Fundamentals of Imaging MCQs

Transvaginal sonography is generally the first choice imaging modality in symptomatic patients with adenomyosis. It is widely available, safe, and low cost with good accuracy, similar to that reported for MRI. MRI is IOC and shows thickening of junctional zone. Reference: Callens page number 1056

Ultrasound imaging is used to assess whether an ovarian cyst is simple or complex and to determine cyst measurement. Simple Cyst is Anechoic with Posterior Acoustic Shadowing Hemorrhagic Ovarian cyst shows internl debris with fibrin strands giving a fish net/reticular/lacy appearance. Ground Glass appearance on Ultrasound Is suggestive Of Endometrioma/Chocolate Cyst Dot and Dash pattern on ultrasound is suggestive of Dermoid cyst/Mature cystic teratoma Reference: Callens page number - 1019

The presence of a solid component, with detectable flow by Doppler imaging, within a cystic ovarian mass is the most important sonographic feature for predicting ovarian malignancy. There is also evidence that the larger the solid component within a cystic mass, the higher the risk of malignancy. Reference: Callen's Ultrasonography in Obstetrics and Gynecology, sixth edition page number 924

MRI is the investigation of choice for Mullerian Duct Anomalies Newer modality - 3D USG also has high sensitivity and specificity and accuracy comparable to MRI.

The fetal anomaly scan or TIFFA scan (Target Imaging for Fetal anomaly) is a 2nd trimester ultrasound usually done between 18-20 weeks of gestation primarily used to assess fetal anomaly and detect the presence of any fetal anomalies. Reference: Ultrasound in obstetrics and gynecology by Dr. P. K. shah, Dr. Mandakini megh,

Myocardial perfusion imaging (MPI) using Thallium-201, Sestamibi, or Tetrofosmin assesses blood flow to the heart and is useful for diagnosing coronary artery disease (CAD) and evaluating myocardial infarction. Pyrophosphate scans detect acute myocardial infarction (AMI) or areas of myocardial necrosis. 18FDG PET is used to assess myocardial viability, distinguishing between viable and non-viable myocardium, which is crucial for treatment decisions in CAD and heart failure.

MRI is The IOC for AVN and Perthes Disease(AVN in Young) MRI is also the IOC for Ankylosing Spondylitis, Acute Osteomyelitis and Stress/March Fracture.

The common imaging features of mucor mycosis is "Black turbinate sign" and non enhancing sino-nasal mucosa, orbital involvement, and diffusion restriction in the optic nerve. Intracranial involvement was seen as perineural extension into the brain, cerebritis, and internal carotid artery involvement. Reference: Yadav T, Tiwari S, Gupta A, Garg PK, Khera PS, Rajagopal R, Goyal A, Soni K, Chugh A, Jain V, Sureka B, Elhence P, Misra S. Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients. Curr Probl Diagn Radiol. 2022 Jan-Feb;51(1):112-120. doi: 10.1067/j.cpradiol.2021.09.004. Epub 2021 Nov 3. PMID: 34802841; PMCID: PMC8564981.