Neuroradiology — MCQs
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How does cerebrospinal fluid (CSF) appear on T1 and T2 weighted MRI images?
What is the most sensitive investigation for diffuse axonal injury?
In which condition is the 'Eye of the Tiger' appearance typically observed?
Hummingbird sign in brain MRI is seen in ?
Who is credited with the development of cerebral angiography?
Presence of delta sign on contrast enhanced CT scan suggests presence of?
Identify the condition based on the provided image.
Identify the condition in the image below?
Epidural hematoma on CT scan shows which of the following?
Investigation of choice for acute intracerebral hemorrhage is -
Neuroradiology Indian Medical PG Practice Questions and MCQs
Question 411: How does cerebrospinal fluid (CSF) appear on T1 and T2 weighted MRI images?
- A. Hyperintense on T1 weighted image and hypointense on T2 weighted image
- B. Hypointense on T1 weighted image and hyperintense on T2 weighted image (Correct Answer)
- C. Hyperintense on both T1 and T2 weighted images
- D. Hypointense on both T1 and T2 weighted images
Explanation: ***Hypointense on T1 weighted image and hyperintense on T2 weighted image*** - **CSF** appears **dark (hypointense)** on **T1-weighted MRI** due to its long T1 relaxation time, which means it returns to its equilibrium magnetization slowly. - On **T2-weighted MRI**, CSF appears **bright (hyperintense)** because of its prolonged T2 relaxation time, indicating that it retains its transverse magnetization longer. *Hyperintense on T1 weighted image and hypointense on T2 weighted image* - This description typically applies to **fat** (hyperintense on T1) and may describe areas with short T2 relaxation times, which is not characteristic of CSF. - If CSF were hyperintense on T1, it would indicate a very short T1 relaxation time, which is contrary to its fluid properties. *Hyperintense on both T1 and T2 weighted images* - Substances that appear **bright on both T1 and T2** are generally those with high lipid content or certain types of hemorrhagic products (e.g., **subacute hemorrhage**). - This appearance is inconsistent with the behavior of cerebrospinal fluid. *Hypointense on both T1 and T2 weighted images* - Material that is **dark on both T1 and T2** typically includes **cortical bone**, **air**, or areas of **calcification**, which have very little free water or fast signal decay. - CSF, being primarily water, shows a distinct signal behavior on T1 and T2 images rather than appearing dark on both.
Question 412: What is the most sensitive investigation for diffuse axonal injury?
- A. MRI (Correct Answer)
- B. CT
- C. X ray
- D. PET scan
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the most sensitive imaging modality for detecting **diffuse axonal injury (DAI)** due to its ability to visualize microscopic changes in white matter integrity. - **Susceptibility Weighted Imaging (SWI)** is particularly sensitive for detecting **microhemorrhages** (petechial hemorrhages) at gray-white matter junctions, corpus callosum, and brainstem—characteristic locations for DAI. - **Diffusion Weighted Imaging (DWI)** and **Diffusion Tensor Imaging (DTI)** can demonstrate disruption of axonal tracts by showing restricted diffusion and measuring changes in fractional anisotropy. - Conventional sequences like **T2*-weighted gradient-recalled echo (GRE)** and **FLAIR** also help detect edema and blood products associated with DAI. *CT* - **Computed Tomography (CT) scans** are often the initial imaging modality in acute head injury due to their speed and ability to detect gross abnormalities like **hemorrhages** or **fractures**. - However, CT is **insensitive** to the microscopic axonal shearing and tears characteristic of DAI, typically appearing normal even in severe cases. *X ray* - **X-rays** are primarily used to evaluate **bone structures** and detect **skull fractures**. - They provide no information about soft tissue injury to the brain parenchyma, making them completely insensitive for detecting DAI. *PET scan* - A **Positron Emission Tomography (PET) scan** measures metabolic activity in the brain and can show changes in glucose metabolism or neurotransmitter function. - While PET may reveal **functional deficits** or **metabolic abnormalities** in chronic stages of brain injury, it is not used in the acute setting to diagnose DAI and does not directly visualize axonal damage.
Question 413: In which condition is the 'Eye of the Tiger' appearance typically observed?
- A. Hallervorden-Spatz syndrome (Correct Answer)
- B. Progressive supranuclear palsy
- C. Levodopa-responsive dystonia
- D. All of the options
Explanation: ***Hallervorden-Spatz syndrome*** - The "Eye of the Tiger" sign is characteristic of **pantothenate kinase-associated neurodegeneration (PKAN)**, formerly known as Hallervorden-Spatz syndrome. - This imaging finding refers to a central region of **pallidal hyperintensity** surrounded by a rim of hypointensity on T2-weighted MRI scans due to **iron accumulation**. *Progressive supranuclear palsy* - This condition is characterized by midbrain atrophy, often described as the "**hummingbird sign**" or "**penguin silhouette sign**" on imaging. - It primarily affects eye movements, balance, and gait, but does not typically present with the "Eye of the Tiger" pattern. *Levodopa-responsive dystonia* - This is a rare genetic disorder, often due to mutations in the **GCH1 gene**, affecting dopamine synthesis. - Imaging findings are typically **normal**, and it is not associated with the "Eye of the Tiger" sign. *All of the options* - Since the "Eye of the Tiger" sign is pathognomonic for **Hallervorden-Spatz syndrome (PKAN)**, it is not observed in the other listed conditions. - Therefore, choosing "all of the options" would be incorrect.
Question 414: Hummingbird sign in brain MRI is seen in ?
- A. Multiple sclerosis
- B. Progressive supranuclear palsy (Correct Answer)
- C. Parkinson's disease
- D. Alzheimer disease
Explanation: ***Progressive supranuclear palsy*** - The **hummingbird sign** is characteristic of progressive supranuclear palsy, seen as a specific pattern on MRI where the midbrain has atrophy, giving a "hummingbird" appearance. - It correlates with symptoms such as **gait instability**, **ocular dysfunction**, and **progressive neurological decline** typical of this condition. *Multiple sclerosis* - Often presents with **plaques** or **lesions in white matter** on MRI rather than a hummingbird sign. - Symptoms typically include **episodic neurological deficits** and may involve sensory, motor, or visual pathways. *Parkinson's disease* - Primarily features **substantia nigra degeneration**, which does not present a hummingbird sign on imaging. - Symptoms include **resting tremors**, and **bradykinesia**, without the distinct midbrain morphological change associated with progressive supranuclear palsy. *Alzheimer disease* - Characterized by **cortical atrophy** and does not show the hummingbird sign; instead, it features changes more related to **memory loss** and **cognitive decline**. - MRI findings may show **ventricular enlargement** and hippocampal atrophy rather than midbrain changes.
Question 415: Who is credited with the development of cerebral angiography?
- A. Sir Walter Dandy
- B. Godfrey Hounsfield
- C. Seldinger
- D. Egas Moniz (Correct Answer)
Explanation: ***Egas Moniz*** - **António Egas Moniz** (1874-1955) was a Portuguese neurologist who introduced the technique of **cerebral angiography** in 1927. - He used a **contrast medium** (initially sodium iodide, later thorium dioxide) to visualize the cerebral blood vessels, significantly advancing the diagnosis of brain tumors and other cerebrovascular diseases. - He was awarded the **Nobel Prize in Physiology or Medicine** in 1949 for his work on prefrontal leucotomy. *Sir Walter Dandy* - **Walter Dandy** (1886-1946) was an American neurosurgeon known for his pioneering work in **ventriculography** and **pneumoencephalography**, techniques used to visualize the brain's ventricular system. - While he made significant contributions to neuroimaging, he is not credited with the development of cerebral angiography. *Godfrey Hounsfield* - **Sir Godfrey Hounsfield** (1919-2004) was a British electrical engineer who developed the first **computed tomography (CT)** scanner in 1972. - He shared the **Nobel Prize in Physiology or Medicine** in 1979 with Allan Cormack for this revolutionary contribution to diagnostic imaging. - His work transformed medical imaging, but cerebral angiography predates CT by several decades. *Seldinger* - **Sven-Ivar Seldinger** (1921-1998) was a Swedish radiologist who developed the **Seldinger technique** in 1953. - This technique is a common method for safely obtaining percutaneous access to blood vessels and other hollow organs, widely used in various interventional procedures, including modern angiography. - While his technique revolutionized how angiography is performed, he did not invent cerebral angiography itself.
Question 416: Presence of delta sign on contrast enhanced CT scan suggests presence of?
- A. Lateral sinus thrombophlebitis (Correct Answer)
- B. Cerebellar abscess
- C. Cholesteatoma
- D. Mastoiditis
Explanation: ***Lateral sinus thrombophlebitis*** - The **delta sign** (also known as the "empty delta sign") on a contrast-enhanced CT scan is a classic radiological finding for **venous sinus thrombosis**. This sign is due to the thrombus filling the sinus, surrounded by contrast-enhanced dura. - While the image specifically mentions the sagittal sinus, the principle of a filling defect in a venous sinus due to thrombosis and the resulting "delta sign" applies to other dural venous thromboses, including **lateral sinus thrombophlebitis**. *Cholesteatoma* - A cholesteatoma is an **epidermal cyst** located in the middle ear or mastoid, visualized on CT as a **soft tissue mass**. - Its presence is typically indicated by **bone erosion** of the ossicles or mastoid, not a delta sign in the venous sinuses. *Cerebellar abscess* - A cerebellar abscess is a **collection of pus** within the cerebellar tissue, usually appearing as a **ring-enhancing lesion** on contrast CT. - It does not present with a delta sign, which is specific to venous sinus thrombosis. *Mastoiditis* - Mastoiditis is an **inflammation** or **infection of the mastoid air cells**, often appearing as **opacification of the mastoid air cells**, bone destruction, or periosteal elevation on CT. - While mastoiditis can sometimes lead to lateral sinus thrombosis, the delta sign itself is direct evidence of the **thrombosis**, not the mastoid inflammation.
Question 417: Identify the condition based on the provided image.
- A. Callosal dysgenesis (Correct Answer)
- B. Dandy-Walker syndrome
- C. Aicardi syndrome
- D. Septo-optic dysplasia
Explanation: ***Callosal dysgenesis*** - The image shows **colpocephaly**, characterized by **dilatation of the posterior horns** of the lateral ventricles and narrowing of the anterior horns. This is a classic MRI finding in callosal dysgenesis. - The absence or partial formation of the **corpus callosum** leads to a high-riding third ventricle and parallel lateral ventricles, which are often visualized alongside colpocephaly. *Dandy-Walker syndrome* - Characterized by a **cystic dilatation of the fourth ventricle** that fills the posterior fossa, leading to an upward displacement of the tentorium. - This condition involves agenesis or hypoplasia of the **cerebellar vermis**, which is not depicted in this image. *Aicardi syndrome* - Aicardi syndrome is characterized by the triad of **agenesis of the corpus callosum**, **chorioretinal lacunae**, and **infantile spasms**. - While it includes agenesis of the corpus callosum, the image alone does not provide evidence of the ocular or seizure components of Aicardi syndrome. *Septo-optic dysplasia* - This condition is defined by the **triad of optic nerve hypoplasia**, **pituitary hormone abnormalities**, and **midline brain defects**, specifically hypoplasia or absence of the septum pellucidum. - The image does not show features specific to optic nerve hypoplasia or the typical midline cysts or absent septum pellucidum characteristic of septo-optic dysplasia.
Question 418: Identify the condition in the image below?
- A. Lacunar infarct (Correct Answer)
- B. Embolic infarct
- C. Thrombotic infarct
- D. Intracerebral hemorrhage
Explanation: ***Lacunar infarct*** - The image displays a small, well-demarcated **hypodensity** (darker area) in the basal ganglia region, characteristic of a lacunar infarct. - Lacunar infarcts are typically caused by **occlusion of small perforating arteries** and result in small, deep infarcts, often appearing as precise, round or ovoid lesions on CT. *Embolic infarct* - Embolic infarcts tend to be **larger**, wedge-shaped, and often extend to the cortical surface, unlike the deep, small lesion seen. - They are commonly associated with a **cardiac source** or large artery atherosclerosis leading to distal embolization. *Thrombotic infarct* - Thrombotic infarcts are usually **larger** areas of infarction due to occlusion of a major artery, often preceded by symptoms like TIAs. - While they also appear hypodense, they are typically **more extensive** and less precisely defined than a lacunar infarct in the early stages. *Intracerebral hemorrhage* - Intracerebral hemorrhage would appear as a **hyperdense** (bright white) area on a non-contrast CT scan due to the presence of acute blood. - The image clearly shows a **hypodense lesion**, ruling out acute hemorrhage.
Question 419: Epidural hematoma on CT scan shows which of the following?
- A. Biconvex hyperdense lesion (Correct Answer)
- B. Crescent-shaped hyperdense lesion
- C. Biconcave hypodense lesion
- D. Ring-enhancing hypodense lesion
Explanation: ***Biconvex hyperdense lesion*** - An epidural hematoma is characterized by a **biconvex** (lens-shaped) collection of blood between the dura mater and the skull. - Since it is an acute hemorrhage, the blood appears **hyperdense** (bright white) on a CT scan. *Crescent-shaped hyperdense lesion* - A **crescent shape** is characteristic of an **acute subdural hematoma**, not an epidural hematoma. - While acute subdural hematomas are also hyperdense, their crescent shape (following the contour of the brain) distinguishes them from the biconvex epidural hematomas. - Epidural hematomas are limited by suture lines and appear lens-shaped, while subdural hematomas can cross suture lines. *Biconcave hypodense lesion* - A **biconcave** shape is not a standard description in neuroradiology and does not represent epidural hematoma. - **Hypodense** would indicate an older lesion or other pathology, not acute hemorrhage. *Ring-enhancing hypodense lesion* - **Ring-enhancing lesions** are typically associated with abscesses, glioblastoma, or metastatic tumors, not an acute hematoma. - A **hypodense** (darker) center with enhancement would indicate an abscess or necrotic tumor, not a fresh extravasation of blood.
Question 420: Investigation of choice for acute intracerebral hemorrhage is -
- A. NCCT (Correct Answer)
- B. MRI
- C. PET scan
- D. None of the options
Explanation: ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** is the investigation of choice for acute intracerebral hemorrhage because it can **rapidly and reliably detect acute blood** within the brain parenchyma. - Acute hemorrhage appears as a **hyperdense (bright) lesion** on NCCT, allowing for quick diagnosis and management vital in emergency settings. *MRI* - While MRI can detect hemorrhage, its sensitivity for **acute hemorrhage** can be variable, and it is **less readily available** and takes longer to perform than NCCT. - MRI is generally preferred for subacute or chronic hemorrhage, or to investigate the **underlying cause** of the bleed (e.g., tumor, vascular malformation). *PET scan* - **Positron Emission Tomography (PET) scan** primarily measures **metabolic activity** and blood flow within the brain. - It is **not suitable for detecting acute bleeding** and is typically used for diagnosing conditions like tumors, epilepsy, or neurodegenerative diseases. *None of the options* - This option is incorrect because **NCCT** is indeed the gold standard for diagnosing acute intracerebral hemorrhage.
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