Correct!
3. Contrast-enhanced thoracic MRI
Unenhanced thoracic CT is unlikely to show findings not already known by previous enhanced thoracic CT and endoscopic ultrasound. A contrast esophagram is a reasonable test to consider, particularly given Zenker’s diverticulum is a consideration, but is unlikely to add information to that already provided by endoscopic ultrasound. The likelihood of Zenker’s diverticulum is low, given the heterogeneous CT appearance, with no gas within the lesion, and the lack of connection to the esophageal lumen at endoscopic ultrasound. High-resolution thoracic CT is primarily performed for the assessment of diffuse lung disorders or bronchiectasis, and would add no additional information in this patient beyond that already known with unenhanced thoracic CT. 18FDG-PET scanning may be capable of showing increased glucose utilization in the superior posterior mediastinal mass, but metabolic activity within the lesion would not distinguish between inflammatory and neoplastic etiologies. Furthermore, the lack of increased tracer utilization within the mediastinal lesion would not mitigate the need for further evaluation. Contrast-enhanced MRI has the ability to further characterize the mediastinal lesion and, in particular, assess for a potential spinal etiology and effects on the spinal canal. Furthermore, contrast-enhanced thoracic MRI may show imaging characteristics that may be specifically suggestive of neurogenic tumor.
The patient underwent CT of the abdomen and pelvis, which was unremarkable. Contrast-enhanced thoracic MRI (Figure 5) was performed.
Figure 5. Upper Panel A-H: Axial contrast-enhanced T1-weighted (A-C), axial T2-weighted (D-F) and sagittal T2-weighted (G and H) MR imaging of the thoracic spine. Lower Panels: Left: Video A-C. Middle: Video D-F. Right: Video G & H.
Which of the following is correct regarding the description of the thoracic MRI findings? (Click on the correct answer to proceed to the eighth and final panel)