Hepatobiliary and Pancreatic Radiology MCQs

Radiology · 27 free questions with answers & explanations.

1. A 45-year-old woman with known cirrhosis undergoes contrast-enhanced CT. A 2.5 cm hepatic lesion shows marked arterial-phase hyperenhancement followed by washout appearance (hypodensity compared to liver) in the portal venous phase with a peripheral capsule. Which diagnosis is confirmed by this pattern alone according to current imaging criteria?
2. Ultrasound of a 55-year-old man with jaundice shows dilated intrahepatic and extrahepatic bile ducts with a hyperechoic focus in the common bile duct casting an acoustic shadow posteriorly. CT confirms a calculus at the distal common bile duct. What is this acoustic shadow phenomenon called and what does it indicate?
3. A 40-year-old man with acute pancreatitis undergoes contrast-enhanced CT on day 4. The body of the pancreas fails to enhance with contrast while the head enhances normally. There is peripancreatic fat stranding. What does the non-enhancing area represent?
4. On dynamic contrast-enhanced MRI of the liver, a lesion shows arterial phase enhancement with rapid washout in the portal venous and delayed phases, resulting in a 'capsule appearance' in the delayed phase. This pattern is diagnostic of:
5. On MRCP, which finding is MOST characteristic of primary sclerosing cholangitis (PSC)?
6. On CT abdomen for a patient with acute pancreatitis, the CT Severity Index (CTSI) includes both the Balthazar grade and the degree of pancreatic necrosis. A patient with grade D (single poorly-defined peripancreatic fluid collection) and 30% gland necrosis has a CTSI score of:
7. On MRI, a hepatocellular carcinoma (HCC) in a cirrhotic liver shows arterial phase hyperenhancement followed by washout appearance and capsule enhancement in the portal venous/delayed phase. This pattern fulfils LI-RADS category:
8. MRCP shows a 'duct-penetrating sign' — the main pancreatic duct passing through a mass without obstruction. This is most characteristic of:
9. On ultrasound of the liver, an echogenic mass with posterior acoustic shadowing and absence of vascularity on Doppler is most consistent with:
10. Multiphasic contrast-enhanced CT of the liver shows a 3 cm hepatic mass in a patient with cirrhosis (Child-Pugh B). The lesion shows arterial phase hyperenhancement and venous/delayed phase washout with a peripheral enhancing capsule. According to LI-RADS criteria, this observation pattern is categorised as:
11. Ultrasound of the abdomen shows a hyperechoic structure within a dilated common bile duct casting an acoustic shadow, with upstream biliary dilatation. The 'double duct sign' on MRCP (simultaneous dilatation of both the common bile duct and the main pancreatic duct) is most classically associated with:
12. MRCP shows a unilocular cystic lesion at the tail of the pancreas, 2.5 cm in diameter, with thin walls, no mural nodules, and no communication with the main pancreatic duct on secretin-MRCP. The patient is a 35-year-old woman with no symptoms. This finding is MOST consistent with:
13. Contrast-enhanced CT in a 50-year-old with acute pancreatitis shows pancreatic parenchymal necrosis (no enhancement in 40% of gland) along with a well-defined, thick-walled, homogeneous fluid collection adjacent to the pancreatic tail at 5 weeks from onset. According to the revised Atlanta Classification, this collection is classified as:
14. On dynamic contrast-enhanced CT, a hepatic lesion in a cirrhotic patient shows arterial phase enhancement with washout (hypodensity) in the portal venous phase. This enhancement pattern is diagnostic of:
15. On MRCP (magnetic resonance cholangiopancreatography), the 'double duct sign' refers to simultaneous dilatation of:
16. On ultrasound, a gallbladder polyp is most likely malignant when:
17. On contrast-enhanced CT of the liver in a 45-year-old woman, a well-defined lesion shows intense peripheral nodular enhancement in the arterial phase, progressive centripetal fill-in on portal venous phase, and becomes isodense with the hepatic parenchyma on delayed phase. This pattern is MOST characteristic of:
18. On CECT abdomen, the LI-RADS (Liver Imaging Reporting and Data System) designation LR-5 requires which combination of features in a cirrhotic patient?
19. On MRCP (Magnetic Resonance Cholangiopancreatography), the 'double duct sign' refers to simultaneous dilation of both the common bile duct and the pancreatic duct. This sign is MOST associated with which condition?
20. On CT pancreas in acute pancreatitis, the Balthazar CT Severity Index (CTSI) assigns points based on two components. Which combination correctly describes the scoring system?
21. MRI liver shows a 3 cm lesion in segment VI with: T1 hypointense, T2 moderately hyperintense, diffusion restriction, arterial phase hyperenhancement (APHE), and washout on portal venous phase with enhancing capsule. The LI-RADS (v2018) category for this observation is:
22. MRCP (magnetic resonance cholangiopancreatography) is performed in a 60-year-old man with obstructive jaundice. It shows an abrupt stricture at the common bile duct with a 'rat-tail' narrowing above the ampulla. The pancreatic duct is not dilated. The MOST likely diagnosis is:
23. MRCP of a 45-year-old male with recurrent pancreatitis shows a dilated main pancreatic duct communicating with a 3 cm cystic lesion in the head of pancreas. The cyst has mural nodules and the main duct is >5 mm. According to Fukuoka criteria, this lesion should be:
24. On multiphasic CT liver, a 2.5 cm hepatic lesion shows arterial phase hyperenhancement with portal venous washout and capsular enhancement. In the appropriate clinical context (cirrhosis, elevated AFP), this pattern is diagnostic of:
25. On multiphasic CT, a 4 cm hepatic lesion in a 50-year-old man with hepatitis B cirrhosis shows arterial phase hyperenhancement (APHE) and portal venous phase washout appearance. LI-RADS categorization of this observation is:
26. MRCP in a 55-year-old woman shows a cystic lesion in the pancreatic head communicating with the main pancreatic duct (MPD), with dilated MPD >5 mm and mural nodules within the cyst. What is the diagnosis and the recommended management?
27. On CT, 'central scar' with radiating fibrous bands in a liver mass showing homogeneous arterial hyperenhancement and washout in delayed phase is characteristic of which entity?