Correct!
4. Unenhanced thoracic CT
Unenhanced thoracic CT is the most appropriate choice among those listed. While some recent data suggest MRI can detect and characterize pulmonary nodules, MR is more costly, takes longer, and is generally less efficacious than CT for this purpose. Typically indeterminate nodular opacities at thoracic CT are characterized using unenhanced CT, although one can employ intravenous contrast injection utilizing a specific nodule enhancement protocol for characterization, but injecting intravenous contrast according to a CT pulmonary angiography is not an appropriate protocol as the nodular opacity cannot be characterized properly with that protocol, and neither the patient’s presentation nor the chest radiographic findings are suggestive or pulmonary thromboembolic disease. As noted above, 18FDG – PET scan is premature at this point. Finally, 68Ga – PET – CT dotatate scanning is typically used for neuroendocrine malignancies, and could play some role in this patient’s assessment if neuroendocrine malignancy is subsequently diagnosed, this study is not appropriate at this point in the patient’s assessment.
The patient underwent unenhanced thoracic CT (Figure 3).
Figure 3. A-I (upper left): Axial unenhanced thoracic CT displayed in soft tissue windows. J-U (upper right): Axial unenhanced thoracic CT displayed in lung windows. Lower left: video of thoracic CT in soft tissue windows. Lower right: video of thoracic CT in lung windows.
Which of the following represents the most accurate assessment of the chest CT findings? (Click on the correct answer to be directed to the fifth of sixteen pages)