Rotation: Mri

Front 1

describe the findings on ADC and DWI for a tumor

Back 1

tissues right on ADC and dark on DWI

Front 2

described fat on T-1

Back 2

Bright

Front 3

what is the regular contrast that we use normally and the Contrast were used for the liver

Back 3

optimark and eovist

Front 4

what happens to the fat in the out of phase image if there is no fat

Back 4

it will drop out and no longer be bright on out of phase

Front 5

what kind of sequence is trim

Back 5

T2 fat sat also known as stir...this means fat saturates out and will no longer be bright

Front 6

why do we give glucagon for enterography

Back 6

to decrease bowel peristalsis

Front 7

which sequence we look at the contrast images

Back 7

T-1 vibe

Front 8

how do you determine if there is hyperemia

Back 8

increased enhancement on post contrast

Front 9

how does metastatic colon cancer appear on MRI

Back 9

T2 bright, and it will be hypoenhancing posts contrast

Front 10

what is T-1 in/out of phase used to look for

Back 10

fatty components

Front 11

when examining the prostate or uterus how do you measure

Back 11

length, width and height

Front 12

true or false: FL2D and VIBE are both gradient echoes

Back 12

true

Front 13

give a brief description of Birad Classifications

Back 13

0- incomplete
1- normal
2- findings but benign
3- 98% benign short-term follow
4- suspicious must biopsy
5- very high suspicion will treat
6- biopsy proven

Front 14

what is the T1 and T2 signal intensity for most malignant bone lesions

Back 14

decrease signal intensity, if it is a met look for enhancement post contrast unless it is sclerotic like prostate which may not enhance

Front 15

how to slow flow-through vessel appeared on a T2 weighted image

Back 15

bright

Front 16

if a tumor is present what are the characteristics and diffusion weighted imaging and ADC images

Back 16

will be bright on diffusion weighted images and dark on ADC image

Front 17

was it called when the signal intensity is high on both diffusion weighted imaging and ADC images

Back 17

T2 shine through

Front 18

what are the locations of fibroids in the uterus

Back 18

mural, submucosal, serousal

Front 19

if something is bright on diffusion weighted imaging is it a tumor

Back 19

what

Front 20

what is a signal intensity of the bile ducts on T2 weighted images

Back 20

high signal intensity

Front 21

what is T2 fat saturation (stir) good to use for

Back 21

checking for edema which will be bright

this will eliminate the fat which will make edema stand out more

Front 22

would happens to the susceptibility artifact as te increases

Back 22

the susceptibility artifact will increase

Front 23

Acroynm for blood products on MRI

Back 23

I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die. (I-isointence, B-hyperintence, D-Hypointense)

I Bleed (hyperacute), I Die (acute), Bleed Die (early subacute), Bleed Bleed (late subacute), Die Die (chronic)

alternate: I Be IDdy BiDdy BaBy DaDdy

Hgb Products over time: Oh Death MIss ME Here

Oxy, Deoxy, Methhem- (Intracellular), Methhem- (Extrecellular), Hemosiderin

Front 24

What is the time frame

Back 24

<24 Hrs: hyperacute
1 d -3 d: acute
3 - 7 d: early subacute
7-14 d: late subacute
>14 d: chronic

Front 25

What is hyper acute

Back 25

less than 24 hours

Front 26

what is acute

Back 26

1-3 days

Front 27

What is early subacute and late sub acute

Back 27

3-7 days and 7-14 days

Front 28

"I bleed" means

Back 28

T1- isointense and T2 hyperintense in hyperacute phase

Front 29

what does 'I die' mean

Back 29

this is during the acute phase
T-1- is Isointense

T2 is hypointense

Front 30

what does "bleed die" me

Back 30

this is the early subacute phase

T-1 hyper intense

T2 hypointense

Front 31

what does bleed bleed mean

Back 31

this is the late subacute

T-1 hyper intense

T2 is hyperintense

Front 32

what does die die mean

Back 32

this is chronic

T-1 is hypointense
T2 is hypointense

Front 33

what other phases of blood from hyper acute to chronic

Back 33

hyperacute, acute, early subacute, leaked subacute, chronic

Front 34

what are the blood products over time

Back 34

oxy, deoxy, meth-hem (intracellular), meth-hem( extracellular) hemosiderin

Front 35

what is the acronym for the blood products over time

Back 35

oh, Death, MIss, ME, Here

Front 36

what is the time frames for to different stages blood goes through on its way to becoming chronic

Back 36

less than 24 hours is hyperacute, one day to three days is acute, three days to seven days is early subacute, in 7 to 14 days is late subacute, greater than 14 days is chronic

Front 37

does methemoglobin make T-1 bright or dark

Back 37

bright

Front 38

what is T-1 and T2 in the presence of hemosiderin

Back 38

both are dark

Front 39

if somebody's GFR is less than 50 and he was to give them gadolinium what is the protocol

Back 39

you must give half dose multihance because higher doses puts the patient at risk for retroperitoneal fibrosis

Front 40

what happens if the patient's GFR is less than 30

Back 40

then gadolinium is contraindicated, if it is over 30 eovist may be given

Front 41

what is the rule of thumb for measuring the common bile duct

Back 41

5 mm in a young patient and then add 1 mm for each decade for max of 8 mm. If the patient status post cholecystectomy it's okay to have up to 1 cm. Also if it's all patient like in the 90s up to 1 cm is okay

Front 42

how is a tri-phase study performed

Back 42

arterial phase occurs at 40 to 50 seconds
the portal venous phase occurs around 80 seconds
and the delayed phase happens somewhere between 80 and 300 seconds( up to five minutes)

Front 43

why is sizing of the tumor so important for transplant patients

Back 43

this will affect the staging of their meld score

Front 44

how is eovist useful in patients that have focal nodular hyperplasia of the liver

Back 44

eovist is useful in differentiating hepatocellular carcinoma and focal nodular hyperplasia because eovist will enhance to much greater degree because it is functional hepatic tissue, also the central scar will enhance and an adenomas central scar will not enhance

Front 45

how does hyperemia appear post contrasts

Back 45

bright

Front 46

was the appearance of hemorrhagic cyst on MRI

Back 46

increased signal intensity on T2 decreased on T-1

Front 47

what is the normal size of a liver

Back 47

16 cm caudal to cephalic, but if the patient has a large body habitus 18 cm is acceptable

Front 48

how do enlarged lymph nodes appear on T2 weighted image

Back 48

bright

Front 49

when interpreting the MRI of the pelvis of a woman where relation to the pubococcygeal line should the bladder vagina and anal canal be

Back 49

the bladder and vagina should be above pubococcygeal line and the anal canal should be no more than 1 cm below

Front 50

if a patient has cirrhosis and you don't MRI what vessel is important to check

Back 50

always check for portal vein thrombosis in cirrhotics

Front 51

what does it mean when you see peripheral wedge shaped enhancement of the liver in the portal venous phase of MRI

Back 51

this is from vascular shunts and will disappear on delay imaging

Front 52

how do you tell the difference between a large cirrhotic nodule and hepatocellular carcinoma

Back 52

check the post contrast

Front 53

what is the appearance of a cirrhotic liver on post contrast

Back 53

it has a cobblestone appearance

Front 54

how does a simple renal cyst appear on MRI

Back 54

high signal intensity on T2 and low signal intensity on T-1

Front 55

how does fat appear in phase and out of phase

Back 55

bright in phase

Dark out of phase

Front 56

what is cholangiocarcinoma associated with

Back 56

ulcerative colitis

Front 57

what is the image that we view the breast in

Back 57

in this image there is T-1 precontrast which is subtracted from a T2 post contrast this enables you to visualize only enhancing areas

Front 58

what does that chart on the bottom screen do

Back 58

tells you how much enhancement over five minutes

Front 59

what do you look for if you suspect the patient has cholangitis

Back 59

at their no really specific findings but look for edema surrounding the bile ducts and also look for hyperemia on post contrast

Front 60

where are the ovaries usually located

Back 60

along the external iliac vessels

Front 61

what separates segment 4b from 5

Back 61

the gallbladder fossa

Front 62

For a patient that has carcinoid mets you see multiple masses in the liver what should you check

Back 62

to see if they enhance, if they don't enhance they may have been ablated and do not need to be measured if they are roughly the same as previous

Front 63

what separates segment 4b from segment 2

Back 63

the left hepatic vein

Front 64

if you stayed a patient has portal hypertension than what additional information should you do to support that

Back 64

spleen size, ascites, varicies

Front 65

what are the different types of ablation techniques used at this hospital

Back 65

chemo embolization,SIRTS ( done with yytrium), radio frequency of ablation, cryoablation ablation

note that IR does chemoembolization and SIRTS,

Front 66

when do you use time of flight imaging

Back 66

if the patient is unable to have contrast this is a good way to visualize the vessels

Front 67

what is the cutoff used by Dr. Saouaf for fatty liver

Back 67

10% decrease in signal intensity from in to out of phase

Front 68

if you are unsure what type of MR sequence which you're reading what is the best density to look at to give you a clue

Back 68

CSF

Front 69

is the gallbladder and bile ducts always dark on T-1

Back 69

no they can be bright

Front 70

when looking at an MRA of the chest what are the main sequences to analyze

Back 70

the candycane sequence which is a sagittal oblique
the left ventricle or outflow tract
and the aortic valve space parentheses does history images which are above at the level of the aortic valve and below

Front 71

what is the normal size of a aorta

Back 71

2.5 cm

Front 72

what is the aorta considered aneurysmal

Back 72

what is 50% greater than normal

Front 73

at what point is surgery done on the ascending aorta

Back 73

if it's greater than 5 cm

Front 74

where are Gartner's ducts cyst located

Back 74

proximal vagina anterior lateral wall

Front 75

if a patient has hemochromatosis what are the characteristics on in phase and out of phase T-1 imaging

Back 75

it will be brighter out of phase compared to in phase

Front 76

what are four distinct features of a hemangioma

Back 76

sharply defined lesions with nodular enhance rim on early scans
incomplete ring of nodular enhancement
gradual filling of the lesion by intravenous contrast
complete and homogenous enhancement on delayed scans ( 10 to 20 minutes)

Front 77

what types of hemangioma typically do not have the typical characteristics of a hemangioma and are often lead to unequivical diagnosis

Back 77

very small or large hemangioma

Front 78

what is a good rule of thumb if you suspect something to be a hemangioma but cannot definitively diagnosis because of unusual characteristics

Back 78

follow-up in 3 to 6 months

Front 79

what should you do if there follow-up imaging to an unequival diagnosis of hemangioma does not lead to a definitive diagnosis

Back 79

biopsy

Front 80

what is the appearance of a hemangioma is on T2 weighted images

Back 80

they are bright

Front 81

what is the recommended echo delay for diagnosis of hemangioma

Back 81

120 to 150 ms

Front 82

what should happen to the signal intensity of hemangioma if the echo delay is prolonged

Back 82

it should increase intensity this is useful for differentiating from a malignant lesion which had delayed echo images revealed decreased signal intensity

Front 83

what are the characteristics of focal nodular hyperplasia

5

Back 83

homogeneous, hypervascular early, rapid washout, central stellate scar which enhances

Front 84

what are the characteristics of a liver adenoma

Back 84

homogeneous, hypervascular early, central scar which does NOT enhance, hemorrhage, capsule in 25% of adenomas

Front 85

how do you differentiate focal nodular hyperplasia from and adenoma of the liver

Back 85

adenomas central scar does not enhance, it may contain hemorrhagic products, it has a capsule in 25% of them

Front 86

if you suspect something to be focal fat what sequences if you look at

Back 86

out of phase gradient echo and fat saturated sequences and he will expect that area of fat to be dark

Front 87

is focal fat dark on out of phase gradient echo and fat saturated sequence

Back 87

yes it is dark

Front 88

what are the findings in a liver abscess

Back 88

complete outer enhance ring with central necrosis

Front 89

what are the characteristics of a liver cyst

Back 89

no perceptible wall, does not enhance, bright on T2

Front 90

what are the characteristics of a regenerating nodule on MRI

Back 90

less than 1 cm, dark on T-1 and T2

Front 91

what are the characteristics of dysplastic nodule on MRI

Back 91

greater than 1 cm, Isointense or bright on T-1, and dark or isointense on T2,

Front 92

What is haste

Back 92

this is always a T2 sequence that is so the fluid is bright. Sometimes sacrificing the contrast of other tissue.