Exam 5
Criteria for the estimation of carotid artery stenosis by CTA and MRA are based on the:
Measurement of luminal diameter
Medial fibromuscular dysplasia (FMD) occurs most often in the:
Mid to distal renal artery
Normal Doppler signals from the portal vein are:
Monophasic with slight pulsatility
The positive predicative value is
The proportion of positive tests results that are correctly identified
A reverse flow component in early diastole should be present in all these vessels except:
The proximal abdominal aorta
In harmonic imaging mode, ultrasound equipment is configured to receive:
The second harmonic frequency which is twice the transmit frequency
Which of the following statements concerning renal transplants is incorrect?
The transplanted kidney is usually placed in the left iliac fossa
Contrast- enhanced imaging of the carotid artery vasa vasorum may prove to help identify:
The vulnerability of a plaque
Microbubbles produced by simple agitation have all of the following problems except:
They are not biodegradable
All of the following are true of saccular aneurysms except
They only involve the outer vessel wall
MRA detection of renal artery stenosis can be challenging due to:
Tissue motion associated with longer acquisition times
What type of ultrasound contrast agent has the potential to enhance the appearance of venous thrombi?
Tissue-specific contrast agents which attach to fibrin
Which of the following criteria describes a post renal transplant biopsy pseudoaneurysm?
To and fro Doppler signal
Hemodialysis access is usually placed as far distal as possible because:
To preserve the proximal portions of the vessels for future use
IVC pathology that can be detected on the gray scale image includes all of the following except
arteriovenous fistula
Anomalies of the IVC can involve the intrahepatic portion. When this portion of the IVC is congenitally absent, blood from the lower extremities is returned to the heart via the:
azygos vein
In situations where the cephalic vein is unusable, this vein is preferred
basilic vein
Which of the following is an indication to perform an aortoiliac ultrasound?
blue toe syndrome
When performing a Doppler examination of a full liver transplant, which of the following vessels would not be routinely examined?
celiac trunk
The most common cause of portal hypertension in North America is:
cirrhosis
As portal vein flow to the liver decreases with disease, hepatic artery flow:
increases
A stenosis that develops within the outflow vein segment of a fistula is most often the result of
intimal hyperplasia
The case in which multiplanar digital image reconstructions demonstrate resolution similar to that in the original acquisition is referred to as:
isotropic resolution
Which of the statements about the technique referred to by the acronym TRICKS is incorrect?
it involves the use of large contrast boluses
Because of the medial location of the basilic vein
it must be transposed and juxtaposed to an artery in order to be used
Which of the following is not a characteristic of flow-reducing renal artery stenosis?
laminar flow
Nutcracker syndrome is the result of extrinsic compression of the:
left renal vein
Normal portal vein diameter measures:
less than 13mm
For celiac and mesenteric vessels, the normal intraoperative velocity ratio should be:
less than 2.0
Disadvantages of CTA include all of the following except:
long length of time to acquire images
All of the following are indications for liver transplantation except:
pancreatitis
When performing an intraoperative ultrasound on an infrainguinal bypass, this is often used to minimize the effects of vasospasm.
papaverine
A vessel with a focal elevation in velocity yet no visible material on B-mode imaging likely has which of the following?
platelet aggregate
Collagenous tissue in the walls of this vessel creates bright echogenic borders:
portal veins
The upper extremity is preferred over the lower extremity because it:
provides the easier access
Which is the most common vascular complication following renal transplantation?
renal artery stenosis
Which veins are lateral tributaries of the IVC?
renal veins
An intimal flap at a carotid endarterectomy site is:
revised if greater than 2mm
Contraindications to MRA include all but which of the following?
scarring from surgical incisions
The main renal artery divides into several branches just proximal to the renal hilum. These branches are called the:
segmental arteries
Contrast enhancement lasting as long as 12 minutes or more has been achieved by:
slow IV infusion
The main portal vein is formed by the confluence of the:
splenic vein and superior mesenteric vein
Which of the following is not a common indication for a duplex ultrasound examination of the hepatoportal system?
systemic hypertension
Sensitivity is defined as the:
the ability of a test to detect disease
What is the threshold end diastolic velocity value which is predictive of a ≥50% in the SMA?
> 45 cm/s
The hepatic artery normally displays:
A PSV from 70 to 120 cm/s and an RI from 0.50 to 0.70
Which of the following is not associated with a TIPS stenosis?
A focal increase in stent velocity greater than 30 cm/s
Using harmonic imaging mode with ultrasound contrast agents will result in
A higher signal to noise ratio
Compared to the normal fasting SMA Doppler waveform, a test meal results in
A near doubling of the PSV and a near tripling of the EDV
A proximal flow-reducing renal artery stenosis would be identified by all of the following except
A peak systolic velocity less than 180 cm/s
Which of the following is typical of a normal main hepatic artery waveform in a patient status post liver transplantation?
A peak systolic velocity less than 200 cm/s
Which two ultrasound findings are observed with spontaneous aortocaval fistula?
A tissue bruit and pulsatile flow central to the fistula
Upon completion of ultrasound-guided IVC filter placement
A transverse image should be obtained to confirm proper filter expansion
The "gold standard" is defined as:
A well established and reliable testing parameter
When calculating volume flow, which of the following is correct?
A wide sample gate should be used
Renal artery stenosis is suspected with all of the following except:
Acute left or right flank pain
Which statement best describes the ultrasound appearance of an acute thrombosis of the IVC?
Anechoic
What technique can be applied by the sonographer to best help with visualization in the presence of bowel gas?
Apply pressure with transducer
The "gold standard" for vascular disease typically refers to:
Arteriography
Recanalized paraumbilical vein is located:
At the fissure of the ligamentum teres
Which of the following is the best location for insonation of the cavernosal artery?
At the penoscrotal junction
Which of the following characteristics is primarily observed with only intravascular tumors?
Color flow within the mass with small vessels apparent
Which of the following is the normal course of arterial blood supply to the penis?
Common iliac, internal iliac, internal pudendal, penile artery
Color flow imaging is helpful with all of the following except:
Confirming the percentage stenosis
Following EVAR, the most compelling duplex ultrasound evidence of procedural success is:
Contraction of the residual sac
A patient is receiving thrombolytic agents for an iliofemoral venous thrombosis. Which of the following techniques is essential for the monitoring of the thrombolytic therapy?
Contrast venography
Which of the following is not usually predictive of renal artery occlusion?
Cortical velocity of 20 cm/s
Elevated renovascular resistance is not a consideration when:
Diastolic flow is 40% of systolic
DSA is considered to be more invasive than other imaging techniques because:
Direct arterial access is required
Extrinsic compression of the IVC by tumors may mostly likely result in:
Distention of the distal IVC
Which of the following statements is correct?
Duplicate renal arteries occur most often on the right side
Endoleak is present when there is:
Flow within the residual aneurysm sac
Compared to traditional aortic surgical repair, stent graft placement usually requires a shorter hospital stay and is less stressful to the cardiopulmonary systems. The trade-off for these advantages is:
Frequent and long-term follow-up
Currently marketed ultrasound contrast agents use all of the following components for the microbubble shell except:
Glycerol
Minimum venous diameter for fistula creation is generally thought to be greater than:
Greater than 2.5 mm
Normal fistula volume flow measured by duplex ultrasound should be:
Greater than 800 ml/min
To be clinically effective, tissue-specific contrast agents must
Have affinity for the targeted tissue
When examining the peripheral arteries, ultrasound contrast agents have been shown to do all of the following except:
Help augment flow through low-flow beds
What is the appropriate size of the cuff for measuring a PBI?
2.5
Published studies using ultrasound contrast agents have shown improved diagnostic accuracy in DVT examinations by what percent over baseline nonenhanced studies?
26%
Minimum arterial diameter for fistula creation and maturation is:
3 ???
What percentage of patients present with bilateral renal artery stenosis?
30%
The normal velocity range for the distal renal artery is:
70-90 cm/s
What is the length of time it takes for an arteriovenous fistula to mature?
8-12 weeks
The length of the normal adult kidney is:
8-13 cm
The peak systolic velocity of the normal proximal renal artery ranges from
90-120 cm/s
Accuracy is defined as:
The overall percentage of correct results
The liver receives a dual blood supply from the:
hepatic artery and portal vein
The primary outflow tract for the liver is:
hepatic veins
Why is it important to discriminate between high-flow and low-flow priapism?
high flow priapism is an emergent condition
Sonographic findings in portal hypertension can include all of the following except:
hydronephrosis
Vascular complications may be expected in what percentage of liver transplant recipients?
10-20%
Normal portal venous flow systolic velocities range from:
10-30 cm/s
Normal peak systolic velocity measurements in a well-functioning fistula are between:
150-300 cm/s
Which velocity would be associated with normal post-injection response?
40 cm/s
Normal portal venous pressure is between:
5-10 mmHg
Postprandially, portal vein velocity increases:
50-100%
This test has essentially replaced ventilation/perfusion (V/Q) scanning
CTA
Valves within the vein of a fistula:
Can be the site of stenosis development
The inferior mesenteric artery:
Can be visualized with ultrasound and can be an important mesenteric collateral pathway
The earliest studies using contrast agents involved
Cardiac imaging with agitated saline
Velocity criteria for diagnosis of Peyronie's disease have been developed for which of the following artery?
Cavernosal
What are the ultrasound characteristics that are used to indicate the need for revision associated with intraoperative visceral vascular surgery?
Celiac PSV >200 cm/s and SMA PSV >275 cm/s
Arterial and venous causes for mesenteric ischemia can be differentiated by a single examination except in the case of:
DSA
Which of the following imaging modalities is used as guidance during carotid stent placement?
DSA (digital subtraction angiography)
A slight increase in velocity is expected in stented renal arteries due to:
Decreased arterial compliance
Which of the following maneuvers/techniques is least helpful to aid in the identification of an endoleak?
Decreasing color persistence
Examination of organ transplants with contrast- enhanced imaging can aid in all of the following except:
Detect rejection earlier
The normal waveform of the intra-parenchymal renal arteries in a patient status post renal transplantation is characterized by which of the following except
EDV less than 10 cm/s
What are the top two uses for ultrasound contrast agents?
Echocardiography and liver evaluation
Which of the following transducers is most applicable to intraoperative scanning?
High frequency, "hockey stick" probe
Ultrasound contrast agents used with renal ultrasound examinations can aid in all of the following except:
Identifying medical-renal disease
Which of the following must the sonographer determine before scanning a liver transplant?
If the patient had a full or partial liver transplant
The position of the renal arteries is normally:
Inferior to the left renal vein
Patients with median arcuate ligament syndrome have
Intermittent compression of the celiac artery origin by the medial arcuate ligament of the diaphragm
Echocardiography referred to as a "bubble study" is commonly used to diagnose:
Intracardiac shunts
IVC filter placement by ultrasound
Is advantageous because it can be done at the bedside without intravenous contrast
Which of the following statements is true of a PBI measurement?
It does not assess physiologic changes during erection
Which of the following statements about aortic aneurysm disease is incorrect?
It is most often superior to the renal arteries
IVC filters are typically placed at what level in the IVC?
Just below where the right renal vein joins the IVC
The following conditions may be diagnosed by CT or MR venography of the abdomen and pelvis except:
Lemierre's syndrome
In order to pass through the pulmonary capillary bed ultrasound, contrast agents should be what size?
Less than 8 micros
In comparing changes in a normal SMA Doppler waveform before and after a meal, one would expect to see a change in waveform from a:
Low flow, high resistance pattern to a high flow, low resistance pattern
Medial fibromuscular dysplasia has a sonographic appearance described as:
Multiple segmental concentric narrowing and dilations
Which of the following is not normally associated with Peyronie's disease?
Normal sexual function
Which of these features is not included with the documentation of a preoperative vein examination?
Number of valves
Acute mesenteric ischemia:
Occurs suddenly with occlusion from embolus or thrombosis and needs to be treated promptly
In the setting of critical celiac artery stenosis
PSV may be elevated in the SMA even though the artery is widely patent
Which of the following is a finding in a normal examination for Peyronie's disease?
PSV, post-ICI, of <3 cm/s in the deep dorsal vein
What is the correct method to calculate the penile-brachial index (PBI)?
Penile pressure divided by highest brachial pressure
Precise determination of the measurement of aortic diameter should be taken:
Perpendicular to the aorta itself
Typical symptoms of chronic mesenteric ischemia include
Postprandial abdominal pain, food avoidance, weight loss
Risks that may preclude the creation of a fistula include all of the following except:
Prior arterial access for diagnostic cardiac catheterization
When should a penile Doppler examination be performed?
Prior to an invasive reconstructive surgery
Tardus parvus waveforms are noted in the right and left intrahepatic arteries. What is the most likely explanation?
Proximal hepatic artery stenosis
Regarding the post biopsy complications in renal transplant recipients, all of the following statements are true except:
Pseudoaneurysms occur more frequently than arteriovenous fistulas
Normal venous Doppler patterns of the IVC are
Pulsatile in the upper abdomen and more phasic near the iliac bifurcations
Severe fluid overload will cause what finding in the IVC?
Pulsatility throughout the IVC and into the iliac veins
Causes of increased RI in a renal transplant 6 months posttransplantation could include all of the following except:
Renal artery stenosis
A patient present with pain and oliguria 6 hours following renal transplantation. Waveforms in the main renal artery reveal reversed pandiastolic flow. What is the most likely cause?
Renal vein thrombsis
The majority of visceral emboli lodge in the:
SMA, 3 to 8 cm beyond the origin
Abnormalities associated with infrainguinal bypasses detected during intraoperative ultrasound include all of the following except:
Shelf lesions
Doppler criteria for the diagnosis of renal artery stenosis in the renal transplant recipient include all of the following except
Tardus parvus waveform proximal to the stenosis
Which feature of contrast- enhanced ultrasound imaging has been shown to improve the detection of aortic endoleaks as compared to CTA?
The ability to access blood flow in real time
What is meant by sonothrombolysis?
The ability to enhance the lysis of thrombus using targeted ultrasound contrast agents and ultrasound energy
Specificity is:
The ability to find a condition as normal
Most duplicated renal arteries arise from:
The aortic wall below the main renal artery
Which artery is insonated in the diagnosis of Peyronie's disease?
The cavernosal artery
Contrast-enhanced ultrasound of the liver is used for all of the following except:
The degree of portal hypertension
When performing an ultrasound on an IVC filter, which of the statements is correct?
The filters often appear as cone-shaped structures
Intraluminal tumors within the IVC and iliac veins most typically arise from:
The hepatic and renal veins
In approximately 96% of individuals, two of the three hepatic veins join together to form a common trunk before entering the IVC. Which two veins join together?
The middle and left hepatic veins
True negatives are:
The number of negative findings by ultrasound that were negative by the arteriogram
False negatives are:
The number of negative ultrasound findings that were found positive by the arteriogram
Negative predictive value is calculated by:
True negatives divided by the sum of true negatives plus false negatives
Flow into a residual aneurysm sac via a lumbar artery is known as what type of endoleak?
Type II
A resistive index of 0.9 is predictive of
Unsuccessful renal revascularization
Iliac arteries are often tortuous, deep, and may have overlying bowel gas. All of the following may be helpful in examining the aortoiliac segments completely except:
Using a 10- to 12-MHz transducer
The destruction of microbubbles by the energy in the ultrasound beam can be limited by:
Utilizing a low mechanical index
Which of the following is not a hemodynamic abnormality associated with ED?
Venous turbulence
Intraluminal iliac or aortic stents placed for atherosclerotic disease should be:
Well opposed to the vessel wall
The most threatening consequence of endoleak following aortic endovascular stent graft repair (EVAR) is:
aneurysm rupture
Accuracy is calculated by determining: a) The total number of tests divided by the positive tests b) The total number of tests divided by the negative tests c) The total number of all tests divided by the number of positive and negative tests d) The total number of correct tests divided by the total number of tests
d) The total number of correct tests divided by the total number of tests
Which of these statements is incorrect with respect to imaging evaluation of traumatic vascular injury?
duplex sonography is usually insufficient to evaluate femoral artery injury after catheterization
Limitations associated with the evaluation of intravascular stents include the following except:
endoleaks associated with aortic stent-grafts require DSA for detection
The following are examples of digital image reformatting in CTA or MRA except:
field-of-view (FOV)
Which of the following is the most likely explanation for a multiphasic Doppler waveform at the common femoral artery ipsilateral to an iliac artery occlusion?
good collateralization
If a strut of an IVC filter penetrates the wall of the IVC, what common complication may be seen on ultrasound?
hematoma
True positives are:
the number of US studies that shows that disease was present and the arteriogram agreed
False positives are:
the number of positive US findings that were reported negative by the arteriogram
What is often described has having a homogeneous ultrasound appearance with smooth borders and is found within the sac of an aneurysm?
thrombus
Duplex ultrasound can differentiate aortic aneurysm disease from:
tortuosity
Distal to the distal attachment/fixation site complications may occur at the access site. Which of the following is least likely to occur?
vasospasm