Neuroradiology. & Contrast Agents in Neuroradiology. & CAT Scan

Transcription

1 Neuroradiology & Contrast Agents in Neuroradiology 1. Complete the following for an iodinated contrast allergy prep. With regard to a prednisone i. pretest timing in hours ii. dose in mg iii. route b Benadryl i. pretest timing in hours ii. dose in mg iii. route c cimetidine i. pretest timing in hours ii. dose in mg iii. route 20 24, 8 12, 2 0 PO 1 0 IM PO or IV G6 p.128:30 mm & CAT Scan 2. For measurment on a CT scan: G6 p.130:4 mm a The eyeball is mm through its 2 equator. b Give Hounsfield units for: i. air 1000 ii. water 0 iii. bone iv. blood clot 7 80 v. calcium vi. disc material 70 vii. thecal sac c Effect of anemia on an acute subdural hematoma (SDH) in a patient with less than 23% HCT will look. isodense

2 Angiography (Cerebral) 7 & Sylvian Point 3. True or False. The sylvian point is: G p.9:10 mm a the apex of the insula true b usually to 10 mm from the inner table of the skull (30 to 43 mm from inner table) c at or within 1 cm below the midpoint of a true vertical line from the superior inner table to the orbital apex d the point where the anterior choroidal artery enters the temporal horn of the lateral ventricle (That is called the plexal point.) & Angiography (Cerebral) 4. Concerning cerebral angiography: G6 p.130:120 mm a What is the overall risk, in %, of a 0.1% complication resulting in a permanent neurological deficit with angiography? b What is the risk, in %, of neuropathy from femoral angiogram? 0.2%. Complete the following about angiography (cerebral): a The complication rate in i. uncomplicated angiography is 0.1% approximately %. ii. asymptomatic carotid stenosis is 1.2% %. b The most common of the persistent persistent primitive carotid basilar anastomoses is. trigeminal artery c This occurs in % of angiograms. 0.6% d The sylvian point marks the apex of the insula. G6 p.130:120 mm 6. The recurrent artery of Heubner arises from the: a segment of the A1 b artery (80%) anterior cerebral c and supplies the: (Controversial item: Rhoton's Anatomy, page 119 column B 4 mm, recurrent branch most commonly arises from A 2 78% A 1 14% A 1 A 2 junction 8%) i. a anterior limb: internal capsule ii. p putamen iii. c caudate head G6 p.131:110 mm

3 76 Neuroradiology 7. What is the name of the artery that is the continuation of the anterior cerebral artery? pericallosal artery G6 p.131:10 mm 8. Complete the following statements about neuroradiology: a The artery enters anterior choroidal b the temporal horn via the choroidal fissure. c This is called the p p. plexal point d It is mm of that vessel. 18 to 26 mm from origin e What is unique about this point on the It makes a distinct kink as angiogram? seen on the lateral angiogram. 9. True or False. From proximal to distal, the branches of the anterior cerebral artery are a medial orbitofrontal, frontopolar, callosomarginal, pericallosal b frontopolar, callosomarginal, medial orbitofrontal, pericallosal c frontopolar, medial orbitofrontal, pericallosal, callosomarginal d medial orbitofrontal, frontopolar, pericallosal, callosomarginal true G6 p.132:80 mm G6 p.132:9 mm 10. True or False. On a lateral internal carotid artery (ICA) angiogram, the structure that is at approximately the center of the sylvian triangle is the: G6 p.132:100 mm a sylvian point (the apex of the sylvian triangle.) b limbus sphenoidale (edge of planum spenoidale) c tuberculum sellae (anterior part of the sella turcica) d foramen of Monro true G p.6:12 mm e plexal point (is the point where the anterior choroidal artery enters the temporal horn)

4 Angiography (Cerebral) True or False. The sylvian triangle on a lateral ICA angiogram is formed by a superior insular line, angular artery, line between MCA origin, and most anterior ascending branch b superior insular line, line from bregma to torcula, line between posterior temporal branch, and lateral orbitofrontal branch c superior insular line, clinoparietal line, limbus sphenoidale d clinoparietal line, angular artery, line from bregma to torcula true G p.60:13 mm 12. True or False. All of the following are MCA branches: a lateral orbitofrontal true b ascending frontal true c medial orbitofrontal (The medial orbitofrontal is a branch of the anterior cerebral artery.) d anterior temporal true e posterior parietal true G6 p.132:16 mm 13. Complete the following about angiography (cerebral): a The foramen of Monro lies at the junction of what three veins? i. i c internal cerebral ii. t thalamostriate iii. s septal b This site is known as the. venous angle G6 p.133:60 mm 14. True or False. All of the following veins will drain into the straight sinus in the normal venous anatomy: a vein of Galen true b basal cerebral vein of Rosenthal true (via the vein of Galen) c inferior sagittal sinus true d vein of Labbé (It empties into the transverse sinus.) G6 p.133:100 mm

5 78 Neuroradiology 1. True or False. In the setting of a brainstem mass seen on a lateral vertebrobasilar angiogram, the displacement of the choroidal and colliculocentral points should be: a both displaced anteriorly (They would both be displaced anteriorly by a cerebellar mass but posteriorly by a brain stem b c choroidal anteriorly, colliculocentral posteriorly choroidal posteriorly, colliculocentral anteriorly mass.) (They outline the fourth ventricle and would move with it.) (They outline the fourth ventricle and would move with it.) d both displaced posteriorly true (Both would be displaced posteriorly by a brain stem mass.) e no displacement G p.62:143 mm 16. Complete the following about angiography (cerebral): a True or False. On a lateral vertebrobasilar angiogram, the most sensitive indicator of the anterior border of the pons is the: i. pontomesencephalic vein true ii. basilar artery (basilar artery may be off to one side) iii. choroidal point (junction of posterior medullary loop and supratonsillar loop) iv. copular point (on the inferior vermian vein) b Twining's line runs between: Hint tt i. t tuberculum ii. t torcula G p.62:13 mm G p.62:130 mm & Magnetic Resonance Imaging (MRI) 17. Match the best completion for each of the following: 1 short TE, short TR; 2 short TE, long TR; 3 long TE, short TR; 4 long TE, long TR a T1-weighted MRI has: 1 b T2-weighted image has: 4 G6 p.134:13 mm

6 Magnetic Resonance Imaging (MRI) Complete the following about magnetic resonance imaging (MRI): a List the three materials that appear white fat, melanin, and subacute on T1-weighted imaging (T1W1) MRI. blood b What color is pathology on T1W1? low signal on T1 (dark) c What color is pathology on T2WI? high signal on T2 (white) G6 p.134:170 mm 19. Match the following phrases with the appropriate signal: 1 high signal (bright); 2 low signal (dark); 3 intermediate signal a Fat on T1 is 1 b Fat on T2 is 2 c 7- to 14-day-old blood on T2-weighted MRI 1 d is: 7- to 14-day-old blood on T1-weighted MRI is: 1 On T1 both fat and 7- to 14- day-old blood are high signal (white). On T2 fat drops out (i.e., is dark); blood remains white. G6 p.13:60 mm 20. Complete the following about MRI: G6 p.13:90 mm a The best sequence for CVA is, FLAIR b which stands for. fluid-attenuated inversion recovery c Cerebrospinal fluid (CSF) is. black d Most lesions appear. bright 21. Complete the following about MRI: G6 p.13:130 mm a True or False. An MRI sequence that summates T1 and T2 signals and causes fat to be suppressed is called the sequence. i. grass ii. stir true iii. echo train iv. spin density b which stands for short tau inversion recovery (STIR) Summates T1 and T2 images c Use it to. see tissues that enhance in areas of fat

7 80 Neuroradiology 22. Name two contraindications to MRI. G6 p.136:10 mm a patients who contain or ferro metals or cobalt (i.e., cardiac pacemaker, implanted neurostimulators, cochlear implants, ferromagnetic aneurysm clips, foreign bodies with a large component of iron or cobalt, metallic fragments in the eye, placement of stent, coil, or filter within past b relative contraindication to MRI is 6 weeks) claustrophobia 23. Matching. Regarding skull films, match the following findings with their characteristics: 1 enlarged sella; 2 J-shaped sella; 3 symmetrical ballooning; 4 erosion of posterior clinoids a craniopharyngioma 4 erosion of posterior clinoids b pituitary adenoma 1 enlarged sella c optic glioma 2 J-shaped sella d empty sella 3 symmetrical ballooning G6 p.138:170 mm 24. True or False. On a skull x-ray, erosion of the posterior clinoids would most often be seen in the setting of: a craniopharyngioma true b empty sella syndrome c pituitary adenoma d Hurler syndrome e optic glioma G6 p.138:170 mm 2. True or False. The percentage of all patients over 20 years old who will have a calcified pineal gland visible on plain skull x-ray is: a 0% b 10% c 20% d % true e 90% G p.70: mm

8 Plain Films 81 & Plain Films 26. True or False. The most common congenital anomaly of the craniocervical junction is: a Chiari malformation b basilar impression true c os odontoideum d incomplete arch of C 1 e C 1-C 2 subluxation G6 p.139:0 mm 27. True or False. Basilar invagination is seen in: (more than one answer) a hypoparathyroidism b Paget's disease true c osteogenesis imperfecta true d osteomalacia true e hyperparathyroidism true G6 p.139:100 mm 28. True or False. In the evaluation of basilar invagination, in the normal patient, no part of the odontoid should be above McRae's line. true G6 p.139:120 mm 29. True or False. A line used in the evaluation of the craniocervical junction is: (There is more than one true statement.) a McRae line true b Chamberlain line true c Wackenheim line true d Maginot line e Fischgold line true G6 p.139:120 mm 30. Complete the following about plain films: a The basion is at the tip of the. clivus b The opisthion is at the anterior lip of the occipital bone. G6 p.141:0 mm

9 82 Neuroradiology 31. A lateral C-spine x-ray has four contour lines with two marking the borders of the spinal canal. Hint: apsp a front of vertebral body called b back of vertebral body called c posterior margin of spinal canal called d posterior margin of spinous processes is called anterior marginal line posterior marginal line (marks anterior border of spinal canal) spinolaminar line posterior spinous line G6 p.141:7 mm 32. Complete the following about plain films: a Cervical spine normal diameter is mm. b Stenosis is present when the anteroposterior diameter is less than mm. 17± mm 12 mm G6 p.141:140 mm 33. C 1 has how many ossification centers? 3 G6 p.142:0 mm 34. C 2 has how many ossification centers? 4 G6 p.142:110 mm 3. True or False. The most common nondisc spinal lesion is: a synovial cyst b Tarlov cyst c astrocytoma d chordoma e metastatic tumor true G6 p.142:10 mm & Myelography 36. True or False. The risk of postlumbar puncture headache is higher with: a water-soluble contrast b non-water-soluble contrast true G p.72: mm 37. Match each of the following two statements with answers 1, 2, 3, or 4: 1 10%; 2 3%; 3 6%; 4 90% a In lumbar disc disease, what percentage of free fragments move inferiorly? b In lumbar disc disease, what percentage of free fragments move superiorly? 2 3 G p.71:14 mm