Abdominal and Pelvic Radiology Practice Questions

Q: Which imaging modality is considered the best for staging rectal carcinoma?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** provides excellent soft tissue contrast, allowing for detailed visualization of the rectal wall layers, mesorectal fascia, and adjacent structures. - This high resolution is crucial for accurate **T-staging (tumor depth of invasion)** and assessment of **nodal involvement**, guiding treatment decisions like neoadjuvant therapy. *CT Scan* - **CT scans** are better for detecting distant metastases (e.g., in the liver or lungs) and assessing vascular involvement, rather than local staging of the primary tumor. - Its soft tissue resolution is inferior to MRI for distinguishing between the different layers of the rectal wall and for precise mesorectal fascia involvement. *TRUS* - **Transrectal ultrasound (TRUS)** is effective for evaluating superficial tumors and their depth of invasion within the rectal wall. - However, it has a limited field of view and is less reliable for assessing mesorectal fascia involvement or metastatic lymph nodes far from the rectal wall. *None of the options* - This option is incorrect because MRI is indeed the preferred imaging modality for precise local staging of rectal carcinoma due to its superior soft tissue resolution. - Accurate staging is critical for determining the appropriate treatment strategy, including the need for neoadjuvant chemoradiotherapy.

Q: The most appropriate first-line investigation to be performed in suspected cases of gastric cancer is:

Endoscopy. ***Endoscopy*** - **Endoscopy with biopsy** is the most definitive first-line investigation for suspected gastric cancer as it allows direct visualization of the gastric mucosa and tissue sampling for histological confirmation. - It is crucial for early detection, staging, and guiding subsequent management strategies in patients suspected of having gastric malignancy. *Double contrast radiography* - **Double contrast radiography** (barium swallow) can reveal suspicious mucosal abnormalities but is less sensitive and specific than endoscopy for detecting and characterizing early gastric lesions. - It does not allow for **biopsy**, which is essential for definitive diagnosis of cancer. *Plain radiography* - **Plain radiography** (X-ray) has very limited utility in diagnosing gastric cancer as it cannot visualize mucosal lesions or provide detailed information about the gastric wall. - It is primarily used for detecting complications like **perforation** or **obstruction**, rather than primary diagnosis. *CT Scan* - A **CT scan** is valuable for staging gastric cancer after diagnosis, assessing local invasion, lymph node involvement, and distant metastases. - However, it is not the first-line diagnostic modality because it cannot directly visualize early mucosal lesions or provide **histological confirmation** via biopsy.

Q: Which of the following HSG findings is most suggestive of genital tuberculosis?

Beaded tubes. ***Beaded tubes*** - **Beading** of the fallopian tubes on hysterosalpingography (HSG) is **the most characteristic finding** of **genital tuberculosis (GTB)**, representing multiple strictures and dilatations. - This appearance is due to the characteristic **granulomatous inflammation** and subsequent fibrosis that occur with tuberculous salpingitis, creating a **"rosary bead" or "string of pearls"** pattern. - This is considered the **most specific HSG sign** for genital TB. *Honeycomb uterus* - A **honeycomb uterus** appearance on HSG shows multiple small filling defects in the endometrial cavity. - This is more commonly associated with **synechiae (Asherman's syndrome)** or advanced **endometrial tuberculosis**, but is not the most suggestive finding. *Golf club tube* - A **golf club tube** appearance refers to a **dilated fallopian tube with a rounded, blunt end** that has lost its fimbrial integrity, seen in **hydrosalpinx**. - While hydrosalpinx can occur due to GTB, this finding is **non-specific** and can result from any chronic salpingitis (PID, post-infectious). *Pipe stem tubes* - **Pipe stem** or **rigid tubes** show straightened, non-dilated fallopian tubes due to fibrosis. - While this can be seen in genital TB, it is **less specific** than the beaded appearance and can occur in other chronic inflammatory conditions.

Q: Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Hydroureter. ***Hydroureter*** - **Hydroureter** (dilation of the ureter) is a **direct/primary sign** of urinary tract obstruction on CT scan. - It represents the physical consequence of upstream blockage and is a **direct visualization** of the obstructed collecting system. - On CT, a dilated ureter proximal to the point of obstruction is the most specific radiological evidence of ureteral obstruction. *Perinephric stranding* - **Perinephric stranding** represents edema in the perinephric fat and is a **secondary/indirect sign** of obstruction. - While commonly seen with acute ureteral obstruction (as part of renal inflammatory response), it is **not a direct sign** of the obstruction itself. - It can also occur with pyelonephritis, trauma, or other inflammatory processes, making it less specific. *Thickening of the lateroconal fascia* - **Lateroconal fascia thickening** is another **secondary/indirect sign** that can accompany urinary tract obstruction. - It reflects inflammatory changes in the retroperitoneal fascial planes adjacent to an obstructed kidney. - Like perinephric stranding, it is a non-specific finding that can occur with various retroperitoneal inflammatory processes. *None of the options* - This option is incorrect because **hydroureter** is a well-established direct sign of urinary tract obstruction on CT scan.

Q: Investigation of choice for detecting hepatic metastasis from stomach cancer is

CECT. ***CECT*** - **Contrast-Enhanced Computed Tomography (CECT)** is the **primary investigation of choice** for detecting **hepatic metastases from gastric cancer** due to its widespread availability, speed, and high spatial resolution. - Multi-phase CECT (arterial, portal venous, and delayed phases) effectively visualizes liver parenchyma and identifies most metastatic lesions with high sensitivity. - It provides excellent anatomical detail for **surgical planning** and **treatment decisions**. *Magnetic Resonance Imaging (MRI)* - While **MRI** with liver-specific contrast agents (e.g., gadoxetate disodium) offers superior **soft tissue contrast** and can be more sensitive for smaller or atypical lesions. - It is typically reserved as a **second-line investigation** when CECT findings are equivocal, for characterization of indeterminate lesions, or for detailed surgical planning, rather than the initial investigation of choice. *PET-CT* - **Positron Emission Tomography-Computed Tomography (PET-CT)** is highly effective for detecting metabolically active lesions and is useful for **whole-body staging and identifying distant metastases** beyond the liver. - However, it's not the primary investigation solely for **hepatic metastasis** due to lower spatial resolution compared to CECT, higher cost, limited availability, and greater radiation exposure. *Ultrasound (USG)* - **Ultrasound** is often used as an initial screening tool for abdominal pathologies due to its accessibility, low cost, and lack of radiation. - Its sensitivity for detecting small or deeply located **hepatic metastases** is limited compared to CECT, making it unsuitable as the definitive investigation of choice for staging gastric cancer.

Q: The 'coffee bean sign' is typically seen in which condition?

Sigmoid volvulus. ***Sigmoid volvulus*** - The **coffee bean sign** is a classic radiographic finding in **sigmoid volvulus**, representing the hugely distended, gas-filled loop of bowel twisting on its mesentery. - This sign is due to the **two limbs of the distended sigmoid colon** converging towards the pelvis, creating a peculiar shape on an abdominal X-ray. *Gastric volvulus* - **Gastric volvulus** involves torsion of the stomach, which can appear as a massively dilated stomach with an air-fluid level or a "double bubble" sign if there is also duodenal obstruction. - It does not typically produce the **coffee bean appearance**, which is characteristic of colonic volvulus. *Hypertrophic pyloric stenosis* - **Hypertrophic pyloric stenosis** is a condition in infants characterized by a thickened pylorus, often leading to non-bilious projectile vomiting. - Imaging typically shows an elongated, narrowed pyloric channel (the "string sign") and a thickened pyloric muscle ("target sign" or "doughnut sign") on ultrasound, not a coffee bean sign. *Achalasia* - **Achalasia** is an esophageal motility disorder where the lower esophageal sphincter fails to relax, leading to food accumulation. - Radiographic findings include a dilated esophagus with a "bird's beak" appearance at the gastroesophageal junction, distinct from the coffee bean sign.

Q: Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Sentinel loop sign. ***Sentinel loop sign*** - The **sentinel loop sign** refers to a focally dilated segment of small bowel (usually proximal jejunum) adjacent to an inflamed pancreas due to localized ileus. - This sign is often visible on **plain abdominal radiographs** in cases of acute pancreatitis. *Murphy's sign* - **Murphy's sign** is a clinical finding, not a radiological sign, characterized by inspiratory arrest upon deep palpation of the right upper quadrant. - It is classically associated with **acute cholecystitis**, not acute pancreatitis. *Renal halo sign* - The **renal halo sign** is a radiological finding (typically on CT) describing perinephric fat stranding that can be seen in various renal pathologies, not acute pancreatitis. - It is not a characteristic sign of pancreatic inflammation on plain radiography. *Grey Turner's sign* - **Grey Turner's sign** is a clinical sign characterized by ecchymosis or discoloration of the flanks. - It indicates **retroperitoneal hemorrhage**, which can be a severe complication of acute pancreatitis but is not a radiological sign itself and is not specific to acute pancreatitis on plain X-ray.

Q: Depth of gastric carcinomas is assessed by -

Endoluminal ultrasound. ***Endoluminal ultrasound*** - **Endoluminal ultrasound (EUS)** utilizes a small ultrasound transducer at the tip of an endoscope to provide high-resolution images of the **gastric wall layers**, making it ideal for assessing the **depth of tumor invasion**. - EUS can accurately stage the **T-stage (tumor invasion depth)** and detect **regional lymph node involvement** (N-stage), which are crucial for treatment planning in gastric carcinoma. *Abdominal ultrasound* - **Abdominal ultrasound** has limited ability to visualize the fine layers of the gastric wall and is primarily used for detecting **larger masses**, **liver metastases**, or **ascites**. - It is not precise enough to determine the **depth of tumor invasion** in gastric carcinoma. *Barium meal* - A **barium meal** (upper GI series) is a radiographic study that visualizes the lumen of the esophagus, stomach, and duodenum, primarily detecting **mucosal abnormalities** or **filling defects**. - While it can identify the presence of a tumor, it provides no information on the **depth of penetration** into the gastric wall. *Laparoscopy* - **Laparoscopy** is a surgical procedure that allows for direct visual inspection of the peritoneal cavity and offers the best method for detecting **peritoneal carcinomatosis** or **distant metastases**. - While it can confirm the presence of a tumor and help in operative planning, it does not provide detailed information about the **depth of intramural invasion** of the gastric wall itself, which is best assessed by EUS.

Q: What is the most sensitive investigation for detecting minimal gas in the abdomen?

CT Scan of the abdomen. ***CT Scan of the abdomen*** - **CT scans** are highly sensitive for detecting even small amounts of **free air (pneumoperitoneum)** due to their ability to produce cross-sectional images with high spatial resolution missing in conventional X-rays. - It can identify the exact location and quantify the volume of gas, often picking up gas that is not visible on plain radiographs. *Chest X-ray in AP View* - An **AP chest X-ray** is less sensitive for detecting subdiaphragmatic free air compared to an erect chest X-ray or CT scan. - With the patient supine (as implied by AP view if not specified as erect), small amounts of gas tend to spread diffusely rather than collect under the diaphragm. *X-ray abdomen in supine position* - A supine abdominal X-ray is generally the **least sensitive** plain radiograph for detecting free air. - Gas in the abdomen tends to accumulate anteriorly when the patient is supine, making it more difficult to visualize against overlying bowel gas or soft tissues. *X-ray abdomen in erect position* - An **erect abdominal X-ray** or erect chest X-ray is commonly used and more sensitive than a supine view for detecting free air, as gas can rise and collect under the diaphragm. - However, it still requires a sufficient volume of gas to be visible and is less sensitive than a CT scan, especially for very minimal amounts or atypical locations.

Q: A female patient presented with recurrent urinary tract infections. Imaging shows the following picture. What can be the most probable diagnosis based on the imaging findings?

Ureterocele. ***Ureterocele (Correct Answer)*** - The image shows a **cystic dilation of the distal ureter** (red arrow) that protrudes into the bladder, which is characteristic of a ureterocele. - Ureteroceles can cause **obstruction and recurrent UTIs** due to stasis and impaired emptying. *Ureteral duplication (Incorrect)* - Ureteral duplication would present as two distinct ureters draining from the same kidney, typically with separate insertions into the bladder or urethra. This is not observed in the image, as there is only one ureter visible from each kidney down to the bladder. - While complete ureteral duplication often features an *ectopic* and *obstructed* upper pole ureter, the imaging here primarily shows a bladder abnormality. *Congenital megaureter (Incorrect)* - A congenital megaureter involves a **diffusely dilated ureter** along its length, without the focal, cystic protrusion into the bladder seen here. - While it can cause UTIs due to stasis, the specific localized dilation inside the bladder strongly points away from this diagnosis. *Urinary calculi (Incorrect)* - Urinary calculi (stones) would appear as **hyperdense opacities within the collecting system** or ureter, which could cause obstruction and UTIs. - The image distinctly shows a **fluid-filled, balloon-like structure** at the ureterovesical junction, not a calcified stone.

Question 1

Which imaging modality is considered the best for staging rectal carcinoma?

Accepted Answer

MRI

Answer

CT Scan

Answer

TRUS

Answer

None of the options

Question 2

The most appropriate first-line investigation to be performed in suspected cases of gastric cancer is:

Accepted Answer

Endoscopy

Answer

Plain radiography

Answer

CT Scan

Answer

Double contrast radiography

Question 3

Which of the following HSG findings is most suggestive of genital tuberculosis?

Accepted Answer

Beaded tubes

Answer

Honeycomb uterus

Answer

Golf club tube

Answer

Pipe stem tubes

Question 4

Which of the following is a direct (primary) sign of obstruction of the urinary tract on a CT scan?

Accepted Answer

Hydroureter

Answer

None of the options

Answer

Perinephric stranding

Answer

Thickening of the lateroconal fascia

Question 5

Investigation of choice for detecting hepatic metastasis from stomach cancer is

Accepted Answer

CECT

Answer

Magnetic Resonance Imaging (MRI)

Answer

PET-CT

Answer

Ultrasound (USG)

Question 6

The 'coffee bean sign' is typically seen in which condition?

Accepted Answer

Sigmoid volvulus

Answer

Achalasia

Answer

Gastric volvulus

Answer

Hypertrophic pyloric stenosis

Question 7

Which of the following is a radiological sign of acute pancreatitis on plain radiography?

Accepted Answer

Sentinel loop sign

Answer

Grey Turner's sign

Answer

Renal halo sign

Answer

Murphy's sign

Question 8

Depth of gastric carcinomas is assessed by -

Accepted Answer

Endoluminal ultrasound

Answer

Barium meal

Answer

Abdominal ultrasound

Answer

Laparoscopy

Question 9

What is the most sensitive investigation for detecting minimal gas in the abdomen?

Accepted Answer

CT Scan of the abdomen

Answer

Chest X-ray in AP View

Answer

X-ray abdomen in supine position

Answer

X-ray abdomen in erect position

Question 10

A female patient presented with recurrent urinary tract infections. Imaging shows the following picture. What can be the most probable diagnosis based on the imaging findings?

Accepted Answer

Ureterocele

Answer

Ureteral duplication

Answer

Congenital megaureter

Answer

Urinary calculi

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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