2    Attenuation measurements are the cornerstone of adrenal nodule characterization with CT. Which of the following adjustments will have the greatest effect on measured CT attenuation 1 minute after the administration of intravenous iopamidol 300 in a scan obtained and reconstructed with the following parameters: 120 kVp, 200 fixed mA, 5-mm collimation, and filtered back projection?

  3    A 50-year-old male with history of clear cell renal cell carcinoma status post–left nephrectomy presents for characterization of a right adrenal nodule detected on follow-up imaging. Images represent dual-echo gradient-recalled echo T1-weighted imaging with the following echo times at 1.5 Tesla: 2.2 msec (image on LEFT) and 4.4 msec (image on RIGHT). Signal intensity measurements within the adrenal mass are as follows: 144 (image on LEFT) and 175 (image on RIGHT) (18% signal loss). If there are no comparison studies, what is the best next step?

  4    A 63-year-old female with a history of gastric cancer presents for characterization of a 3.3-cm adrenal mass. There are no comparison images. Regions of interest drawn in the center of the mass on triphasic adrenal protocol CT are as follows: (a) unenhanced: 16 Hounsfield units; (b) 1-minute delay: 55 Hounsfield units; and (c) 15-minute delay: 28 Hounsfield units. What is the calculated absolute percent washout?

  5    A 54-year-old female with node-positive invasive lobular breast cancer has a 2.1-cm homogeneous right adrenal mass. Adrenal protocol CT is performed utilizing 1-minute and 15-minute delays. Relative washout is calculated to be 50%. Which of the following is the most likely diagnosis?

  6    A 60-year-old male with hypertension and right lower quadrant pain undergoes a CT of the abdomen and pelvis to rule out appendicitis. An incidental 1.5-cm homogeneous right adrenal mass is identified. He has no other relevant medical history. What is the estimated risk that this adrenal nodule is malignant?

  7    A 65-year-old male ICU patient with a complicated medical history presents with new findings in the adrenal glands. The unenhanced CT image on the left was obtained 2 weeks after the unenhanced CT image on the right. What is the best next step?

  8    A 40-year-old female with postprandial pain and no other past medical history undergoes a right upper quadrant ultrasound. The gallbladder and biliary tree are normal, but an incidental 2.0-cm mass is identified in the right suprarenal fossa. An abdominal MRI follows confirming that the mass arises from the right adrenal gland. India ink artifact is observed within the mass encircling a 1.2-cm internal nodule. What is the most likely diagnosis?

  9    A 23-year-old female with MEN-IIb syndrome and hypertension presents for an I¹²³-MIBG scan. In which of the following organs is uptake on an I¹²³-MIBG scan always abnormal?

  10    A 25-year-old male with a hereditary paraganglioma–pheochromocytoma syndrome undergoes an I¹²³-MIBG study. What is the best diagnosis?

  11    T1-weighted dual-echo gradient-recalled echo imaging is used for the detection of intracellular lipid and macroscopic fat. With this sequence, when fat and water protons are out of phase, fat protons are shifted a certain distance along the frequency-encoding axis depending on the receiver bandwidth and field strength. What is the approximate calculated fat/water chemical shift at 1.5 Tesla? Use the following formula:

  12    A 56-year-old male with no history of malignancy and suspected primary hyperaldosteronism undergoes an adrenal protocol CT demonstrating a 1.5-cm left adrenal nodule with 70% absolute washout. The right adrenal gland is normal. What is the best next step?

  13    A 59-year-old female with suspected primary hyperaldosteronism and a 1.3-cm unilateral left adrenal nodule undergoes adrenal vein sampling. Which description best characterizes the adrenal venous anatomy?

  14    A 55-year-old male with non–small cell lung cancer and a 1.5-cm homogeneous right adrenal nodule presents for triphasic adrenal protocol CT. Which of the following image–time combinations has been shown to be most effective for adrenal nodule characterization?

  15    A 62-year-old female with invasive ductal carcinoma of the breast and an indeterminate 1.5-cm left adrenal nodule undergoes a staging PET study. Which of the following adrenal nodule characteristics has the highest negative predictive value for metastasis?

  16    A 38-year-old female with early-onset diabetes mellitus presents with a dark rash covering her neck and armpits. CT imaging is performed and demonstrates a 4.9-cm left adrenal mass. An image representative of the entire mass is shown below. The patient has no history of malignancy. What is the best next step?

  17    One of the fundamental sequences of adrenal protocol MR is T1-weighted dual-echo gradient-recalled echo imaging for the detection of intracellular lipid and macroscopic fat. Which of the following correctly describes a difference between gradient echo imaging and spin echo imaging?

  18    A 70-year-old female with lung cancer and an indeterminate 2.2-cm left adrenal mass presents for percutaneous biopsy. Which of the following positional maneuvers will most effectively reduce the risk of pneumothorax during the biopsy while minimizing risk to other structures?

  19    A 32-year-old male (body mass index: 22 kg/m²) with intermittent diaphoresis, palpitations, and early-onset hypertension (190/110) presents for adrenal protocol CT. What is the serious adverse event risk of administering intravenous low-osmolality iodinated contrast material to a patient with pheochromocytoma who is not receiving alpha- and beta-blockade?

  20    A 62-year-old male with clinical-stage T1cN0Mx Gleason 5 + 4 = 9 prostate cancer and no signs of adrenal hyperactivity presents for MR characterization of a 2.4-cm right adrenal nodule. Images represent dual-echo gradient-recalled echo T1-weighted imaging with the following echo times at 1.5 Tesla: 2.2 msec (image on left) and 4.4 msec (image on right). What is the best next step?

  21    Homogeneous loss of signal intensity within an adrenal nodule <4 cm on opposed-phase T1-weighted dual-echo gradient-recalled echo imaging is compatible with an adrenal adenoma in most cases. What organ is best used as an internal reference standard to determine the degree of signal loss within an adrenal nodule?

  22    A 60-year-old female with right lower quadrant abdominal pain undergoes a CT of the abdomen and pelvis demonstrating perforated appendicitis and an incidental finding in the left adrenal gland. The following image is representative of the entire gland. Which of the following is most strongly associated with this abnormality?

  23    A 58-year-old male with mild hypertension (140/90) managed with one medication and no history of malignancy undergoes an abdominal MRI that shows a 3.2-cm enhancing mass in the right adrenal gland. No intracellular lipid or macroscopic fat is identified. The left adrenal gland is normal, and the patient is asymptomatic. What is the best next step?

  24    A 45-year-old male with a right adrenal myelolipoma undergoes MR imaging. The following T2-weighted images were acquired without (left) and with (right) a conventional inversion recovery technique. Along what vector do the protons align in conventional inversion recovery imaging immediately following the preparation radiofrequency pulse (applied before the excitation pulse)?

  25    A 51-year-old male with no comparison imaging and a recently diagnosed obstructing sigmoid colon cancer presents for staging CT of the chest, abdomen, and pelvis. Imaging demonstrates the known colon mass, enlarged regional lymph nodes, and a 2.2-cm left suprarenal abnormality. What is the best next step?

  26    A 28-year-old male with suspected pheochromocytoma is scheduled to undergo an I¹³¹-MIBG scan to confirm the diagnosis and evaluate for distant disease. Which organ is at greatest risk of radiation-induced carcinogenesis if no precautionary measures are taken?

  27    A 4-year-old girl with recurrent abdominal pain and unexplained fevers presents with a right suprarenal mass. What is the most likely diagnosis?

  28    Where is the organ of Zuckerkandl?

  29    Pheochromocytoma is associated with several tumor-forming genetic syndromes. Which of the following is an example of that?

  30    A 75-year-old male with altered mental status undergoes an abdominopelvic CT examination that demonstrates an abnormal left adrenal gland. The right adrenal gland is normal. Which of the following best explains this imaging finding?