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SPRINGFIELD IMAGING CENTER CT Chest, Abdomen, and Pelvis with IV Contrast Patient: Robert Chen MRN: MRN003 Date of Exam: July 12, 2024 Ordering Provider: Dr. Michael Anderson Indication: Response assessment after 6 cycles of FOLFOX chemotherapy COMPARISON: Prior CT dated March 18, 2024 TECHNIQUE: CT of the chest, abdomen, and pelvis was performed following administration of intravenous contrast. FINDINGS: CHEST: Lungs: Previously identified bilateral pulmonary nodules are stable to slightly decreased in size. Largest right lower lobe nodule now measures 1.0 cm (previously 1.2 cm). Other nodules remain unchanged. Heart: Normal size. No pericardial effusion. Mediastinum: No lymphadenopathy. Pleura: No pleural effusion. ABDOMEN: Liver: Interval decrease in size and number of hepatic metastases. Previously identified segment 7 lesion now measures 2.8 cm (previously 4.2 cm), representing 33% reduction. Several smaller lesions are no longer visualized on current study. Remaining 4 lesions show decreased size. Spleen, Pancreas, Adrenals: Unremarkable. Kidneys: Normal. Colon: Sigmoid wall thickening has decreased in extent, now measuring 4 cm (previously 6 cm). Decreased associated fat stranding. Port-a-cath identified in right chest with catheter tip in appropriate position in the SVC. Peritoneum: No ascites. No new peritoneal disease. Lymph Nodes: Previously enlarged sigmoid mesenteric lymph nodes have decreased in size, largest now 1.2 cm (previously 1.8 cm). PELVIS: No significant change. No new pelvic masses or lymphadenopathy. BONES: No new osseous lesions. IMPRESSION: 1. PARTIAL RESPONSE to chemotherapy by RECIST 1.1 criteria. 2. Significant decrease in size of hepatic metastases, with largest lesion showing 33% reduction (4.2 cm → 2.8 cm). 3. Decrease in size of primary sigmoid tumor and regional lymphadenopathy. 4. Stable to slightly decreased bilateral pulmonary nodules. 5. No evidence of new metastatic disease. RECOMMENDATIONS: Findings indicate favorable response to current chemotherapy regimen. Continue systemic therapy as directed by oncology team. Follow-up imaging recommended per standard protocol. Radiologist: Dr. Thomas Richardson, MD Board Certified Diagnostic Radiology Date Signed: July 12, 2024