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A 49-year-old man with a history of recurrent melanoma in the parotid was treated with parotidectomy, external beam radiation, and high-dose interferon-alpha-2b. Combined F-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) performed for restaging demonstrated multiple bilateral hilar and mediastinal hypermetabolic foci corresponding to hilar and mediastinal lymphadenopathy. Cytologic specimens obtained by bronchoscopy were negative for malignancy, revealing reactive lymph nodes. Subsequent FDG PET/CT showed regression of the findings. Awareness of possible interferon-associated reaction in melanoma patients who undergo FDG PET is important to avoid pitfalls in the interpretation.

Purpose: The purpose of this study was to compare two non-contrast 2D techniques with the current contrast-enhanced MRI standard 3D technique for the routine assessment of thoracic aortic pathologies., Methods: One hundred patients with suspected or known thoracic aortic diseases were examined with a 1.5 T scanner using 2D turbo spin echo (TSE), 2D balanced steady state free precession (balanced SSFP) and 3D contrast-enhanced MR angiography (CE-MRA). The diameters of the aorta at predefined levels were measured. The feasibility to visualize the aortic root and supra-aortic branches was tested. All morphologic abnormalities of the aorta, the aortic wall and the aortic valve, as well as image quality of TSE and balanced SSFP influencing the diagnosis were analysed., Results: Compared to CE-MRA, balanced SSFP and TSE allowed for the detection of a significantly higher number of relevant pathologies (thickened aortic wall and signs of emergency) in less time. No significant differences were found among the sequences for the identification of aneurysms, dissection membranes and thrombi. No single technique was able to address all clinically relevant issues. TSE was associated with a better image quality compared to balanced SSFP, which however did not translate into a significantly improved diagnostic accuracy., Conclusion: The total number of pathologic findings was higher using 2D TSE and balanced SSFP when compared to 3D CE-MRA. None of the techniques applied could address all clinically relevant issues. The major drawback of TSE is its relatively long scanning time while balanced SSFP is associated with more artifacts.

We describe a patient with history of an acute coronary syndrome. Cardiovascular magnetic resonance (CMR) was used for the assessment of coronary artery status using a high-resolution whole heart coronary artery imaging sequence, cardiac function at rest and detection of myocardial fibrosis using delayed enhancement. In the current case there were multiple giant aneurysms, one with evidence of thrombosis in combination with wall motion abnormalities and late enhancement in the myocardial segments supplied by this coronary artery.

Purpose: Different centers and vendors use different sequences and contrast agent application schemes for MR myocardial perfusion imaging. The purpose of this study was to evaluate the role of different sequences, dosages, and injection speeds of contrast media for semiquantitative MR-perfusion assessment., Methods: In a pilot study with 58 consecutive patients three of the most commonly used sequences for MR myocardial perfusion imaging (T1-GrE, GrE-EPI or SSFP) were compared to each other in terms of peak myocardial enhancement and image quality. For the main part of the study dynamic first pass MR perfusion imaging (Philips Intera CV, Best, Tthe Netherlands) was performed in 24 patients using the most favorable sequence from the pilot study (SSFP) after peripheral i.v. administration of Gd-BOPTA during adenosine stress. Two doses (0.05 mmol/kg bw and 0.025 mmol/kg bw) and four different injection speeds (8, 4, 3, 2 ml/s) were used. Signal intensity time curves were determined in the LV and myocardial segments supplied by normal coronary arteries and correlation between LV and myocardial upslope as well as peak enhancement were noted., Results: The SSFP-sequence showed a higher peak enhancement when using 0.05 mmol/kg bw of Gd-BOPTA and a superior image quality for both dosage regimen compared with the other sequences and was consequently applied for the main study. A significant correlation was found between the upslopes in the LV and the myocardium (r square = 0.85, p < 0.001). However, LV and myocardial upslopes were largely independent of the dosage. Myocardial upslope was significantly slower at an injection rate of 2 ml/s compared to 3 and 4 ml/s. Higher Gd-doses led to significantly higher enhancement (p < 0.001)., Conclusion: In healthy myocardial segments, the myocardial upslope is mainly determined from the LV upslope. Both myocardial enhancement and upslope are largely independent from the injection rate of a contrast agent bolus as long as the injection speed is not below 3 ml/s. Myocardial enhancement, however, is dose dependent. Thus, a simple correction for LV upslope allows to normalize a wide variety of input parameters. Differences of myocardial upslope or peak signal intensity after correction should be mainly dependent on blood flow.