2    A retrospective cohort study evaluating the incidence of contrast-induced acute kidney injury (CI-AKI) compares acute kidney injury rates following CT in two groups: (1) patients who received contrast-enhanced CT as part of routine clinical care and (2) patients who received unenhanced CT as part of routine clinical care. Serum creatinine measurements drawn 48 hours after the CT are compared to serum creatinine measurements drawn prior to the CT. An increase at the 48-hour time point of ≥0.3 mg/dL is considered indicative of CI-AKI. All patients included in the study had all necessary serum creatinine measurements available. What source of bias is of greatest concern with this type of study design?

  3    A 70-year-old male with a dilated left collecting system undergoes a retrograde pyelogram. What entity is classically associated with the imaging findings?

  4    A 52-year-old female with chronic obstructive pulmonary disease on 2 L of home oxygen therapy undergoes a CT for right lower quadrant pain. A 1.5-cm cortically based left renal mass is identified. Biphasic renal mass protocol CT is performed demonstrating the following features: (1) unenhanced attenuation 50 HU, (2) nephrographic phase attenuation 100 HU, (3) no macroscopic fat, and (4) homogeneous enhancement. The unenhanced background renal parenchyma is 30 HU, the adjacent renal artery is 180 HU, and there are no comparison studies. What is the best next step?

  5    A new blood test is developed for prostate cancer screening. When the test is positive, a transrectal ultrasound (TRUS)-guided random prostate biopsy is performed. After decades of study, it is determined that patients diagnosed with prostate cancer through the screening program have improved survival. However, it is repeatedly noted that prostate cancers resulting from a screening-triggered biopsy are more likely to be variants with a slower growth rate. What type of screening bias results from the disproportionate identification of slowly progressive disease?

  6    Calculate the approximate voxel size of the 2D T2-weighted fast spin echo image shown below provided the following assumptions: (1) field of view = 16 cm × 16 cm, (2) phase-encoding matrix = 168, (3) frequency-encoding matrix = 228, (4) TE = 110 msec, (5) TR = 5,190 msec, (6) slice thickness = 3 mm, (7) interslice gap = 1 mm, (8) echo train length = 21.

  7    A 59-year-old female with hematuria undergoes an intravenous pyelogram (IVP) demonstrating a mass in the left renal pelvis. What is the main reason that CT urography (CTU) has supplanted IVP for the detection of upper tract malignancy?

  8    A 55-year-old female with no comorbidities undergoes percutaneous core biopsy of a 3.2-cm solid mass in the right perinephric space. The histology demonstrates epithelioid angiomyolipoma. What is the best next step?

  9    A 75-year-old male with elevated prostate specific antigen (PSA, 25 ng/mL) undergoes a 3.0-Tesla prostate MRI. What is the hyperintense elliptical structure identified along the midline?

  10    A 73-year-old male with Gleason 4 + 3 = 7 prostate cancer undergoes a 3.0-Tesla prostate MRI. What can be done to reduce the artifacts within the prostate gland?

  11    A 50-year-old female with a left renal angiomyolipoma presents for treatment. At what size is embolization commonly considered for the treatment of an asymptomatic angiomyolipoma?

  12    A 30-year-old male with acute left flank pain undergoes an unenhanced CT of the abdomen and pelvis. What is the most likely explanation for the abnormality in the left perinephric space?

  13    A 75-year-old female with stage IV chronic kidney disease (estimated glomerular filtration rate is 19 mL/min/1.73 m²), hypertension, peripheral vascular disease, and claudication symptoms presents for a CT angiogram of the abdomen and pelvis with runoff to the lower extremities. Which of the following prophylactic measures has the most supportive evidence as a technique to reduce this patient’s risk of contrast-induced acute kidney injury?

  14    A 70-year-old male presents for an ultrasound-guided percutaneous biopsy of an incidentally detected 2-cm homogeneously enhancing solid renal mass. What is the most common complication of this procedure?

  15    A 70-year-old female with a 2.0-cm heterogeneous solid renal mass presents for percutaneous renal mass biopsy. Which of the following approaches is most likely to yield a diagnostic result with the least risk of complication using an 18-gauge spring-loaded end-firing core biopsy device with a 1.0-cm or 2.0-cm throw length?

  16    A 50-year-old female with back and flank pain undergoes an abdominal MRI. What is the most likely cause of the signal abnormality anterior to the common iliac arteries?

  17    A 63-year-old male with metastatic prostate cancer undergoes a CT of the abdomen and pelvis. How should the current images be interpreted?

  18    A 63-year-old male presents with scrotal discomfort and an ultrasound is performed. What is the most likely diagnosis?

  19    A 45-year-old female presents with an incidental finding. What is the most likely diagnosis?

  20    A 28-year-old female presents with lower abdominal pain and a CT is performed. What is the most likely antecedent history?

  21    A 40-year-old female with vague abdominal pain undergoes a CT of the abdomen and pelvis. What is the most likely diagnosis?

  22    A 33-year-old female with left lower quadrant pain undergoes a pelvic MRI. A nonenhancing abnormality is identified within the left ovary. What is the most likely cause of the T1 shortening within this abnormality?

  23    A 50-year-old female with pelvic pain undergoes a pelvic MRI and a large necrotic mass is identified. What is the most likely diagnosis?

  24    A 70-year-old male with an incidentally detected 2-cm solid renal mass presents for a discussion regarding management. What is the commonly cited size threshold at which renal cell carcinoma is prone to metastasize?

  25    Which of the following patients has the greatest risk of nephrogenic systemic fibrosis upon administration of gadolinium-based contrast material?

  26    A radiology practice is interested in reducing radiation exposure to patients undergoing CT urography. Assuming that each of the following preserves the diagnostic accuracy of the examination, which will have the greatest effect on radiation dose reduction?

  27    A 70-year-old female with peripheral vascular disease and a suspected paraneoplastic syndrome undergoes a CT of the chest, abdomen, and pelvis. A 1.2-cm ovoid retrocrural mass is identified that measures 12 Hounsfield Units. How should this finding be interpreted?

  28    A 45-year-old average-size male with a psoas abscess is given conscious sedation with midazolam IV and fentanyl IV for an ultrasound-guided drainage catheter placement. During the procedure, the patient complains of ongoing back pain, and so three additional doses of fentanyl IV are administered at 5, 10, and 15 minutes. At 20 minutes, the patient becomes hypoxic and his respiratory rate is 6. Verbal and tactile stimulation has minimal effect. What is the best next step?

  29    A 55-year-old male with new-onset proteinuria is being scheduled for an elective renal biopsy. He has a history of atrial fibrillation and is receiving chronic warfarin therapy. According to the Society of Interventional Radiology 2012 consensus guidelines, what should be the target INR (International Normalized Ratio) for this procedure?

  30    A 20-year-old male with upper abdominal pain undergoes a contrast-enhanced CT of the abdomen and pelvis, and an abnormality is identified in his pelvis. Which of the following is strongly associated with this imaging finding?