Correct!
5. Unenhanced thoracic CT
Unenhanced thoracic CT is the next most appropriate step for the characterization of the pulmonary opacities in this patient. Enhanced thoracic MRI can be useful for cardiovascular evaluation and the evaluation of chest wall and mediastinal masses, but the rather poor signal typical of the pulmonary parenchyma at MRI renders MRI less suitable than CT for pulmonary nodule evaluation. 68Ga-Dotatate scanning is typically employed for the evaluation of neuroendocrine malignancies, which may ultimately prove useful in this patient should that diagnosis be established, but is premature at this point. As noted previously, 18FDG-PET scanning is commonly reserved for patients in whom pulmonary nodules are found to be indeterminate following thoracic CT characterization. Bronchoscopy with transbronchial biopsy is not an unreasonable choice, but this procedure may be best utilized following CT characterization of the nodules. If nothing else, the bronchoscopic procedure may be more appropriately targeted using the information obtained at thoracic CT.
The patient subsequently underwent thoracic CT (Figure 3) for further characterization of the pulmonary nodule seen at chest radiography.
Figure 3. Left: Thoracic CT displayed in lung (A-C) and soft tissue (D-F) windows. Right: video of thoracic CT scan in lung windows.
Regarding the thoracic CT, which of the following statements is most accurate? (click on the correct answer to be directed to the sixth of 11 pages)