Our series of 5 cases of histologically-proven Giant cell myocarditis with concurrent CMR shows a pattern of late gadolinium enhancement which tends to be widespread involving all layers of the myocardium.

Background Brain metastases (BM) are the most common intracranial tumors in adults outnumbering all other intracranial neoplasms. Positron emission tomography combined with computed tomography (PET/CT) is a widely used imaging modality in oncology with a unique combination of cross-sectional anatomic information provided by CT and the metabolic information provided by PET using the [18F]-2-fluoro-2-deoxy-d-glucose (FDG) as a tracer. The aim of the study is to assess the role and diagnostic performance of brain-included whole-body PET/CT in detection and evaluation of BM and when further imaging is considered necessary. The study was conducted over a period of 12 months on 420 patients suffering from extra-cranial malignancies utilizing brain-included whole-body PET/CT. Results Thirty patients with 71 brain lesions were detected, 18 patients (60%) had BM of unknown origin while 12 patients (40%) presented with known primary tumors. After brain-included whole-body FDG-PET/CT examination, the unknown primaries turned out to be bronchogenic carcinoma in 10 patients (33.3%), renal cell carcinoma in 2 patients (6.7%), and lymphoma in 2 patients (6.7%), yet the primary tumors remained unknown in 4 patients (13.3%). In 61 lesions (85.9%), the max SUV ranged from 0.2- < 10, while in 10 lesions (14.1%) the max SUV ranged from 10 to 20. Hypometabolic lesions were reported in 41 (57.7%) lesions, hypermetabolic in 3 lesions (4.2%), whereas 27 lesions (38.0%) showed similar FDG uptake to the corresponding contralateral brain matter. PET/CT overall sensitivity, specificity, positive and negative predictive, and accuracy values were 78.1, 92.6, 83.3, 90, and 88% respectively. Conclusion Brain-included whole-body FDG-PET/CT provides valuable complementary information in the evaluation of patients with suspected BM. However, the diagnostic performance of brain PET-CT carries the possibility of false-negative results with consequent false sense of security. The clinicians should learn about the possible pitfalls of PET/CT interpretation to direct patients with persistent neurological symptoms or high suspicion for BM for further dedicated CNS imaging.

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Background Tinnitus, sensory neural hearing loss (SNHL), and vertigo are common audio-vestibular symptoms. Many diseases are associated with these symptoms; however, the exact cause is not always identified. Some studies show that the etiology could be related to the presence of a vascular loop in contact with the 8th cranial nerve. Three-dimensional (3D) constructive interference in steady state (CISS) is a fully refocused gradient-echo magnetic resonance imaging (MRI) sequence that has high sensitivity in evaluation of the cranial nerves. This high sensitivity is a result of its inherent ability to accentuate the T2 values between cerebrospinal fluid (CSF) and adjacent anatomical or pathological structures. We aimed to evaluate the association of audio-vestibular symptoms with the presence of vascular loops and vascular contact in cerebellopontine angle (CPA) and the internal auditory canal (IAC) using 3Tesla MRI. The study included 98 patients (196 ears); 51 females and 47 males with audio-vestibular dysfunction symptoms in isolation or combined; 40 patients with tinnitus, 50 with sensory neural hearing loss, and 32 with vertigo. The healthy control group with no symptoms in either ear, n = 60 (120 ears): 32 females and 28 males. The non-symptomatic ears in the patients were added to the healthy control group. All MRI examinations were performed by using a 3 T (Magnetom Verio 3 T; Siemens Medical Solutions, Erlangen, Germany). Results No statistically significant association was detected between the presence of different grades of vascular loop or types of vascular contact and any of the studied audio-vestibular symptoms. Conclusion No possible role of the presence of vascular loop/contact was identified in causing tinnitus, deafness, or vertigo as evaluated by 3D-CISS sequence. Therefore, presence of vascular loops in contact with the 8th cranial nerve is not certainly considered pathological but possibly to be a normal anatomical coincidental finding.

Introduction: Visceral pleural biopsy and peripheral lung biopsy can be undertaken at the same time as parietal pleural biopsy during medical thoracoscopy, with or without coexistence of a pleural effusion with lung disease.Objective: To assess the accuracy and safety of medical thoracoscopy for the evaluation of peripheral parenchymal pulmonary lesions.Patients: We studied 15 patients with peripheral parenchymal pulmonary disease, the cause of which had not been determined after initial investigations, including needle biopsy and thoracocentesis if pleural effusion is present. Two patients have solitary peripheral lesions while thirteen have diffuse pathology. Seven patients have pleural effusion in addition to parenchymal lesions.Methods: Only one patient had thoracoscopy under general anaesthesia while the remaining fourteen were given local anaesthesia with mild sedation. Visually directed biopsies were taken from the lung using electrocautery in all patients. Biopsies were taken also from the parietal pleura in only seven patients.Measurements: We recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure.Results: A definitive diagnosis was established in 12 patients: 4 patients had primary bronchogenic carcinoma while 5 patients had metastases. Only 3 patients had benign parenchymal disease. Overall, thoracoscopy had a sensitivity of 80% for the diagnosis of peripheral parenchymal pulmonary lesions. Thoracoscopy was well tolerated under local anaesthesia and entailed hospitalization for less than 48 h in most cases. No deaths occurred, although 6.7% of patients had major complications, and 20% had minor complications.Conclusions: Among patients with peripheral parenchymal pulmonary lesions remaining undiagnosed after usual initial investigation and even transthoracic needle biopsies, thoracoscopy done under local anaesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.

The principle aim of diagnostic cardiovascular imaging is to provide clinically relevant information regarding cardiac anatomy and function. This may be broadly categorised into coronary vascular anatomy, plaque architecture, myocardial perfusion, cavity volume, valvular pathology, and haemodynamics. Each of the major cardiac imaging techniques (chest X-ray, coronary angiography, cardiac MRI, multislice CT, SPECT, FDG-PET, echocardiography) provides a subset of this information to varying degrees according to strengths and weaknesses of the particular modality. The techniques may be compared by invasiveness, spatial resolution, temporal resolution, radiation dose, cost, repeatability, and availability.In this issue of IJCI Bansal et al. report their study comparing 16-slice multi-detector computed tomography (16CT) with conventional 2-dimensional echocardiography for assessment of left ventricular function by cavity volumes and ejection fraction. Their study population consisted of 52 patients with suspected coronary artery disease (CAD) who were referred for routine cardiological investigation. The computed tomography scans were acquired using a 16-slice scanner with contrast enhancement but without dose modulation. Echocardiographic assessment of cavity volumes and ejection fraction were calculated from Simpson's and biplane Simpson's planimetry. Their results showed significant correlation between the two modalities for biplane cavity volume measurements (LVESV r = 0.69; LVEDV r = 0.73; P \ 0.01) with echocardiography consistently underestimating cavity volume, but very close agreement for ejection fraction (CT EF = 59.7 ± 12% vs. Echo EF = 58 ± 13%, r = 0.59; P \ 0.01). Previous studies [1, 2] have reported similar results to that by Bansal et al. and there is evidence for consistent over-or under-estimation with multidetector CT and echocardiography, respectively, compared with cardiac MRI.Technical limitations as well as the immutable laws of physics govern the strengths and weaknesses of the major cardiac imaging techniques. Cardiac MRI is accepted as the 'gold standard' measurement for ventricular cavity volume, and therefore ejection fraction, by calculation. Cardiac MRI is also known for its excellent tissue delineation, useful when assessing infarcted myocardium or fibrosis. These Editorial comment on the article by Bansal et al. in the current issue of this journal.

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