2018 papers

Question 1

How does the US appearance differ between normal canine cephalic veins and cephalic veins with phlebitis?

Answer 1

Normal

• Smooth, thin wall
• Completely compressable
• Unidirectional, non-pulsatile flow without turbulence or filling defects

Phlebitis

• Thickened, hyperechoic wall
• Less compressable
• Intraluminal thrombi
• Abnormal color Doppler flow

Question 2

T/F: Canine cephalic veins with phlebitis had a correlation between filling defects (thrombus) and reduced compressability

Answer 2

True

Question 3

What is the most common US finding in canine cephalic veins with phlebitis?

Answer 3

• Wall thickening

Question 4

What CT findings was associated with canine tonsilar neoplasia?

Answer 4

• Medial retropharyngeal lymphadenomegaly (>18mm W) with heterogeneity and loss of the hypoattenuating hilus
• Usually ipsilateral
• Metastatic mandibular lymphadenopathy only present if MRPLN was abnormal

Question 5

T/F: In dogs with tonsilar neoplasia, the tonsil may be normal in size to minimally enlarged despite associated metastatic medial retropharyngeal lymphadenoapthy

Answer 5

True

Question 6

What was the most common tonsilar neoplasm in Thierry et al., VRU 2018?

Answer 6

• Carcinoma > melanoma > lymphoma
• Can have bilateral tonsilar neoplasia with carcinoma or lymphoma

Question 7

What is the suggested pulmonary trunk-to-aorta ratio as described by Sutherland-Smith et al.? How does this relate to pulmonary hypertension?

Answer 7

• Cut-off of PT:Ao 1.4
• > 1.4 suggests moderate to severe pulmonary hypertension

Question 8

What are suggested cut-off scores to differentiate benign versus neoplastic lymph nodes via elastography? How definitive are these measurements?

Answer 8

Suggested cut-offs

• < 2 = hard = malignant
• > 2 = soft = benign

There is considerable overlap between benign and malignant lymph nodes; elastography alone does not allow differeniation.

Question 9

What is the most likely diagnosis?

Answer 9

Radioulnar ischemic necrosis (RUIN)

Question 10

What CT findings are associated with Crenosoma vulpis infection in dogs?

Answer 10

• Multifocal ground glass opacities or alveolar regions
• Cylindrical bronchiectasis
• Irregular to nodular bronchial wall thickening
• Parenchymal bands

Causes interstitial lung disease. These findings are not specific and can be seen with canine chronic bronchitis, angiostrongylosis, and eosinophilic bronchopneumopathy.

Question 11

Is ¹⁸F-FDG-PET/CT useful for determining cause of fever of unknown origin?

Answer 11

• In cases where initial diagnostic evaluation failed to identify a cause of fever, PET/CT was able to either localize a lesion or rule out the presence of a lesion
• PET/CT also permitted follow-up
  
  • Identify resolution or recurrence
• Can be used as an adjunctive modality in FUO cases

Question 12

What is the “spaghetti sign”? What signalment has a higher incidence of this sign?

Answer 12

• Spleno-systemic collateral circulation
  
  • Originates from splenic vein
  • Terminates in left renal vein or caudal vena cava
• Occured in spayed females

Question 13

What are the most common tarsal bones to sustain traumatic fractures?

Answer 13

• Talus
• Calcaneus

Question 14

Is CT or radiography more sensitive for canine tarsal fracture identification? What about specificity?

Answer 14

• CT is more sensitive than radiography (both 10-view and 2-view)
  
  • CT is good for identifying fractures of the:
    
    • 4th tarsal bone
    • Talus
    • Calcaneus
    • Central tarsal bone
• Specificity of all three are similar

Question 15

T/F: In all dogs with gliomatosis cerebri, MRI underestimated the lesion extent and meningeal infiltration

Answer 15

True

Question 16

Which of the following is incorrect regarding canine gliomatosis cerebri?

1. On MRI, appears as widespread, intra-axial, T2w/FLAIR hyperintensity with mild parenchymal enhancement
2. Has a predilection for gray-white matter
3. Commonly involves the forebrain, but also involves the thalamus and brainstem +/- caudal fossa
4. Degree of T2w signal intensity does not correspond to the density of neoplastic cells

Answer 16

​

• On MRI, appears as widespread, intra-axial, T2w/FLAIR hyperintensity with mild parenchymal enhancement
• Has a predilection for gray-white matter
• Commonly involves the forebrain, but also involves the thalamus and brainstem +/- caudal fossa
• Degree of T2w signal intensity DOES correspond to the density of neoplastic cells

Question 17

Regarding CT-lymphography for lymph node staging, which of the following are true?

• Draining lymph nodes had a high HU (348)
• Primary draining lymph nodes were visible after 1-3 minutes
• There was often good visibility of the lymphatic ducts

Answer 17

All are true

• Draining lymph nodes had a high HU (348)
• Primary draining lymph nodes were visible after 1-3 minutes
• There was often good visibility of the lymphatic ducts

Question 18

T/F: During CT-lymphography, 25% of dogs had multiple draining lymph nodes or the primary lymph node did not correspond to the anatomically closest node

Answer 18

True

Question 19

What parameters are associated with need for diagnostic imaging beyond CT in dogs with TL myelopathy?

• Increased age
• Lack of surgical lesion identified on CT
• Non-Dachsunds
• Studies performed during business hours

Answer 19

• Increased age
• Lack of surgical lesion identified on CT
• Non-Dachsunds
• Studies performed AFTER business hours (this is dumb)

7.6% of dogs needed additional imaging after CT

Dogs without additional imaging were much more likely to get surgery (probably bc they are dachsunds with discs)

Question 20

How does elastrography differ between benign lipomatous and malignant subcutaneous masses?

Answer 20

• Malignant masses are harder (above 50% hardness); minimal overlap with benign lesions
• Malignant mass = Tsukuba score >1.5

Question 21

What is the appearance of the normal feline pancreas on 3 phase CTA?

Answer 21

• Hypo- to isoattenuating to the liver and spleen in all phases
• Homogeneous enhancement pattern
• Left lobe > right lobe

No association between pancreatic volume and body weight, sex, or age

Question 22

Regarding the use of PPE in radiology rooms at a teaching hospital, which of the following is incorrect?

1. An apron and thyroid shield were worn for fewer than 99% of studies
2. Gloves were correctly used in 45% of studies and leaded eyeglasses worn in 2%
3. Workers overestimate their use of PPE, particularly gloves
4. Use of PPE is less frequent when unsupervised

Answer 22

1. An apron and thyroid shield were worn for MORE than 99% of studies
2. Gloves were correctly used in 45% of studies and leaded eyeglasses worn in 2%
3. Workers overestimate their use of PPE, particularly gloves
4. Use of PPE is less frequent when unsupervised

Question 23

Which imaging modality (CT- arthrography, MR-arthrography, CT, MR) resulting in the best sensitivity for localizing cartilage defects in the equine carpal joint?

Answer 23

• CT-arthrography; followed by MR-arthrography
• No statistical significance was found

FYI a 2016 study evaluating CT-arthrography, MR-arthrography, and MR failed to identify a method for accurate cartilage thickness measurement in the metacarpophalangeal joint

Question 24

T/F: The popliteal LN drained directly to the ipsilateral medial iliac lymph node and, in 25% of dogs, also drained to the internal iliac and/or sacral nodes.

Answer 24

True. Also can drain to ipsilateral inguinal LN

There are also lymphatic connections between right and left MILN and right and left IILN

4% incidence of distal femoral LN.

Question 25

Which upper airway dimensional measurements are least likely to change with endotracheal tube placement in brachycephalic dogs?

Answer 25

* Rostral soft palate thickness * Tracheal perimeter * Rostral nasopharynx cross-sectional area These measurements are likely most useful for BAS studies

Question 26

In brachycephalic dogs, how does endotracheal tube placement affect the following measurable parameters: * Tracheal dimension * Tracheal perimeter * Soft palate cross-sectional area (CSA) * Rostral soft palate thickness * Rostral nasopharynx CSA * Caudal nasopharynx CSA

Answer 26

* Does not affect tracheal perimeter, rostral naspharynx CSA, rostral soft palate thickness * Increases tracheal dimension * Decreases soft palate CSA * Variable effect on caudal nasopharynx CSA

Question 27

What are radiographic features of colonic torsion? With Barium?

Answer 27

Radiographic features * **Segmental dilation of the colon** * **Displacement of the descending colon** * **Mild to no small intestinal distention** * Focal narrowing of the colon * Displacement of the cecum \*\* Bold are most common With Barium: * Focal narrowing of the colon * Longitudinal striations in a helical pattern ("torsion sign")

Question 28

What is the clinical presentation and common signalment associated with colonic torsion?

Answer 28

* Middle aged, medium-to-large breed dog, males * Great Danes and Labs have been reported * 64% have a history of GI disease * Present with mild, non-specific clinical signs

Question 29

In sheep affected by slow-growing intracranial lesions, what clinical and/or MRI findings are associated with increased intracranial pressure?

Answer 29

* Neuroscore * Objective MR findings (volume of calvarium) Subjective MRI findings were not associated with increased ICP

Question 30

CEUS of the gallbladder correctly identified what conditions without false positive results? What condition had false positivies?

Answer 30

* No false positives * Necrosis/rupture * Benign polypoid lesions * Gallbladder neoplasia * False positives * Cholecystitis/edema

Question 31

T/F: CEUS of the gallbladder can distinguish between polypoid lesions due to cystic mucosal hyperplasia and neoplasia

Answer 31

True. They have different wash-in and wash-out characteristics

Question 32

What are the consensus recommendations for MRI brain tumor clinical trials?

Answer 32

* Sequences * T2w, pre-T1w, post-T1w in all 3 planes * GRE, FLAIR, DWI in transverse plane * FOV \<150mm * Slice thickness =2mm

Question 33

Which of the following are true regarding B-mode and power Doppler US of the equine suspensory branches? 1. Branches appearing normal in B-mode had Doppler signal 2. Doppler signal was detected in the suspensory branches in both lame and sound limbs 3. Doppler scores were higher in suspensory ligament branches of lame limbs 4. Doppler scores were higher in branches with more severe B-mode changes

Answer 33

1. Branches appearing normal in B-mode had **NO** Doppler signal * Doppler signal was detected in the suspensory branches in both lame and sound limbs * Doppler scores were higher in suspensory ligament branches of lame limbs * Doppler scores were higher in branches with more severe B-mode changes

Question 34

T/F: Skeletal scintigraphy in poorly performing sport horses has a high sensitivity and specificity

Answer 34

False. The sensitivity is low (many false negatives), but the specificity was high (few false positives). Authors state that scintigraphic evaluation alone is unlikely to lead to a full and correct diagnosis when used in isolation.

Question 35

Regarding accuracy of skeletal scintigraphy for diagnosis of foot pain compared with MRI, in which three regions did scintigraphy and MRI agree?

Answer 35

* Distal phalanx (palmar processes and body) * Ungular cartilages * Chondral ligaments Similar to more general study, sensitivity varied, but specificity was high for all regions Authors conclude that skeletal scintigraphy does not meet the miniumum reliability level for a diagnostic test, but is reliable for identification of osseous trauma to the distal phalanx and ungular cartilages

Question 36

Addition of what view can improve detection of navicular flexor cortical lysis in horses?

Answer 36

* Addition of additional palmaroproximal-palmarodistal oblique views (aka Skyline) at flatter angles * Increased sensivitiy and interobserver agreement, decreased specificity

Question 37

Does uptake of ¹⁸F-FDG PET/CT differentiate between canine mast cell tumor grades?

Answer 37

* There is a correlation between uptake and grade, but there is significant overlap in values, so authors determined it is not a better staging tool than standard of care methods * High uptake - higher grade * Lower uptake - lower grade

Question 38

Mammary ultrasonography evaluation by \_\_\_\_\_\_, \_\_\_\_\_\_, and _____ enabled the grade and some characteristics of high-grade mammary carcinomas with limited accuracy

Answer 38

* B-mode * Contrast enhancement ultrasonography * Acoustic radiation force impulse–elastography

Question 39

What US findings were helpful for differentiating the following mammary neoplasms: * Special carcinoma * Complex carcinoma * Grade 2 and 3 carcinomas

Answer 39

* Special carcinoma - width:length ratio \> 0.53 * Complex carcinoma - * wash-in time \< 7.5s * peak enhancement \<1 3.5s * Grade 2 and 3 carcinoma - * Wash-in \> 6.5s * Peak enhancement \> 12.5s * Washout \>1 min

Question 40

T/F: Post-contrast T2w FLAIR images are more sensitive to low concentrations of gadolinium compared to T1w images

Answer 40

True Enhancement on FLAIR likely represents gadolinium leakage across a normal or pathologic barrier

Question 41

Pugs show a higher prevalence of caudal articular process (HYPOPLASIA/APLASIA), but a lower prevalence of caudal articular process (HYPOPLASIA/APLASIA) than Bulldogs

Answer 41

Pugs show a higher prevalence of caudal articular process APLASIA, but a lower prevalence of caudal articular process HYPOPLASIA than Bulldogs Pugs also have a higher number of affected vertebrae and are more frequently affected with generalized, bilateral pattern

Question 42

Pugs have a high prevalence of articular process aplasia at what site? Why is this interesting?

Answer 42

* High prevalence between T10-13 * Interesting because this region is almost entirely spared in Bulldogs

Question 43

T/F: Three-view abdominal radiography has a greater accuracy than two-view abdominal radiography in evaluating dogs presenting with an acute abdomen

Answer 43

* No statistical difference in accuracy * Third view did not increase confidence in GPs

Question 44

Can HUs differentiate between types of pleural effusion?

Answer 44

Limited differentiation * \<14 HU --\> chylous or transudate * \>14 HU --\> exudate, modified transudate, or hemorrhage

Question 45

Under what conditions would an intra-cardiac thrombus be likely to be missed in cats undergoing CT angiography?

Answer 45

* A small thrombus that incompletely fills the left auricle * Thrombus that is more mobile with surrounding contrast

Question 46

Both dynamic and continuous image acquisitions are useful for the evaluation of cardiac thrombi in cats; however, _______ was more sensitive

Answer 46

continuous phase

Question 47

Rank the following by prevalence of pharyngeal collapse (high to low) while undergoing video fluoroscopy: * Non-brachycephalic dogs without airway collapse * Non-brachycephalic dogs with airway collapse * Brachycephalic dogs

Answer 47

Brachy \> Non-brachy with airway collapse \> Non-brachy w/o airway collapse

Question 48

Which MRI plane is the most useful for visualizing the majority of the feline carpal ligaments?

Answer 48

Transverse plane

Question 49

T/F: In MRI of the proximal tarsus and metatarsus in horses, the MRI findings and degree of lameness were not significantly correlated for many of the lesions

Answer 49

True Bone marrow lesions of the third tarsal bone were the only MRI finding that correlated with grade of lameness

Question 50

What is the most common MRI change affecting the distal intertarsal and tarsometatarsal joints?

Answer 50

Osteoarthritis (sclerosis and osteophytosis)0

Question 51

These represent fractures of the central tarsal bone in horses. For each picture, what is the horse's job and what is the fracture configuration?

Answer 51

* Left - non-racehorse with a dorsolateral to plantaromedial configuration * Right - racehorse with a dorsal slab fracture

Question 52

In regards to equine MRI of the distal tarsus and proximal metatarsus, nearly 50% of limbs that responded to analgesia of the proximal suspensory ligament had severe MRI abnormalities in the \_\_\_\_\_

Answer 52

Tarsus Remember that the suspensory ligament originates at the proximal aspect of the third metacarpal/metatarsal bone and inserts on the abaxial surface of the corresponding proximal sesamoid bone

Question 53

Which multiphasic MDCT injection test protocol had the best arterial and portal conspicuity for 4-row, 16-row, and 64-row machines? Options: * Test-bolus protocol * Bolus tracking software * Fixed-injection-duration protocol

Answer 53

* 4 and 16 = fixed injection duration protocol * 64 = test-bolus protocol

Question 54

What is the most sensitive and specific radiographic measurement in the diagnosis of atlantoaxial instability?

Answer 54

* C1-2 overlap \<1.55mm

Question 55

Are the absolute measurements of the dens and atlantoaxial distance useful for diagnosis of AA-luxation?

Answer 55

No - they are both affected by body weight

Question 56

T/F: The following diagnostic criteria may provide support for AA-luxation, but can also be normal in dogs with AA-luxation * Ventral atlantodental interval: dorsal atlantodental interval ratio * Dens: C2 ratio * C1-C2 angle

Answer 56

True

Question 57

Temporohyoid Osteoarthropathy with fracture: * Prevalence * Fracture laterality, displacement, and direction * What are the 2 fracture configurations * Is it associated with severity of THO? * Breed predisposition * Clinical signs * Outcome

Answer 57

* Nearly 50% * Unilateral, minimally displaced, rostrodorsal to caudoventral * Fracture configurations * Complete into cranial vault * Only through lateral petrous temporal bone * Majority had fusion of the temporohyoid joitn * Quarter horses * Ipsilateral neuro deficits * Cranial vault involvement --\> less likely to return to clinical use

Question 58

Bone marrow lesion of distal condyle of MC3 in horses: * Prevalence * Common locations * Clinical significance

Answer 58

* High prevalence (75%) * Dorsomedial and dorsal sagittal ridge * Uncertain clinical significance * Not associated with lameness or type or activity