a round 5 mm\nfocus of hyperenhancement arterial phase images shows no correlate on pre\ncontrast imaging sequences or on more delayed contrast-enhanced imaging\nsequences.  This is highly nonspecific would probably not significant\nclinically.\n\nThere is an elongated geographic subcapsular lesion in segment 5 of the liver\nmeasuring 4.1 cm x 1.0 cm and demonstrating T1 and T2 isointensity to the\nliver parenchyma.  It is very faintly hypointense compared to background liver\non precontrast T1 weighted imaging.  It is indistinguishable from background\nliver on T2 weighted images.  Post gadolinium injection, the lesion is not\nvisible on the arterial phase. On the portal venous phase, it is\nhypoenhancing. On the later phases, this lesion fills in with contrast and is\nagain indistinguishable from the liver parenchyma. The lesion is not seen on\nthe diffusion weighted imaging.  There is no macroscopic fat. This could be\npostoperative in nature.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nhas been surgically removed.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\n\nSpleen: The spleen is absent.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A few subcentimeter cortical cysts are seen bilaterally.  No\nhydronephrosis.\n\nGastrointestinal Tract:  The partially visualized bowel is unremarkable.\n\nLymph Nodes: No size significant lymph nodes.\n\nVasculature: Patient is status post liver transplant with the piggyback. \nThere is mild celiac stenosis at the origin.  A stent is noted along the\nhepatic artery.  There is signal dropout along the stent making it difficult\nto assess with this technique, but intra hepatic arterial branches opacify\nappropriately.  Portal vein and its major branches appear patent.  Hepatic\nvenous branches are also patent.,\n\nOsseous and Soft Tissue Structures: Unremarkable.",
            "output": "1.  Status post liver transplant.  Mild celiac stenosis.  Stent along the\nhepatic artery, difficult to assess with this technique.  Patent distal\narterial branches, however.\n\n2.  Geographic peripheral subcapsular hypovascular lesion along segment V of\nthe liver, likely corresponding to the lesion seen by ultrasound.  The lesion\nis mainly seen on the portal venous phase, where it is hypoenhancing.  Seems\nvery unlikely to represent any type of tumor and seems most likely to\nrepresent postoperative/post ischemic change.\n\n3.  Very small nonspecific arterial enhancing focus in the dome of the right\nlobe measuring 5 mm within segment 8.  This is very unlikely to be significant\nclinically although follow-up might be considered depending on risk level.\n\nRECOMMENDATION(S):  3 month follow-up with ultrasound could be considered to\nensure stability of the lesion.  Also, small arterial enhancing focus in the\nright hepatic dome is doubtful in significance, but if there is any concern\nfor recurrent hepatitis C and/or hepatic fibrosis, it may be appropriate to\nconsider follow-up MR."
        },
        {
            "input": "Lower Thorax: Minor bibasal atelectasis. No pleural or pericardial effusion. \nBilateral gynecomastia is noted.\n\nLiver: The liver is homogeneous in signal characteristics.  There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth.  Multiple\npunctate T2 hyperintense, non-enhancing foci scattered throughout the liver\nparenchyma are most in keeping with biliary hamartomas.  No concerning solid\nor cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits.  The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern.  There is a stable 2 mm cyst\nin the head of the pancreas. No nodularity or duct abnormality is identified.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images.  Bilateral subcentimeter cortical cysts\nare noted. The largest cyst arises from the right interpolar region measuring\n15 x 12 mm.  There are no concerning solid or cystic lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.  No\nabnormal areas of mural thickening.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative change is noted\nthroughout the thoracolumbar spine.  The bone marrow demonstrates normal\nsignal characteristics.  No concerning osseous lesions.",
            "output": "2 mm pancreatic cyst statistically most likely represents a side-branch IPMN.\nThere are no concerning features. Follow-up MRCP in ___ years is recommended."
        },
        {
            "input": "Multiple gallstones are present within the gallbladder, which is not\ndistended. The common bile duct is dilated, measuring 0.9 cm but tapers\nsmoothly to the level of the ampulla without etiology identified.  This is\nslightly larger than ___ CT.\n\nPancreatic duct is normal in caliber.  2 mm cystic lesion in the pancreas\n(9:15). Normal signal of the pancreas. Multiple sub centimeter subcortical T2\nbright lesions in the right kidney, likely representing small cysts.\n\nThe adrenal glands are normal in appearance bilaterally. No adrenal mass is\nidentified.",
            "output": "1.  Normal bilateral adrenal glands.  Extra-adrenal paraganglioma is not\nexcluded on this study however.\n\n2.  Cholelithiasis.  Mild common bile duct dilation, suggestive of papillary\nstenosis.\n\n3.  2 mm cystic lesion in the pancreas head, possibly side branch IPMN, for\nwhich follow-up MRCP in ___ year is recommended."
        },
        {
            "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Peripheral reticular enhancement seen on delayed contrast phase is\nconsistent with fibrotic changes.  There is hypertrophy of the left hepatic\nlobe and caudate lobe.  7 mm T2 hyperintense biliary cyst or hamartoma in the\nright hepatic lobe (04:18).\n\nBiliary: Cholelithiasis without gallbladder wall thickening.  No intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas:  Tiny 5 mm T2 hyperintense lesion in the body tail junction of the\npancreas (08:12).  The pancreatic parenchyma otherwise maintains normal bulk,\nintrinsic hyperintense T1 signal and enhancement pattern. No focal lesion or\nductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics.  There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics.  No focal lesions.\n\nKidneys:  6.6 x 4.0 x 6.2 cm left perinephric rim enhancing collection (19:26)\nwith intrinsic hyperintensity on T1 weighted images consistent with the known\nchronic abscess/infected hematoma, previously 6.7 x 4.6 x 6.7 cm.  There is a\nmoderate amount of left perinephric and ___ stranding. The left\nkidney is partly displaced by this collection and demonstrates overall delayed\nand decreased enhancement.  The left proximal ureter is thick walled and\nenhancing with periureteral stranding compatible with inflammatory changes\nfrom ureteral stones and ureteral stent.  Large left proximal ureteral stones\nare again identified, unchanged in size and position.  Left internal ureteral\nstent is not well visualized on this exam but likely present.\nThere is also a 3.7 x 1.9 x 7.8 cm rim enhancing fluid collection tracking\nalong the lateral aspect of the left psoas muscle and anterior to the left\nquadratus lumborum muscle, previously measuring 3.1 x 2.6 x 8.1 cm, not\nsignificantly changed.  Along the track where the drainage catheters were\nremoved, there has been accumulation of a small amount of fluid with a 4.0 x\n1.5 cm small rim enhancing collection in the left posterior flank/body wall.\n\nGastrointestinal Tract:  The GI tract is of normal caliber throughout.\n\nLymph Nodes: Multiple prominent retroperitoneal lymph nodes are likely\nreactive.\n\nVasculature: Moderate atherosclerotic disease of the abdominal aorta.\n\nOsseous and Soft Tissue Structures:   Bone marrow signal is normal in\nappearance",
            "output": "1.  No significant change in size of left perinephric collection or of the\nextension of the collection tracking along the posterior para renal space,\ncompared to prior CT given differences in technique.  MR cannot further\ncharacterize ___, however we note that this collection is known to be\nheavily loculated and resistant to catheter drainage previously, and continues\nto display internal complexity and hemorrhagic components.\n2.  New small (4.0 x 1.5 cm) amount of fluid/abscess collecting along the\ntrack of the removed drainage catheters in the left posterior lateral body\nwall.\n4.  Changes in the liver suggestive of early hepatic cirrhosis.\n5.  Probable 5 mm side-branch IPMN in the pancreatic body tail junction.\n6.  Cholelithiasis.\n\nRECOMMENDATION(S):  Follow up MRI one year for probable sidebranch IPMN"
        },
        {
            "input": "Lower Thorax: The imaged lower thorax is clear.  There is no pleural or\npericardial effusion.\n\nLiver: The partially imaged liver demonstrates a nodular contour, in keeping\nwith cirrhosis.  As intravenous contrast was not administered, evaluation for\nliver lesions is limited.\n\nBiliary: There is no intra or extrahepatic biliary dilation.  The common bile\nduct is normal in caliber.  Stones are noted within the the gallbladder, with\nno secondary signs of inflammation.\n\nPancreas: The pancreas is normal in signal intensity with no duct dilation.  5\nmm pancreatic body cystic lesion (5:5), is unchanged from the prior MRI,\nlikely a side-branch IPMN.\n\nSpleen: The spleen is normal in size with a focal T2 hyperintensity at the\nupper pole (6:6), which may represent a splenic cleft.\n\nAdrenal Glands: The adrenal glands are morphologically normal bilaterally.\n\nKidneys:  The right kidney is normal in size no hydronephrosis or perinephric\nabnormality.\n\nThere is a complex loculated perinephric collection in the left posterior para\nrenal space, extending posteriorly and inferiorly towards the iliacus muscle. \nThe collection measures 8.9 x 3.4 x 6.9 cm (05:16, 6:18), and has decreased in\nsize since the prior MRI where it measured 9.7 x 4.0 x 7.3 cm.  The signal\ncharacteristics of the collection are heterogeneous on T2 weighted imaging\nwith restricted diffusion, as on the prior study.  A drain tract extends\nposterolaterally to the skin surface.  The margins of the tract have collapsed\nand the previously seen peripherally enhancing fluid collection within the\ntract has resolved.\nTwo stones in the proximal to mid left ureter are again seen, measuring 19 and\n18 mm respectively (06:21).\n\nGastrointestinal Tract:  Imaged bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesion is\nappreciated.",
            "output": "1. Interval slight decrease in size of the heterogeneous, multiloculated left\nposterior pararenal collection, now measuring 8.9 x 3.4 x 6.9 cm, previously\n9.7 x 4.0 x 7.3 cm.  No new collection.\n2. Resolution of a fluid collection along the left posterolateral flank drain\ntract.\n3. Unchanged 5 mm pancreatic body cystic lesion, likely a side-branch IPMN.\n4. Unchanged left ureterolithiasis.\n5. Cirrhotic morphology of the liver."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver:  The entire liver has not been included on this scan.  The imaged\nportion of the liver demonstrates normal T2 signal intensity and a 6 mm T2\nhyperintense, likely cyst in segment 6 (5:7).\n\nBiliary: The gallbladder is distended and demonstrates presence of dependent\ncalculi in the region of the neck extending into the cystic duct.  There is no\nintrahepatic or extrahepatic biliary ductal dilation.\n\nPancreas: There is significant atrophy of the pancreatic parenchyma without\nmain duct dilation.  There are multiple foci of coarse calcification within\nthe pancreatic parenchyma likely related to chronic pancreatitis, better\nevaluated on the CT torso from ___.\n\nSpleen: No splenomegaly or focal splenic lesions.\n\nAdrenal Glands: No right adrenal nodule.  Left adrenal nodule measuring 1.6 x\n1.1 cm in size (5:8) is not well visualized on the in and out-of-phase\nsequences and hence cannot be optimally characterized.  This nodule was also\nseen on the CT torso dated ___ with ___ approximately 28 of\nthe noncontrast scan, hence not an adenoma.  However it remains unchanged in\nsize compared to that prior scan.\n\nKidneys:\nNo right-sided hydronephrosis or discrete solid lesion.\nThe left kidney appears dysmorphic.  There is a 1.0 cm homogeneously T2\nhyperintense cyst in the superior pole of the left kidney.  No hydronephrosis.\nThere is a left-sided nephroureteral stent in place, better visualized on the\nprior CT torso.  The known left perinephric fluid collection located along the\nposterolateral aspect of the left kidney, within the perinephric space\nmeasures approximately 5.0 by 1.7 cm in size (05:21) with a homogeneously T2\nhypointense rim, likely calcification as seen on the prior CT.  No significant\ninterval increase in size of this perinephric collection compared to the prior\nCT.  There is another smaller collection measuring approximately 2.5 by 2.0 cm\nin size abutting the left quadratus lumborum muscle (05:26) with linear tracts\nextending to the adjacent perinephric collection, slightly smaller than\nbefore.\nA fistulous tract is seen communicating from the left perinephric collection\nup to the skin along the left posterolateral body wall.  Compared to the CT\ndated ___ there is no significant increase in size or no new\nramifications from this fistula.\n\n\nGastrointestinal Tract:  There is no bowel obstruction.  Small hiatus hernia. \nPartially visualized is a right anterior abdominal wall hernia containing\nnonobstructed small bowel loops.\n\nLymph Nodes: No upper abdominal lymphadenopathy.\n\nVasculature: Limited evaluation in the absence of intravenous contrast.\n\nOsseous and Soft Tissue Structures: Visualized bones demonstrate normal signal\nintensity.  Mild degenerative changes of the thoracolumbar spine.",
            "output": "1. The known left perinephric fluid collection demonstrates wall\ncalcification, is slightly smaller in size compared to the CT dated ___ and continues to communicate with another smaller fluid\ncollection located anterior to the left quadratus lumborum muscle.  There is a\npatent fistulous tract extending from the left perinephric collection to the\nskin overlying the left posterolateral back which has not changed\nsignificantly compared to the prior CT.  No new fluid collections seen in the\nleft perinephric space.\n2. There is a left ureteral stent and known left ureteral calculi -not well\nvisualized on this scan.  No hydronephrosis on either side.\n3. Small hiatus hernia, partially imaged right anterior abdominal wall hernia\ncontaining a nonobstructed small bowel loop, cholelithiasis and stones within\nthe cystic duct without intra or extrahepatic biliary ductal dilation are\nadditional incidental findings."
        },
        {
            "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver:  Liver has a cirrhotic morphology with widening of the hilar periportal\nspace and blunting of the left lateral lobe.  There are numerous T2\nhyperintense foci without enhancement scattered throughout all of the lobes of\nthe liver.  None of these demonstrate any enhancement or restricted diffusion.\nThese are consistent with simple cysts, however correlation with prior imaging\nis recommended.  No evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis not well seen.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.  There is 0.6 cm nonenhancing cystic lesion in\nthe uncinate process of the pancreas, likely represents side-branch IPMN,\nstable since CT exam.\n\nSpleen:  Top normal size.  Normal signal and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis.  Main portal vein is patent and dilated, very blunted at the\nhilum.  Right and left portal vein branches are very attenuated, though\nvisible.  There is a large recanalized paraumbilical vein.  There is a\nsplenorenal shunt.  Hepatic veins are patent.  There are perigastric and\nparaesophageal varices.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.",
            "output": "1. Innumerable hepatic lesions are seen throughout the liver.  These\ndemonstrate high signal on T2 weighted images and do not demonstrate any\nenhancement or restricted diffusion to suggest a solid lesion.  These are most\nconsistent with innumerable simple cysts based on this single exam. \nCorrelation prior imaging is recommended in the setting of a history of breast\ncancer.\n\n2. Cirrhosis with sequela of portal hypertension including borderline\nsplenomegaly, patent paraumbilical vein, and varices (both paraesophageal and\nperigastric)."
        },
        {
            "input": "Lower Thorax: The lower thorax is unremarkable.  There is no pericardial or\npleural effusion.\n\nLiver: The liver demonstrates a cirrhotic morphology compatible with\ncirrhosis.  There is no evidence of signal dropout on out of phase imaging to\nsuggest diffuse hepatic steatosis.  T2 hyperintense nonenhancing foci within\nthe liver are compatible with cysts or biliary hamartomas. No suspicious\nhepatic masses are seen.\n\nThe right and left portal veins are attenuated.  The main portal vein is\npatent and there is a large patent paraumbilical vein.  The SMV and splenic\nvein are patent.  Numerous upper abdominal collaterals are seen.\n\nBiliary: The gallbladder is present. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation or peripancreatic fluid.No pancreatic lesions are seen.\n\nSpleen: Spleen is enlarged measuring up to 15.6 cm.  The signal intensity is\nnormal. There is no focal lesion seen.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.No renal lesions are\nseen.\n\nGastrointestinal Tract:  The visualized large and small bowel demonstrate\nnormal thickness and caliber.\n\nLymph Nodes:  There is no lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in size.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen.\nThe body wall is within normal limits.",
            "output": "1. Cirrhotic morphology of the liver with sequela of portal hypertension\nincluding splenomegaly and prominent upper abdominal collateral vessels\nincluding a large patent paraumbilical vein.  No suspicious hepatic lesion.\n2. Numerous hepatic cysts are similar from the prior study, none demonstrating\nconcerning features.\n3. Mild splenomegaly is new since ___."
        },
        {
            "input": "The liver is visualized and is of normal signal\nintensity.  No focal liver lesions identified.  The spleen is of normal size\nbut multiple subcentimeter areas of low signal intensity are identified on the\nout- of- phase imaging that demonstrate some blooming and reduced signal on\nthe in- phase imaging.\n\nThe adrenals are visualized and are normal.  The kidneys are visualized and\nare normal.  The gallbladder is normal.\n\nThe pancreas is visualized and is of normal signal intensity.  The pancreatic\nduct is normal in caliber.  Post-administration of secretin, the pancreatic\nduct fills normally to a maximum at 3 minutes, but does not decompress\ncompletely by 10 minutes.  The clinical significance of this delayed emptying\nof the pancreatic duct is unclear. It could represent an element of ampullary\nstenosis. However, no evidence of any irregularity in the duct and no evidence\nof any stenosis within the pancreatic duct.\n\nNo evidence of any intrahepatic or extrahepatic bile duct dilatation.\n\nNo evidence of any significant lymphadenopathy.  The bowel where visualized is\nnormal.  The osseous structures where visualized are normal.  No evidence of\nany free fluid.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.",
            "output": "1.  Secretin MRCP reveals normal filling of pancreatic duct at 3 minutes, but\nincomplete emptying at 10 minutes, the clinical significance of which is\nclear.  However, it could represent an element of ampullary stenosis.\n2.  Multiple low signal subcentimeter areas on T1-weighted imaging that\ndemonstrate a drop in signal and blooming on the in-phase imaging. Calcified\ngranulomas are unlikely as no calcification is seen on CT and Gamna- Gandy\nbodies are unlikely because there is no evidence of portal hypertension. Less\ncommon conditions to cause this appearance includes splenic peliosis."
        },
        {
            "input": "In segment III of the liver are two arterially enhancing foci, the larger\nmeasuring 0.6 cm (1001:38). Slightly more superiorly is an additional 5 mm\narterial-enhancing focus without associated washout (1001:41).  A similar\nappearing 0.5 cm focus is present in segment 4 (1001:51).  Some of these are\nmore subtle, but present on ___ study.  No additional arterially enhancing\nlesions are identified within liver. Post radiofrequency ablation changes in\nsegment 6 of the liver present without enhancement to suggest recurrent tumor.\nPostsurgical changes are noted at the junction of segments VII and VIII. The\nliver surface is nodular, compatible with known cirrhosis. There is an 8 mm\ncyst adjacent to the intrahepatic IVC.  Slight drop out of signal in the\nliver, compatible with steatosis.\n\nThere is no ascites. Normal gallbladder. The spleen is normal size. The\npancreas enhances normally. Normal adrenal glands and kidneys. Visualized\nloops of bowel are within normal limits. Normal bone marrow signal. Lung bases\nare clear.",
            "output": "1.  Three tiny arterially enhancing foci in the liver, which may represent\ntransient hepatic intensity differences (THIDs) and do not demonstrate\nwashout.  Attention on follow-up is recommended.\n\n2.  Post RFA and surgical changes without evidence of recurrence in the liver.\n\n3.  Cirrhosis."
        },
        {
            "input": "MR ABDOMEN: The liver is nodular with left lobe hypertrophy in keeping with\nknown cirrhosis. There is loss of signal on the out of phase images relative\nto the in phase images, compatible with mild fatty deposition. Postsurgical\nchanges are seen at the junction of segment VII/VIII without enhancement to\nsuggest local recurrence. Post RFA changes are seen in segment VI with\nintrinsic T1 hyperintensity due to coagulation necrosis, also without abnormal\nenhancement to suggest local recurrence.\n\n5-mm arterially enhancing foci in segment III without washout (1401:56, 59)\nare unchanged. The previously seen arterially enhancing focus in segment IV is\nless apparent on today's study. Additional peripherally enhancing arterial\nfoci in segment IVb/V adjacent to the gallbladder (1401:61) are unchanged\nsince ___, likely perfusional.\n\nThere is no intra or extrahepatic bile duct dilation. The gallbladder is\nnormal without stones. The spleen is normal in size. The pancreas is normal in\nsignal intensity and enhancement with a normal caliber main pancreatic duct.\nBilateral adrenal glands are normal. The kidneys enhance symmetrically without\nhydronephrosis. Visualized bowel is unremarkable. There is no ascites. No\nenlarged mesenteric or retroperitoneal lymph nodes are seen in the upper\nabdomen. The imaged portions of the abdominal aorta are normal in caliber.\nHepatic arterial anatomy is conventional. The hepatic veins in the main portal\nvein, splenic vein and SMV are patent.\n\nNo bone marrow signal abnormality is identified.",
            "output": "1.  Tiny arterially enhancing foci in segment III are unchanged from ___, likely representing transient hepatic intensity differences. Routine\nfollow up is recommended. The segment IV arterial enhancing focus is less\napparent on this study.\n2.  Posttreatment changes without evidence of recurrence.\n3.  Cirrhosis."
        },
        {
            "input": "There are postsurgical changes consistent with provided history of liver\ntransplantation.\n\nPunctate nonenhancing T2 hyperintense foci in the hepatic parenchyma are\nconsistent with cysts versus small biliary hamartomas. There is a 1.7 cm\nsubcapsular wedge-shaped area of hyper enhancement in segment V (14 01:22)\nwhich becomes isointense to surrounding hepatic parenchyma more delayed phase\nimaging. There is no evidence of washout or pseudo capsule formation.  There\nis no suspicious hepatic lesion.\n\nThe gallbladder is surgically absent. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nSpleen is not enlarged. There is no evidence of pancreatic mass or pancreatic\nductal dilatation.\n\nAdrenal glands are unremarkable. There is symmetric renal enhancement and\nexcretion of intravenous contrast. There is no evidence of hydronephrosis.\nThere is no suspicious renal lesion in the visualized kidneys.\n\nAbdominal aorta has a normal caliber.",
            "output": "Post liver transplantation. No concerning hepatic mass.  No lymphadenopathy."
        },
        {
            "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver:  Evaluation of the liver is somewhat limited due to non breath holding\ntechnique.  Given this limitation, the liver is normal in signal intensity\nwithout evidence of focal suspicious mass. The hyperechoic lesion seen on\nultrasound has no imaging correlate on today's study. The portal vein is\npatent.\n\nGallbladder and Biliary System: The gallbladder is normal with no evidence of\nstones. There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.The main pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal\nlesion.The adrenal glands are normal bilaterally.\n\nBowel:  There is extensive circumferential submucosal edema involving the\ngastric antrum extending into the duodenal bulb with some mucosal\nhyper-enhancement. The visualized bowel loops and mesentery are within normal\nlimits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1.  No suspicious focal liver lesion identified. The hyperechoic mass seen on\nultrasound has no imaging correlate on MRI.\n\n2.  Extensive circumferential submucosal edema as well as mucosal\nhyper-enhancement involving the gastric antrum extending into the duodenal\nbulb. These findings may represent gastritis/ duodenitis.  Ulcer can not be\nexcluded. Correlation with symptoms and endoscopy is recommended.\n\nNOTIFICATION:  Findings discussed with ___ by ___ telephone at\n5:10pm on ___, 10 minutes following review."
        },
        {
            "input": "Exam is limited by non breath hold technique.\n\nLower thorax: There is a small right pleural effusion.\n\nLiver: The liver demonstrates normal morphology.  There is patchy drop in\nsignal on out of phase imaging compared with in phase imaging, compatible with\nsteatosis, with a fat fraction measuring up to 16%.  There is increased\ndiffusion signal in the remainder of the hepatic parenchyma which may be due\nto inflammation.  No suspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel:  Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement.   There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.  There is a\nrecannulized paraumbilical vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.  There is small ascites.",
            "output": "1. Exam is limited by non breath hold technique.\n2. Patchy moderate hepatic steatosis.\n3. Increased diffusion signal in the remainder of the hepatic parenchyma, may\nbe due to acute hepatitis.\n4. No focal suspicious hepatic lesions.\n5. Sequela of portal hypertension including a recannulized paraumbilical vein\nand small ascites.  No splenomegaly.\n6. Small right pleural effusion."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are grossly clear.  There is no\npleural effusion.\n\nLiver: The transplant liver is normal in contour and signal intensity.  There\nis no evidence of hepatic steatosis.  No suspicious liver lesions are seen.  A\nT2 hyperintense focus in segment VII of the liver is compatible with cyst or\nbiliary hamartoma (series 5, image 20).\n\nBiliary: There is mild central intrahepatic biliary ductal dilatation.  There\nis no extrahepatic biliary ductal dilatation.  Note is made of an abandoned\nsegment of native proximal extrahepatic duct in the hilum.  The gallbladder is\nsurgically absent.\n\nPancreas:  The pancreas is atrophic but normal in intrinsic signal intensity. \nThere is no main ductal dilatation.  No focal pancreatic lesions are seen.\n\nSpleen: The spleen is mildly enlarged measuring 13.7 cm without focal lesions.\n\nAdrenal Glands:  Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation.  Multiple T2 hyperintense nonenhancing\nlesions in the bilateral kidneys, the largest measuring 8.7 cm in the\ninterpolar region of the right kidney, are consistent with simple cysts.  A\nfew subcentimeter no T1 hyperintense lesions in bilateral kidneys are\ncompatible with hemorrhagic cysts.  No suspicious renal lesions are\nidentified.  No hydronephrosis. There is no perinephric abnormality.\n\nGI: Visualized intra-abdominal loops of small and large bowel are normal in\ncaliber.\n\nLymph nodes:  There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The hepatic arterial, portal and venous anastomoses are patent. \nThe abdominal aorta and its major branches are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions detected.",
            "output": "No evidence of recurrent hepatocellular carcinoma in the transplant liver."
        },
        {
            "input": "Lower Thorax: No pleural effusion.\n\nLiver: An orthotopic liver transplant is again seen.  There are a few minute\nstable cysts.  There is a minute nonenhancing mildly hyperintense T2 lesion in\nthe right hepatic lobe on series 3, image 12, possibly hemorrhagic cysts,\nstable.  No findings of hepatocellular carcinoma.  The portal vasculature is\npatent.\n\nBiliary: There is stable minimal of biliary ductal dilatation along the right\ninferior transplant margin.\n\nPancreas: There is a stable 6 mm pancreatic cystic lesion in the uncinate\nprocess.  No main ductal dilatation.  The pancreas is otherwise unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Multiple renal cysts are again noted, the largest on the right with\nthin internal nonenhancing septations measuring 8.7 cm.  No hydronephrosis.\n\nGastrointestinal Tract:  There is no intestinal obstruction or ascites in the\nupper abdomen.  There is stable mild nodularity in the omentum, most likely is\npostsurgical.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nVasculature: Conventional hepatic branches again seen.  The hepatic\nvasculature is patent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions are seen.",
            "output": "Post liver transplant.  No hepatocellular carcinoma.\n\nStable 6 mm side-branch intraductal papillary mucinous neoplasm.  No main\npancreatic ductal dilatation."
        },
        {
            "input": "Liver: Hepatic contour is nodular with geographic redistribution with areas of\nreticular delayed enhancement compatible with given diagnosis of cirrhosis.\nExophytic 21 mm mass in hepatic segment IV B adjacent to the gallbladder\ndemonstrate areas of an arterial hyper enhancement with delayed washout,\ndiffusion restriction, as well as a pseudo capsule (10:59). Several areas of\nperipheral, non masslike arterial enhancement seen throughout the liver do not\npersist on delayed phases and are compatible with perfusion anomaly.\nGallstones within otherwise unremarkable gallbladder.  Portal vein is patent.\n\nBiliary: No intra or extrahepatic biliary dilatation.\n\nPancreas: Mildly atrophied without focal lesion or ductal dilatation.\n\nSpleen: Enlarged measuring up to 16 cm in maximal dimension.  Few focal areas\nof signal void on out of phase imaging compatible with Gamna Gandy bodies.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Several large bilateral simple cysts measuring up to 67 mm in the\nright interpolar kidney and 25 mm in the left lower pole kidney.  No solid\nrenal mass. No hydronephrosis.\n\nGastrointestinal Tract: Stomach, duodenum and visualized small and large bowel\nloops are normal caliber without evidence of obstruction.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal caliber.",
            "output": "1. 21 mm exophytic mass in hepatic segment IVb demonstrating arterial\nenhancement with washout, diffusion restriction and pseudocapsule meeting OPTN\ncriteria for HCC, corresponding to the lesion seen on ultrasound.\n2. Cirrhotic liver with sequela of portal hypertension including splenomegaly.\n3. Cholelithiasis.\n4. Several, large bilateral simple renal cysts.\n\nNOTIFICATION:  Results were entered into the online critical results\ncommunication dashboard by Dr. ___ at 16:47 ___."
        },
        {
            "input": "Lower Thorax: Lung bases and lower pleural spaces are clear.\n\nLiver: The liver demonstrates a nodular contour, along with lobar\nredistribution, with enlargement of the caudate lobe and left lateral lobe,\nmorphological features in keeping with hepatic cirrhosis.  No evidence of\nhepatic steatosis.  The previously seen hepatocellular carcinoma within\nsegment 4B, treated with chemo embolization has significantly decreased in\nsize from the first post chemoembolization hepatic MRI dated ___. \nToday the lesion measures 0.7 x 1.3 cm (series 1002, image 53), and previously\nmeasured approximately 1.5 x 1.6 cm (series 14, image 60).  This treated\nlesion remains hypo enhancing on the post gadolinium images.  Multiple\narterially enhancing lesions with no associated washout or signal abnormality\non the diffusion-weighted images are identified within the liver, largest\nwithin segment ___ measuring 8 mm (series 1001, image 63), unchanged in size\nand appearance from the comparison study.  No new hepatic mass lesions. \nBackground hepatic fibrosis as appreciated on the post contrast images. \nHepatic vasculature remains patent.  Trace ascites.\n\nBiliary: No intra or extrahepatic ductal dilatation.  The gallbladder contains\nmultiple gallstones, as seen previously, with no evidence of gallbladder wall\nthickening or pericholecystic inflammatory changes.\n\nPancreas: Pancreas enhances homogeneously with no main pancreatic ductal\ndilatation or peripancreatic abnormality.\n\nSpleen: The spleen remains enlarged in size, measuring up to 14 cm in the CC\ndimension.  No focal splenic mass.\n\nAdrenal Glands: Adrenal glands are normal in size and appearance with no focal\nmass lesion.\n\nKidneys: No dilatation of the renal collecting system.  Multiple renal cysts\nare noted bilaterally, largest in the right kidney measuring up to 8.6 cm,\nunchanged in appearance from the comparison study.  2.3 cm exophytic cyst\narising from the lower pole of the left kidney is again noted containing a\nthin internal septation.\n\nGastrointestinal Tract:  Visualized loops of small large bowel are\nunremarkable.\n\nLymph Nodes: No large sized retroperitoneal lymphadenopathy.  Small periportal\nlymph nodes are identified, which appear less prominent than on the prior\nstudy.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.  2 left renal\narteries.  Gastric varices.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.",
            "output": "Status post chemoembolization of segment 4 hepatocellular carcinoma which has\nsignificantly decreased in size from the comparison study. No evidence of\nresidual or recurrent HCC.\n\nTrace ascites with splenomegaly and gastric varices, in keeping with sequelae\nof portal hypertension.  Background hepatic cirrhosis.\n\nCholelithiasis."
        },
        {
            "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear.  There\nis no pleural effusion.  The base of the heart is normal in size.  There is no\npericardial effusion.\n\nLiver: The caudate lobe is enlarged, and the liver has a nodular contour. \nThis is in keeping with the history of cirrhosis.  The patient is status post\na TACE to a lesion in segment 4.  Due to the location of this previously\ntreated lesion, is somewhat difficult though evaluate, though no residual\nlesion is definitely identified.  There is slight heterogeneous enhancement in\nthe area of the treatment zone, suggestive of post-treatment fibrosis.  There\nare no foci of arterial hyperenhancement or washout to suggest recurrent or\nresidual tumor.\n\nThere are innumerable regenerative nodules.  There are several tiny foci of\narterial hyperenhancement without a correlate on the T2 weighted images or\nevidence of washout.  The largest is in segment 5, and measures 8 mm (12, 44).\nThis is unchanged dating back to ___.  No lesions meet OPTN-5 criteria\nfor HCC.\n\nThe hepatic arterial anatomy is conventional.  The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  Multiple\nstones are identified in the gallbladder, including one which is hyperintense\non the T1 weighted images.  There is no MRI evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously.  There is no duct dilation or mass.\n\nSpleen: The spleen is mildly enlarged, measuring 14.8 cm.  It previously\nmeasured 14 cm.  There are no focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  There is a dominant simple renal\ncyst measuring 89 mm in the lower pole of the right kidney (8, 40).  A 28 mm\nexophytic cyst arising from the lower pole of the left kidney has a single\nthin septation which is not significantly changed.  The other cysts are\nsimple.  There are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is very trace perihepatic ascites, similar to\nthe prior exam.\n\nLymph Nodes: There are mildly prominent periportal lymph nodes, which are\nlikely reactive to the underlying liver disease.  There is no retroperitoneal\nor mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.  There are esophageal and\ngastric varices.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted throughout the spine.  The soft\ntissues are unremarkable.",
            "output": "1.  Posttreatment changes in segment 4 without evidence of residual or\nrecurrent disease.\n2.  Several unchanged foci of arterial hyperenhancement which are nonspecific.\nNo lesions meet OPTN-5 criteria for HCC.\n3.  Cirrhosis with portal hypertension, including splenomegaly, varices, and\ntrace ascites.\n4.  Cholelithiasis."
        },
        {
            "input": "Lower Thorax: Limited views of the lung bases are clear.  There is no pleural\neffusion.\n\nLiver: The liver demonstrates a nodular contour with enlargement of the left\nlateral segment and caudate lobe compatible with cirrhosis.  Diffuse fibrosis\nand innumerable regenerative nodules are again identified.  Patient is status\npost TACE to an exophytic lesion in segment IV.  There is no evidence of\nresidual or recurrent tumor.  Heterogeneous enhancement at the area of the\ntreatment zone appears minimally decreased compared to the prior study and\nlikely represents post treatment changes.  Scattered sub centimeter arterially\nenhancing lesions without washout on subsequent phases or T2 correlate are\nagain noted.  The largest of which measures 8 mm in segment V (10:47).  These\nare overall unchanged compared to the prior study.  The portal vein is patent.\nHepatic arterial anatomy is conventional.  Sliver of perihepatic ascites is\npresent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. \nMultiple gallstones are again identified within a mildly distended\ngallbladder.  There is no gallbladder wall thickening or pericholecystic\nfluid.\n\nPancreas: The pancreas demonstrates normal contour and signal intensity. \nThere is no main duct dilatation or peripancreatic abnormality.\n\nSpleen: The spleen remains enlarged and measures 15.4 cm, previously 14.8 cm. \nNo focal splenic lesion is seen.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  Multiple T2 hyperintense\nnon-enhancing lesions are identified compatible with simple cysts with the\nlargest arising from the interpolar region of the right kidney measuring 8.5\ncm.  Minimally complex 2.6 cm cyst arising from the lower pole of the left\nkidney is also unchanged since the prior study.  There is no hydronephrosis.\n\nGastrointestinal Tract:  The stomach, small and large bowel are unremarkable\nwithout bowel wall thickening or dilatation.  Gastroesophageal varices are\nagain identified.\n\nLymph Nodes: Prominent reactive periportal lymph nodes are unchanged.  There\nis no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation.  The major branch vessels are patent.\n\nOsseous and Soft Tissue Structures: No marrow abnormality is identified.  The\nsoft tissues are grossly unremarkable.",
            "output": "1.  Post treatment changes in segment IV of the liver without residual or\nrecurrent tumor.\n\n2.  Multiple unchanged arterially enhancing hepatic foci, non-specific\nfindings.  No lesion meeting OPTN-5 criteria for HCC.\n\n3.  Cirrhotic liver with sequelae of portal hypertension including\nsplenomegaly, gastroesophageal varices, and trace ascites.\n\n4.  Cholelithiasis band renal cysts."
        },
        {
            "input": "Lower Thorax: Visualized lung bases and lower mediastinal structures are\nunremarkable.\n\nLiver: The liver has a nodular contour with lobar redistribution, consistent\nwith cirrhosis.  The patient is status post TACE treatment in segment 4B from\n___ which demonstrates heterogeneous enhancement.  No evidence of\nrecurrent tumor.\n\nPreviously demonstrated arterial hypervascular lesions are not seen, likely\nrelated to timing of the contrast bolus.  However, on portal venous and\ndelayed phases, there are multiple transient hepatic intensity differences.\n\nNo lesions concerning for hepatocellular carcinoma.\n\nTrace perihepatic ascites.\n\nBiliary: Cholelithiasis.  No intrahepatic or extrahepatic biliary duct\ndilatation.\n\nPancreas: Pancreas is normal.  No focal pancreatic lesion.  No pancreatic duct\ndilatation.\n\nSpleen: Splenomegaly is demonstrated, measuring 15.7 cm, previously 14.8 cm.\n\nAdrenal Glands: Adrenal glands are normal.\n\nKidneys: Kidneys are normal size and are symmetric.  Numerous cysts are\ndemonstrated, largest lobulated cyst in the interpolar region of the right\nkidney measuring 8.1 cm.  Largest in the left kidney is noted in the lower\npole with a single septation.\n\nGastrointestinal Tract:  Visualized small and large bowel are unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Conventional hepatic arterial anatomy.  Gastroesophageal varices.\nAbdominal aorta is unremarkable.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative changes of the\nvisualized thoracic and lumbar spine.No soft tissue lesions.",
            "output": "1. Cirrhosis with evidence of portal hypertension.  Splenomegaly has mildly\nprogressed compared to the prior exam.\n2. Stable TACE treatment site in segment 4B. No concerning lesions for\nhepatocellular carcinoma.\n3. Stable renal cysts."
        },
        {
            "input": "Lower Thorax: The lung bases are grossly clear.  No pleural or pericardial\neffusion.\n\nLiver: The liver has a markedly nodular contour with reticular enhancement,\ncompatible with cirrhosis and fibrosis.  Patient is status-post TACE treatment\nto segment 4B, where there is heterogeneous signal and enhancement.  No\nevidence of recurrent tumor.\n\nThere are numerous foci of arterial enhancement without T2, precontrast or\ndelayed phase correlate (for example 1401:32, 44, 48, 61, 69).  Some of these\nlesions are new, and some were previously seen, however, none meet OPTN 5\ncriteria for HCC.  These are most consistent with transient hepatic intensity\ndifferences.\n\nSeveral punctate T2 hyperintense nonenhancing foci are seen within the liver\nas well, consistent with cysts or biliary hamartomas.  No concerning hepatic\nlesions are identified.  No ascites.\n\nBiliary: Multiple gallstones are seen within the gallbladder, without evidence\nof wall thickening or pericholecystic fluid.  No intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: Pancreas is normal in signal intensity and bulk.  No evidence of\npancreatic ductal dilatation or enhancing pancreatic lesions.\n\nSpleen: Spleen is enlarged, measuring 16.4 cm, previously 15.8 cm.  Multiple\nGamna Gandy bodies are seen within the spleen.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal in size, and demonstrate symmetric enhancement\nafter the administration of contrast.  Multiple T2 hyperintense nonenhancing\ncortical and parapelvic cysts are present.  The largest of which is located in\nthe interpolar region of the right kidney, and measures 8.4 x 7.2 cm.\n\nGastrointestinal Tract:  The stomach is under distended, but grossly normal. \nImaged loops of small and large bowel are normal in course and caliber.\n\nLymph Nodes: Enlarged lymph nodes measured 1.2 x 1.1 cm in the porta hepatis,\nand 1.2 x 1.1 cm in the region of the gastroduodenal artery are likely\nreactive.  Several other scattered prominent retroperitoneal and mesenteric\nlymph nodes are present.\n\nVasculature: Abdominal aorta is normal in caliber.  Note is made of\nparaesophageal and gastric varices.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions.",
            "output": "1. Cirrhosis with sequela of portal hypertension, including splenomegaly and\nvarices.  No ascites.\n2. Status post TACE to a lesion in segment 4B, without evidence of residual or\nrecurrent disease.\n3. Multiple transient hepatic intensity differences within the liver.\n4. No concerning liver lesions meeting OPTN 5 criteria for HCC.\n5. Cholelithiasis."
        },
        {
            "input": "Lower Thorax: Lung bases are clear.  No pleural or pericardial effusion\n\nLiver: Liver demonstrates nodular contours compatible with liver cirrhosis. \nThere is no significant drop of signal on the out of phase images as compared\nto the in-phase images to suggest hepatic steatosis.  There is diffuse\nreticular lace-like enhancement on the more delayed phases suggestive of\nfibrosis.\n\nPatient is status post transarterial chemoembolization of segment IVB.  No\nevidence for tumor recurrence.  Multiple peripheral nodular areas of arterial\nenhancement that do not persist on the more delayed phases, or without washout\nmost likely suggestive of transient hepatic intensity differences.  No\nworrisome enhancing hepatic mass lesions meeting OPTN Class 5 criteria for\nHCC.\n\nBiliary: Gallbladder is present containing multiple gallstones.  No\ngallbladder wall thickening or pericholecystic fluid.  There is no\nintrahepatic or extrahepatic biliary duct dilatation.  The common bile duct\ntapers normally towards the ampulla without obstructing filling defects or\ncholedocholithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously.  No suspicious solid or cystic mass lesion.\nThe main pancreatic duct is not dilated.  No peripancreatic inflammatory\nchanges or fluid collections.\n\nSpleen: Spleen is enlarged measuring 15 cm in maximal diameter.  It otherwise\nenhances homogeneously without focal mass lesion.\n\nAdrenal Glands: The adrenal glands are normal bilaterally without focal\nnodules.\n\nKidneys: The kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation.  There is adequate excretion of contrast on\nthe more delayed phases.  Multiple stable simple renal cortical cysts, the\nlargest at the interpolar region of the right kidney measuring 7.7 x 8.9 cm. \nNo suspicious renal masses or hydronephrosis.\n\nGastrointestinal Tract:  The stomach, visualized small bowel and colon the\nupper abdomen are within normal limits.  No ascites.\n\nLymph Nodes: Multiple prominent periportal, peripancreatic and gastrohepatic\nlymph nodes, stable from prior and not pathological by size criteria, likely\nreactive to underlying chronic liver disease.  No suspicious mesenteric or\nretroperitoneal lymphadenopathy by size criteria.  There are 2 new nonenlarged\nprominent lymph nodes along the anterior left chest wall (series 16, image\n40).\n\nVasculature: Abdominal aorta is normal in caliber its major branches are\npatent.  Hepatic arterial anatomy is conventional.  The splenic vein, SMV,\nportal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.  Small nonspecific foci of enhancement within the costochondral\njunctions bilaterally, unchanged from prior, of questionable etiology.",
            "output": "1.  Status post TACE.  No evidence of residual or recurrent tumor.\n2.  Cirrhotic morphology of the liver with extensive fibrosis. No worrisome\nenhancing hepatic mass lesions meeting OPTN Class 5 criteria for HCC.  Trace\nperihepatic free fluid.\n3.  Cholelithiasis."
        },
        {
            "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology.  No suspicious focal liver\nlesion identified.  Iron level:  ___ Micromol/g with a standard deviation of\n30, consistent with light to moderate iron overload.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is borderline enlarged, measuring 12.5 cm, stable.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel:  Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement.   There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.  Hepatic arterial\nanatomy is conventional.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.  No free fluid.",
            "output": "Light to moderate hepatic iron overload."
        },
        {
            "input": "The visualized lung bases are clear. There is no pleural effusion.\n\nThe liver again demonstrates diffusely decreased signal intensity on T2\nweighted imaging, as well as signal dropout on in-phase compared to out of\nphase imaging, consistent with hemosiderosis. A previously characterized\nhemangioma in the left lobe is unchanged. There is no intra or extrahepatic\nbiliary duct dilation.  There is adenomyosis of the gallbladder fundus. The\nspleen is normal in size, again with decreased T2 signal intensity consistent\nwith hemosiderosis. The pancreas is within normal limits, without focal\nlesion, peripancreatic fluid collection, iron deposition, or ductal dilation.\nThe adrenal glands and kidneys are normal bilaterally, with multiple bilateral\nsimple renal cysts unchanged. The visualized loops of small and large bowel\nare unremarkable.  Intra-abdominal vascular flow voids are preserved. There is\nno retroperitoneal or mesenteric lymphadenopathy. No focus of abnormal\nenhancement with contrast administration is identified. The osseous structures\nare unremarkable.",
            "output": "1.    Redemonstration of hemosiderosis.  Liver iron content using the\n___ calculator is estimated to be 200 (+/-50) umol iron/g dry\nweight liver(normal < 36 \u00b5mol/g) using the PD sequence.  This corresponds to\nmoderate iron overload.  Given the significant iron deposition within the\nliver, we are unable to concurrently assess for coexisting fatty liver.\n2.  Unchanged left hepatic lobe hemangioma.\n3.  Bilateral simple renal cysts."
        },
        {
            "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear other\nthan minimal atelectasis.  There is no pleural effusion.  The base of the\nheart is normal in size.  There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour.  There are no morphologic\nfeatures of cirrhosis.  There is mild iron deposition in the liver, compatible\nwith hemosiderosis.  The liver iron concentration estimated the T2++ sequence\nis 45 (+/-20) umol/g.  Normal is less than 36 umol/g.  In comparison the prior\nexam, the liver iron content has decreased.  It previously was 200 (+/-50)\numol/g.  No significant hepatic steatosis is identified, though a small amount\ncould be obscured by the presence of iron within the liver.\n\nIn the left lobe of the liver, there is a lobulated 21 mm T2 hyperintense\nlesion which demonstrates peripheral nodular arterial enhancement that fills\nin on the delayed phases.  This is compatible with a hemangioma.  There is a\nsmall perfusion abnormality surrounding this lesion.  It is unchanged from\nprior exams.  No other liver lesions are identified.  The hepatic arterial\nanatomy is conventional.  The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  The\ngallbladder is collapsed, which somewhat limits evaluation.  Within the\nlimitations, there is no MRI evidence of cholecystitis.  A small gallstone is\nnoted in the gallbladder fundus.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously.  There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 9.2 cm.  There is very mild\ndrop in signal on the in phase images in comparison to the out of phase\nimages, suggesting mild iron deposition within the spleen.  This is in keeping\nwith hemosiderosis.\n\nAdrenal Glands:  The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  Multiple subcentimeter renal cysts\nare noted bilaterally.  There are no worrisome renal lesions, hydronephrosis,\nor perinephric abnormalities.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is no ascites.\n\nLymph Nodes: There are few mildly prominent periportal lymph nodes.  None meet\nsize criteria for pathologic enlargement.  There is no retroperitoneal or\nmesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nIn a mid thoracic vertebral body, there is a 10 mm T2 hyperintense lesion,\nwhich is unchanged from the prior exam, and most compatible with a hemangioma.\nThe soft tissues are unremarkable.",
            "output": "1.  Mild hemosiderosis.  The liver iron concentration has decreased notably\nfrom the prior exam, as detailed above.\n2.  Unchanged left hepatic hemangioma.\n3.  Cholelithiasis."
        },
        {
            "input": "Lower Thorax: The heart is normal in size.  There is no pleural or pericardial\neffusion.\n\nLiver: The liver is normal in size and smooth in contour.  There is no hepatic\nsteatosis.  There is a 0.7 x 0.5 cm cyst or biliary hamartoma in segment VII. \nThere are a few scattered arterially enhancing lesions without T2 correlate,\nincluding a 0.5 cm lesion in segment VIII (series 1001, image 34), a 1.0 cm\nlesion at the border of segments VI and VII (series 1001, image 44), 0.8 cm\nlesion in segment VI (series 1001, image 100), likely representing transient\nhepatic intensity differences.  There is no correlate for the echogenic right\nhepatic lobe lesion described on abdominal ultrasound from ___. \nNo suspicious hepatic lesion is detected.\n\nBiliary: The gallbladder is within normal limits.  There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity.  No focal\nlesion is detected.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size.  There is a 3.2 x 1.5 cm simple\ncyst in the upper pole of the left kidney, and a another tiny cyst in the\ninterpolar region.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified.  The abdominal wall is within normal limits.",
            "output": "No correlate for the right hepatic lesion described on abdominal ultrasound\nfrom ___.  Subcentimeter cyst or biliary hamartoma in segment\nVII, and a few scattered transient hepatic intensity differences.  No\nsuspicious hepatic lesion."
        },
        {
            "input": "The liver is shrunken and nodular, consistent with known cirrhosis. There is a\n4.8 x 3.9 cm area of hypoenhancement in segment VI, representing the site of\nchemoembolization.  Hypoenhancement on all phases in a wedge-shaped area\nextending to the inferior margin of the liver likely tissue necrosis\n(1402:115). There is an 8 mm arterially enhancing focus in the peripheral\nright lobe with no definite washout in segment VII/VIII (1401:43).\n\nAccessory left hepatic artery is better appreciated on prior CTA (___:65).\nThe hepatic and portal veins are patent.  There is a 4.1 cm long seroma along\nthe posterior margin of the right lobe, unchanged from multiple priors\n(12:58). The spleen is not enlarged. Evaluation of the pancreas on T2 weighted\nsequences is severely limited by dielectric defect. The adrenal and kidneys\nare unremarkable. There is large volume ascites.  Bone marrow signal is\nnormal.",
            "output": "1.  Post treatment changes in segment VI after chemoembolization including\ntissue necrosis.  No evidence of residual tumor. Patent hepatic vasculature.\n2.  8 mm arterially enhancing focus in segment VII/VIII without definite\nwashout.  Attention at followup is recommended.\n3.  Accessory left hepatic artery.\n4.  Large volume ascites."
        },
        {
            "input": "The morphologic appearance of the liver is unchanged, with contour nodularity\nand segmental size variation in keeping with the known underlying cirrhosis.\nPosttreatment change within segments V and VI is also unchanged. There\ncontinues to be a 5.0 x 5.9 x 9.6 cm region of nonenhancing liver parenchyma,\nconsistent with tissue necrosis (17:87). This is somewhat wedge-shaped in\ncontour extending to the inferior margin of the liver. More superiorly there\nis peripheral bile duct obstruction (16:77).  The contents of this area of\nnecrosis are heterogeneous on T2 weighted imaging, as well as T1 weighted\nimaging, but without enhancement.\n\nOn arterial phase of imaging there are numerous foci of punctate arterial\nhyperenhancement including at the margin of segments VII and VIII, as was seen\npreviously.  The largest in segment VII/VIII has a diameter of 8-mm, unchanged\nfrom prior (10:34). None demonstrate associated subsequent washout.  A tiny T2\nhyperintense, nonenhancing focus is noted within segment 4B (16:52),\nconsistent with a biliary hamartoma.\n\nThere is evidence of chronic portal hypertension on the basis of a\nrecannulized paraumbilical vein and innumerable portosystemic collateral\nvessels (16:104).  The spleen is borderline enlarged, measuring up to 13 cm\ncaudocranially. Large volume of ascites is again noted with mild thickening\nand hyperenhancement of the peritoneal surface, likely related to recent\nparacentesis. Splenic vein, superior mesenteric vein and portal venous system\nare patent and contrast opacified.\n\nLobulated area of T1 hyperintensity and T2 hypointensity without enhancement\nis noted posterior to the right lobe of the liver (07:39).  This may reflect a\nloculated collection of chronic blood products or proteinaceous seroma,\nunchanged from multiple priors and measures 4.5 x 1 cm.  Other smaller similar\nappearing foci are noted adjacent to this dominant collection.\n\nThe pancreas, adrenal glands and right kidney are normal in appearance. There\nis a tiny cyst within the superior pole of the left kidney.\n\nLymph nodes within the porta hepatis and gastrohepatic ligament are unchanged\nand nonspecific in etiology. Note is made of an accessory left hepatic artery.\nOtherwise arterial vascular anatomy is conventional. There is mild\natherosclerotic plaque involving the infrarenal abdominal aorta. Osseous\nstructures are unremarkable. The lung bases are clear.",
            "output": "1. Cirrhosis with sequela of portal hypertension including large volume\nascites.\n2. Stable post treatment appearance within segments V and VI without evidence\nof residual or recurrent tumor.\n3. Multiple sub-cm foci of arterial hyperenhancement without washout or\nT2-correlate, similar compared to the prior study and are non-specific,\npossibly perfusional abnormalilties.  Continued attention on follow up to\nthese regions are recommended."
        },
        {
            "input": "The bases of the lungs are grossly clear. There is no pleural or pericardial\neffusion.\n\nThe liver has a nodular contour, compatible with known cirrhosis. A previously\ndescribed treated lesion in hepatic segment VI is again noted, measuring\napproximately 7.5 by 7.3 x 8.4 cm (01:15, 04:32). This area is\nwell-circumscribed, and contains heterogeneous contents with a predominant\nportion of T2 hyperintense, T1 hypointense central liquefaction, with a\nsmaller amount of necrotic tissue contained within. Along the posterolateral\nmargin of the lesion are 2 hypointense projections extending to the hepatic\ncapsular surface (1004:104), with no evidence of enhancement, likely\nretractile tissue/fibrosis, also related to posttreatment change. Wedge-shaped\nT2 hyperintense signal within the inferior-most tip of the right hepatic lobe\nin segment VI (04:40) is likely related to a small area of infarcted hepatic\nparenchyma.\n\nNo new concerning hepatic lesions with washout are identified. A patent\nindwelling TIPS stent. Extending from the right hepatic vein to the right\nportal vein is unchanged in position compared to prior studies. A small\nlobulated focus of T1 hyperintensity and T2 hypointensity with no enhancement\nis again noted posterior to the right hepatic lobe (5a:21, 04:28, 1004:54),\nunchanged, compatible with loculated collection of chronic blood products.\n\nThe pancreas, bilateral adrenal glands, and right kidney are unremarkable. A\nnonenhancing tiny left upper pole renal cyst is unchanged (1004:76). There is\nno pathologic enlargement of mesenteric or retroperitoneal lymph nodes, and\nslightly prominent porta hepatic lymph nodes are unchanged, measuring up to 7\nmm in short axis diameter (1004:78). There is no portal venous or hepatic\nvenous thrombosis identified. Incidental note is made of an accessory left\nhepatic artery arising from the left gastric artery (1001:56). \nAtherosclerotic plaque within the abdominal aorta is again noted, with\npersistent mild infrarenal ectasia, with no aneurysmal formation. No focal\nbone marrow signal abnormalities are detected.",
            "output": "1.  Continued evolution of post treatment changes predominantly in hepatic\nsegment VI, with no evidence of residual or recurrent tumor.\n2.  Small wedge-shaped parenchymal infarct in the inferior most tip of hepatic\nsegment VI.\n3.  Cirrhotic liver with patent TIPS shunt."
        },
        {
            "input": "Lower Thorax: Please see the chest CT obtained immediately prior to this exam\nfor complete intrathoracic details.\n\nLiver: The liver is shrunken and nodular, compatible with the history of\ncirrhosis.  There is no hepatic steatosis.  There is a well-circumscribed 7.4\nx 7.3 x 8.6 cm cystic lesion with internal blood products, compatible with the\npreviously treated hepatocellular carcinoma.  Allowing for changes in\nmeasurement technique, the appearance of this lesion is not significantly\nchanged.  There is no abnormal enhancement around this lesion to suggest local\nrecurrence.\n\nIn the periphery adjacent to this lesion, there is T2 hyperintense material\nwhich is nonenhancing and likely related to post treatment changes or an old\ninfarct.  There is some mild biliary duct dilation in this region.  This is\nstable in appearance.\n\nIn segment VIII, there is an 8 mm focus of arterial hyperenhancement (901,\n50).  There is no definite washout or a correlate on the T2 weighted images. \nThis is new from the prior exam.  No other foci of arterial hyperenhancement\nare noted.\n\nThere are few punctate T2 hyperintense lesions, compatible with cysts or\nbiliary hamartomas.\n\nThe patient is status post TIPSS.  The TIPSS is patent.  There is minimal\nbiliary duct dilation in the parenchyma peripheral to the TIPSS, which is also\nunchanged.  The remainder the portal veins are also patent.  The hepatic veins\nare attenuated, though patent.\n\nAlong the posterior aspect of the right lobe of the liver, there is an\nunchanged non-enhancing T1 hyperintense crescent-shaped fluid collection\nmeasuring 38 x 13 mm, which is compatible with a benign cystic lesion.  Given\nthe lack of a perceptible wall, it is unlikely to be a hematoma.\n\nBiliary: There is no central intrahepatic or extrahepatic biliary duct\ndilation.  The gallbladder is collapsed, which limits evaluation.  No stones\nor cholecystitis is identified.\n\nPancreas: The pancreas is normal in signal and enhances homogeneously.  There\nis no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 12.6 cm.  There no focal\nlesions.  A 7 mm accessory spleen is noted in the left upper quadrant (4, 16).\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  There are no focal lesions,\nhydronephrosis, or perinephric abnormalities.  The kidneys enhance\nsymmetrically.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is no ascites.\n\nLymph Nodes:  An enlarged portocaval lymph node is unchanged.  There is no\nretroperitoneal or mesenteric lymphadenopathy.  Two prominent epiphrenic lymph\nnodes along the diaphragm (903, 45 and 52), do meet criteria for pathologic\nenlargement, and are unchanged from the prior exam.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm.  There is mild atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.",
            "output": "1.  Posttreatment changes in the right hepatic lobe, unchanged from the prior\nexam, as described above.  No evidence of local recurrence.\n2.  No lesions meet OPTN-5 criteria for HCC.  There is an 8 mm focus of\narterial enhancement in segment VIII without washout or a T2 correlate, which\nbears watching on follow-up exams.\n3.  Patent TIPSS."
        },
        {
            "input": "Liver: There are no imaging features of advanced cirrhosis.  Minute foci of\narterially hyper enhancement throughout the liver (1101:32, 40, 53, 66, 70),\nthe largest in hepatic segment VII (1101:41) that have no correlate on other\nsequences, most consistent with transient hepatic intensity differences. \nOtherwise, no lesion characteristic of hepatocellular carcinoma is seen.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits without evidence of cholelithiasis.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: Unremarkable\n\nAdrenal Glands: Unremarkable\n\nKidneys: The kidneys are unremarkable aside for small cysts\n\nGastrointestinal Tract: There is no evidence of bowel obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.  The major abdominal\nvasculature are patent.  Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.",
            "output": "No HCC."
        },
        {
            "input": "Lower thorax: The lung bases are grossly clear.  Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nLiver: The liver demonstrates normal morphology and signal intensity.  No\nsuspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.  There no discrete lesion, but an equivocal 5 mm\nresidual hypodensity in the posterior right upper pole, not seen on all\nsequences, the region of a previously seen hyperdensity which measured\napproximately 1.3 cm in ___ (17:56).\n\nBowel: The stomach is unremarkable.  The small and large bowel are\nunremarkable. There is no wall thickening, adjacent inflammatory change, or\nabnormal enhancement.   There is no evidence of stricture or obstruction.\n\nPelvis: The bladder and distal ureters are unremarkable.  The prostate and\nseminal vesicles are unremarkable.  No free fluid in the pelvis.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.  Incidental note is\nmade of a retroaortic left renal vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nOsseous/Soft Tissue: There are stable sclerotic changes along the endplates of\nthe T11 and T12 vertebral bodies, likely Schmorl's nodes.  No concerning\nosseous lesions.  No free fluid.",
            "output": "1. Equivocal residual 5 mm remaining signal abnormality in the posterior right\nupper pole, in the region of a 1.3 cm exophytic lesion seen on CT in ___, may be due to collapse of a hemorrhagic cyst or a treated metastasis. \nOtherwise no concerning renal lesions.\n2. No additional evidence of metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "Lower Thorax: Atelectasis is seen dependently at the lung bases, otherwise, no\ngross abnormalities.\n\nLiver: The liver demonstrates normal signal intensity.  There is no suspicious\nhepatic lesion.\n\nBiliary: No intra- or extrahepatic biliary dilation.  Gallbladder is\nunremarkable without gallstones.\n\nPancreas: Pancreas has a normal appearance without ductal dilation.\n\nSpleen: Spleen is normal in appearance and size.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: Several small subcentimeter T2-hyperintense foci seen within the\nkidneys, consistent with renal cysts.  No hydronephrosis or other focal\nabnormality.\n\nGastrointestinal Tract:  Stomach is grossly unremarkable.  Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: Visualized abdominal vasculature is grossly unremarkable.\n\nOsseous and Soft Tissue Structures: There are no gross abnormalities.",
            "output": "No focal abnormality on MRI corresponding to the area of increased FDG\nactivity along the superior edge of the gallbladder fossa at the posterior\nedge of segment four/eight.  No dedicated follow-up is required based on the\ncurrent findings."
        },
        {
            "input": "Lower Thorax: The lung bases are clear.  No pleural or pericardial effusion. \nGynecomastia is present.\n\nLiver:  Scattered mildly T1 bright regenerative nodules are present.  There is\nno chemical shift on the in or out of phase sequences to suggest the presence\nof hepatic steatosis or iron deposition. The liver contours are smooth.  No\nsolid or cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation.  The common bile duct is\nwithin normal limits.  The gallbladder is unremarkable.  No cholelithiasis.\n\nPancreas:  There is abnormally low heterogenous signal intensity on\nT1-weighted images and heterogenous enhancement of the left aspect of the\npancreatic body and most of the pancreatic tail with an expanded parenchyma\nand irregular spiculated defined contour.  There are small side branches\nidentified in the abnormal pancreas but no significant ductal dilation.  The\nremainder of the pancreas maintains normal bulk, intrinsic hyperintense T1\nsignal and enhancement pattern. No focal lesion or ductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics.  There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics.  No focal lesions.\n\nKidneys: Scattered bilateral renal cortical cysts, largest in the lower pole\nthe right kidney measuring 1.3 cm (02:31).\n\nGastrointestinal Tract:  There is a small ___ duodenal\ndiverticulum.  The GI tract is of normal caliber throughout.\n\nLymph Nodes:  There are enlarged porta hepatis and peripancreatic lymph nodes\nmeasuring up to 12 mm with (04:20), likely secondary to underlying liver\ndisease.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics.  No concerning osseous lesions.",
            "output": "There are scattered mildly T1 bright regenerative nodules, one of which may\ncorrespond to abnormality seen on ultrasound.  No concerning liver lesions\nidentified.\n\nAbnormal appearance of the left pancreatic body and most of the pancreatic\ntail as detailed above, likely secondary to prior or resolving pancreatitis. \nClinical correlation is recommended and consideration for EUS should be given.\n\nRECOMMENDATION(S):  Follow up ultrasound routine screening."
        },
        {
            "input": "Lower Thorax: Within normal limits.\n\nLiver: There are scattered T1 hyperintense regenerative nodules.  No\nsuspicious enhancing lesions.  Background liver appears normal.\n\nBiliary: No intra extrahepatic biliary ductal dilatation.  Gallbladder is\nabsent.\n\nPancreas: Diffuse signal heterogeneity of the body and tail of pancreas is\nagain seen however the pancreas appears less swollen since the prior MR\nexamination from ___.  There is no peripancreatic fluid or edema. \nThe main pancreatic duct is not dilated.\n\nSpleen: The spleen size is normal.  There is no focal splenic mass.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: There is 1.3 cm simple cyst in lower pole of the right kidney. \nPunctate hemorrhagic cyst noted in the mid polar region of the left kidney. \nKidneys are otherwise unremarkable.\n\nGastrointestinal Tract:  The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber.  There is no focal gastrointestinal mass.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber.  There is a tiny accessory left renal artery\n(series 1201, image 84).  Conventional hepatic arterial anatomy is\ndemonstrated.  The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.",
            "output": "1.  Regenerative nodules throughout the liver.  No concerning hepatic mass.\n2.  The pancreas again demonstrates heterogeneous abnormal signal intensity,\nbut appears less wall and in comparison to the ___ examination. \nThere is no pancreatic duct dilation or focal mass.  The findings likely\nrepresent resolving pancreatitis.  A follow-up MRCP is recommended in 6 months\nto assess for continued improvement."
        },
        {
            "input": "Liver: Again seen is cirrhotic liver morphology.  No steatosis demonstrated. \nThe hepatic vasculature is patent.  No hepatic mass demonstrated.\n\nBiliary: Post cholecystectomy.  No biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable\n\nSpleen: The spleen is unremarkable\n\nAdrenal Glands: The adrenal glands are unremarkable\n\nKidneys: The kidneys remain unremarkable aside for a few diminutive cysts some\nof which are hemorrhagic.  There is no hydronephrosis.\n\nGastrointestinal Tract:  Small periampullary duodenal diverticulum is again\nseen.  There is no intestinal obstruction or ascites in the upper abdomen.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions are seen.",
            "output": "Cirrhotic liver.  No HCC."
        },
        {
            "input": "Lower thorax: No pleural effusions.\n\nLiver: At least three T2 hyperintense lesions (slightly decreased signal\nintensity compared to fluid), the largest in segment 7 of the liver measures\n25 mm in diameter.  These lesions most likely correspond to the hyperechoic\nlesions seen on ultrasound and most likely represent hemangiomas.\n\nBiliary: No intra or extrahepatic bile duct dilatation.  The gallbladder\nappears normal.\n\nPancreas: No pancreatic abnormality.\n\nSpleen: No splenic abnormality.\n\nAdrenal Glands: Appear normal.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract:  No features of small or large bowel obstruction.  The\nappendix is not clearly visualized, but there are no secondary features of\nappendicitis.\n\nPelvis: ___ intrauterine pregnancy.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Major vasculature are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.",
            "output": "1.  The appendix is not identified, but there is no secondary features of\nappendicitis.\n\n2.  No acute intraabdominal pathology identified.\n\n3.  Three T2 hyperintense lesions most likely correspond to the hyperechoic\nlesion seen on ultrasound and most likely represent hemangiomas."
        },
        {
            "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs:  The solid organs including the liver, gallbladder, spleen,\npancreas, adrenals and kidneys are within normal limits.  There is no\nhydronephrosis.  No evidence of intra or extrahepatic biliary dilatation.\n\nGastrointestinal Tract:  The visualized small and large bowel loops are normal\nin caliber.  The appendix is normal in caliber measuring approximately 3-4 mm\nin maximum diameter. There is no evidence of appendiceal wall thickening or\nperiappendiceal inflammatory changes.\n\nPelvis: Uterus shows a fetus in a cephalic position with a posterior placenta.\nThe cervix measures 4.6 cm.  No adnexal abnormality seen on the given images. \nThe urinary bladder is normally distended with normal wall thickness.\n\nLymph Nodes: No significant lymphadenopathy.\n\nVascular: Time-of-flight imaging shows patent pelvic vasculature.  The\nbilateral gonadal veins are enlarged however patent.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal.  No soft tissue\nabnormality.",
            "output": "No acute process in the abdomen or pelvis to explain patient's symptoms."
        },
        {
            "input": "The study was terminated prematurely by the patient due pain. Only localizer\nand axial and coronal SSFSE sequences were obtained.\n\nLower thorax: Limited visualization of the lower thorax demonstrates no large\npleural effusion.\n\nHepatobiliary: Partially visualized liver with no intra or extrahepatic ductal\ndilatation.  No cholelithiasis.  No gallbladder wall thickening.\n\nPancreas: No pancreatic ductal dilatation.  No peripancreatic stranding.\n\nSpleen: No splenomegaly.\n\nAdrenal Glands: Symmetric bilaterally.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract:  No abnormally dilated loops of bowel.  Normal caliber\nappendix.  No periappendiceal inflammation.\n\nPelvis: Intrauterine fetus in cephalic position with posterior placenta.  No\nlarge adnexal lesions given the limitations of technique.\n\nLymph Nodes: No significant lymphadenopathy, given limitation of technique.\n\nVasculature: Normal caliber abdominal aorta.  Limited evaluation without\nTime-of-flight imaging.\n\nOsseous and Soft Tissue Structures: No destructive osseous lesions.",
            "output": "The study was terminated prematurely by the patient due pain, however there is\nno evidence of acute appendicitis."
        },
        {
            "input": "Lower Thorax: The lung bases are clear.  Heart size is normal.\n\nLiver: The liver is normal in morphology and signal intensity.  There is a 1.3\nx 1.3 cm simple cyst in segment ___ of the liver.  No additional focal hepatic\nlesions are seen.  There is no ascites.\n\nBiliary: The gallbladder is unremarkable without stones.  There is no intra or\nextrahepatic biliary duct dilation.\n\nPancreas: The pancreas in morphology and signal intensity.  There is no\nevidence of pancreas divisum.  There is no focal pancreatic lesion.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right adrenal gland is unremarkable.  There is a 1.4 x 1.7\ncm left adrenal nodule with diffuse drop of signal on out-of-phase imaging,\nconsistent with an adenoma.\n\nKidneys: The kidneys are symmetric in size.  There are scattered simple in the\nbilateral kidneys.  In addition to simple cysts, there is a 2.1 x 1.5 x 1.9 cm\nT2 intermediate intensity exophytic lesion arising from the anterior right\nlower pole with internal hyperenhancement similar to that of background kidney\n(series 3, image 43).  There is intra voxel but no for bulk fat seen within\nthis lesion.  The left, right, and main renal veins are unremarkable.  There\nis 1 renal artery bilaterally.\n\nGastrointestinal Tract:  There is no hiatal hernia.  Postsurgical changes from\nRoux-en-Y gastric bypass are present.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion.  There\nis no superficial soft tissue abnormality.",
            "output": "2.1 cm right lower pole renal mass containing intra voxel, but no identifiable\nbulk fat.  Findings are concerning for clear cell renal cell carcinoma with\nalternative differential of a fat poor AML.  No renal vein invasion."
        },
        {
            "input": "Lower Thorax: Unremarkable.\n\nLiver: The portions visualized of the liver is unremarkable.  There is no\nsteatosis.  There is a simple 1.3 cm left hepatic cyst.\n\nBiliary: No dilatation of the intra or extrahepatic biliary duct.  The portion\nvisualized of the gallbladder is  unremarkable.\n\nPancreas: No pancreatic lesion.  No dilatation of the main duct.\n\nSpleen: unremarkable.\n\nAdrenal Glands: 16 mm left adrenal nodule showing drop of signal suggesting an\nadrenal adenoma.\n\nKidneys: The kidneys are symmetric in size.  There is scattered simple cysts\nin bilateral kidneys.  We again see a 2.1 x 1.5 x 2 cm intermediate to\nhyperintense T2 lesion that is exophytic at the anterolateral right lower lobe\nwith internal enhancement.  This mass is unchanged since the previous exam.\n\nGastrointestinal Tract: Gastric bypass.  No signs of bowel obstruction. The\nprior colitis has improved.\n\nLymph Nodes: No adenopathy.\n\nVasculature: The renal veins are patent.  There is a duplicated IVC with the\nleft IVC draining via the left renal vein.\n\nOsseous and Soft Tissue Structures: No aggressive looking bone lesion.",
            "output": "Stable solid right renal mass suggestive of a clear cell RCC.  No metastasic\ndisease."
        },
        {
            "input": "Lower thorax: Lung bases, visualized pleural spaces, and lower mediastinal\nstructures are unremarkable.\n\nLiver: Liver is normal in signal and contour.  No liver steatosis.  No\nmorphologic features of cirrhosis.  A partially visualized small septated cyst\nis noted in segment ___ of the liver.  This is incompletely assessed on\ntoday's study, but was seen on multiple prior studies dating back to ___.\n\nBiliary: Normal gallbladder and biliary tree.  No intrahepatic or extrahepatic\nbile duct dilatation.\n\nPancreas: Pancreas maintains normal bulk.  The main pancreatic duct is normal.\n\nSpleen: The spleen is not enlarged (10 cm).\n\nAdrenals: Stable left adrenal adenoma which measures up to 16 mm in diameter\n(stable from ___.  Right adrenal gland unremarkable.\n\nKidneys: Again re-demonstrated are scattered millimetric renal cortical cysts.\nKnown T2 hyperintense lesion at the lower pole of the right kidney, without T1\nhyperintense components, and with nodular internal enhancement, measures\napproximately 1.7 x 2.1 x 1.8 cm in AP, transverse, and craniocaudal\n___, unchanged from prior.  It is unchanged in size and morphology from\nthe MR performed ___.  No additional solid renal lesions identified.\n\nBowel: Patient is status post Roux-en-Y gastric bypass surgery.  Visualized\nloops of large and small bowel otherwise normal in appearance.  No mural\nthickening.  No luminal distention.\n\nVasculature: Abdominal aorta is normal in caliber.  Major branch vessels are\npatent.  Portal and hepatic veins are patent.\n\nLymph nodes: No lymphadenopathy\n\nOsseous/Soft Tissue: No acute or focal destructive osseous lesions.  Spinal\nhardware lower lumbar spine.  Additional susceptibility artifact within the\nparaspinal subcutaneous soft tissues, again post-surgical in nature. On the\npost-gadolinium sequences, note is made of patchy enhancement along the\nposterior elements of the lower lumbar spine and extending into the paraspinal\nfascia and the paraspinal subcutaneous fat (series 21, images 85-112). \nCranial to the hardware, symmetric enhancement is noted in the facet joints. \nAdditionally, there is a thin slip of fluid within the subcutaneous paraspinal\nfat (series 2, image 29).  Upon review of patient's electronic records, we\nnote that patient was treated for wound dehiscence.  Recent surgical note\nstates interval healing of the wound.  Thin fluid collection may reflect\npostsurgical seroma.  Similarly, the enhancement described above is likely-in\nnature.  No drainable fluid collection is identified.",
            "output": "1.  Stable size and morphology of T2 hyperintense enhancing mass at the lower\npole of the right kidney, with imaging features suggestive of renal cell\ncarcinoma, likely clear cell type.\n2.  Stable left adrenal adenoma.\n3.  Soft tissue in hands meant the subcutaneous soft tissues of the lumbar\nspine, related to spine surgery and subsequent wound related care.  No\nevidence of drainable fluid collection."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The liver demonstrates normal morphology.  No steatosis.  There is a\n1.4 cm hyperintense lesion in segment IV a on T2 weighted images with thin\nseptation without enhancement on postcontrast images, consistent with a\nseptated cyst, unchanged.  Scattered punctate hyperintense lesion on T2\nweighted images without enhancement are consistent with cysts or biliary\nhamartomas.  No suspicious hepatic lesion.\n\nBiliary: The gallbladder is within normal limits.  No biliary ductal\ndilatation.\n\nPancreas: The pancreas demonstrate normal signal intensity without focal\nlesion or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: The right adrenal gland is unremarkable.  2.0 x 1.5 cm left\nadrenal nodule demonstrates drop in signal intensity on out of phase images,\nconsistent with an adenoma, unchanged compared to ___ allowing for\ntechnique differences.\n\nKidneys: The kidneys demonstrate normal nephrogram bilaterally.\n\nAgain seen is a 1.9 x 1.6 cm right lower renal pole exophytic lesion (series\n5, image 30 and series 3, image 9), hyperintense on T2 weighted images and\nisointense to renal parenchyma on precontrast T1 weighted images, overall\nunchanged compared to ___ allowing for technique differences.  On\npostcontrast images, this lesion demonstrate progressive avid enhancement. \nConstellation of finding is most consistent with a clear cell renal cell\ncarcinoma.  When compared to MRI from ___, the mass unchanged.\n\nNo new suspicious renal lesion.  Bilateral punctate cortical simple cysts are\nnoted.  No hydronephrosis.\n\nGastrointestinal Tract:  The patient is status post gastric bypass.  Otherwise\nthe visualized upper abdominal bowel loops are within normal limits.\n\nLymph Nodes: No enlarged abdominal lymph nodes.\n\nVasculature: No abdominal aortic aneurysm.  Single renal artery bilaterally. \nThe celiac artery, SMA, and renal arteries are patent.  The portal venous\nsystem is patent.\n\nOsseous and Soft Tissue Structures: The patient is status post L4-5 posterior\nfusion and laminectomy.  There are post surgical changes in the midline lower\nback subcutaneous tissue.  There is a 3.2 x 2.1 cm lesion in the right lower\nback, mildly hyperintense on both T2 and precontrast T1 weighted images with\nrim enhancement, which could represent a hematoma.",
            "output": "1. Unchanged 1.9 x 1.6 cm right lower renal pole exophytic mass compared to\nrenal MRI from ___ with imaging features most consistent with a clear\ncell renal cell carcinoma.  No new suspicious renal mass.\n2. 3.2 x 2.1 cm lesion in the right lower back with imaging features probably\nrepresenting a hematoma.  Correlation with any history of recent trauma is\nrecommended."
        },
        {
            "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is normal in morphology and signal intensity.  There is no\nhepatic steatosis.  No suspicious focal liver lesion identified.  A previously\nseen arterially enhancing lesion in segment 2 of the liver is not imaged on\nthis study.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  There is\ncholelithiasis, with no evidence of gallbladder wall thickening or\npericholecystic fluid (4:15).\n\nPancreas:  Again seen is a 6 mm cystic lesion in the body of the pancreas, not\nsignificantly changed from prior, and likely representing a side branch IPMN\n(4:13).  Pancreas otherwise demonstrates normal signal intensity on T1\nweighted images and enhances homogeneously.  Pancreatic duct is normal in\ncaliber.\n\nSpleen: The spleen is normal in size, measuring 12.1 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys:  Compared with MRI abdomen on ___, there is increase in size\nof a predominantly T2 hyperintense complex solid and cystic lesion with\nnumerous thin septations in the interpolar region of the left kidney,\nmeasuring 2.2 x 2.0 cm compared with 2.0 x 1.8 cm previously, with interval\nincrease in the enhancing solid component along the medial edge, measuring 1.4\nx 1.1 cm, compared with 1.4 x 0.7 cm previously (5:13, 18:49, 1501:31).  There\nare multiple additional T2 hyperintense, T1 hypointense, nonenhancing lesions\nin the bilateral kidneys, the largest arising from the upper pole of the right\nkidney and measuring 1.3 cm, consistent with simple cysts (5:20).  A 1.0 cm T2\nhyperintense, T1 isointense, nonenhancing lesion in the midpole of the right\nkidney is consistent with a cyst (5:22, 13:40).  The kidneys otherwise enhance\nand excrete symmetrically without hydronephrosis.\n\nBowel:  There is colonic diverticulosis.  Partially imaged loops of small and\nlarge bowel are otherwise unremarkable.\n\nPelvis:  A partially imaged ovarian cystic lesion is unchanged (5:10).\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.  No free fluid.",
            "output": "1. Interval increase in size of a 2.2 x 2.0 cm complex solid and cystic mass\nin the interpolar region of the left kidney, with interval increase in size of\nthe enhancing solid component, suspicious for renal cell carcinoma.\n2. Stable 6 mm pancreatic cystic lesion, likely represents represents a\nside-branch IPMN, for which no additional follow-up is required given\npatient's age and size of lesion.\n3. Cholelithiasis with no evidence of acute cholecystitis.\n4. Colonic diverticulosis.\n5. A partially imaged simple ovarian cystic lesion is grossly unchanged."
        },
        {
            "input": "Lower Thorax: The lower lungs are clear.  No pericardial or pleural effusion.\n\nLiver: The hepatic parenchyma is normal in contour, without evidence of\nsteatosis.  No focal lesions are identified.\n\nBiliary: There is no evidence of intrahepatic or extrahepatic biliary\ndilation.  The gallbladder contains numerous gallstones without evidence of\nwall thickening and pericholecystic stranding.\n\nPancreas: The pancreas is atrophic.  There is no evidence solid masses or\nductal dilation.  In the body of the pancreas, a 4 mm focus of hyperintense\nsignal on T2 weighted imaging is unchanged or slightly smaller than in ___\n(06:17).\n\nSpleen: Normal in size and appearance without focal lesions.\n\nAdrenal Glands: Normal in size and appearance.\n\nKidneys: Kidneys are symmetric in size with normal cortical medullary\ndifferentiation.  There is no hydronephrosis or perinephric abnormality. \nSeveral bilateral cortical nonenhancing foci demonstrate hyperintense signal\non T2 weighted sequences and hypointense signal on T1, measuring maximally 1.1\ncm in the upper pole of the right kidney, consistent with simple cysts.\n\nIn the midpole of the right kidney, a well-defined oval lesion with\nintermediate signal on T2 weighted imaging and iso to hyperintense signal on\nT1 weighted imaging with a tiny adjacent vessel peripherally and no internal\nenhancement, measuring 0.9 x 1.0 cm, unchanged from ___ (9:36, 11:36),\nlikely a proteinaceous cyst.  No restriction on diffusion-weighted imaging.\n\nIn the midpole of the left kidney is oval well-circumscribed lesion measuring\n2.0 x 2.0 x 2.0 cm, unchanged from ___.  It is predominantly cystic as\ndemonstrated by hyperintense signal on T2 weighted imaging and hypointense\nsignal on T1 weighted imaging precontrast.  An internal nodular\navidly-enhancing component along the medial aspect measuring 1.4 x 1.2 cm is\nstable since the ___ study (2:14, 6:21, 11:22).\n\nGastrointestinal Tract:  The stomach and visualized small intestine are\nnormal.  Diverticulosis is noted in colon.\n\nLymph Nodes:  A left periaortic retroperitoneal lymph node measures 9 mm in\nshort axis, unchanged from ___.  No retroperitoneal, mesenteric, or porta\nhepatis lymphadenopathy is present by size criteria.\n\nVasculature: The visualized aorta proximal mesenteric vasculature are patent.\n\nPelvis:  In the right adnexa, a 1.6 x 1.4 cm lesion demonstrating hyperintense\nsignal on T2 weighted imaging, unchanged from ___ (2:9).\n\nOsseous and Soft Tissue Structures:   Moderate compression deformity of the T9\nvertebral body is new since the prior MR in ___ and more prominent than on\nchest CT from ___ (02:16). Previously described rib fractures ___\nare not included within the study.  No concerning lesions suspicious for\nneoplasm are identified.",
            "output": "1. Overall stable size and appearance of complex left renal lesion since\n___, remaining concerning for renal cell carcinoma, likely clear cell type.\n2. Moderate compression deformity of the T9 vertebral body has slightly\nworsened since ___, and is new since the ___ study.\n3. 4 mm cystic lesion within the pancreatic body is unchanged, statistically\ndelete likely an IPMN.  No dedicated followup required.\n4. Cholelithiasis.\n5. Unchanged 1.6 cm benign-appearing right adnexal cyst.  This could be\nfollowed with a yearly pelvic ultrasound.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Lower Thorax: Limited evaluation of the lung bases are clear.  Cardiomegaly is\nincidentally noted.\n\nLiver:   Enlargement of caudate lobe and widening of periportal hilar space is\nconsistent with known cirrhosis.  Within segment II is a T2 hyperintense, T1\nhypointense, nonenhancing 7 mm focus consistent with a cyst or biliary\nhamartoma.  There is a 8 mm mildly T2 hyperintense, heterogeneously\nhypoenhancing focus with intravoxel fat in segment IVb just superior to the\ngallbladder fossa (3:24, 16:46 and 6:17), most compatible with focal fat\ndeposition, which could correspond to one of the previously identified\nechogenic foci on ultrasound, although it measures smaller today.  No other\nMRI correlates are identified.  There is no suspicious hepatic lesion.  No\nascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. \nCholedocholithiasis is agsin seen.  The gallbladder is unremarkable.\n\nPancreas: Stable subcentimeter cystic lesions in the pancreatic body and tail,\nlikely side-branch IPMNs, measuring up to 4 mm.  Pancreas is otherwise\nhomogeneous in signal intensity without suspicious mass.  No pancreatic duct\ndilatation.  No peripancreatic fat stranding.\n\nSpleen: Spleen is homogeneous in signal intensity and normal in size.  No\nsuspicious lesion.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Kidneys demonstrate normal signal intensities and are symmetric in\nsize.  There are multiple bilateral T2 hyperintense nonenhancing simple renal\ncysts.  There also two hemorrhagic cysts in the right kidney, the larger\nmeasuring 1.1 cm in the interpolar region (02:36 and 16:51).  Again noted\nwithin the interpolar region of the left kidney is a 2 cm round complex cystic\nand solid mass demonstrating avid hyperenhancement of the solid component\n(03:32, 02:30), concerning for a clear cell renal cell carcinoma.  There is no\ninterval so fat within this mass.  This mass has remained stable in size and\nappearance since studies dating back to ___.  No hydronephrosis.\n\nGastrointestinal Tract: No hiatal hernia.  The stomach is unremarkable. The\nvisualized small and large bowel are notable for colonic diverticulosis.  No\nobstruction.  The T2 bright simple-appearing 1.8 cm simple cyst within the\nright adnexa remains unchanged since ___ (02:27); this can be followed\nwith yearly pelvic ultrasound.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not pathologically\nenlarged.\n\nVasculature: There is conventional hepatic arterial anatomy. The portal and\nhepatic veins are patent. The aorta is normal in caliber. The major\nintra-abdominal aortic branches are normal in caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.  T9\nvertebral body compression deformity is again seen.  Soft tissues are\nunremarkable.",
            "output": "1. 8 mm focal fat in liver segment IVb may correspond to one of the echogenic\nlesions seen on US although it measures smaller today; otherwise no other MRI\ncorrelates are identified.  Therefore, short interval ultrasound follow-up of\nthe liver in 6 months is recommended.\n2. Stable size and appearance of the known 2 cm complex cystic and solid left\nrenal mass, with signal enhancement characteristics concerning for a clear\ncell renal cell carcinoma, compared to ___ MRI.\n3. Multiple bilateral simple renal cysts and right hemorrhagic cysts.\n4. Cholelithiasis.\n5. Stable 1.8 cm simple right adnexal cyst, unchanged since ___, can be\nfollowed with yearly pelvic ultrasound.\n6. Stable pancreatic cystic lesions measuring up to 4 mm likely represent\nsidebranch IPMNs.  No specific follow-up is indicated due to small size and\npatient's age.\n\nRECOMMENDATION(S):  Short interval ultrasound follow-up of the liver in 6\nmonths to re-evaluate multiple echogenic foci.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:41 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Lower Thorax: No pleural effusion.  Subsegmental atelectasis at the lung\nbases.\n\nLiver: The liver is again noted to be cirrhotic.  A 6 cm mass is seen at the\ndome of the liver in segment ___.  This mass demonstrates central necrosis and\nperipheral arterial hyperenhancement with washout consistent with HCC, OPTN\n5X.  In retrospect, this is difficult to see prior CTs, however previously\nmeasured 5.5 cm.  There are additional subcentimeter hypoenhancing satellite\nserpiginous lesions and nodules distal to the mass, in segment 7, either\nsatellite tumor or intravascular tumor.\n\nBiliary: There is moderate intra and extrahepatic biliary ductal dilatation up\nto the ampulla.  No choledocholithiasis is demonstrated..  Cholecystectomy\nchanges are redemonstrated.\n\nPancreas: The pancreas is difficult to evaluate due to motion.\n\nSpleen: Moderate splenomegaly is again seen\n\nAdrenal Glands: The adrenal glands appear unremarkable.\n\nKidneys: Bilateral renal cysts are present.\n\nGastrointestinal Tract:  Distal esophageal dilatation with reflux is again\nnoted a laparoscopic gastric band is redemonstrated.  There is no bowel\nobstruction in the upper abdomen.  Changes of colectomy and ileostomy are\nagain noted.  There is trace perihepatic ascites.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes visualized.\n\nVasculature: A TIPS is again noted from the right portal to the right hepatic\nvein.  The remaining portal vasculature appears patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are seen. \nModerate diffuse subcutaneous soft tissue edema may be due to third spacing.",
            "output": "1. Cirrhotic liver with 6 cm mass at the right hepatic dome in segment ___\nconcerning for hepatocellular carcinoma, OPTN 5 X and subcentimeter satellite\nlesions or intravascular thrombus in segment 7.\n2. Moderate biliary ductal dilatation up to the ampulla.  No\ncholedocholithiasis.\n3. Sequela of portal hypertension including portosystemic shunts, splenomegaly\nand trace ascites.\n4. Additional findings as above."
        },
        {
            "input": "Lower Thorax: The lung bases are clear.  No pleural or pericardial effusion. \nTiny enhancing nodule in the right lower lobe is unchanged compared to prior\nCT and likely represents scarring.\n\nLiver:\n\nCirrhotic hepatic parenchyma, nodular in contour and demonstrating peripheral\nreticular areas of progressive enhancement with capsular retraction indicating\nfibrotic changes.  Numerous siderotic/regenerative nodules are identified.\n\nThere are 2 radiofrequency ablation cavities in segment III of the liver. \nThese cavities demonstrate areas of increased T1 signal consistent with blood\nproducts, which is expected.  Adjacent to the more inferior 3.2 x 2.7 cm\n(1004:86) ablation zone along the falciform ligament there are some ill\ndefined areas of discontinuous arterial hyperenhancement predominantly\ninferiorly and anteriorly, most concerning of which is seen on series 1001\nimage 93.  Adjacent to the more superior 4.1 x 2.4 cm (1004:59) ablation zone\nthere are areas of peripheral hyperenhancement likely representing normal\npost-ablation changes.\n\nThere is a 0.9 cm arterial enhancing lesion in segment 2 of the liver\n(1001:44) which demonstrates possible central washout.  By size criteria alone\nthis does not meet OPTN criteria.\n\nMultiple other small sub centimeter arterial enhancing lesions, without\ndefinitive washout, some of which are more conspicuous today but do not need\nto meet OPTN criteria but are suspicious for ___.  Multiple small foci of\nwashout on delayed phase imaging, may represent changes from fibrosis and\nregenerative nodularity but cannot exclude multifocal HCC.\n\nNonspecific simple cystic structure in between the superior pole the right\nkidney and the inferior edge of the liver.\n\nTrace ascites.\n\nBiliary: Small gallstones identified.  No intra or extrahepatic biliary\ndilatation.  No gallbladder wall thickening or mass.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics.  There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics.  No focal lesions.\n\nKidneys: Multiple scattered small bilateral well-defined T2 hyperintense\nlesions, compatible with simple renal cysts and not significantly changed.  No\nhydronephrosis.  No concerning renal lesion.\n\nGastrointestinal Tract:  The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature:  Early recannulized umbilical vein noted.  Gastric varices are\nnoted.   Conventional hepatic arterial anatomy.  Normal caliber aorta and\nbranches.\n\nOsseous and Soft Tissue Structures: Partially visualized small fat containing\nmidline ventral hernia noted.",
            "output": "1.  Two post radiofrequency ablation sites in hepatic segment III.  The more\ninferior treatment zone along the falciform ligament demonstrates some nodular\nenhancement at the inferior anterior aspect, potentially suspicious though not\nmeeting OPTN criteria for ___.  Close attention on followup is suggested.\n2.  There are multiple hepatic subcentimeter arterial enhancing lesions\nwithout clear washout.  These are suspicious for ___ although none of which\nmeet CT criteria by size criteria alone.  There are also multiple small sub cm\nfoci on washout phase without clear correlate on other phases, which may\nrepresent changes from fibrosis and regenerative nodules.\n\nRECOMMENDATION(S):  Close interval follow-up of multiple\narterial-hyperenhancing foci to exclude multifocal HCC."
        },
        {
            "input": "Motion artifact substantially limits study.\n\nLower thorax: The lung bases are grossly clear.\n\nLiver:  The liver is heterogeneous and nodular in appearance, consistent with\ncirrhosis.  There are innumerable nodules, some of which are spontaneously\nbright, similar to prior.  There is no hepatic steatosis.  Patient is status\npost RFA to two segment III lesions in ___, both decreased in size\nand measuring 3.1 x 2.1 cm and 3.0 x 2.3 cm, compared with 4.1 x 2.4 cm and\n3.3 x 2.5 cm previously (1504:56, 81).   Again seen is intrinsic T1\nhyperintensity of the RFA sites, consistent with coagulation necrosis, with no\npersistent hyper enhancement to suggest recurrent disease.  Peripheral\nhyperenhancement adjacent to the more superior ablation zone is similar to\nprior, and is likely perfusional in nature (1501:37).  Previously seen areas\nof arterial hyperenhancement adjacent to the more inferior ablation zone is no\nlonger visualized.\nAgain seen is a 0.9 cm T1 hyperdense lesion in segment 2 of the liver,\nunchanged (13:25).  Numerous scattered foci of washout on delayed phase\nimaging without correlate on other sequences are similar to prior, and may\nrepresent fibrotic changes.  There is trace ascites.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  There are\nsmall gallstones (4:15, 7:35).  There is no gallbladder wall thickening or\npericholecystic fluid.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is normal in size, measuring 10 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys:  Again seen is a 1.5 cm cystic lesion between the upper pole of the\nright kidney and the liver (4:35).  There are multiple additional\nsubcentimeter T2 hyperintense, T1 hypointense, non enhancing lesions at the\nbilateral kidneys, consistent with simple renal cysts.  There is a hemorrhagic\ncyst in the right kidney.  The kidneys otherwise enhance and excrete\nsymmetrically without suspicious lesions or hydronephrosis.\n\nBowel:  Partially imaged loops of small and large bowel are unremarkable.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.  Hepatic arterial\nanatomy is conventional.  There is a recannulized umbilical vein.  There is an\naccessory left renal artery.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.",
            "output": "1. Study is substantially limited by motion.  Within this limitation, there is\nno evidence of residual tumor at prior segment III RFA sites.  No new hepatic\nlesions meeting OPTN criteria for HCC.\n2. Cirrhosis with trace ascites.\n3. Cholelithiasis with no evidence of acute cholecystitis."
        },
        {
            "input": "Motion artifact degrades the quality of the study.\n\nLower Thorax: The lung bases are clear.  No pleural or pericardial effusion. \nBilateral gynecomastia is noted.\n\nLiver:  The liver is nodular in keeping with the known history of cirrhosis. \nMultiple nodules demonstrate intrinsic high signal on the T1 weighted images. \nThe RFA sites in segment 3 measure 17 x 23 mm and 28 x 20 mm and demonstrate\nhigh signal on the T1 weighted images in keeping with coagulation necrosis\n(___).  No central enhancement to suggest recurrent/residual\ndisease.  Although the study is limited by motion artifact, no definite new\nlesions meeting OPTN 5A criteria for ___.  Scattered foci of arterial\nhyperenhancement without washout or T2 correlate are most in keeping with\ntransient hepatic intensity differences.  There is a small amount of ascites.\n\nBiliary: No intra- or extra-hepatic duct dilatation.  The common bile duct is\nwithin normal limits.  There is cholelithiasis.  Pericholecystic fluid is\nlikely related to chronic liver disease.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern.  There is a 2 mm cyst in the\ntail (10:21) which was difficult to see on the prior exam due to motion\nartifact.  Statistically, this lesion is most in keeping with a side-branch\nIPMN.  No nodularity or ductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics.  There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics.  No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics.  The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images.  Bilateral millimetric cysts are again\nnoted.  6 and 7 mm hemorrhagic cysts in the right kidney are unchanged\ncompared to the prior exam.  There are no concerning solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract:  The GI tract is of normal caliber throughout. No\nmural thickening or abnormal enhancement.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: No definite esophageal varices.  The visualized abdominal aorta\nand proximal mesenteric vessels appear patent without any significant areas of\nnarrowing or dilatation.  Conventional hepatic arterial anatomy.  The portal\nand hepatic veins are patent.  An accessory left renal artery is noted.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics.  No concerning osseous lesions.  Posterior to the upper pole\nof the right kidney, there is a well-defined cystic lesion measuring 11 x 12\nmm which may represent a duplication cyst.",
            "output": "1. Limited study due to motion artifact.  No evidence of recurrent/residual\ndisease at the prior segment 3 RFA sites.  No new lesions meeting OPTN 5\ncriteria for ___.\n2.  Cirrhosis with trace ascites.\n3.  Cholelithiasis\n4.  There is a 2 mm cyst in the tail (10:21) which was difficult to see on the\nprior exam due to motion artifact. Statistically, this lesion is most in\nkeeping with a side-branch IPMN.  No concerning features.  This lesion can be\nassessed at the time of further follow-up imaging for the liver."
        },
        {
            "input": "Lower Thorax: The lower lungs are clear without pleural or pericardial\neffusion.\n\nLiver: A moderate amount of perihepatic ascites is increased from ___.\nHepatic contour is nodular in keeping with history of cirrhosis. Reticular\npattern of enhancement suggests mild fibrosis accentuated by motion. There is\nno significant hepatic steatosis (fat fraction less than 2%). Numerous nodules\ndemonstrate hyperintense signal on T1 weighted imaging consistent with iron\ndeposition.  No new focal lesions meeting OPTN criteria for HCC.\n\nRFA treatment sites in hepatic segment III measure 2.7 x 2.0 cm, stable from\n___, and 2.4 x 1.3 cm near the porta hepatis, slightly smaller than in ___\nwhen it measured 2.3 x 1.7 cm (1302:73, 1302:53).  Both areas demonstrate\nhyperintense signal on T1 weighted imaging consistent with coagulation\nnecrosis and no abnormal hyperenhancement to suggest recurrent disease.\n\nBiliary: The gallbladder contains stones.  No intraductal stones are seen. \nTop normal common hepatic and common bile ducts measure 6 and 8 mm,\nrespectively, stable from ___.  Trace pericholecystic fluid is stable from\n___, likely due to underlying liver disease.\n\nPancreas: Parenchyma is normal in signal without focal lesions ductal\ndilation.\n\nSpleen:  A small amount perisplenic ascites is increased from ___.  The\nspleen measures 10.8 cm, normal in size and appearance without focal lesions.\n\nAdrenal Glands: Normal in size and appearance.\n\nKidneys: Subcentimeter foci demonstrate hyperintense signal on T1 weighted\nimaging in the right renal cortex consistent with hemorrhagic or proteinaceous\ncysts (11:110, 11:88).  A 3 mm focus demonstrating hyperintense signal on T2\nweighted imaging in the cortex of the left kidney is consistent with a simple\ncyst.  No solid masses, hydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract:  The stomach is normal.  Visualized loops of small and\nlarge intestine demonstrates normal caliber and wall thickness.\n\nLymph Nodes: No retroperitoneal, mesenteric, or porta hepatis lymphadenopathy\nby size criteria.\n\nVasculature: The visualized aorta is normal in caliber.  Hepatic arterial\nvasculature is conventional.  The celiac axis, SMA, portal vein, and hepatic\nveins are patent.  No evidence of varices.\n\nOsseous and Soft Tissue Structures: Cyst in Morison's pouch measures 1.4 x 1.2\ncm, stable from ___ (7:20).  No concerning lesion for neoplasm.",
            "output": "1. Cirrhotic liver with fibrosis and multiple siderotic nodules. No lesions\nmeeting OPTN-5 criteria for HCC.\n2. Post hepatic segment III RFA x 2 without evidence of residual or recurrent\ndisease.\n3. Moderate ascites increased from ___.  No splenomegaly.\n4. Patent vasculature.\n5. Cholelithiasis."
        },
        {
            "input": "Lower Thorax: There is a right lower lobe opacity that is better characterized\non the recent CT of the chest.  This is compatible with pneumonia.  Within the\nlimitations of MRI, the lung bases are otherwise clear. There is no pleural\neffusion.  The base of the heart is normal in size.  There is no pericardial\neffusion.\n\nLiver: The liver has a nodular contour, compatible with cirrhosis.  There is\nno background hepatic steatosis.  In segment ___, there is a rim enhancing 28\nx 25 x 21 mm lesion which corresponds to the abnormality seen on CT.  The\ndominant rim in the lesion is slightly hyperintense on the T2 weighted images.\nIt demonstrates arterial hyperenhancement that persists on the delayed phases.\nWithin the lateral aspect of the rim, there is a 8 mm more nodular focus of\narterial hyperenhancement that appears to washout on the delayed phases (1401,\n26 and 1403, 36).  The central portion of the lesion is nonenhancing.  There\nis no restricted diffusion.  The signal on the T2 weighted images centrally is\nintermediate to hypointense.  The entire lesion is hypointense on the\npre-contrast T1-weighted images.\n\nThere are two sub-5 mm foci of arterial hyperenhancement in the periphery of\nthe liver in segment 4A (1401, 29) and in segment 7 (1401, 27).  They have no\ncorrelate on other sequences.  These are most likely are transient hepatic\nintensity differences.  No other liver lesions are identified.\n\nThe hepatic arterial anatomy is conventional.  The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  In the body\nof the gallbladder, there is a 3 mm enhancing focus, most compatible with a\npolyp (8, 27).  A polyp of this size requires no specific follow up.  No\nstones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 12.3 cm.  There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  There are multiple simple cysts\nbilaterally, measuring up to 21 mm.  There are no worrisome renal lesions,\nhydronephrosis, or perinephric abnormalities.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is no ascites.\n\nLymph Nodes: There are no concerning osseous lesions.  Mild-to-moderate\nmultilevel degenerative changes are noted throughout the spine.  The soft\ntissues are unremarkable.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.  Incidentally noted is a\ncircumaortic left renal vein.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild-to-moderate degenerative changes are noted throughout the spine.  The\nsoft tissues are unremarkable.",
            "output": "1.  Indeterminate liver lesion in segment ___, as described above.  There are\nno classic features for either hepatocellular carcinoma or infection.  The\narea of washout in the rim and the lack of diffusion weighted images argues\nagainst infection.  The nonenhancing portion of the lesion may represent\nhemorrhage.  Alternately, it could be a partially treated abscess/phlegmon. \nBiopsy is recommended.\n2.  Cirrhotic liver.  No evidence of portal hypertension.\n3.  Tiny gallbladder polyp, which requires no specific follow-up.\n4.  Right lower lobe pneumonia, which as better characterized on the recent CT\nthe chest.\n\nRECOMMENDATION(S):  Biopsy of the indeterminate liver lesion, as above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:48 AM, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lower thorax: Included lower thorax demonstrates no abnormal masses aside for\nlinear atelectasis at the lung bases.  No pericardial or pleural effusion.\n\nLiver: The liver demonstrates homogeneous signal intensity.  No suspicious\nliver masses.  A subcentimeter simple hepatic cyst is noted.\n\nBiliary: Gallbladder is normal in appearance.  No intrahepatic or extrahepatic\nbiliary dilation.\n\nPancreas: Pancreas demonstrates normal T1 signal intensity.  No focal masses. \nMain pancreatic duct is normal in caliber.\n\nSpleen: Normal spleen size without focal masses.\n\nAdrenal Glands: Right adrenal gland is normal in appearance.  Re-demonstrated\nwithin the left adrenal gland is a circumscribed 2.5 x 2.3 x 2.1 cm nodule\ndemonstrating intralesional foci of signal dropout on out of phase imaging\ncompatible with an adrenal myelolipoma (04:24, 06:53).\n\nKidneys: The kidneys are normal and symmetric in size.  No hydronephrosis.  No\nabnormal renal masses.\n\nGastrointestinal Tract:  Bowel loops are normal in caliber.  No bowel\nobstruction.\n\nPelvis: Included portion of the upper pelvis demonstrates no acute\nabnormalities.\n\nLymph Nodes: No retroperitoneal or abdominal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No abnormal body wall soft tissue masses\nor aggressive osseous lesions.",
            "output": "1. 2.5 cm left adrenal myelolipoma.  Of note the lesion is stable in size and\nFDG avidity dating back to ___.\n2. No abdominal lymphadenopathy."
        },
        {
            "input": "Liver: The patient is status post liver transplant.  There is a segment V 1.1\ncm focus of arterial hyperintensity without correlate on subsequent sequences,\npossibly perfusion (___).  There are two unchanged, 3 mm hypoenhancing\nlesions without T2 correlate on the right (___) and on the left (___). No\nhepatic steatosis.  No fluid collection, abnormal enhancement or edema.\n\nBiliary: No biliary ductal dilatation.  The gallbladder is surgically absent.\n\nPancreas: There are multiple T2 hyperintense, well-circumscribed lesions\nthroughout the pancreas, likely representing side branch IPMNs.  No main\nductal dilatation.\n\nSpleen: Splenomegaly, measuring 21.0 cm.\n\nAdrenal Glands: The bilateral adrenal glands are unremarkable.\n\nKidneys: Unremarkable aside for multiple cysts.\n\nGastrointestinal Tract:  No ascites or obstruction.\n\nLymph Nodes: No upper abdominal lymphadenopathy.\n\nVasculature: Again seen is mild varicose dilatation of the central right and\nleft portal veins.  The portal veins are patent.  Stable narrowing of the\narterial vasculature at the anastomosis (___). The hepatic arterial and\nvenous vasculature is otherwise patent.  Stable multiple perisplenic and\nperigastric varices.  Stable collateral vessels along the chest wall.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.",
            "output": "1. The patient is status post liver transplant.  No biliary obstruction, fluid\ncollection, abnormal enhancement or edema.\n2. Multiple pancreatic cystic lesions, likely representing side-branch\nintraductal papillary mucinous neoplasms, as on prior.  Recommend attention on\npresumed interval follow-up imaging or follow-up MRI in ___ year."
        },
        {
            "input": "Linear atelectasis are seen in the lung bases.  There is no pleural or\npericardial effusion.\n\nThe transplant liver demonstrates homogeneous signal intensity on T1 and T2\nweighted images, and on DWI.  There is somewhat heterogeneous arterial\nenhancement of the hepatic parenchyma, which normalizes on later phases. \nThere is no evidence of hepatic necrosis.  The hepatic artery appears kinked\njust below the caudate lobe (10:44), with normal distal filling, an appearance\nunchanged from prior imaging.  Portal and hepatic veins are patent.\n\nThe spleen is enlarged, measuring 19 cm in craniocaudal dimension.\n\nCortical renal cysts present.\nThe pancreas is not in size signal, without ductal dilatation.  1.6 cm cluster\nof cystic pancreatic lesion (07:26) is similar compared to ___.\n\nThere is trace amount of perihepatic free fluid.\nNo concerning retroperitoneal or mesenteric lymphadenopathy is seen.\nThe bone marrow signal is normal.",
            "output": "1.  Transplant liver, with splenomegaly; no evidence of liver necrosis.\n2.  Unchanged kinking morphology of the hepatic artery, with normal distal\nfilling.\n3.  Clustered pancreatic cystic lesions, similar compared to ___,\nlikely side branch IPMNs.\n\nRECOMMENDATION(S):  Followup of pancreatic cystic lesions by MRCP in one year."
        },
        {
            "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs: There are bilateral renal cysts measuring up to 2.3 cm in the\nright kidney.  The spleen measures 8 cm and is low in T2 signal, compatible\nwith history sickle cell.  The solid organs including the liver, gallbladder, \npancreas, and adrenals are within normal limits.  No hydronephrosis.  No\nevidence of intra or extrahepatic biliary dilatation.\n\nGastrointestinal Tract:  The visualized small and large bowel loops are normal\nin caliber.  The appendix is not definitively visualized, however there is a\ncandidate for the appendix seen medial to the pedunculated fibroid which is\nnormal in appearance however cannot be followed completely to confirm it is\nblind ending (5:48).\n\nPelvis: There is a fibroid uterus, the largest fibroid a 7.9 x 7.8 x 8.3 cm\nright pedunculated fibroid (5:50; 4:14).  The uterus is gravid with the fetus\nin cephalic position with a posterior placenta.  The cervix measures 6.5 cm in\nlength.  The internal os measures 2.5 cm and has a funneled appearance,\nconcerning for cervical incompetence (6:38).  The bilateral ovaries are\nnormal.  Just superior to the right ovary and inferior to the pedunculated\nfibroid in the right anterior lower quadrant, there is a small amount of\nstranding and trace edema which can be seen in relation to the ovary in\npregnancy (5:60; 7:60).  There is no edema in the ovary itself to indicate\ntorsion or any other acute abnormality.  The urinary bladder is normally\ndistended with normal wall thickness.\n\nVasculature: The vasculature including the gonadal veins demonstrates normal\nsignal on time-of-flight.\n\nLymph Nodes: No significant lymphadenopathy.\n\nOsseous and Soft Tissue Structures: Status post bilateral hip arthroplasty,\nwith hardware slightly limiting evaluation of the low pelvis.  There is drop\nin signal on inphase imaging compared out of phase imaging in the bone marrow\nsuggestive iron disposition and compatible with history sickle cell anemia. \nNo concerning osseous lesions.",
            "output": "1. No acute process in the abdomen or pelvis.\n2. The appendix is not definitively visualized, however a likely candidate for\nthe appendix is identified and is normal in appearance.\n3. Appearance of the cervix suggestive of cervical incompetence.\n4. Fibroid uterus including a 8.3 cm right pedunculated fibroid, a potential\nsource of right-sided pain.\n5. Findings compatible with history of sickle cell anemia.\n\nNOTIFICATION:  The additional findings of cervical incompetence which was not\nincluded in the wet read was discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 8:42 am, 1 minutes after discovery of the findings."
        },
        {
            "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear.  There\nis no pleural effusion.  The base of the heart is normal in size\n\nLiver: The patient is status post a trisegmentectomy of the liver.  Along the\nupper aspect of the surgical margin, there is a 22 x 14 mm nonenhancing focus,\nwhich is heterogeneous signal on the T2 weighted images and slightly high\nsignal on the precontrast T1 weighted images.  This likely represents a\nresolving hematoma.  The known fiducial at the margin is not well seen by MRI.\nThere is trace ill-defined fluid in the fat of the right upper quadrant, which\nis likely reactive.\n\nIrregularity along the resection margin is noted, and of uncertain etiology. \nIt is most likely post-surgical changes, so tumor recurrence cannot be\ncompletely excluded.\n\nIn segment 3, there is a 29 x 20 mm lobulated lesion (14, 43) which is\nslightly high signal on the T2 weighted images, contains no fat or hemorrhage,\nand demonstrates rim enhancement.  There is also enhancement within the\ncentral aspect of the lesion that increases on the delayed phases.  There is\nrestricted diffusion.  This is most consistent with a cholangiocarcinoma\nmetastasis.  This is increased in size since the prior exam from ___.  Just inferior and left of this lesion is a similar 18 x 16 mm lesion\n(4, 48), which is also most compatible with a metastasis.  This is new from\nthe prior exam from ___.  Finally, along the right border of\nsegment 3, there is a 17 x 12 mm lesion (14, 55), which is also suspicious.\n\nNo other lesions are identified.  The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  The\ngallbladder is surgically absent.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously.  There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 11.8 cm.  There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  Several subcentimeter cysts are\nnoted bilaterally.  There are no worrisome renal lesions, hydronephrosis, or\nperinephric abnormalities.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal other than scattered diverticula.  There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nPostsurgical changes are noted in the anterior abdominal wall.  There is no\nfluid collection or hernia.  The soft tissues are otherwise unremarkable.",
            "output": "1.  Three discrete lesions in the left hepatic lobe are highly suspicious for\ncholangiocarcinoma metastases, as described above.\n2.  Irregularity along the surgical margin is most likely post-surgical,\nthough peritoneal tumor recurrence at the surgical site cannot be completely\nexcluded.  Continued attention on follow-up exams is recommended."
        },
        {
            "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear.  The\nbase of the heart is normal in size.  There is no pericardial effusion.\n\nLiver: The patient is status post a trisegmentectomy.  There is compensatory\nhypertrophy of the left lobe.  There is no background hepatic steatosis. \nOverall, the configuration of the liver is not significantly changed from the\nprior exam.  The previously identified resolving hematoma along the resection\nbed is similar in size, measuring 14 mm (8, 24).  There is minimal linear\nenhancement along the resection margin, which likely represents postsurgical\nchanges.\n\nThe previously identified metastases have decreased in size.  In segment 3,\nthere is a 17 x 15 mm rim enhancing lesion (11, 42), which previously measured\n29 x 20 mm.  Just lateral to this lesion is a 18 x 14 mm lesion, which is also\ndecreased in size.  It previously measured 18 x 16 mm.  Finally, along the\nright border of segment 3, there is a 7 x 6 mm lesion (10, 52), which\npreviously measured 17 x 12 mm.  No new lesions are identified.\n\nThe portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  The\ngallbladder is surgically absent.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously.  There is no duct dilation or mass.\n\nSpleen: The spleen size is at the upper limits of normal, measuring 13 cm. \nThere are no focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size.  There are few subcentimeter simple\ncysts.  There are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is no ascites.\n\nLymph Nodes: A few scattered subcentimeter perihepatic and retroperitoneal\nlymph nodes are noted, though none meet size criteria for pathologic\nenlargement or have worrisome morphologies.  There is no mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nA 10 mm T2 hyperintense lesion in the sacrum is most compatible with a\nhemangioma.  Postsurgical changes are noted in the anterior abdominal wall. \nThere is no fluid collection or hernia.  The soft tissues are otherwise\nunremarkable.",
            "output": "Interval decrease in size of the three hepatic metastases, as described above.\nNo new metastases are identified.  No evidence of other metastatic disease in\nthe upper abdomen."
        },
        {
            "input": "Lower Thorax: The heart is normal in size.  There are no pleural or\npericardial effusions.\n\nLiver: There are postsurgical changes of trisegmentectomy of the right hepatic\nlobe, with compensatory hypertrophy of the left hepatic lobe.  There is no\nevidence of hepatic steatosis.  The patient is status post radiofrequency\nablation of two metastatic lesions in segment III of the left hepatic lobe on\n___.  An irregularly marginated, confluent area of nonenhancement in\nthe lateral aspect of segment III is in keeping with coagulative necrosis, and\nthere is no suspicious enhancement in this area.  An approximately 0.8 x 0.4\ncm rim enhancing lesion at the medial aspect of the left hepatic lobe adjacent\nto the resection margin (series 10, image 65), is about the same in size\n(previously 0.7 x 0.6 cm), and is again most compatible with a small\nmetastasis.  The main portal, left portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is within normal limits.  There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: The adrenal glands are within normal limits.  No focal nodules\nare seen.\n\nKidneys: There are tiny cortical cysts in the bilateral kidneys.\n\nGastrointestinal Tract:  There are no dilated bowel loops within the\nvisualized upper abdomen.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and mesenteric branch vessels are normal in\ncaliber and patent.\n\nOsseous and Soft Tissue Structures: The bone marrow signal is normal.  There\nare incisional changes of the anterior abdominal wall.",
            "output": "1.  Interval radiofrequency ablation of two segment III metastases without\nevidence of residual viable tumor.\n2.  0.8 x 0.4 cm suspected metastasis at the right edge of the remnant liver,\nadjacent to the resection margin, is unchanged in size since the ___\nstudy.\n3.  No new hepatic lesion."
        },
        {
            "input": "Lower Thorax: Lung bases are within normal limits.  No pleural or pericardial\neffusion.\n\nLiver: Postsurgical changes are seen status post trisegmentectomy and multiple\nradiofrequency ablations.  At the inferior margin of hepatic segment III,\nthere are several new progressively peripherally enhancing lesions, most\nlikely representing cholangiocarcinoma metastases.  These are all in close\nproximity to each other, with the largest measuring approximately 2 cm.  Some\nof these were present on prior CT from ___, measuring up to 0.8 cm. \nAdditional is smaller metastases are seen on image images 47 and 40 of series\n16.  Hepatic vasculature is patent.\n\nBiliary: No biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable aside for a stable small left renal\ncyst.\n\nGastrointestinal Tract:  No bowel obstruction or ascites.  Previous fluid\ncollections subjacent to the stomach is no longer seen.\n\nLymph Nodes: No upper abdominal adenopathy.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions.  Extensive\npostsurgical changes are seen along the anterior abdominal wall.",
            "output": "Interval progression of disease manifested as several new and enlarging\nhepatic metastases as above."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The patient is status post right trisegmentectomy.  Three hypovascular\nablation beds in segment 3 (series 100, image 78, 90) do not demonstrate\nsuspicious internal enhancement.\n\nThere has been interval decrease in tumor burden at the site of prior disease\nseen at the inferior aspect of segment 3.\n\nThere are several new or significantly increased T2 hyperintense, hypovascular\nmasses scattered throughout the remaining liver, concerning for metastatic\ncholangiocarcinoma.  For example, a 10 mm enhancing mass in segment 3 (series\n200, image 77) is new from prior examination.  A 4.0 x 3.5 cm hypovascular\nmass with internal enhancement in segment 2 (series 200, image 67) previously\nmeasured 0.4 cm.  Numerous additional hypovascular masses measuring up to 3.3\ncm (series 200, image 28, 41, 58, 82) are also concerning for metastatic\ndisease.\n\nThere is extensive confluent fibrosis in the periphery of segment 3.\n\nBiliary: There is new mild multifocal intrahepatic biliary ductal dilatation\nlikely secondary to the intrahepatic masses described above.  The gallbladder\nis surgically absent.\n\nPancreas: The pancreas is normal in size and signal intensity.  There is no\nmain pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable, bilaterally.\n\nKidneys: There is no suspicious renal mass or hydronephrosis.\n\nGastrointestinal Tract:  The stomach and visualized loops of small and large\nbowel are unremarkable.\n\nLymph Nodes: Prominent retroperitoneal lymph nodes do not meet CT size\ncriteria for lymphadenopathy.\n\nVasculature: The patient is status post right portal vein embolization.\n\nOsseous and Soft Tissue Structures: There is no evidence of osseous malignancy\nor infection.",
            "output": "1.  Evidence of treatment response at the site of Y-90.\n2.  Numerous new large hepatic lesions concerning for metastatic\ncholangiocarcinoma.\n3.  Mild new intrahepatic biliary ductal dilatation due to obstructing central\nmasses."
        },
        {
            "input": "Cervix and nondistended vagina: There is a 5.9 x 5.3 x 7.1 cm heterogeneously\nenhancing mildly T2 hyperintense mass originating from the cervix with\nsuperior component extending into the lower and mid uterine body and inferior\ncomponent extending into the upper third of the anterior vaginal wall.  No\ninvolvement of the mid or lower third of the vagina.  There is parametrial\nextension of the tumor along its posterior and bilateral lateral borders (8 mm\non left and 10 mm on right) (10:15).  The tumor abuts the distal right ureter\n(10:15) without right-sided hydroureter or hydronephrosis or direct\ninvolvement.  Adhesions are noted extending from the posterior aspect of the\ncervix to the anterior rectal wall without tumor extension (___).  There is\nthickening of the left round ligament (10:9) without definite tumor\ninvolvement.\n\nThe uterus is anteverted and measures 4.2 x 10.5 x 4.4 cm.  A 0.8 cm T2\nhypointense lesion along the right posterolateral uterine body is consistent\nwith a uterine fibroid.  (05:16).  The residual endometrium is normal in\nthickness for age and measures 5.The residual junctional zone is not\nthickened.\n\nThe right ovary is visualized and appears within normal limits with\nphysiologic follicular cysts.\nThe left ovary is visualized with a subtle 1.7 x 1.1 cm T2 hypointense\nheterogeneously enhancing area which may (series 1202, image ___ which may\nrepresent an ovarian primary, or implant, however given location differential\nincludes distal fallopian tube (10:9).  This represents the general area of\nFDG avidity on the radioscintigraphy examination from ___.\n\nTrace pelvic free fluid is within physiologic limits.\n\nLYMPH NODES: There are abnormally enlarged bilateral external iliac lymph\nnodes measuring 1.5 cm on the right and 1.3 cm on the left.  (10:12, 9). \nAdditionally, there is an abnormal left internal iliac lymph nodes which\nmeasures 0.6 cm in short axis and although does not meet size criteria for\nenlargement demonstrates heterogeneous enhancement worrisome for disease\ninvolvement.  (10:7).\n\nBLADDER AND DISTAL URETERS: Bladder and distal ureters are unremarkable.\n\nRECTUM AND INTRAPELVIC BOWEL: Rectum is notable for adhesions extending from\nthe posterior cervix to the anterior rectal wall without tumor extension. \nSigmoid diverticulosis noted without evidence of acute diverticulitis. \nVisualized small and large bowel are otherwise unremarkable.\n\nVASCULATURE: Patent vasculature.  No aneurysmal dilatation.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No suspicious osseous lesions.  Again\nnoted is disc protrusion at L4-L5 which is partially imaged.  Soft tissues are\nunremarkable.",
            "output": "1.  7.1 cm cervical mass with parametrial, lower/mid uterine, and anterior\nvaginal wall extension with bilateral external iliac lymphadenopathy and\nsuspicious left internal iliac lymph node.  Tumor abuts the right ureter\nwithout hydroureter or hydronephrosis.  FIGO stage at least T2b.\n2.  1.7 cm left ovarian lesion may represent an ovarian primary or tumor\nimplant, however given its location the distal fallopian tube abutting the\novary could be similar in appearance."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: Redemonstration of diffusely decreased T2 signal intensity throughout\nthe liver.\n\nIron level:  215 Micromol/g (severe overload), ___ Micromol/g in ___.\n\nNo focal concerning lesions. The portal veins and hepatic veins appear patent.\nHepatic arterial anatomy is conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is normal.\n\nPANCREAS: The pancreas normal in signal intensity and enhancement.  No focal\nconcerning lesions or pancreatic duct dilatation. No evidence of\nperipancreatic inflammation.\n\nSPLEEN: The spleen is normal size.  No focal concerning lesions.  Diffuse\nsiderosis is again noted.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThere are a few subcentimeter simple cyst in the right kidney.  No concerning\nlesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.\n\nBONES: No concerning osseous lesion.  Diffusely decreased T2 signal intensity\nthroughout imaged osseous structures is again noted, compatible with\nsiderosis.\n\nSOFT TISSUES: No concerning soft tissue lesions.",
            "output": "Siderosis involving the liver, spleen and bones with interval increase of\nsevere liver iron overload."
        },
        {
            "input": "Lower Thorax: The lung bases are clear.  There is no pericardial pleural\neffusion.  The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There is a large blooming artifact from a metallic CBD\nstent, obscuring the central liver. Within this limitation. No focal hepatic\nlesion is detected. Specifically, a subcentimeter hypodensity along the\nperiphery of the right hepatic lobe seen on the CT examination from ___ does not demonstrate an MRI correlate.  No focus of restricted diffusion\nis identified.\n\nBiliary: There is no intra or extrahepatic bile duct dilation.  The\ngallbladder is decompressed, and appears normal.\n\nPancreas: There is moderate dilation of the main pancreatic duct, which\nmeasures up to 9 mm (series 5, image 23), unchanged since the CT from ___.  A known pancreatic head mass is not well evaluated on MR due to\nthe blooming artifact from the adjacent CBD stent.\n\nSpleen: The spleen size is within normal limits.  There are no focal splenic\nlesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  A well-circumscribed 7 mm cyst is seen arising from the upper\npole of the right kidney (series 5, image 22, series 1102 image 64).  No\nconcerning renal lesion is identified.\n\nGastrointestinal Tract:  The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber.  There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy, and no\nascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber.  The visualized portions of the portal and\nhepatic veins are patent.  The portal SMV confluence is not evaluated due to\nsusceptibility artifacts from the adjacent CBD stent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.",
            "output": "1. No abdominal metastasis or lymphadenopathy.\n2. No MRI correlate seen for the subcentimeter focal hypodensity on the right\nhepatic lobe from the ___ CT.\n3. Known pancreatic head mass is not visualized due to susceptibility artifact\nfrom adjacent metallic CBD stent.  Moderate dilation of the main pancreatic\nduct, to 9 mm, is unchanged."
        },
        {
            "input": "The liver is visualized and is irregular and nodular in\noutline, consistent with patient's known diagnosis of hepatitis C cirrhosis.\nPost-administration of contrast, an arterially enhancing lesion is identified\nmeasuring 7 mm (series 8, image 28).  This was not seen on the previous MRI.\n\nA second lesion is seen in segment III and measures 7 mm in maximum diameter.\nThis demonstrates enhancement on the arterial phase.  It is best seen on\nseries 8, image 56. This lesion was identified on the previous MR and is\nunchanged. There are multiple other tiny less focal areas that demonstrate\nenhancement on the arterial phase.\n\nThe spleen is enlarged at 15.6 cm.  The gallbladder is visualized and is\nnormal.  No evidence of intra- or extra-hepatic bile duct dilatation.  The\nadrenals are normal.\n\nSome subcentimeter cysts are seen in the kidneys bilaterally.\n\nThe pancreas is visualized and is normal.\n\nMultiple enlarged lymph nodes are identified in the region of the porta\nhepatis and the peripancreatic area.  The largest of these measures 2.9 cm and\nis best seen on series 9, image 48.\n\nNo evidence of any free fluid.  The bowel where visualized is normal.  The\nosseous structures visualized are normal.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.",
            "output": "1.  Two discrete subcentimeter and arterially enhancing lesions in the liver,\none of which is seen in segment III (series 8, image 56), measures 7 mm and is\nunchanged, the second lesion which is new measures 7 mm (series 8, image 28)\nand is in segment VIII. Continue follow up imaging with MR is recommended.\n2.  Cirrhotic liver.  Splenomegaly.\n3.  Retroperitoneal lymph nodes, which are unchanged.\n4.  Renal cysts."
        },
        {
            "input": "Lower thorax: There are small bilateral pleural effusions, left greater than\nright, and adjacent atelectasis at the lung bases, as seen on recent CTA\nchest.\n\nLiver: The liver is nodular in contour and has a mottled appearance with\nhypertrophy of the caudate lobe.  There is patchy severe fatty deposition in\nthe liver with a fat fraction measuring up to 44 % in the caudate lobe where\nit is most severe.  There is heterogeneous enhancement of the liver\nperipherally.  No suspicious focal liver lesion identified.  There is large\nvolume ascites.\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  The\ngallbladder is distended without wall thickening or cholelithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: There are edematous loops of bowel, similar to recent CT and likely due\nto third spacing.  There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  Hepatic arterial anatomy is conventional.  The portal vein, splenic\nvein and SMV are patent.  The hepatic veins are compressed and narrowed,\nhowever remain patent.  There is a circumaortic left renal vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.  There is diffuse anasarca.",
            "output": "1. Cirrhotic appearance of the liver with patchy areas of severe steatosis and\nperipheral enhancement which may represent confluent fibrosis, of uncertain\netiology, however parenchymal storage diseases are in the differential given\npatient's young age and severe hepatic fat deposition.\n2. The hepatic veins are narrowed however remain patent, with no evidence of\nBudd Chiari.\n3. Large volume ascites, bilateral pleural effusions, and diffuse anasarca."
        },
        {
            "input": "The liver is shrunken and irregular in outline\nconsistent with patient's known cirrhosis.  Note is made of ascites.  The\nspleen is enlarged at 16 cm.  Note is made of paraesophageal varices. No gross\nliver lesions identified.  However, non-gadolinium study is not optimal for\nevaluating focal liver lesions.\n\nThe adrenals are normal.  The right kidney is unremarkable.  A large cyst is\nseen protruding from the lower pole of the left kidney and measures 6.4 cm.\nThe pancreas is unremarkable.  No evidence of any significant lymphadenopathy.\nNote is made of a filter in the IVC.\n\nTime-of-flight imaging and phase-contrast was performed to evaluate\nthe patency of the SMV.  The SMV is patent throughout its length.  Note is\nalso made of a non-patent portal vein.  There is noted to be chronic occlusion\nof the portal vein when compared with previous imaging and perhaps slight\nnonocclusive filling defect at the confluence of the splenic and superior\nmesenteric veins (unchanged since prior CTs).\n\n2D and 3D reformations provided multiple perspectives for the series.",
            "output": "1.  Patent SMV and chronically occluded/obliterated portal vein in patient\nwith cirrhosis, ascites, and splenomegaly.\n2.  Limited evaluation of the liver reveals no focal lesion."
        },
        {
            "input": "Development of large layering right pleural effusion.\n\nStable heterogeneous liver compatible with known cirrhosis.  No focal liver\nabnormalities identified.  Patchy areas of signal dropout on out-of-phase\nimaging indicate hepatic steatosis, a new finding from prior exam.  The liver\nis markedly displaced to the midline, due to massive ascites. No intrahepatic\nor extrahepatic biliary ductal dilatation.  Stable splenomegaly measuring 16\ncm. Stable hyperenhancement at the posterosuperior subcapsular spleen, likely\nvarix.\nMultiple perisplenic, retroperitoneal, and paraesophageal varices are noted.  \n\nMain portal vein occlusion/obliteration is chronic.  Stable cavernous\ntransformation.  There is non-occlusive clot in a branch of the left portal\nvein.  No involvement of the SMV or splenic vein.  Common hepatic artery has\nconventional branching from the celiac axis.  The abdominal aorta is normal in\ncaliber.  Small subcentimeter paraaortic lymph nodes are seen, increased in\nnumber from prior exam.  \n\nSusceptibility gallbladder fossa consistent with cholecystectomy. The adrenal\nglands and pancreas remain unremarkable.  A stable simple cyst is seen at the\nlower pole of the left kidney measuring up to 3.1 cm.  Smaller T2\nhyperintensities are seen in both renal cortices, likely cysts.  No\nhydronephrosis or hydroureter.  Preserved corticomedullary differentiation. \nRenal arteries and veins are patent.\n\nThe stomach and duodenum appear within normal limits.  There is suggestion of\nmild wall thickening of the jejunum, nonspecific in the setting of ascites and\nmight represent third spacing.   No significant mesenteric adenopathy by size\ncriteria.  Colon is collapsed containing a moderate amount of stool.\n\nMild thickening and apparent enhancement of the peritoneum, slightly more\nexaggerated in comparison to older studies.",
            "output": "1.  Cirrhotic liver without focal abnormality.\n\n2.  Worsening massive ascites and development of a layering right pleural\neffusion.\n\n3.  Stable splenomegaly and paraesophageal/splenic/retroperitoneal varices.\n\n4.  Chronic obliteration of the main portal vein at the porta hepatis with\ncavernous transformation.  No new clot or extension is identified within the\nproximal SMV or splenic vein.  The dynamic images are degraded by motion\nartifact.\n\n5.  New hepatic steatosis.\n\n6.  Mild thickening and enhancement of the peritoneum, slightly more\nexaggerated in comparison to prior exams, of uncertain significance."
        },
        {
            "input": "Lower Thorax: Lungs are clear.  There is no pleural effusion.  Heart size is\nwithin normal limits.\n\nLiver: The liver has a nodular contour with an enlarged caudate lobe\nconsistent with cirrhosis.  There are a few scattered subcentimeter biliary\nhamartomas.\n\nThere are post ablation changes from ablation of the HCC lesion in hepatic\nsegment VI and hepatic segment VII.  Also seen are post embolization changes\nof the lesion at the right hepatic dome.  There is uniform enhancement\nsurrounding the TACE site. There is no significant internal enhancement to\nsuggest residual tumor at either site.\nThere is a 1.0 cm nodular arterially enhancing mass at the junction of hepatic\nsegment 7 and the caudate (series 1101, image 63).  The lesion has washout and\na pseudo capsule, consistent with HCC.\n\nThere are multiple scattered foci of nodular arterial enhancement without\nwashout or pseudo capsule  .\nFor example in the right lobe: 8 mm (series 1101, image 128), 7 mm (series\n1101, image 110), 6 mm (series 1101, image 102) and 7 mm (series 1101, image\n64).\nFor example in the left lobe: 6 mm (series 1101, image 54) and 6 mm (series\n1101, image 50).\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation.  The\ngallbladder is nondistended.  Focal enhancement could represent\nadenomyomatosis.\n\nPancreas: The pancreas has normal morphology.  There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is homogeneous without focal masses or lesions.\n\nAdrenal Glands: The adrenal glands are symmetric and within normal limits.\n\nKidneys: The kidneys are normal size and symmetric.  There are a few simple\ncysts within the left kidney.\n\nGastrointestinal Tract: The visualized bowel is nonobstructed.\n\nLymph Nodes: There are a few prominent mesenteric lymph nodes in the celiac\ndistribution.  The largest measures 1.4 cm in diameter and is unchanged from\n___.\n\nVasculature: There is no visualized abdominal aortic aneurysm.  There is a\nduplicated left renal artery.\n\nOsseous and Soft Tissue Structures: The visualized soft tissues and osseous\nstructures appear within normal limits.  There are no suspicious enhancing\nmasses or lesions.",
            "output": "1.  1.0 cm nodular arterial enhancing  lesion in hepatic segment VII/caudate\nlobe with washout and rim enhancement concerning for HCC.\n2. Multiple subcentimeter arterial enhancing foci within the right and left\nhepatic lobes as detailed above, none of which meet OPTN criteria for HCC.\nClose attention on follow up recommended.\n3. Posttreatment changes from ablation  at hepatic segment VI and VII as well\nas embolization of an HCC lesion near the dome of the liver. No suspicious\nenhancement to suggest residual disease."
        },
        {
            "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is cirrhotic in morphology.  Compared with MRI liver ___, patient has undergone interval chemoembolization to segments IV and VIII\nfor recurrence around a prior TACE site.  There has been interval decrease in\nextent of arterial enhancement with washout and pseudo capsule surrounding the\ntreatment cavity, however there remains a significant amount remains, most\nprominent along the medial and superior aspect of the treatment cavity,\ndifficult to measure, however measures greater than 5 cm (10:19; 16: 18). \nMore medially along the treatment site in segment IV, there is a 1.3 cm focus\nof arterial enhancement with washout and pseudo capsule which appears slightly\nincreased in size compared with prior, previously measuring 10 mm, meeting\nOPTN 5A criteria for HCC (10:30; 16:29).\n\nIn the caudate lobe, there is a 1.4 cm focus of arterial enhancement which is\nincreased in size from prior, previously measuring 10 mm, and now displays\nwashout with pseudo capsule, meeting OPTN 5A criteria for HCC (10:36; 16:35).\n\nIn segment II, there is a 1.2 cm focus of arterial enhancement which is\nincreased in size from prior, previously measuring 8 mm, and now displays\nwashout with pseudo capsule, meeting OPTN 5A criteria for HCC (10:30; 16:30).\n\nIn segment VI, laterally to a prior treatment cavity, there is new nodular\narterial enhancement which displays washout and pseudo capsule on delayed\nphases, overall spanning up least 1.8 cm, meeting OPTN 5A criteria for HCC\n(10:65; 14:51).\n\nThere are additional treatment cavities in segments VII and at the borders of\nsegments VII/VIII which do not have evidence of significant residual or\nrecurrent tumor.\n\nThere are numerous additional arterially enhancing foci which do not currently\nmeet OPTN criteria for ___ including a 7 mm subcapsular focus of arterial\nenhancement which displays washout in segment VI (10:64).\n\nBiliary: There is no intra or extrahepatic biliary dilatation.  The\ngallbladder is collapsed and likely contains a small amount of sludge.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously.  Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is enlarged up to 15 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.  There are bilateral renal cysts measuring up to\n2.2 cm in the left mid kidney.\n\nBowel:  Partially imaged loops of small bowel are unremarkable.  There are\ncolonic diverticula without evidence of acute diverticulitis.  There is no\nwall thickening, adjacent inflammatory change, or abnormal enhancement.  \nThere is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent.  The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: Periportal and pericaval lymph nodes are not significantly\nchanged.  There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.  No free fluid.",
            "output": "1. Compared with ___, patient has undergone interval repeat\nchemoembolization for recurrent tumor around a prior TACE cavity.  There is\ninterval decrease in extent of tumor surrounding the TACE cavity, however a\nsignificant amount of tumor remains, difficult to measure, however spanning\nmore than 5 cm.\n2. Interval slight increase in size of a 1.3 cm arteria"
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: The liver is nodular consistent with cirrhosis.  Patient appears\nstatus-post multiple lesions and trans arterial chemo embolizations, including\ninterval microwave ablation of four separate lesions in segments II, IV, VI,\nand I.\n\nA large, heterogeneous, arterially enhancing lesion with washout surrounding a\nprior segment ___ ablation cavity has increased in size since the prior\nexamination, measuring up to approximately 9.5 x 6.7 cm, previously 8.6 x 6.3\ncm (series 1201, image 36).  Mass growth is most impressive inferior to the\nlevel of the ablation cavity, with much more washing out soft tissue in\nsegment IVB compared to the prior examination.\n\nDespite no definite residual tumor at any of the recent ablation sites, there\nare innumerable new and enlarging arterially enhancing lesions with washout\nand pseudo capsule scattered throughout the liver.  Lesions now meeting OPTN\ncriteria for hepatocellular carcinoma and include, but are not limited to, the\nfollowing:\n\n1. 1.2 cm segment VIII (series 1201, image 26)\n2. 1.3 cm segment VII (series 1201, image 50)\n3. 1.5 cm segment VII (series 1201, image 60)\n4. 1.7 cm segment V/VIII (series 1201, image 74)\n5. 1.3 cm segment V (series 1201, image 86)\n6. 1.3 cm segment VI (series 1201, image 92)\n7. 1.7 cm segment VI (series 1201, image 41)\n\n  The portal veins and hepatic veins appear patent. Hepatic arterial anatomy\nis conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation.  There\nis cholelithiasis without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is normal in signal intensity. No concerning lesions.\nNo main pancreatic duct dilatation. No evidence of peripancreatic\ninflammation.\n\nSPLEEN: The spleen is enlarged measures 15.0 cm.  There is a small accessory\nspleen.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and nephrogram.  There are multiple\nsimple appearing renal cysts.  No concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: A heterogeneous retrocaval lymph node is increased in size since\nthe prior examination measures 1.4 cm, previously 1.0 cm (series 1201, image\n118).  Allowing for differences in measurement technique, a preaortic lymph\nnode measuring 1.3 cm is unchanged (series 1201, image 127).\n\nVASCULAR: No abdominal aortic aneurysm. There are bilateral accessory renal\narteries.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions.",
            "output": "1. A large recurrent hepatocellular carcinoma centered in segment IV has\nsignificantly increased in size since the prior examination.\n2. There are innumerable new and enlarging hepatic lesions, many of which now\nmeet OPTN criteria for hepatocellular carcinoma.\n3. A 1.4 cm retrocaval lymph node has enlarged and is concerning for\nmetastasis.\n4. Cirrhosis with evidence of portal hypertension including splenomegaly."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: Patient appears status-post multiple ablations involving segments II,\nIV, VI, and I. A large, heterogeneous, arterially enhancing lesion with\nwashout surrounding a prior segment ___ ablation cavity has decreased in size\nsince the prior MRI now status-post repeat trans arterial chemoembolization. \nMeasured in a similar plane as the prior examination's maximum axial\n___, the lesion measures up to approximately 9.3 x 5.5 cm, previously\n9.5 x 6.7 cm.  More inferiorly, the lesion measures approximately 7.4 x 4.5\ncm, previously 7.9 x 7.3 cm.\n\nScattered arterially enhancing lesions throughout the right hepatic lobe are\nsignificantly decreased in number and size since the prior examination.\nPreviously seen OPTN 5 lesions in the right hepatic lobe have decreased in\nsize and demonstrate predominantly non enhancement compatible with treatment\nresponse (series 1002, images 30, 55, 73 84, 139).  A previously seen OPTN 5\nlesion in the posterior aspect of segment VI has decreased in size and\nmeasures 1.2 cm, previously 1.5 cm, and demonstrates central non enhancement\nand minimal residual peripheral enhancement (series 1001, image 58).\n\nScattered arterially enhancing lesions in the left hepatic lobe appear similar\nin number, but increased in size, some now meeting OPTN criteria for\nhepatocellular carcinoma.  Representative lesions include:\n\n1. 1.3 cm segment II, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 50; series 1002, image 54).\n2. 1.0 cm segment II, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 48; series 1002, image 52).\n3. 1.1 cm segment III, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 74; series 1002, image 74).\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation.  There\nis cholelithiasis without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is normal in signal intensity. No concerning lesions.\nNo main pancreatic duct dilatation. No evidence of peripancreatic\ninflammation.\n\nSPLEEN: The spleen is enlarged and measures 15.5 cm.  No focal concerning\nlesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and nephrogram.  There are multiple\nsimple appearing renal cysts.  No concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: A 1.6 cm avidly enhancing retrocaval lymph node measuring 1.6 cm\nhas slightly increased in size since the prior examination measures 16 mm,\npreviously 14 mm (series 1001, image 106).  A 1.3 cm preaortic lymph node is\nunchanged.\n\nVASCULAR: No abdominal aortic aneurysm. There are bilateral accessory renal\narteries.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions.",
            "output": "1. A large recurrent hepatocellular carcinoma centered in segment IV has\ndecreased in size since the prior examination.\n2. Right hepatic lobe lesions, including previously characterized OPTN 5\nlesions demonstrate evidence of treatment response, most decreased in size\nwith non enhancement.  A segment VI lesion has decreased in size and\ndemonstrates minimal residual peripheral enhancement.  Recommend attention on\nfollow-up imaging.\n3. Segment II and III left hepatic lobe lesions are similar in number, but\nincreased in size since the prior examination.  Three lesions now demonstrate\nOPTN criteria for hepatocellular carcinoma.\n4. A 1.6 cm retrocaval lymph node has increased in size and conspicuity, very\nconcer"
        },
        {
            "input": "Lower Thorax: Visualized lower lungs are unremarkable.  No pericardial or\npleural effusion.  Heart is normal in size.\n\nLiver: Patient is status post multiple ablation cavities scattered throughout\nboth hepatic lobes.\n\nStatus post chemoembolization of the right hepatic lobe in ___.  Though\nthe largest heterogeneous mass in segment 4A surrounding a prior ablation\ncavity is unchanged in size measuring 7.2 x 5.0 cm (1301:58) it shows\nsignificant decrease in overall arterial enhancement compared to prior study. \nThere are 2 residual arterially enhancing nodules with washout in the anterior\naspect of this mass (1301:37) measuring 1.1 and 1.4 cm.  Previously mentioned\narterially enhancing lesions that were scattered throughout the right hepatic\nlobe have continued to decrease in size with central nonenhancement and\nminimal residual peripheral enhancement (1302:22, 45, 64, 77, 128).\n\nThere are least 3 new arterially enhancing nodules with washout in segment 6\n(1301:73, 67) the largest of which measures 1.0 cm meeting OPTN criteria and\nthe 2 smaller subcentimeter however showing washout and pseudocapsule\nformation.\n\nStatus post chemoembolization of the left hepatic lobe in ___. \nPreviously mentioned lesions in segments 2 and 3 with washout and\npseudocapsule formation now show central nonenhancement and minimal peripheral\nenhancement (1301:50, 53, 77) all decreased in size since prior.\n\nBiliary: Cholelithiasis with no surrounding wall thickening or edema.  No\nintra or extrahepatic biliary dilation.  No choledocholithiasis.\n\nPancreas: The pancreas is mildly atrophic but otherwise with normal signal and\nenhancement throughout.  No pancreatic duct dilation or focal lesions.\n\nSpleen: The spleen is again noted to be enlarged measuring 15.3 cm in\ncraniocaudal dimension, stable.  Signal and enhancement are homogeneous with\nno focal lesions.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal and symmetric size, shape, nephrogram and\ncontrast excretion.  No hydronephrosis.  Bilateral simple cysts are again\nnoted measuring up to 2.2 cm (5:41).  No worrisome solid lesions.\n\nGastrointestinal Tract:  The lower esophagus, stomach, duodenum and visualized\nsegments of small and large bowel are unremarkable and undistended.\n\nLymph Nodes: There are multiple periportal and retroperitoneal lymph nodes\nwhich have grown in size compared to prior study, the largest in the\nretrocaval station measuring 1.7 cm (1301:102), previously 1.4 cm. Other\nexamples are an aortocaval lymph node measuring 1.5 cm (1301:110), and\nepiphrenic lymph node measuring 0.9 cm (1301:32) and the periportal lymph node\nmeasuring 1.1 cm (1301:95).\n\nVasculature: Major vessels of the upper abdomen are patent and normal in\ncaliber.  Normal conventional vascular anatomy is again noted.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures.  Unremarkable appearance of the superficial soft tissues of the\nupper abdominal wall.",
            "output": "Overall marked decreased tumor burden noted in the liver with residual tumor\nin the anterior aspect of the heterogeneous mass in segment ___.\n\nNew nodules with arterial hyperenhancement and washout in segment VII/VI\nmeasuring up to 1.0 cm, at least one of which meets size criteria for OPTN 5A.\n\nSlight increase in size of the retroperitoneal and periportal lymphadenopathy\nmeasuring up to 1.7 cm consistent with progression of disease.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:02 into th"
        },
        {
            "input": "Lower Thorax: Visualized lower thorax is grossly unremarkable.\n\nLiver: The liver is nodular and cirrhotic.  Redemonstration multifocal hepatic\npost ablation changes with heterogeneous peripheral hepatic enhancement on the\narterial phase.\n- At the level of the large segment ___ ablation cavity there is\nsurrounding heterogeneous nodular arterial enhancement with 2 foci\ndemonstrating associated washout and pseudo capsule which measure 2.2 x 1.1 cm\nand 2.4 x 1.5 cm (1601:40-41, 1603:40-41 and 1601:37, 1603:37).  The overall\nappearance of this lesion is stable compared to the MRI of ___.\n- There is a new 0.6 cm focus of arterial hyperenhancement with washout and\npseudo capsule in segment V of the liver (1601: 96, 1603: 96), this is\nsuspicious for ___, however, it does not meet OPTN criteria.\n- Stable arterially hyperenhancing lesions with washout pseudo capsule noted\nat the posterior aspect of segments VI/VII with one lesion measuring 1 cm and\nmeeting OPTN 5A criteria for HCC (1601:75-79).\n-Additional punctate areas of arterial enhancement with millimetric foci of\nwashout within segment 4 are highly suspicious for additional foci of HCC\n(series 1601 image 8, series 1603, image 80).\n- Stable small focus of arterial hyperenhancement without significant washout\nmeasuring 7 mm in segment V of the liver (1601:73).  The previously described\nsmall foci of arterial hyperenhancement on MRI of ___, that decreased\nin size on the prior exam of ___, have either further decreased in\nsize or are no longer visualized.  There are few new punctate foci of arterial\nhyperenhancement without correlate on other sequences or washout, seen in\nsegments V and III of the liver (1601:79, 1601:65 and 61), these measure up to\n5 mm.\n\nBiliary: No intra- or extrahepatic biliary dilation.  There is cholelithiasis\nwithout cholecystitis.\n\nPancreas: The pancreas is mildly atrophic without focal suspicious pancreatic\nlesions.  No significant pancreatic duct dilatation.\n\nSpleen: The spleen is enlarged measuring 15.7 cm.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: There are bilateral renal cortical simple cysts measuring up to 2.2 x\n1.8 cm on the left side.  No focal concerning renal lesions.  No\nhydronephrosis.\n\nGastrointestinal Tract:  Stomach is grossly unremarkable.  Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: Stable mildly enlarged periportal lymph nodes measuring up to 1.3\ncm in short axis (1601:86).  Stable mildly enlarged retroperitoneal lymph\nnodes measuring up to 1.6 cm in short axis (1601:105, 115).  Relatively stable\nepiphrenic lymph nodes measuring up to 1 cm in short axis (1601:30 ___.\n\nVasculature: Visualized abdominal vasculature is grossly unremarkable.\n\nOsseous and Soft Tissue Structures: There are no gross abnormalities.",
            "output": "1.  Cirrhotic liver with multiple prior ablations and stable appearance of the\nablation cavities.  There is relatively unchanged appearance of the\nheterogeneous arterial enhancement with 2 foci of washout along the segment IV\na ablation cavity as described above (measuring up to 2.4 cm).\n2.  Stable arterially hyperenhancing lesions with washout noted at the\nposterior aspect of segments VI/VII with one stable lesion measuring 1 cm and\nmeeting OPTN 5A criteria for ___.  Additional adjacent arterially enhancing\nmillimetric foci with washout, highly concerning for ___.\n3.  There is a new 7 mm arterially hyperenhancing segment V liver lesion with\nwashout that is concerning for ___ but does not meet the OPTN 5A criteria\ngiven its size.\n4.  Few new foci of arterial hyperenhancement without washout of correlate on\nothe"
        },
        {
            "input": "Liver/Biliary: No change in progressively enhancing 3.6 x 2.5 cm hepatic\nsegment 3 and 4B mass when compared to CT from ___ however this lesion\nhas decreased in size since ___ MR where it measured 4.2 x 2.7 cm. \n(17:39) Mass is again noted to extend into the porta hepatis with persistent\ninvasion of the left portal vein in a similar distribution to prior MRI. There\nis mild decrease in left-sided intrahepatic biliary duct dilatation with\npersistent left hepatic lobe atrophy (17:36). Moderate hepatic steatosis\npredominately involving the right hepatic lobe with relative sparing of left\nhepatic lobe again noted.  (Fat fraction 19.2%).  No ascites.  Gallbladder is\nsurgically absent.\n\nPancreas: Few subcentimeter pancreatic cystic lesions are unchanged,  largest\nmeasuring 0.3 cm in pancreatic tail, likely IPMNs (07:27).  Unchanged 1.3 x\n2.3 cm cystic extra pancreatic lesion anterior to the pancreas is likely\nrelated to lymphatics (07:25).  No pancreatic duct dilatation.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: 1.4 cm left renal cysts noted.  Otherwise unremarkable without\nhydronephrosis.\n\nGastrointestinal Tract:  No obstruction.  Small duodenal diverticulum again\nnoted.\n\nLymph Nodes: The retroperitoneal adenopathy is unchanged.  Representative\nnodes are as follows: portacaval node measures 1.3 cm (12: 47), 0.9 cm para\naortic node (07:39), and 1.3 cm centrally necrotic mesenteric lymph node are\nunchanged (10:44).\n\nVasculature: No abdominal aortic aneurysm.  Celiac axis, SMA, bilateral renal\narteries, and accessory right renal artery are patent.  Hepatic anatomy is\nnotable for accessory left hepatic artery arising off left gastric artery. \nHepatic veins, right portal vein, main portal vein, SMV, and splenic vein are\npatent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions.",
            "output": "1.  Unchanged 3.6 cm left hepatic lobe mass with left intrahepatic biliary\nduct dilation and similar left portal vein invasion when compared to ___ CT, however, findings are overall improved from ___ MR.\n2.  Stable retroperitoneal adenopathy."
        },
        {
            "input": "There is no abnormality identified in the roots, trunks, divisions or cords of\nthe brachial plexus bilaterally.  There is no evidence of edema or enlargement\nof the nerves. There is no intrinsic or extrinsic mass identified. No evidence\nof muscular atrophy or edema. No axillary or supraclavicular lymphadenopathy. \nThe great vessels are normal in caliber and patent. The heart is normal in\nsize.\n\nIncreased signal intensity in the right lung consistent with fibrosis.  Small\nleft pleural effusion.",
            "output": "No brachial plexus abnormality bilaterally.\n\nFibrotic changes in the both lungs.  Small left pleural effusion."
        },
        {
            "input": "The exam is limited.  Only T2 weighted images and diffusion weighted images\nwere obtained, as the exam was terminated early due to patient discomfort. \nMotion artifact is also present throughout the exam.\n\nLower Thorax: There are small bilateral pleural effusions, greater on the\nright than the left.  The bases of the lungs are otherwise clear.  The base of\nthe heart is normal in size.  There is no pericardial effusion.\n\nLiver: The liver is diffusely enlarged in comparison to the prior exam from\n___.  The parenchyma is replaced by innumerable nodules which are mildly\nhyperintense on the T2 weighted images.  The nodules are small, measuring\nbetween 1 and 2 cm, though they appear to coalesce in many regions of the\nliver.  They demonstrate restricted diffusion.  This is most compatible with\ndiffuse metastatic disease.  These appear to be new from ___.  The\nhepatic vasculature is not well characterized on this noncontrast exam.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation.  The\ngallbladder is not distended, which limits evaluation.  Apparent wall\nthickening and pericholecystic fluid is likely due to the liver disease.\n\nPancreas: The pancreatic parenchyma is normal in signal.  There is no duct\ndilation or mass.\n\nSpleen: The spleen is normal in size, measuring 9.8 cm.  There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands appear slightly thickened in\ncomparison the prior exam, though no discrete nodule is identified.\n\nKidneys: The kidneys are normal in size.  There are no worrisome lesions,\nhydronephrosis, or pyelonephritis.  There is a probable punctate cysts in the\nright kidney (3, 39).\n\nGastrointestinal Tract:  The stomach and small bowel are normal in course and\ncaliber.  There is no evidence of obstruction.  The imaged portions of the\nlarge bowel are normal.  There is a small amount of ascites.\n\nLymph Nodes: There is lymphadenopathy in the porta hepatis.  It is poorly\ncharacterized on this limited exam.  There is no retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm.  Evaluation of the vasculature is limited on this noncontrast exam.\n\nOsseous and Soft Tissue Structures: There are many osseous metastases, best\nseen on the diffusion-weighted images.  They are seen in almost all the\nvertebral bodies in the lower thoracic and upper lumbar spine.  Within the\nlimitation of this exam, the spinal canal appears within normal limits without\nfocal narrowing from the metastatic disease.  There is diffuse anasarca.  The\nsoft tissues are otherwise normal.",
            "output": "1.  Innumerable nodules replacing the entire hepatic parenchyma is most\ncompatible with diffuse metastatic disease, new from ___.\n2.  Lymphadenopathy in the porta hepatis.\n3.  Diffuse osseous metastases.\n4.  Small amount of ascites.\n5.  Small bilateral pleural effusions, greater on the right than the left.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 8:52 AM, 5 minutes after discovery of the findings."
        },
        {
            "input": "The liver is nodular, consistent with cirrhosis. The gallbladder contains\nseveral stones, without wall thickening or pericholecystic fluid to suggest\nacute cholecystitis. The spleen is enlarged, measuring 14.1 cm. The pancreas\nis without focal lesion, ductal dilation, or peripancreatic stranding or fluid\ncollection. The adrenal glands are normal in size and configuration. The\nkidneys are symmetric and normal in size. There is no hydronephrosis or focal\nmass.   There is a right lower quadrant ileostomy. Bowel loops are normal in\ncaliber, without wall thickening or evidence of obstruction. The patient is\nstatus post stenting of an intra-abdominal aortic aneurysm. The stent and\nvessels are patent, though the left renal artery is focally stenotic at its\norigin. There is no retroperitoneal or mesenteric lymph node enlargement.\n\nThere is asymmetric thickening of the right aspect of the bladder wall with\nlayering debris within the bladder lumen.  The prostate is enlarged, measuring\n5.3 x 6.0 x 4.3 cm with a calculated volume of 71 cc.  There is no concerning\nfocal mass or fluid collection.  There is no pelvic sidewall or inguinal lymph\nnode enlargement. No pelvic free fluid is seen.\n\nNo focal osseous lesion concerning for infection or neoplasm is identified.",
            "output": "1.  No abscess or other evidence of infection.\n2.  Asymmetric thickening of the right aspect of the bladder wall, with\nbladder debris. If not explained by the patient's history or previously\nevaluated, direct visualization with cystoscopy is recommended.\n3.  Cholelithiasis without evidence of acute cholecystitis.\n4.  Cirrhotic liver and splenomegaly.\n5.  Prostate hypertrophy."
        },
        {
            "input": "Lower Thorax: A moderate right pleural effusion with relaxation atelectasis\nhave increased since ___.\n\nLiver: Cirrhotic-appearing liver again seen with a few diminutive cysts. \nHepatic lesions are as follows:\n\n-An 1.6-cm arterially enhancing lesion in segment III with washout is overall\nunchanged, highly suspicious for ___ but not meeting OPTN 5 criteria.\n\n-A stable 6-mm arterially enhancing lesion with washout in segment V is more\nconspicuous on current exam and also highly suspicious for ___ but does not\nmeet OPTN criteria (1301,49).\n\nTrace ascites, similar to the prior exam.  Retroperitoneal edema is mild, not\nsignificantly changed.\n\nBiliary: Cholelithiasis. No intrahepatic or extrahepatic biliary ductal\ndilation.\n\nPancreas: Normal bulk and signal intensity.  No evidence of mass or ductal\ndilation.\n\nSpleen: Moderate splenomegaly, unchanged.\n\nAdrenal Glands: Normal configuration and size.\n\nKidneys: Symmetric size without a suspicious mass.  A small left upper renal\npole cyst is unchanged.\n\nGastrointestinal Tract: Mild esophageal wall thickening and increased\nenhancement with surrounding edema suggests esophagitis. No bowel obstruction.\n\nLymph Nodes: No enlarged abdominal lymph nodes.\n\nVasculature: Patent hepatic vasculature.  Hepatic artery anatomy is\nconventional.  Multiple gastric and esophageal varices are compatible with\nsequelae of portal hypertension.  Normal caliber abdominal aorta.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.",
            "output": "1.  Cirrhotic liver with sequelae of portal hypertension.  Stable enhancing\nlesions with washout lesions are highly suspicious for ___ but do not meet\nOPTN criteria: 1.6 cm in segment III and 6-mm in segment V.\n\n3.  Possible esophagitis.\n\n4.  Moderate right pleural effusion, increased from prior."
        },
        {
            "input": "Lower Thorax: There is a large right pleural effusion with right lower lobe\ncollapse.  Small left pleural effusion.\n\nLiver: Morphologic features of cirrhosis.  Arterially enhancing lesion within\nsegment 3 with washout now measures 20 mm (axial series 18, image 15),\npreviously 16 mm.  No definite pseudo capsule.  Arterially enhancing lesion\nwithin segment 5 with mild washout now measures 13 mm, previously 6 mm.  No\ndefinite pseudocapsule.  There are several additional T2 hyperintense\nsubcentimeter nonenhancing lesions which may represent small cysts or\nhamartomas.  Small volume ascites.\n\nBiliary: Uncomplicated cholelithiasis.  No biliary ductal dilatation.\n\nPancreas: Unremarkable.\n\nSpleen: Marked splenomegaly, measuring 18.3 cm.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable.\n\nGastrointestinal Tract:  Imaged portions of the stomach and small bowel are\nunremarkable.  Mural thickening of the ascending colon, likely related to\nportal colopathy.\n\nLymph Nodes: Unremarkable.\n\nVasculature: No abdominal aortic aneurysm.  The portal venous and hepatic\nvenous systems appear patent.  However, there are multiple portosystemic\nshunts with multiple prominent collateral vessels along the left anterior\nabdomen.\n\nOsseous and Soft Tissue Structures: Lower abdominal ventral wall hernia\npartially imaged on wide field of view T2 weighted coronal images.",
            "output": "1. Interval growth of arterially enhancing lesions within segments 3 and 5. \nGiven size and washout, segment 3 lesion would meet OPTN 5B criteria for HCC,\nalthough these criteria cannot be strictly applied to the current examination\ngiven non-breath hold technique.  Segment 5 lesion does not meet OPTN 5\ncriteria for HCC, but remains suspicious.\n2. Morphologic features of cirrhosis with findings of portal hypertension.\n3. Uncomplicated cholelithiasis.\n4. Lower abdominal ventral wall hernia, partially imaged."
        },
        {
            "input": "Lower Thorax: Limited evaluation of the lung bases are notable for persistent\nlarge right pleural effusion with severe right lower lobe atelectasis.  No\nleft pleural effusion.\n\nLiver: The liver is shrunken and nodular in contour with hypertrophy of the\nleft lateral segment consistent with cirrhosis.  No significant signal drop on\nout of phase imaging to suggest hepatic steatosis.  No ascites.\n\nA 2 x 2.3 cm segment 3 ablation cavity is noted with intrinsic T1 hyperintense\nsignal consistent with coagulation necrosis.  No abnormal or nodular\nenhancement to suggest residual or recurrent disease.  (1501:69).\n\nWithin segment 5 there is a T1 hyperintense 1 x 0.9 cm arterially\nhyperenhancing lesion without definite washout on delayed phases which is\nunchanged since ___ (1501:57) and remains nonspecific.  No pseudo\ncapsule.\n\nThere is a mildly T2 hyperintense nonenhancing band like area along segment 5\nwith subtle capsular retraction which may represent an evolving hepatic\ninfarct given occlusion of the hepatic vein and portal vein branch at this\nlevel (6:22).\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation.  No\ncholedocholithiasis.  Large gallstone noted.  Gallbladder is nondistended. \nMild gallbladder wall edema is likely related to underlying liver dysfunction.\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding.  No pancreatic\ndivisum.\n\nSpleen: Spleen is enlarged measuring 18.3 cm, previously 21 cm.  No suspicious\nmass.\n\nAdrenal Glands: Adrenal glands are symmetric in size and normal in morphology\nwithout suspicious mass.\n\nKidneys: Homogeneous in signal intensity without suspicious mass.  No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract:  Distal esophagus, stomach, visualized small and large\nbowel are unremarkable.  No obstruction.  Paraesophageal varices noted.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm.  Celiac axis, SMA, bilateral renal\narteries, and ___ are patent.  Hepatic anatomy is conventional.  Left and\nmiddle hepatic veins are patent.  A TIPS catheter shunt is seen extending from\nthe supra hepatic aorta to the right main portal vein with small amount of\nintraluminal contrast.  Anterior right portal vein, SMV, and splenic vein are\npatent.  There is nonenhancing thrombus involving the distal left portal vein\nand distal aspect of right posterior portal vein consistent with thrombus. \nThrombus within the middle hepatic vein noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.  Mild\ndependent anasarca noted.  Soft tissues are otherwise unremarkable.",
            "output": "1.  Nonspecific 0.9 cm segment 5 hepatic lesion is without washout or pseudo\ncapsule, unchanged since ___.\n2.  No suspicious hepatic lesions meeting OPTN 5 criteria for HCC.\n3.  Post ablation of hepatic segment 3 lesion with expected coagulation\nnecrosis.  No evidence of residual or recurrent disease.\n4.  Cirrhosis with splenomegaly.  No ascites.\n5.  TIPS catheter with new thrombus involving distal left portal and distal\naspect of right posterior portal veins.\n6.  Cholelithiasis without evidence of acute cholecystitis.\n7.  Unchanged large right pleural with severe right lower lobe collapse.\n\nRECOMMENDATION(S):  Recommend follow-up MR liver in 3 months to assess for\ninterval change."
        },
        {
            "input": "Lower Thorax: Visualized lung bases are grossly clear.  No pleural or\npericardial effusion.\n\nLiver: The liver is normal in morphology.  There is no evidence of hepatic\nsteatosis.  There is a large heterogeneous mass is seen in segments ___\nmeasuring approximately 10.2 x 6.9 cm.  This lesion demonstrates intrinsically\nT1 hyperintense, irregular enhancing solid components.  There also\nnonenhancing components which demonstrate blooming artifact on the T1 weighted\nimages, compatible with blood products.\n\nAdditionally there is a mildly heterogeneous lesion in segments ___ (1003:93)\nmeasuring approximately 4.9 x 3.5 cm, which demonstrates subtle\nhyperenhancement relative to background hepatic parenchyma on the delayed\npost-contrast phases, as well as suggestion of a central scar.  There is\nassociated perfusion alteration throughout the right hepatic lobe surrounding\nthis lesion on the arterial phase postcontrast images, normalizing to\nbackground liver on the later phases.  A smaller 1.8 cm lesion with similar\nsignal and enhancement characteristics is seen in segment VII (1001:71).\n\nBiliary: The gallbladder is within normal limits.  No intra or extrahepatic\nbiliary dilation.\n\nPancreas: The pancreas is normal in size and shape.  There is an 10 mm focus\nof interdigitating fat in the downstream pancreatic body (4:28 and 3:18). \nThere is a 10 mm cystic lesion in the upstream pancreatic body (4:26 and\n3:22), likely a side-branch IPMN.  There is no main ductal dilatation.\n\nSpleen: The spleen is normal in size with no focal lesions.\n\nAdrenal Glands: The left adrenal gland is unremarkable.  The right adrenal\ngland is not visualized.\n\nKidneys: The kidneys are normal and symmetric in size.  Multiple bilateral\nsimple cysts, including a dominant cyst in the upper pole of the left kidney\n(3:26) measuring up to 3 cm, and others of which are subcentimeter in size. \nThere is also a 4 mm hemorrhagic cyst in the upper pole of the right kidney\n(8:99).\n\nGastrointestinal Tract:  The stomach, duodenum and visualized segments of\nsmall and large bowel are unremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.  Major branch vessels\nare patent.  Portal vasculature is patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures.",
            "output": "1. Large heterogeneous mass in segment ___ with enhancing components and\ninternal hemorrhage, possibly an underlying adenoma though imaging features\nare nonspecific.  Malignancy is not excluded.  Biopsy is recommended.\n2. Two other lesions in the right hepatic lobe measuring up to 4.9 cm and 1.8\ncm could represent atypical FNH or atypical adenoma.  Recommend follow-up\ncontrast enhanced MRI of the abdomen 3 months with Eovist.\n3. 10 mm cystic lesion in the pancreatic body, likely a side-branch IPMN.  See\nbelow for recommendations.\n\n\nRECOMMENDATION(S):  For management of pancreatic cyst(s) between 6-15 mm in\npatients less than ___ years at presentation, recommend annual non-contrast\nMRCP follow-up for ___ years, then every other year up to a total of ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___"
        },
        {
            "input": "Lower Thorax: Minimally imaged lung bases are grossly unremarkable. There is\nno pleural effusion.\n\nLiver: The liver is smooth in contour.  There is no signal loss on\nout-of-phase imaging to suggest hepatic steatosis.  There are no suspicious\nfocal lesions in the partially imaged liver.  There is incompletely imaged 0.7\ncm nonenhancing lesion the hepatic dome(13; 12), similar to prior CT.\n\nBiliary: There is a small duodenal diverticulum containing the ampulla (3; 4).\nThere is no intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis not visualized.\n\nPancreas: The pancreas is normal, without focal lesion or main ductal\ndilatation.\n\nSpleen: The spleen is normal in signal intensity and size without focal\nlesion.\n\nAdrenal Glands: The adrenal glands appear unremarkable bilaterally.\n\nKidneys: Bilateral kidneys are symmetric in size and demonstrate normal\nnephrogram.  There is no hydronephrosis.  In the right upper pole, there is a\n0.4 cm lesion which demonstrates signal loss on out-of-phase imaging, likely\nan angiomyolipoma (6; 8), (11; 45).  In the right lower pole, there is a 0.9 x\n1.0 cm exophytic, T2 isointense and T1 hypointense lesion with avid\nenhancement, concerning for a small renal cell carcinoma.  There is no\nevidence of bulk or intravoxel fat within this lesion.\n\nGastrointestinal Tract: There is a small hiatal hernia.  Scattered diverticula\nnoted throughout the colon.  The visualized small and large bowel appear\nnormal in caliber without evidence of obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal or pelvic sidewall lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.  There are single left\nand two right renal arteries.  Bilateral renal veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified.",
            "output": "1. 1 cm avidly enhancing lesion in the lower pole of the right kidney,\ncorresponding to the CT finding, is concerning for a small renal cell\ncarcinoma.\n2. 0.4 cm fat-containing lesion in the right upper pole is likely an\nangiomyolipoma."
        },
        {
            "input": "Lower Thorax: No focal consolidation.  No pleural pericardial effusion.\n\nLiver: The liver demonstrate normal morphology without steatosis.  0.8 cm\nlesion in the hepatic dome likely representing a cyst or biliary hamartoma is\nunchanged.  No suspicious hepatic lesion.\n\nBiliary: No biliary ductal dilatation.  The gallbladder is surgically absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement\nwithout focal lesion.  No pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal in size with normal nephrogram.  Again seen is\na 1.2 x 1.0 x 0.9 cm exophytic predominantly isointense lesion on T1 and T2\nweighted images, compared to the renal parenchyma arising from the posterior\nright lower renal pole with avid enhancement.  When compared to MRI from ___, the lesion has minimally increased in size, at which time it\nmeasured 0.9 x 0.7 x 0.8 cm when measured in similar fashion.\n\nThere is a 4 mm right upper renal pole hyperintense lesion on T2 weighted\nimages (series 6, image 10) with loss of signal intensity on out of phase\nimages, unchanged, consistent with an angiomyolipoma.  No new suspicious renal\nmass.  No hydronephrosis.\n\nGastrointestinal Tract:  There is a small hiatal hernia.  There is a 1.9 cm\nduodenal diverticulum.  Otherwise the stomach is within normal limits.  The\nvisualized upper abdominal bowel loops are within normal limits.\n\nLymph Nodes: The abdominal lymph nodes are not enlarged.\n\nVasculature: The abdominal aorta is normal in caliber.  The major tributaries\nof the abdominal aorta are patent.  The portal venous system is patent.  There\nare 2 right renal arteries.  Single left renal artery.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.Small fat containing ventral hernia.",
            "output": "1.  Minimal increase in size of an exophytic posterior right renal lower pole\n1.2 x 1.0 x 0.9 cm mass compared to ___, at which time the mass\nmeasured 0.9 x 0.7 x 0.8 cm.  Imaging features are concerning for renal cell\ncarcinoma.\n2.  Unchanged 0.9 cm right upper renal pole angiomyolipoma.\n3.  No new solid enhancing renal masses; upper abdominal lymphadenopathy or\nsuspicious hepatic/osseous lesions."
        },
        {
            "input": "Lower Thorax: Visualized lung bases are normal.  No pleural or pericardial\neffusion.\n\nLiver: Liver demonstrates normal contour.  Diffuse drop in signal intensity on\nout of phase imaging is consistent with hepatic steatosis.  Fat fraction\nmeasures 20%, previously 14%.\n\nBiliary: The gallbladder is normal.  No intrahepatic or extrahepatic biliary\nduct dilatation.\n\nPancreas: Pancreas is signal intensity and bulk. No focal pancreatic lesion. \nNo pancreatic duct dilatation.\n\nSpleen: Spleen is normal.  Accessory splenic tissue.  No focal splenic lesion.\n\nAdrenal Glands: Left adrenal gland is normal.  Multiloculated cystic lesion\ninterposed between the limbs of the right adrenal gland and adjacent to the\nperiphery of segment 7 of the liver is again noted measuring 4.9 x 1.9 cm.  No\ninternal enhancing component.  The T1 hyperintense areas are not seen on\ntoday's examination.\n\nKidneys: Kidneys are normal size and symmetric.  A 5 mm cyst is noted in the\ninterpolar region of the right kidney.\n\nGastrointestinal Tract:  Visualized small large bowel loops are unremarkable.\n\nLymph Nodes: No enlarged lymph nodes.\n\nVasculature: Major abdominal vasculature is normal.\n\nOsseous and Soft Tissue Structures: Mild levoconvex curve of the lumbar spine.\nNo focal osseous lesion.",
            "output": "1. Multiloculated cystic lesion located between the right adrenal gland and\nsegment 7 of the liver is unchanged in size and appearance.  No suspicious\nenhancement or other concerning features.  Differential considerations would\ninclude retroperitoneal lymphangioma or complex adrenal cyst.\n2. Hepatic steatosis with fat fraction measuring 20%, previously 14%."
        },
        {
            "input": "Lower thorax: Partially imaged lung bases are clear.\n\nLiver: Liver demonstrates normal parenchymal morphology.  There is no hepatic\nsteatosis. No focal lesions on this unenhanced study.\n\nBiliary: The gallbladder is normally distended.  No intra or extrahepatic\nbiliary dilatation.\n\nPancreas: Pancreas shows homogeneous signal intensity.  No evidence of\npancreatic ductal dilatation.\n\nSpleen: Normal size.\n\nAdrenal Glands: Again seen is evidence of a right adrenal mass measuring 2.8 x\n1.3 cm showing diffuse signal dropout on the out of phase images consistent\nwith an adrenal adenoma.  The left adrenal is normal in size.\n\nKidneys: Both kidneys are normal in size.  There is no hydronephrosis.\n\nGastrointestinal Tract:  Stomach and visualized bowel loops are within normal\nlimits.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. Dextroscoliosis\nof the lumbar spine.  No soft tissue abnormality.",
            "output": "Stable right adrenal adenoma."
        },
        {
            "input": "There is no fat stranding, bowel wall thickening or free fluid in the right\nlower quadrant. The appendix is not confidently identified.\n\nBoth ovaries are visualized and normal in size (04:33 left, 35 right). A\nsmooth and thin walled cyst containing simple fluid and measuring 5.2 cm in\ndiameter is present in the right ovary, indicating the right bladder wall\n(04:41).\nThe uterus measures 12 x 5.6 cm. Intra uterine gestational sac is seen. The\ncervix is 4.3 cm in length.\nMinimal amount of fluid is seen in the pelvis (4:44).\n\nThe liver is grossly normal. The gallbladder and the biliary ducts are normal.\nThe spleen is not enlarged. The kidneys are normal without hydronephrosis. The\nadrenals are normal.\nNo significant retroperitoneal, mesenteric or pelvic lymphadenopathy is\npresent.\nThe bone marrow signal is normal.",
            "output": "1. No evidence of appendicitis.\n2. Early intrauterine pregnancy.\n3. Right ovarian simple appearing cyst measuring 5.2 cm."
        },
        {
            "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs: The solid organs including the liver, spleen, adrenals, pancreas\nand kidneys are within normal limits.  There is no hydronephrosis.  The\ngallbladder is normal in appearance.  No cholelithiasis.  No evidence of intra\nor extrahepatic biliary dilatation.\n\nGastrointestinal Tract:  The visualized small and large bowel loops are normal\nin caliber.  The appendix is normal in caliber measuring approximately 5 mm in\nmaximum diameter (5:6).  There is no evidence of appendiceal wall thickening\nor periappendiceal inflammatory changes.\n\nPelvis: There is an intrauterine gestational sac, better evaluated on pelvic\nultrasound performed on same day.  There is a cyst in the right ovary which\nmeasures up to 6.2 cm and is displaced into the right lower quadrant, just to\nthe right of the umbilicus (3:14).  There is no surrounding fat stranding or\nfree fluid.  The urinary bladder is normally distended with normal wall\nthickness.  Trace pelvic free fluid is within physiologic limits.\n\nLymph Nodes: No significant lymphadenopathy.\n\nVasculature: The pelvic vasculature is patent on time-of-flight imaging.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal.  No soft tissue\nabnormality.",
            "output": "1. Normal appendix.  No evidence of acute appendicitis.\n2. The right ovary contains a 6.2 cm cyst which is displaced into the right\nlower quadrant, just to the right of the umbilicus.  Although there is no\nsurrounding inflammatory change seen, and blood flow was seen to the right\novary on pelvic ultrasound performed on the same day, given patient's focal\nsymptoms in this region, intermittent torsion/detorsion remains in the\ndifferential diagnosis."
        },
        {
            "input": "Lower Thorax: Within the limits of evaluation by MRI, bilateral lung bases\ngrossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is nodular in contour compatible with cirrhosis.  There is no\nhepatic steatosis.  No suspicious liver lesions are seen.\n\nBiliary: There is no evidence of intra or extrahepatic biliary dilation.  The\ngallbladder has a thin wall and gallstones.\n\nPancreas:  The pancreas is normal in signal intensity without evidence of\nductal dilation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands:  Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys demonstrate ___ multiple T2 hyperintense cysts\nare seen in bilateral kidneys measuring up to 2.0 cm.  L signal intensity. No\nsuspicious renal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes:  There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. The major visualized branches of the aorta are patent.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities\ndetected.  No suspicious osseous or soft tissue lesions detected.",
            "output": "1. Cirrhotic liver without suspicious liver lesions.\n2. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: A lobulated, heterogeneous, centrally necrotic lesion centered in\nsegment VII and extending into the posterior aspect of segment VIII is\ndecreased in size since 4 months prior, previously measuring up to\napproximately 9 cm. Enhancement is predominantly peripheral and persistent. \nNo macroscopic or intravoxel fat.  No additional lesions identified.  Mild\nhepatic steatosis. The portal veins are patent.  The hepatic veins are patent.\nHepatic arterial anatomy is conventional.\n\nTotal liver volume: 2184 cc\nLeft lobe volume: 767 cc\nRight lobe volume: 1417 cc\nSegment VI/VII: 552 cc\n\nBILIARY: Mild dilation of the common hepatic duct measuring up to 1.2 cm is\nnot significantly changed since the prior examination.  Mild central\nintrahepatic biliary ductal dilation is similarly unchanged.  No obstructing\nstone or lesion identified.  Patient appears status-post cholecystectomy.\n\nPANCREAS: There is extensive fatty replacement of the pancreas.  No concerning\nlesions.  No main pancreatic duct dilation.\n\nSPLEEN: The spleen is normal size and signal intensity. No focal concerning\nlesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: Gastric bypass changes.  There is nonspecific enhancement of\nthe distal esophagus/gastric pouch.  partially imaged loops of large and small\nbowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There is an 8 mm right renal artery\naneurysm, unchanged since ___ (series 9, image 83; series 21, image\n1).\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: There are postoperative changes in the anterior abdominal wall. \nNo concerning soft tissue lesions.",
            "output": "1. A large liver mass predominantly in segment VII but extending to the\nposterior edge of segment VIII has decreased in size since 4 months prior.\n2. Liver volumes created in the Imaging Lab:\nTotal liver volume: 2184 cc\nLeft lobe volume: 767 cc\nRight lobe volume: 1417 cc\nSegment VI/VII: 552 cc\n3. There is nonspecific enhancement of the wall of the distal\nesophagus/gastric pouch.\n4. There is an unchanged 8 mm right renal artery aneurysm."
        },
        {
            "input": "Lower Thorax: Please refer to separate report from CT chest performed the same\nday for description of the intrathoracic findings.\n\nLiver: There is no evidence of background hepatic steatosis.  The large,\nmildly T2 hyperintense, heterogeneously enhancing hepatic mass, compatible\nwith known HCC/cholangiocarcinoma, involving the entire left and central right\nhepatic lobes, measures approximately 13.2 x 10.2 x 9.7 cm, increased in size\nfrom ___ CT at which time it measured 12.5 x 8.7 x 9.0 cm, and ___\nMRI when it measured 11.9 x 8.3 x 9.4 cm.  There are increased areas of\nhypoenhancement within the mass, most pronounced in the left hepatic lobe,\ncompatible with treatment response status post Y-90 radio embolization.  Note\nis made of a 1.0 cm rim enhancing lesion along the posterior margin of the\nmass in segment VII, new since prior examinations (series 1202, image 30),\ncompatible with a satellite lesion.  Incidental note is made of a few\nscattered cysts, the largest measuring 1.0 cm in segment VIII.\n\nBiliary: Status post cholecystectomy.  Mild diffuse intrahepatic biliary\ndilation has increased since ___.  There is no extrahepatic biliary\ndilation.\n\nPancreas: Normal parenchymal signal without focal lesions.  No main ductal\ndilatation.  One or two ectatic side branches in the pancreatic head.\n\nSpleen: Measures 12.5 cm in length although prominent anteroposterior diameter\nsuggests it is mildly enlarged.  No focal lesions.\n\nAdrenal Glands: The right adrenal glad is normal in size and shape. The left\nadrenal gland is not well visualized amid retroperitoneal collateral vessels.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal nephrograms.\nNumerous bilateral subcentimeter T2 hyperintense foci are compatible with\ncysts, measuring up to 1.0 cm in the lower pole right kidney and 1.0 cm in the\ninterpolar region of the left kidney.  No suspicious renal lesion.  No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable.  Visualized loops of\nsmall and large bowel are normal in caliber.\n\nLymph Nodes: Mild porta hepatis lymphadenopathy measuring up to 10 mm in short\naxis (series 1201, image 72) and periaortic lymphadenopathy measuring up to 7\nmm in short axis appears similar to ___.  A right paraesophageal lymph node is\nminimally larger, measuring 11 mm, previously 9 mm (series 1201, image 34).\n\nVasculature: The main and right portal veins are patent.  The left portal vein\nis again occluded by the mass.  The splenic vein is chronically occluded with\nanterior abdominal, perigastric and perisplenic collateral vessels. The right\nhepatic vein is compressed as it courses along the posterior margin of the\nmass, and left and middle hepatic veins are not seen.  The superior mesenteric\nvein, renal veins and IVC are patent.\n\nOsseous and Soft Tissue Structures: No concerning osseous or soft tissue\nabnormality.",
            "output": "1. Mild interval enlargement of known HCC/cholangiocarcinoma involving the\nentire left and central right hepatic lobes, with increased areas of\nhypoenhancement particularly in the left hepatic lobe, compatible with\ntreatment response status post Y-90 radioembolization.  Associated occlusion\nof the left portal vein and middle and left hepatic veins.  Mild diffuse\nintrahepatic biliary ductal dilatation, increased compared to ___ MRI.\n2. Unchanged mild porta hepatis and retroperitoneal lymphadenopathy. \nMinimally larger right paraesophageal lymph node.\n3. Chronic thrombosis of the splenic vein with anterior abdominal, perigastric\nand perisplenic collateral vessels.\n4. Splenomegaly."
        },
        {
            "input": "Lower Thorax: No pleural or pericardial effusions.  The heart is not enlarged.\n\nLiver: Stable size of the large central infiltrative mass in the liver, now\nmeasuring approximately 13 x 10 cm, previously measuring 13.2 x 10.2, with new\ncapsular retraction along the left lobe of the liver.  The main and left\nhepatic veins are encased and occluded.  The right hepatic vein is partly\nencased.  The left portal vein is encased and occluded by the mass.  The right\nportal vein is encased but patent.  In addition, the mass now appears\ninseparable from the pylorus/antrum of the stomach, with loss of intervening\nfat plane.  A new satellite lesion is present adjacent to the dominant mass in\nsegment 4A/8 measuring 2.1 x 2.0 cm.  Smaller adjacent satellite lesions in\nthe same segment are either new or have increased in size measuring up to 1 cm\nin diameter.  A 1 cm cyst/biliary hamartoma and segment 5 the liver stable.  A\n1.1 cm enhancing lesion on arterial phase in segment 7 of the liver is also\nunchanged.  This remains hyperintense on portal venous and delayed phases and\nmay reflect a small hemangioma.\n\nThere is mild drop in signal intensity on the later echo, suggesting iron\ndeposition.\n\nBiliary: The gallbladder is absent.  There is mild intrahepatic biliary duct\ndilatation in the right hepatic lobe, with more severe segmental biliary duct\ndilatation in the left hepatic lobe.\n\nPancreas: The pancreas is normal in signal intensity and morphology. \nPancreatic duct is not dilated.  6 mm cystic lesion in the neck of the\npancreas is stable, likely representing a side-branch IPMN.\n\nSpleen: Spleen is borderline in size measuring up to 13 cm in craniocaudal\ndimension, at the upper limits of normal.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: No focal suspicious renal lesions identified.  Bilateral renal\ncortical cysts measuring up to 9 mm at the lower pole of the right kidney. \nLeft parapelvic cyst.\n\nGastrointestinal Tract:  There is loss of intervening fat plane between the\npylorus/antrum of the stomach and the large infiltrative mass in the liver. \nThere is no gastric outlet or bowel obstruction.\n\nLymph Nodes: There are multiple prominent retroperitoneal/periaortic lymph\nnodes, unchanged since the previous study.  A retrocrural/paraesophageal lymph\nnode measures up to 1 cm short axis.\n\nVasculature: There is no abdominal aortic aneurysm.  Chronic occlusion of the\nsplenic vein and multiple varices are again demonstrated.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.  Incidental\nnote is made of a left gluteus minimus intramuscular lipoma.\n\nSmall intramural uterine fibroids are partially visualized.",
            "output": "Stable size of the large intrahepatic cholangiocarcinoma, with new capsular\nretraction along the left hepatic lobe anteriorly.  There are new and\nenlarging satellite lesions in segment 4A/8 of the liver measuring up to 2.1\ncm in diameter.\n\nLoss of intervening fat plane between the pylorus/antrum of the stomach and\nthe infiltrative liver mass.  No definite extension of tumor into the stomach,\nand no evidence of bowel obstruction on the present study.\n\nChronic encasement and occlusion of the left portal vein, middle and left\nhepatic veins."
        },
        {
            "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: Redemonstration of the large lobulated mass occupying most of the left\nhepatic lobe, and extending to the right, measuring 11.0 cm x 13.1 cm x 10.7\ncm previously 10.5 cm x 13.2 cm by 10.0 cm with associated capsular\nretraction.  There is intrahepatic biliary dilatation and atrophy of the left\nlobe of the liver.  Post-contrast injection, there is heterogeneous\nenhancement of the posterior component in the right lobe.  The anterior\ncomponent extending into the left lobe has necrosis.\nThe middle and left hepatic veins as well as the left portal vein are\nobliterated, as before.  No free fluid.\nThere is some intrinsic signal centrally, which could represent a small amount\nof hemorrhage.\nTwo segment 7 satellite lesions are slightly enlarged compared to previously,\nmeasuring up to 1.4 cm.\nOther satellite lesions at the anterior aspect are unchanged.\nBiliary: No extrahepatic bile duct dilatation.  Previous cholecystectomy.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\nTiny T2 cystic structures are seen in the neck and tail of the pancreas\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Small cortical cysts are seen in the kidneys bilaterally.  No\nhydronephrosis.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No size significant lymph nodes. The pericardial lymph node is\nslightly smaller.  Stable retrocrural lymph node measuring 9 mm in short axis.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Degenerative changes are seen in the\nvisualized spine. No suspicious bone lesion.",
            "output": "1.  Revisualization of the known treated cholangiocarcinoma replacing most of\nthe left hepatic lobe, measuring 11.0 cm x 13.1 cm x 10.7 cm, with associated\npost treatment changes with necrosis in the anterior component- too early from\ntreatment time to comment upon residual or recurrent disease.\n2.  Two satellite lesions in segment VII of the liver- now measuring up to\n1.4cm in size  are slightly enlarged compared to prior.\n3.  The middle and left hepatic veins as well as the left portal vein are\nobliterated by the tumor, unchanged.\n4.  No enlarged upper abdominal lymph nodes. Slight decrease in size of the\npericardial lymph node."
        },
        {
            "input": "Lower Thorax: No pleural or pericardial effusion..\n\nLiver: The patient is status post left hepatectomy.  Intrinsic abnormal signal\nin the posterior aspect of segment VII could represent posttreatment changes\nfrom prior chemoembolization.\n\nMultiple liver lesions are redemonstrated, most of the demonstrating mild\nincrease in size and/or conspicuity compared to most recent MRI, including:\n- 1.8 cm targetoid enhancing lesion in segment VIII (12:71) previously\nmeasured 1.1 cm (3:7, 8:11, 12:11, 4:1).\n- 0.8 cm targeted enhancing lesion in the subcapsular segment VIII previously\nmeasured 0.6 cm (4:2, 8:19, 12:19)\n- 1.4 cm targetoid subcapsular lesion segment VIII, previously measure 1.1 cm\n(8:12, 12:12, 3:6)\n- 0.8 cm enhancing in segment VIII appears more conspicuous than on prior\nstudy (8:29).\n-1.7 cm targetoid enhancing lesion in segment V, previously measured 1.5 cm\n(8:69, 12:69).\n-1.5 cm enhancing lesion in segment VII, previously measured 0.8 cm (8:60,\n12:60).\n-0.7 cm enhancing lesion in segment VII, appears more conspicuous in current\nstudy in spite of being similar in size (8:49, 12:49).\n-0.6 cm mildly enhancing lesion in segment VI is more conspicuous than on\nprior study (8:79, 12:79).\n\nThere are no definitive new liver lesions. Stable cyst measuring up to 1 cm\n(3:28).\nPatient is status post cholecystectomy.\n\nBiliary: There has been interval removal of a right anterior transhepatic\nbiliary drainage catheter.  There is similar mild intrahepatic biliary\ndilation.\n\nPancreas: Normal intrinsic T1 signal throughout.  No suspicious lesions or\nductal dilatation.\n\nSpleen: Spleen remains top-normal in size measuring up to 12.8 cm in\ncraniocaudal dimension.\n\nAdrenal Glands: The bilateral adrenal glands are normal and symmetric in size.\nNo focal lesions.\n\nKidneys: Bilateral kidneys are normal and symmetric in size with normal\nnephrogram.  No suspicious renal lesions.  Bilateral extrarenal pelvises are\nredemonstrated.  There is no hydronephrosis.\n\nGastrointestinal Tract:  Visualized loops of small and large bowel are normal\nin caliber.\n\nLymph Nodes: No mesenteric retroperitoneal adenopathy.\n\nVasculature: The portal vein, splenic vein and SMV are patent.  Abdominal\naorta is patent and normal in caliber.\n\nOsseous and Soft Tissue Structures: New T2 hyperintense and enhancing focus in\nthe left transverse process of T10 is incompletely characterized on MRI. \nSimilar appearance of serpiginous sacral and bilateral iliac bone T1\nhypointensities and T2 hyperintensities without enhancement, are which could\nrepresent bone infarcts.A T2 hyperintense lesion in the right L2 vertebral\nbody is stable since at least ___ and likely represents a hemangioma.",
            "output": "1. Multiple enhancing liver lesions appear slightly larger in size or more\nconspicuous than on most recent MRI.  No new liver lesions.\n2. Patient is status post removal of a right PTBD with mild intrahepatic\nbiliary dilation.\n3. New T1 hyperintense and possibly enhancing focus in the left transverse\nprocess of T10 is only partially imaged and incompletely characterized on MRI;\nunclear if this represents artifact or may be a true lesion.  No definite\ncorrelate is seen on the same-day chest CT.  If clinically relevant, bone scan\nmay be considered for further evaluation."
        },
        {
            "input": "MRA:\n\nThere are bilateral fusiform common iliac artery aneurysms.  On the right, the\naneurysm measures 7.1 cm in length.  The maximum transverse diameter is 4.2\ncm.  The lumen measures up to 3.0 cm.  The proximal landing zone is 0.2 cm\nfrom the aortic bifurcation.  The right internal iliac artery is ectatic\nmeasuring up to 1 cm in maximum transverse diameter over a length of 1.5 cm.\n\nOn the left, the aneurysm spans approximately 6.6 cm and demonstrates a\nmaximum transverse diameter of 4.2 cm.  The lumen measures up to 2.2 cm.  The\nproximal landing zone is a 1.2 cm.  The left internal iliac artery is ectatic\nmeasuring up to 1.3 cm over a 2.0 cm length.\n\nThe remainder of the abdominal aorta is ectatic but of normal caliber\nthroughout measuring up to 2.1 cm.\n\nThe left common iliac artery aneurysm compresses the left common iliac vein;\nhowever, the vessel remains patent both distally and proximally.  The\nremainder of the visualized pelvic veins appear patent.\n\nThere is an accessory left renal artery which appears narrowed at its origin.\n\nNON-ANGIOGRAPHIC FINDINGS:\n\n\n\nAlthough the study is not optimized for assessment of the abdominal viscera,\nno gross abnormalities are detected.\n\nLower thorax:  The lung bases are clear.\n\nLiver:  The liver is homogeneous in signal characteristics.  There are no\nsolid or cystic lesions.\n\nBiliary:  There is no intra or extrahepatic duct dilatation.  The gallbladder\nis within normal limits.\n\nSpleen:  The spleen is normal in size and signal characteristics.  The adrenal\nglands are unremarkable.\n\nKidneys:  The kidneys are normal in size and signal characteristics.  No\nconcerning solid lesions are identified.\n\nPancreas:  The pancreas is within normal limits.  There is no pancreatic duct\ndilatation.\n\nGI tract:  The GI tract is of normal caliber throughout.\n\nLymph nodes:  There is no significant mesenteric or pelvic adenopathy by size\ncriteria.\n\nOsseous structures:  Anterior wedge compression deformities of L1, L3 and L4\nare unchanged compared to the previous lumbar spine MRI dated ___. \nMultilevel degenerative change is noted throughout the lumbar spine.  There\nare no concerning osseous lesions.",
            "output": "1.  Bilaterally, there are common iliac artery aneurysms extending within 1.5\ncm of the aortic bifurcation and distally to the internal iliac arteries. \nThere is mass effect on the left common iliac vein; however, the vein remains\npatent both proximally and distally with no evidence of thrombosis.  Vascular\nsurgery consult is recommended."
        }
    ]
}