Quiz: Kidneys & Bladder 1

Objectives: This course is a comprehensive review of the most important aspects of Genito-Urinary MRI, covering multiple organs and diagnoses. The knowledge required for general competence in interpreting GU MRI exams is delivered in 15 lectures by international experts on each topic.

1. Which is TRUE regarding the sagittal post-contrast sequence in MRI of renal masses?*

It gives a more accurate depiction of location of renal masses compared to other renal structures
It is required to visualize the renal veins on-end to reliably exclude thrombosis
It can be acquired faster due to less z-axis coverage compared to the axial sequence
It allows higher spatial resolution images due to smaller field- of-view focused only on the kidneys
None of the above

Jump to the relevant part of the video for question 1:

2. What is the current/future role of MRI of renal masses?*

To distinguish benign from malignant neoplasms
To replace ultrasound as the modality of choice for assessment of incidental renal lesions
To predict subtypes of renal masses
To confirm presence of suspected renal masses and detect internal enhancement
None of the above

Jump to the relevant part of the video for question 2:

3. What are the limitation of using regions-of-interest ROI for signal intensity comparison for detection of renal mass enhancement? Select all that apply.*

No accurate %enhancement value has been established to differentiate enhancing from non-enhancing lesions.
Noise maps are (usually) not available for interpretation of clinical cases.
The transmit gain and receive gain differ between pre- and post-contrast images.
Sequence parameters (FOV, Matrix size, TR, TE...) are not kept constant between pre- and post-contrast images.
Subjective assessment is as accurate as quantitative ROI measurements and is much faster.

Jump to the relevant part of the video for question 3:

4. What are important pitfalls in assessment of lesion enhancement on MRI? Select all that apply.*

The enhancing region maybe too small for ROI measurement.
Noise is additive and creates erroneous signal on subtraction images.
Mis-registration can mimic peripheral enhancement on subtraction images
MRI cannot detect enhancement in lesions with calcification.

Jump to the relevant part of the video for question 4:

5. Which of the following incidental renal lesions can be ignored? Select all that apply.*

CT density <20HU or >70HU on non-contrast CT scan.
Hemorrhagic cysts with lesion/renal parenchyma ROI SI > 2.5 on pre-contrast T1 VIBE/LAVA
Lesions smaller than 1cm that are cyst-appearing (much lower than renal parenchyma on subjective assessment), on either pre- or post-contrast images
Lesions that are almost entirely calcified.

Jump to the relevant part of the video for question 5:

6. Which are the most important sequences in sub-typing enhancing renal masses?*

Pre- and post-contrast T1 weighted (T1WI), Diffusion weighted (DWI)
Chemical shift images (CSI), DWI
T2WI, DWI
T2WI, CSI
Pre- & post-contrast T1WI, CSI

Jump to the relevant parts of the video for question 6:

7. Which statement(s) is(are) CORRECT regarding fat within a renal lesion? Select all that apply.*

Presence of bulk fat is diagnostic for angiomyolipoma (AML).
Presence of intravoxel fat is diagnostic for clear-cell renal cell carcinoma (ccRCC).
Lesions with intravoxel fat can be differentiated based on their appearance on T2 weighted images.
Absence of intra-voxel fat excludes diagnosis of lipid-poor AML.
Non-contrast CT scan may be helpful if MRI is not conclusive regarding presence of bulk fat.

Jump to the relevant parts of the video for question 7:

8. Which set of lesion differential diagnosis will require biopsy for definitive diagnosis/subtyping? Select all that apply.*

Lipid-rich AML, Oncocytoma, clear cell RCC (ccRCC)
Papillary RCC (pRCC), lipid-poor AML, ccRCC
Transiotional cell carcinoma, AML, Oncocytoma
Oncocytoma, chromophobe RCC, ccRCC
Hemorrhagic RCC, Lymphoma, Tuberculous abscess

Jump to the relevant part of the video for question 8:

9. Which statements are true regarding diffusion weighted MRI (DWI) for detection or characterization of renal lesions? Select all that apply.*

DWI can be reliably used to detect local recurrence without IV contrast
Lower apparent diffusion coefficient (ADC) values can differentiate benign from malignant lesions
Lower apparent diffusion coefficient (ADC) values can be seen in higher grade lesions.
DWI has a limited role due to low lesion cellularity and low signal.
Intra-Voxel Incoherent Motion (IVIM) may be superior to ADC maps in lesion sub-typing.

Jump to the relevant part of the video for question 4: