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ESHNR 2020 Teaching Weeks MCQs

Correct answers are in bold.

L.01 – Orbital inflammation
Burce Özgen Mocan, Chicago/US

1. Regarding idiopathic orbital inflammation, which of the following is UNTRUE?
a. It is a diagnosis of exclusion
b. Patients typically present w painless proptosis
c. Can be seen anywhere in the orbit
d. Tendon insertions are typically involved
e. Has rapid response to steroid treatment

2. Which of the following is NOT a recognized cause of optic perineuritis?
a. IgG-4 related disease
b. Sarcoidosis
c. Idiopathic orbital inflammation
d. Multiple sclerosis
e. Granulomatosis with polyangiitis

3. Regarding thyroid associated orbitopathy, which of the following is UNTRUE?
a. It is the most frequent cause of exophthalmos in adults
b. It typically causes progressive, bilateral, painless proptosis
c. Imaging is essential for the diagnosis of active inflammation
d. It is usually a self-limited disease
e. Imaging does not supersede clinical assessment for the diagnosis of Dysthyroid Optic Neuropathy

4. Which of the following is NOT a typical feature of IgG4-related orbital disease?
a. Subacute onset and indolent course
b. Bilateral involvement
c. Lacrimal gland is most commonly involved site
d. Lateral rectus is the most commonly involved EOM
e. Can have accompanying pachymeningitis

5. Which of the following is TRUE?
a. IgG4 related orbital disease can demonstrate perineural extension
b. Orbital sarcoidosis only involves the lacrimal gland
c. Optic perineuritis is seen as enhancement of the optic nerve
d. Lid retraction is a common feature in idiopathic orbital inflammation
e. Fat expansion is a central characteristic of IgG4 related orbital disease

 

L.02 – Trauma imaging
Steve Connor, London/UK

1. The following is NOT a potential complication of a naso-ethmoid complex fracture?
a. Telecanthus
b. Dacryocystitis
c. CSF rhinorrhea
d. Carotico-cavernous fistula

2. The following is TRUE of orbital “blow out” fractures
a. Orbital floor blow out fractures may result in delayed exophthalmos
b. Ophthalmoplegia may only occur if there is herniation of the inferior rectus through an orbital floor fracture site
c. “Trapdoor type” fractures typically occur in adults
d. Enophthalmos may result if the fracture involves the “bulge” of the posterior medial wall of orbit

3. Regarding skull base fracture complication
a. Sudden onset sensori-neural hearing loss is more typical of longitudinal otic capsule sparing temporal bone fractures
b. Fractures of the optic nerve canal may result in sudden visual loss
c. Sudden onset facial nerve paralysis usually results from neural contusion in the temporal bone
d. Fractures of the anterior wall of the frontal sinus may result in a sudden CSF rhinorrhea

4. The following is TRUE of maxillo-facial trauma
a. Zygomatico-maxillary fractures are a type of medial midface fracture
b. Smash type transfacial fractures are now more commonly seen than classical LeFort fractures in the context of high energy trauma
c. Zygomatic fractures always need assessment with CT imaging
d. Frontal sinus fractures involving the frontal sinus outflows predispose to meningoceles

 

L.03 – Salivary gland inflammation
Gitta Madani, London/UK

1. Regarding obstructive sialadenitis, which of the following is UNTRUE?
a. 90% of salivary calculi occur in the submandibular and ducts
b. Parotid obstructive sialadenitis is most commonly seen in middle-aged women
c. Mucous impaction may cause obstructive sialadenitis
d. Submandibular calculi are bilateral in 2% of cases
e. 80% of calculi occur is submandibular

2. Which causes sialectasis and dry mouth?
a. Sjögren’s syndrome
b. HIV sialopathy
c. IgG 4 disease
d. Sarcoidosis
e. All of the above

3. Which of the following is NOT a recognized cause of chronic subtotal sialadenitis?
a. Ductal calculi
b. IgG4 disease
c. Autoimmune disorders
d. HIV
e. All of the above

4. Regarding Sjögren’s syndrome, which of the following is UNTRUE?
a. MR sialography is now considered the gold standard for grading of Sjögren’s syndrome
b. T cell lymphomas are the most common type of lymphoma in Sjögren’s syndrome
c. The typical ultrasound findings in Sjogren’s are multiple hypoechoic foci (representing sialectasis) which increase in size and number depending on the severity of disease
d. Sjögren’s syndrome may cause duct dilatation
e. Gland atrophy is seen in established long standing disease

5. Which of the following is TRUE?
a. Sialosis is an uncommon cause of parotid gland enlargement
b. Parotid gland involvement is uncommon in sacoidosis
c. Kimura and Kikuchi Disease are precursors to lymphoma
d. Benign Lymphoepithelial cysts can always be distinguished from tumour
e. Ductal calculi up to 3 times the diameter of the duct may be removed by radiologically guided basket retrieval

 

L.04 – Salivary gland lesions
Roberto Maroldi, Brescia/IT

1. Parotid gland nodule: Which MR feature does NOT suggest a pleomorphic adenoma?
a. Hyper-intensity on T2
b. Regular margins
c. Inhomogeneous enhancement
d. Hyper-intense rim on T2

2. Parotid gland nodule: Which MR feature does suggest malignancy?
a. A nodule hyper-intense on T2
b. A nodule hyper-intense on T1
c. A nodule hypo-intense on T2
d. A nodule hypo-intense on T1
e. High ADC value (>1.4) on DWI

3. Parotid nodule, mostly hyper-intense on T2, high values on ADC. If an intra-nodular component hypo-T2 and with low value ADC (<1.4) is present, what could it indicate?
a. Necrosis in a pleomorphic adenoma
b. Malignant degeneration in a pleomorphic adenoma
c. Cystic degeneration in a pleomorphic adenoma
d. Hyper-cellular component or malignant degeneration in a pleomorphic adenoma
e. Fibrotic component in a pleomorphic adenoma

4. A 1.5 cm nodule within the parotid gland. Hypointense on T2, hyperintense on plain T1, 0.8 on ADC map, enhancing after Gd-administration. Your guess?
a. A complicated branchial cleft cyst type I
b. Pleomorphic adenoma
c. Whartin tumour
d. Adenoid cystic carcinoma
e. Intra-parotid nodal metastasis

5. Long-standing lump (2.5 cm) within the parotid gland. Lobulated contours, appearing low-signal on T2. Hyperintense central signal on T2. 1.94 value on ADC map. Your guess?
a. A complicated branchial cleft cyst type I
b. Pleomorphic adenoma
c. Whartin tumour
d. Adenoid cystic carcinoma
e. Intra-parotid nodal metastasis

 

L.05 – Imaging of cholesteatoma
Bert de Foer, Antwerp/BE

1. 1. One of the major differential diagnosis of cholesteatoma on imaging is cholesterol granuloma. Cholesterol granuloma displays
a. High SI on T1 / high SI on T2/ high SI on b1000 images / low SI on ADC maps
b. Low SI on T1 / low SI on T2/ high SI on b1000 images / low SI on ADC maps
c. High SI on T1 / low SI on T2 / high SI on b1000 images / low SI on ADC maps
d. High SI on T1 / high SI on T2 / low SI on b1000 images / high SI on ADC maps
e. Low SI on T1 / high SI on T2/ high SI on b1000 images / low SI on ADC maps

2. Evaluation of patients after first stage cholesteatoma surgery is done using
a. Obligatory second look surgery after one year
b. Wait and see policy
c. CT scan after one year
d. MRI using non-EP DWI after one year
e. Clinical evaluation alone

3. Which statement is correct?
a. The most frequent complication of middle ear cholesteatoma is facial nerve palsy
b. Incus long apophysis erosion is a hallmark of pars flaccida middle ear cholesteatoma
c. Chronic middle ear infection never causes ossicular erosion
d. Malleus head and/or incus body and/or incus short process erosion is a hallmark of pars flaccida cholesteatoma
e. Chronic middle ear infection may cause erosion of the scutum

4. A routine MRI evaluation protocol in patients 1 year after first stage surgery to exclude residual cholesteatoma should include
a. TSE T2 / SE T1 without and with Gd
b. TSE T2 / SE T1 without and with Gd / EP DWI
c. TSE T2 / SE T1 without Gd / EP DWI
d. TSE T2 / SE T1 without and with Gd / non – EP DWI
e. TSE T2 / SE T1 without Gd / non – EP DWI

5. Which statement is correct?
a. Congenital cholesteatoma is more frequent than the acquired cholesteatoma
b. The acquired cholesteatoma is never associated to chronic infection
c. The pars flaccida cholesteatoma is much more frequent than the pars tensa cholesteatoma
d. Imaging in cholesteatoma prior to first stage surgery is only required in case of complications
e. Imaging in cholesteatoma prior to second stage surgery is only required in case of complications

 

L.06 – Congenital temporal bone lesions
Berit Verbist, Leiden/NL

1. Affected structures in aural atresia are derived from the
a. First branchial arch
b. First and second branchial arch
c. First, second and third branchial arch
d. First and second branchial arch and otocyst

2. What is the most crucial information to determine feasibility of surgical repair in aural atresia according to Jahrsdörfer?
a. Dysplasia of the manubrium of the malleus
b. Presence of the stapes
c. Pneumatization of the mastoid
d. Size of the middle ear cavity

3. What is the term used for Mondini malformation in the Sennaroglu classification?
a. Labyrinthine aplasia
b. Incomplete partitioning type 1
c. Incomplete partitioning type 2
d. Incomplete partitioning type 3

4. In which malformation should Auditory Brainstem Implantation be considered instead of Cochlear Implantation?
a. Common cavity
b. Hypoplasia type 4
c. Incomplete partitioning type 3
d. Labyrinthine aplasia

5. The normal size of the cochlear aperture is
a. 0.5mm
b. 1mm
c. 2mm
d. 3mm

 

L.07 – Oral cavity tumours
Minerva Becker, Geneva/CH

1. Which of the following statements regarding imaging techniques in oral cavity tumours is correct?
a. CT is superior to MRI because it is less hampered by dental artifacts
b. MRI should – whenever possible – be obtained with a “puffed cheek technique”
c. Ultrasound is superior to CT for the assessment of gross tumour size
d. Tumour thickness assessed by MRI does not correspond to the depth of invasion

2. Which of the following statements regarding the 8th edition of the TNM classification of oral cavity squamous cell carcinoma (SCC) is correct?
a. Lip SCC belongs to the category “SCC arising in the buccal mucosa”
b. Minimal bony cortical erosion upstages a SCC as T4a
c. Skull base invasion upstages a SCC as T4b
d. Extranodal spread upstages lymph nodes as N2

3. Which of the following anatomic structures if invaded by SCC upstage the T category?
a. Lingual septum
b. Skin
c. Genioglossus muscle
d. Base of the tongue

4. Which of the following statements regarding mandibular invasion by SCC are correct?
a. CT is superior to MRI and PET CT in terms of sensitivity
b. Periodontal disease affects the performance of MRI, CT and PET CT
c. MRI has less false positive findings than CT
d. PET CT is superior to MRI in terms of sensitivity

5. Perineural spread to and from the pterygopalatine fossa (antegrade and retrograde) typically occurs in the following tumours
a. Mucoepidermoid carcinoma
b. Adenocarcinoma
c. Adenoid cystic carcinoma
d. Rhabdomyosarcoma

 

L.08 – Facial infection
Minerva Becker, Geneva/CH

1. Which of the following statements regarding MRI in facial infections and related complications is correct?
a. MRI is the examination method of choice in the emergency setting
b. MRI should be used instead of CT in suspected vascular complications
c. MRI should be used instead of CT in suspected necrotizing fasciitis
d. MRI should be used to assess complications of facial fillers

2. Which of the following statements regarding invasive fungal sinusitis is correct?
a. It is characterized by frontal bone osteomyelitis associated with subperiosteal involvement
b. Orbital involvement is seen in 75% of cases and intracranial involvement in 25%, respectively
c. Necrosis of the sinonasal mucosa as depicted by MRI points towards the correct diagnosis
d. Thrombosis of the superior ophtalmic vein and cavernous sinus are pathognomonic

3. Which of the following anatomic structures do NOT contribute significantly to the spread of facial infections?
a. Fatty compartments
b. Lymph nodes
c. Facial veins
d. Bony structures

4. Which of the following findings on contrast enhanced CT belong to obligate criteria for the diagnosis of necrotizing fasciitis of the head and neck?
a. Gas collections
b. Mediastinitis
c. Pleural effusions
d. Myositis

5. An abscess in the submandibular space is most often caused by odontogenic infection from one of the following teeth:
a. First premolar
b. Second incisive
c. Third molar
d. Canine

 

L.09 – Odontogenic tumours, jaw infection and necrosis
Soraya Robinson, Vienna/AT

1. Groundglass appearance is pathognomonic for (more than one answer is correct)
a. Odontoma
b. Ameloblastoma
c. Fibrous dysplasia
d. Ossifying fibroma
e. Periapical cemental dysplasia

2. Ameloblastoma (more than one answer is correct)
a. Is primarily lytic
b. Can erode cortical bone and teeth
c. Characteristically has scalloped borders
d. Never occurs with impacted teeth
e. Is a disease of the elderly

3. Compound odontomas (more than one answer is correct)
a. Belong to the rarest odontogenic tumours
b. Is the most common odontogenic tumour
c. Has corticated margins
d. Shows a peripheral halo
e. Are found especially in basal cell naevus syndrome

4. Myxoma
a. Derive from ectoderm and contain enamel
b. Derive fom ectoderm and contain dentin
c. Derive from mesoderm and contain primitive pulp
d. Respect anatomic borders
e. Display speckled calcifications

5. Endosteal osteoma (more than one answer is correct)
a. Respects periodontal space
b. Infiltrates periodontal space
c. Expands cortical bone
d. Has broad contact to cortical bone
e. Is typically heterogenous

6. Biphosphonate therapy induced osteonecrosis
a. Affects the mandible more often than the maxilla
b. Affects the maxilla more often than the mandible
c. Widens the periodontal ligament
d. Effaces the periodontal ligament
e. Produces an involucrum

 

L.10 – HN compartments and ultrasound
Soraya Robinson, Vienna/AT

1. Lesions of the carotid space push the parapharyngeal fat space
a. Anteriorly
b. Posteriorly
c. Laterally
d. Medially
e. Centrally

2. Typical lesions arising from the masticator space are
a. Salivary gland tumours
b. Hodgkin’s lymphoma
c. Sarcoma
d. Squamous cell carcinoma
e. Amyloidosis

3. The following statement regarding the retropharyngeal space is TRUE
a. It connects the skull base to the os coccygis
b. It does not contain lymphatic tissue
c. It is highly vascularized
d. It consists of dense fibrous tissue
e. Lesions arising in it push the parapharyngeal space posteriorly

4. The most likely differential diagnosis of a left supraclavicular cystic lesion includes
a. Ectopic thyroid adenoma
b. Salivary inclusion cyst
c. Thoracic duct
d. Unilocular paraganglioma
e. Cystic adventitial disease

5. Thyroglossal duct cysts
a. Are typically located in the middle third of the floor of the mouth
b. Are found lateral above the hyoid and in the midline below the hyoid
c. Are precursors of branchiogenic carcinoma
d. Contain floating cholesterol crystals
e. Are found in the midline above the hyoid and lateral below the hyoid

 

L.11 – Post-operative middle ear
Berit Verbist, Leiden/NL

1. Which surgical approach gives the widest access to the middle ear cavity?
a. Canal wall down mastoidectomy
b. Canal wall up mastoidectomy
c. Cortical mastoidectomy
d. Epitympanotomy

2. Which technique is considered the most diagnostically accurate imaging sequence for detection of recurrent cholesteatoma?
a. CT
b. Contrast-enhanced T1
c. EPI DWI
d. Non-EPI spin echo based DWI

3. DWI in the follow-up of cholesteatoma removal may render false positive results due to
a. Cerumen, cartilage, cholesterol granuloma
b. Inflammation, granulation tissue, operative material
c. Squamous cell carcinoma, silastic sheet, serous otitis media
d. All of the above

4. Postoperative imaging after ossiculoplasty is indicated
a. To correlate position of the prosthesis with hearing outcome
b. To find a reason for vertigo immediately after stapes surgery
c. To investigate recurrent hearing loss after temporary improvement
d. All of the above

5. An active middle ear implant is connected to the
a. Round window
b. Ossicular chain
c. Oval window
d. All of the above

 

L.12 – Imaging of otospongiosis
Bert De Foer, Antwerp/BE

1. The primary imaging technique in cases of a suspected otospongiosis is
a. X-ray of the skull
b. Cone Beam CT
c. Non-EP diffusion-weighted MRI
d. MDCT
e. Gadolinium-enhanced T1-weighted MRI

2. Otospongiosis clinically resembles
a. Cholesteatoma
b. Tympanosclerosis
c. Glomus tumors
d. Dehiscent superior semicircular canal
e. Acute coalescent otomastoiditis

3. Clinically, otospongiosis presents primarily as
a. Chronic ear discharge
b. Conductive hearing loss
c. Tinnitus
d. Sensorineural hearing loss
e. Vertigo

4. Which statement regarding otospongiosis is correct?
a. Otospongiosis only causes mixed hearing loss
b. Otospongiosis can be detected on CBCT in all cases
c. Otospongiosis can never be detected on MRI
d. Otospongiosis is the most frequent cause of hearing loss in adolescents
e. Otospongiosis only can be treated by cochlear implant

5. Which statement regarding otospongiosis is wrong?
a. The etiology of otospongiosis is unknown
b. There are two forms of otospongiosis: the fenestral and retrofenestral form
c. Cochlear cleft is a predecessor of otospongiosis
d. Otospongiosis is mainly causing conductive hearing loss
e. Active otospongiosis is enhancing on gadolinium-enhanced T1-weighted images

 

L.13 – Extranodal lymphoma
Frank Pameijer, Amsterdam/NL

1. General imaging features of extranodal head and neck lymphoma include
a. CT non-homogeneous enhancement; MR: variable T2 signal intensity; PET-CT: usually high metabolic activity
b. CT homogeneous enhancement; MR: variable T2 signal intensity; PET-CT: usually high metabolic activity
c. CT homogeneous enhancement; MR: High T2 signal intensity; PET-CT: usually high metabolic activity
d. CT non-homogeneous enhancement; MR: variable T2 signal intensity; PET-CT: usually low metabolic activity

2. In which subsites is Waldeyer’s ring located?
a. Nasopharynx / oropharynx
b. Oropharynx / hypopharynx
c. Nasopharynx / soft palate
d. Oropharynx / oral cavity

3. Which feature is ATYPICAL in extraocular lymphoma?
a. Diplopia
b. Palpable mass
c. Ptosis
d. Vision loss

4. Which disease is NOT included in the differential diagnosis for sinonasal lymphoma?
a. Mucocele
b. Invasive fungal rhinosinusitis
c. Granulomatosis with polyangiitis (GPA)
d. Sarcoidosis

5. Which type of lymphoma occurs in increased frequency in patients with Sjögren’s disease?
a. Diffuse large B-cell lymphoma (DLBCL)
b. Follicular NHL
c. NK-T-cell lymphoma
d. MALT lymphoma

 

L.14 – Multiple myeloma
Alexandra Borges, Lisbon/PT

1. One of the following is NOT a typical imaging feature of multiple myeloma on CT
a. Lytic lesion
b. Bubbly appearance
c. Surrounding sclerosis
d. Spontaneous hyperdensity
e. Contrast-enhancement

2. Involvement of the jaws can manifest by all of the following EXCEPT
a. Floating teeth
b. Supernumerary teeth
c. Resorption of the lamina dura
d. Pathologic fracture
e. Lytic punched out lesion

3. The Mini Brain appearance on MRI refers to
a. A honeycomb pattern of contrast enhancement
b. A pattern of bone destruction
c. The presence of an associated encephalocele
d. The presence of serpentine areas of low signal intensity on both T1 and T2W images
e. The presence of vascular flow voids

4. Bone involvement limited to the bone marrow cavity is best depicted by
a. MRI
b. CT
c. Bone densitometry
d. FDG-PET-CT
e. Bone scintigraphy

5. The degree of contrast enhancement in a plasmacytoma was shown to correlate with
a. Patient’s age
b. Level of circulating M protein
c. Lesion size
d. EGFR expression on tumour cells
e. VEGF expression on tumour cells

6. Multiple myeloma of the head and neck
a. Is only characterized by a solitary bone lesion
b. Is only characterized by a solitary soft tissue lesion
c. Is only characterized by extramedullary soft tissue lesions
d. Is only characterized by multiple osteolytic lesions
e. Can show the above-mentioned spectrum

7. Solitary plasmacytoma of the bone
a. Has a high rate of local recurrence
b. Rarely disseminates
c. Has a tendency for haemorrhage
d. Affects the skull base more often than the jaws
e. Affects the head more often than the spine

 

L.15 – Skull base variants
Vincent Chong, Singapore/SG

1. In the imaging of the jugular foramen (more than one answer is correct)
a. An asymmetrical enlargement of the right jugular foramen seen on CT should be further evaluated with MRI
b. An iso intense signal intensity focus which enhances with contrast seen in axial sections and confirmed on coronal images is highly suggestive of a tumour glomus tumour
c. T2 weighted images are frequently useful in differentiating flow-induced signals in the jugular foramen from space occupying lesions
d. The petroclival fissure a useful landmark for the jugular foramen
e. On coronal MR images, the jugular foramen is located in the same plane as the odontoid peg which serves as a landmark

2. Regarding mass-like lesions in the nasal, nasopharyngeal cavity or anterior skull base (more than one answer is correct)
a. Meningocoeles are best confirmed on coronal high-resolution CT demonstrating the bony defect
b. Fibrous dysplasia may appear as a mass on MRI
c. Lesions detected on MRI showing contrast-enhancement require biopsy for further management
d. Scalloping erosions of the orbital plate of the frontal bone are suspicious of enlarged arachnoid granulations
e. Thornwaldt cysts are typically located in the midline or slightly off the midline in the roof of the nasopharynx

3. Regarding imaging of the middle ear cavity (more than one answer is correct)
a. The floor of the hypotympanum is frequently dehiscent allowing for the protrusion of a high jugular bulb
b. An absent jugular plate predisposes to the herniation of the carotid canal into the tympanic cavity
c. The single most important imaging sequence for diagnosis congenital cholesteatoma is DWI
d. Congenital cholesteatoma is often associated with congenital malformation of the temporal bone
e. A fluid filled lesion in contiguity with dehiscent tegmen tympani is suspicious of a meningocoele

4. In the imaging diagnosis of fibrous dysplasia (more than one answer is correct)
a. The complexity of imaging findings is due to the variable admix of fibrous tissues and mineralised matrix
b. The fibrous tissues are relatively avascular and show relatively poor enhancement characteristics
c. CT findings are characteristic and need no MRI confirmation
d. MR findings are often complex and require CT for confirmation
e. Fibrous dysplasia is typically asymptomatic

5. Which of the following is true regarding lesions in the skull base (only one answer is correct)?
a. Associated osseous abnormalities seen in neurofibromatosis are usually due to erosions from neurofibromas
b. The internal carotid artery may protrude into the sphenoid sinus and is at risk during surgery
c. Lipomas are soft lesions and bony erosions seen are suspicious of liposarcomas
d. Epidermoids are best confirmed on T1-weighted images because of the high fat content
e. A large jugular bulb typically causes pressure erosion of the jugular foramen

 

L.16 – Dental imaging
André Gahleitner, Vienna/AT
Soraya Robinson, Vienna/AT

1. Which of the following Dental Imaging methods has the HIGHEST irradiation dose?
a. MSCT
b. CBCT
c. Dental Film
d. Panoramic X-ray

2. Which of the following Dental Imaging methods has the LOWEST irradiation dose?
a. MSCT correct
b. CBCT
c. Dental Film
d. Panoramic X-ray

3. What is a typical average FoV-Diameter when imaging the complete upper or lower jaw?
a. 10 mm
b. 4 cm
c. 30 cm
d. 100 mm

4. What is the most recent development in conventional Dental Imaging?
a. Digital Panoramic devices
b. Digital Dental Film devices
c. Dental CT
d. Thin slice Panoramic devices

5. Disk dislocation
a. Affects primarily patients in their late 60ies
b. Resolves by itself
c. Is more common in rheumatoid arthritis
d. Is most commonly directed posteromedially
e. Is most commonly directed anterolaterally

6. The upper belly of the lateral pterygoid muscle
a. Pulls the disk laterally
b. Pulls the disk anteriorly
c. Is innervated by the facial nerve
d. Is prone to rupture in bruxisms
e. Closes the mouth

 

L.17 – Cranial nerve imaging
Jan Casselman, Bruges/BE

1. Which sequences is best suited to show the myelinated structures and nuclei in the brainstem?
a. Unenhanced T1-weighted image
b. TSE T2 weighted images
c. Diffusion weighted images
d. Multi-Echo m-FFE images
e. Black Blood images

2. Which sequence would you use to see the cisternal segment of the abducent nerve (CN 6)?
a. 3D FLAIR images
b. TSE T2 images (e.g. DRIVE)
c. GE T2 images (e.g. b-FFE)
d. Un-enhanced T1W images
e. T2* or Susceptibility Weighted Images (SWI)

3. Which statement is CORRECT about the extra-cranial MR Neurography sequence used to see the cranial nerves in the neck?
a. The nerves are better seen when Gd is used
b. The nerves are better seen without Gd
c. Is suited to follow the VIIIth nerve into the neck
d. MRN is a fast sequence
e. Unfortunately, the facial nerve cannot be followed outside the temporal bone

4. Which statement about black blood imaging is WRONG?
a. The flowing blood inside the vessels remains black even after Gd injection
b. The images are fat suppressed
c. Cannot show enhancement along the nerves
d. Is extremely sensitive for Gd enhancement
e. Can visualize both intracranial and extracranial nerve segments

5. Schwannomas are extremely rare on which nerve:
a. The cochleovestibular nerve
b. The Trigeminal neve and branches
c. The facial nerve
d. The vagus nerve
e. The abducent nerve

 

L.18 – Non-nodal neck masses
Bela Purohit, Singapore/SG

1. Which of the following neck lump moves with protrusion of the tongue?
a. Branchial cleft cyst
b. Thyroglossal duct cyst
c. Lipoma
d. Neurogenic tumour
e. Cystic hygroma

2. A ‘sac of marbles’ appearance on CT is seen in which of the following lesions?
a. Dermoid cyst
b. Lipoma
c. Neurogenic tumour
d. Branchial cleft cyst
e. Cystic hygroma

3. What is the direction of displacement of the pre-styloid parapharyngeal space by a vagal schwannoma?
a. Anterior
b. Posterior
c. Lateral
d. Postero-medial
e. Postero-lateral

4. Which of the following is not an imaging feature of paragangliomas?
a. Flow voids on T2
b. Salt-pepper appearance on T1
c. Arterial phase enhancement
d. Delayed phase enhancement
e. High uptake on DOPA-PET scan

5. Which of the following is an imaging feature suspicious for sarcomatous degeneration in a soft tissue mass in the neck?
a. Size of 3 cm
b. Intramuscular location
c. Well-circumscribed margins
d. Erosion of adjacent bone
e. Multiplicity

 

L.19 – Skull base tumour aspects
Anouk van der Hoorn, Groningen/NL
Ana Navas Cañete, Leiden/NL

1. Follow-up MRIs for recurrence of a chordoma
a. Can be stopped if a patient is stable for 5 years
b. Can be stopped if a patient is stable after 10 years
c. Has to be performed life-long
d. Can be stopped if a lesion shows restriction
e. Can be stopped if a lesion shows no haemorrhage

2. Which of the following microvascular aspects can be seen as late-delayed effect of radiotherapy?
a. White matter lesions
b. Microbleeds
c. White matter lesions and microbleeds
d. Neither white matter lesions nor microbleeds
e. Restriction

3. Which tumour of the skull base can show a septonodular pattern of enhancement on MRI? (more than one answer is correct)
a. Giant cell tumour of the bone
b. (Chondroid) chordoma
c. Chondrosarcoma
d. Echordosis physalifora
e. Fibrous Dysplasia

4. A type 4 curve during DCE (Dynamic contrast enhancement) MRI may help in the differentiation of some bone and soft tissue tumours such as
a. Chondrosarcoma
b. Benign notochordal tumour
c. Giant cell tumour of the bone
d. Paget disease
e. Echordosis physalifora


5. Fibrous dysplasia of the skull base will NEVER present on CT as a lesion with (more than one answer is correct)
a. A “ground glass” aspect
b. Periosteal reaction / periostitis
c. An associated soft tissue mass
d. Cystic-osteolytic components
e. Expansion of the bone

 

L.20 – Functional imaging
Sotirios Bisdas, London/UK

1. Which of the following statements about dynamic contrast-enhanced (DCE)-MRI is TRUE??
a. The gadolinium concentration is linearly proportional to the signal change
b. The biomarkers derived from DCE-MRI include Ktrans, vp, SUV and ve
c. The 2-compartment pharmacokinetic modelling is not suitable for head and neck tumours
d. The extracellular extravascular volume (ve) is highly correlated with the ADC derived from DWI
e. Ktrans parameter shows the exchange rate constant between ve and vp , and depends on blood flow (F)

2. Which of the following statements about diffusion-weighted (DWI)-MRI is TRUE?
a. The diffusion coefficient – D from the IVIM model shows the random molecular diffusion in the capillaries
b. The pseudodiffusion coefficient – D* is derived from the higher b-values (>1000 mm2/s)
c. Increased cellularity is reflected in low D and D*
d. Large stromal tissue in head and neck tumours is linked to high D values
e. The ADC value derived from the total diffusion signal decay is more accurate than the D value

3. Which of the following statements about PET is TRUE?
a. FDG-PET is a useful technique for hypoxia imaging
b. FDG-PET/CT acquisitions benefit from low-dose, non-contrast CT
c. Late FDG-PET after chemoradiation treatment has high negative predictive value
d. FDG-PET shows increased tracer accumulation in areas with low vascularity
e. FDG-PET is suitable for primary staging in T1 head and neck tumours

4. Which of the following statements about PET is FALSE?
a. FDG-PET should be considered for tumour recurrence diagnosis when salvage treatment is planned
b. Standardised uptake values (SUV) in FDG-PET are indispensable to diagnose tumour disease and the nodal metastases
c. FDG uptake in tumours is driven by their perfusion properties
d. High FDG uptake and low vascularity index are hallmarks of tumour hypoxia
e. Chronic hypoxia is related to passive diffusion abnormalities in tumour tissue

5. Which of the following statement is FALSE?
a. Dynamic FMISO-PET and subsequent kinetic analysis have stronger predictive value than static FMISO
b. Dose painting is the mainstay clinical indication for FMISO-PET
c. 64Cu-ATMS shows poorer signal to background ratio in tumours compared with FMISO
d. Immuno-positron emission tomography (immuno-PET) allows the in vivo tracking of monoclonal antibodies (mAbs)
e. FLT can be used for to image tumor proliferation as TK1 is selectively expressed in the S, G2, and M phases of the cell cycle