There is growing evidence that pericardial and epicardial fat volume (PFV, EFV) are associated with cardiovascular risk. We evaluated a novel method for accurate measurement of PFV and EFV using a 3D-Dixon based cardiac magnetic resonance (CMR) approach. An electrocardiography triggered and respiratory navigator gated 3D-gradient echo pulse sequence was used for cardiac Dixon imaging. Based on this sequence, voxels predominantly containing fat were identified and added up for volumetry. After accuracy assessment in phantoms, consisting of muscle tissue and seven different fat samples (50-200 ml), the sequence was acquired in 34 healthy volunteers (22 male, BMI range 14-42 kg/m(2), age range 21-79 years) at 1.5 T. Analysis was performed independently by two readers who draw two 3D-regions of interest, one for EFV and one for PFV. Additionally, EFV and PFV were compared between overweighted and non-overweighted subjects. The phantom study showed an excellent agreement of measured and true fat volumes (maximum difference = 6 %, linear correlation coefficient R = 1.00). PFV over all volunteers was 158.0 ± 126.4 ml and EFV was 77.0 ± 55.3 ml. PFV and EFV were highly correlated (R = 0.96). Inter-reader agreement was good with a mean difference of 0.2 ± 5.6 and 4.5 ± 4.2 ml for PFV/EFV, (R > 0.99, each). EFV and PFV differed significantly between subjects with BMI > 25 kg/m(2) and BMI < 25 kg/m(2), n = 17 each (PFV 219.0 ± 151.8 vs. 96.9 ± 44.7 ml and EFV 102.3 ± 66.3 vs. 51.7 ± 23.6 ml, p < 0.001, each). The proposed 3D-Dixon based method allows accurate measurement of cardiac fat volumes. It provides a valuable tool for cardiovascular risk stratification by CMR.

• Establishing a diagnosis of indeterminate vertebral lesions is a common clinical problem • Benign bone marrow processes may mimic the signal alterations observed in malignancy • PDFF differentiates between benign and malignant lesions with a high diagnostic accuracy • PDFF of non-neoplastic vertebral lesions is significantly higher than that of malignancy • PDFF from six-echo modified Dixon may help avoid potentially harmful bone biopsy.

The results of the first screening round suggest that MRI is suitable for lung cancer screening with an excellent sensitivity and specificity for nodules ≥ 6 mm.

Lung-RADS might be applied for lung cancer screening with MRI, since findings correlated with LDCT. Relevant findings with a Lung-RADS score of 3 and higher were never missed or underestimated by MRI KEY POINTS: • MRI performed comparably to low-dose CT in a lung cancer-screening programme. • Lung-RADS might be applied for lung cancer screening with MRI. • Lung-RADS findings score of 3 and higher were never missed by MRI.

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Background There is increased interest in pulmonary magnetic resonance imaging (MRI) as a radiation-free alternative to computed tomography (CT) for lung cancer screening. Purpose To analyze MRI characteristics of pulmonary nodules with different non-enhanced sequences. Material and Methods Eighty-two participants of a lung cancer screening were included. MRI datasets of 32 individuals with 46 different nodules ≥ 6 mm were prospectively evaluated together with 50 controls by two readers. Acquired sequences were T2- short tau inversion recovery (STIR), T2, balanced steady-state free precession (bSSFP), 3D-T1, and diffusion-weighted imaging (DWI). Each sequence was randomly and separately viewed blinded to low-dose CT (LDCT). Size, shape, and contrast of nodules were evaluated on each sequence and then correlated with LDCT and histopathology. Results All eight carcinomas were detected by T2-STIR, T2, and bSSFP, and 7/8 by 3D-T1. Contrast was significantly higher for malignant nodules on all sequences. The highest contrast ratio between malignant and benign nodules was provided by T2-STIR. Of eight carcinomas, seven showed restricted diffusion. Size measurement correlated significantly between MRI and LDCT. Sensitivity/specificity for nodules ≥ 6 mm was 85-89%/92-94% for T2-STIR, 80-87%/93-96% for T2, 65-70%/96-98% for bSSFP, and 63-67%/96-100% for 3D-T1. Seven of eight subsolid nodules were visible on T2-sequences with significantly lower lesion contrast compared to solid nodules. Two of eight subsolid nodules were detected by bSFFP, none by 3D-T1. All three calcified nodules were detected by 3D-T1, one by bSSFP, and none by T2-sequences. Conclusion Malignant as well as calcified and subsolid nodules seem to have distinctive characteristics on different MRI sequences. T2-imaging was most suitable for the detection of nodules ≥ 6 mm.

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