Correct!
3. The thoracic CT shows that the subcarinal mediastinal lesion is homogenous

The thoracic CT shows that the lesion in the subcarinal space is fairly homogeneous. There is no central low attenuation, which could represent cystic or necrotic change, evident. The lesion may be enhancing, but enhancement at CT cannot always be known with certainty, particularly when low-level, in the absence of unenhanced imaging for comparison. This is because some processes, such as hemorrhage and proteinaceous fluid within a cystic lesion, can appear somewhat hyperattenuating. Therefore, although this mass appears mildly hyperattenuating (similar to intercostal muscle), this appearance could reflect hemorrhage or proteinaceous fluid within a cyst rather than enhancement. Similarly, clear low attenuation to suggest internal cystic change is not evident, but a cystic lesion containing hyperattenuating contents remains a possibility. The subcarinal lesion is smoothly marginated and circumscribed and does not appear locally aggressive.

To further characterize the lesion discovered at CT scanning, the patient was underwent thoracic MR (Figure 5).

Figure 3: Axial double inversion recovery T1-weighted (A-D), triple inversion recovery (E-H; a fluid-sensitive sequence), axial unenhanced (I-K) and enhanced (L-N) liver acquisition with volume acceleration (LAVA) imaging.

Which of the following regarding this MR examination is correct? (Click on the correct answer to proceed to the fifth of seven panels)

1. The thoracic MR reveals additional sites of abnormality, suggesting a systemic process
2. The thoracic MR shows that the lesion contains fat
3. The thoracic MR shows that the lesion does not enhance significantly
4. The thoracic MR shows that the lesion is solid
5. The thoracic MR shows the same mass at CT, but adds little additional information to that already available with CT

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