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CME TEST QUESTIONS: JANUARY 2016
CME TEST QUESTIONS: JANUARY 2016
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME tests. Each test will be available online for 3 years from the month/date of publication. The CME questions in this issue are derived from the article “Diffusion-Weighted MR Imaging of Hepatocellular Carcinoma: Current Value in Clinical Evaluation of Tumor Response to Locoregional Treatment” by Yuan et al. 1. In this review article, the authors highlight the use of diffusion-weighted MRI (DWI) and calculation of apparent diffusion coefficient (ADC) measurement in evaluating tumor response after locoregional therapy (LRT). What unique property does DWI and ADC imaging possess that allows it to assess response? a. Its ability to demonstrate viable tumor enhancement more avidly. b. Its ability to reflect the water molecule diffusion in tissue that in turn reflects cell wall integrity. c. Its ability to reflect the presence of viable tumor by signal drop-out. d. Its ability to define tumor margins and hence provide true tumor size. 2. Which of the following statements about DWI and ADC mapping to assess tumor response after LRT is TRUE? a. DWI and ADC optimizes the signal to noise ratio, allowing for better visualization of viable portions of the tumor following administration of intravenous contrast. b. DWI and ADC provide better lesion characterization by demonstrating areas of lipiodol retention as areas of signal loss that, in turn, reduces artifact. c. Areas of viable versus necrotic tumor can be assessed based on the finding that viable tumor cells have intact cell membranes and subsequently restricted water diffusion where as necrotic cells don’t. d. The optimal temporal resolution provided by DWI and ADC maximizes the agreement
between the kinetic parameters, allowing for the ideal wash-in and wash-out phase and thus tumor visualization. 3. The most widely used sequence for DWI is echoplanar imaging (EPI). Which of the following statements is TRUE about DWI using EPI? a. The technique is insensitive to susceptibility artifacts. b. The technique is extremely sensitive to motion artifacts. c. The technique has the best spatial resolution. d. DWI imaging should be interpreted concurrently with ADC measurements to avoid misinterpretation due to confounding factors such as inherent T2-relaxation time of the tissue. 4. Which of the following statements regarding DWI and ADC measurement for HCC is FALSE? a. Post-treatment ADC values have no correlation to the degree of tumor necrosis on pathology. b. Pre-treatment ADC measurement and percentage change in ADC measurement following LRT have been correlated with the progression-free and overall survival after LRT. c. On DWI, following ablative therapies the coagulation zone is marked by a central dark area, while the bright signal surrounding the coagulation zone represents the hyperemic margin extending beyond the initial tumor. d. Pre- and post-treatment comparisons of DWI and ADC measurement are needed to prevent incorrect interpretation due to confounding factors such as tissue characteristics.
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME tests. Each test will be available online for 3 years from the month/date of publication. The CME questions in this issue are derived from the article “Diffusion-Weighted MR Imaging of Hepatocellular Carcinoma: Current Value in Clinical Evaluation of Tumor Response to Locoregional Treatment” by Yuan et al. 1. In this review article, the authors highlight the use of diffusion-weighted MRI (DWI) and calculation of apparent diffusion coefficient (ADC) measurement in evaluating tumor response after locoregional therapy (LRT). What unique property does DWI and ADC imaging possess that allows it to assess response? a. Its ability to demonstrate viable tumor enhancement more avidly. b. Its ability to reflect the water molecule diffusion in tissue that in turn reflects cell wall integrity. c. Its ability to reflect the presence of viable tumor by signal drop-out. d. Its ability to define tumor margins and hence provide true tumor size. 2. Which of the following statements about DWI and ADC mapping to assess tumor response after LRT is TRUE? a. DWI and ADC optimizes the signal to noise ratio, allowing for better visualization of viable portions of the tumor following administration of intravenous contrast. b. DWI and ADC provide better lesion characterization by demonstrating areas of lipiodol retention as areas of signal loss that, in turn, reduces artifact. c. Areas of viable versus necrotic tumor can be assessed based on the finding that viable tumor cells have intact cell membranes and subsequently restricted water diffusion where as necrotic cells don’t. d. The optimal temporal resolution provided by DWI and ADC maximizes the agreement
between the kinetic parameters, allowing for the ideal wash-in and wash-out phase and thus tumor visualization. 3. The most widely used sequence for DWI is echoplanar imaging (EPI). Which of the following statements is TRUE about DWI using EPI? a. The technique is insensitive to susceptibility artifacts. b. The technique is extremely sensitive to motion artifacts. c. The technique has the best spatial resolution. d. DWI imaging should be interpreted concurrently with ADC measurements to avoid misinterpretation due to confounding factors such as inherent T2-relaxation time of the tissue. 4. Which of the following statements regarding DWI and ADC measurement for HCC is FALSE? a. Post-treatment ADC values have no correlation to the degree of tumor necrosis on pathology. b. Pre-treatment ADC measurement and percentage change in ADC measurement following LRT have been correlated with the progression-free and overall survival after LRT. c. On DWI, following ablative therapies the coagulation zone is marked by a central dark area, while the bright signal surrounding the coagulation zone represents the hyperemic margin extending beyond the initial tumor. d. Pre- and post-treatment comparisons of DWI and ADC measurement are needed to prevent incorrect interpretation due to confounding factors such as tissue characteristics.