A.    Presence of microcalcifications is an impor-

tant marker for ductal carcinoma in situ 

(DCIS).

B.    In screening mammography, a palpable 

mass may not be present and as many as 30 

- 50% of non-palpable breast cancers pres-

ent themselves as clusters of microcalcifica-

tions alone.

C.    It is important to develop good radiological 

and histopathological correlation.

D.    Depending on the radiological appearance 

on mammography and ultrasound, patients 

do not require further evaluation.

2.  Which of the following 
statements is false?

CPD QUESTIONNAIRE

Give ONE correct answer for each 
question.

104         SA JOURNAL OF RADIOLOGY • December 2008

1.  Regarding screening and 
diagnostic mammography, 
choose one false answer.

A.    According to BI-RADS, the calcification 

patterns suggestive of malignancy are 

heterogeneous or pleomorphic, amorphic 

or indistinct, fine linear and/or branching 

types.

B.    A study by Gulsun et al. compared the 

positive predictive value (PPV) of using 

LeGal’s classification and the BI-RADS 

classification in terms of identification 

of malignancy and concluded that both 

succeed in reducing the ambiguity in 

assessment of breast calcifications and they 

are useful in standardisation of reports.

C.    Atypical ductal hyperplasia (ADH), lobular 

carcinoma in situ (LCIS) and atypical 

lobular hyperplasia (ALH) may also present 

with calcifications which may exhibit high 

density, clustered punctuate calcification 

and tend to lack the characteristic features 

of DCIS such as rod shapes, ductal 

distribution and branching.

D.    DCIS can present as a stellate mass without 

calcifications.

3.  Which of the following 
statements is false?

A.    Diffuse signal changes in the liver on MRI 

often represent a depositional process.

B.    The signal is decreased when iron is 

deposited or increased with copper or fatty 

deposition.

C.    Diffuse signal change is often incidental 

when imaging is done to identify a cause 

for other symptoms or to assess for 

complications of primary pathology.

D.    In patients who receive multiple blood 

transfusions, the excess iron is initially 

deposited in the reticuloendothelial system 

of the liver, spleen and bone marrow as well 

as the heart and endocrine system.

5.  Which of the following 
statements regarding CT of the 
appendix is false?

A.    CT scanning has emerged as a valuable 

resource in the imaging of appendicitis.

B.    This modality has the advantage of 

improved rates of visualisation of the 

appendix and surrounding structures, as 

well as more accurate evaluation of the rest 

of the abdomen.

C.    The ionising radiation dose delivered is 

negligible.

D.    It allows more confident detection of 

a normal appendix, thus excluding 

appendicitis as a cause of symptoms.

6.  Identify the false statement in the 
following choices.

A.    Peripancreatic pseudo-aneurysms in 

patients with chronic pancreatitis are an 

uncommon but serious complication.

B.    Mortality rates can reach 40%, depending 

on the clinical status, site and characteristics 

of the bleeding lesion, and the surgical 

management.

C.    Arterial lesions related to pancreatitis are 

predominantly localised in the splenic 

artery, the pancreaticoduodenal arteries and 

the gastroduodenal artery.

D.    The pathogenesis of pseudo-aneurysms 

in pancreatitis is due to the proteolytic 

action of the pancreatic enzymes in the 

pseudocyst, mainly lipase, in direct contact 

with the visceral artery.

7.  The following is true about ductal 
carcinoma in situ (DCIS), except-
ing:

A.    DCIS may present with multifocal or 

multicentric disease.

B.    The above implies that all visible lesions 

should be biopsied.

C.    Comprehensive baseline mammography 

is indicated in young patients with breast 

disease so that abnormal calcification 

patterns are not missed.

D.    In patients under the age of 40, ultrasound 

is still the investigation of choice, but 

a single baseline medio-lateral oblique 

mammogram view of the affected breast 

should be performed to exclude any 

abnormal calcification patterns as this may 

be missed on ultrasound.

8.  Identify the false statement 
among the following. 

     Features that are important when 
evaluating calcifications are:

A.    Form i.e. are they round, oval or linear in 

shape, or do they have no specific shape 

(amorphic).

B.    Sizes of the microcalcifications i.e. are 

they large calcifications or small punctuate 

calcifications and do they demonstrate 

homogenous or heterogeneous size.

C.    Distribution i.e. are they clustered together 

or sporadic or are they distributed in a 

particular pattern e.g. in a breast segment 

or along a duct.

D.    Margin – calcifications with regular 

margins are more likely to be malignant.

9.  Regarding pseudo-aneurysm 
of the gastroduodenal artery, 
identify the one false statement.

A.    In chronic pancreatitis, several factors may 

increase the risk of acute bleeding, such as 

duration of disease, proximity of a vessel 

to a pseudocyst, communication with the 

biliary or pancreatic ducts, and splenic vein 

occlusion due to thrombosis.

B.    In the diagnostic workup, invasive 

diagnostic procedures are the priority; 

ultrasonography with colour Doppler is a 

second choice.

C.    The pseudo-aneurysm size, presence 

of thrombus, and pseudo-aneurysm 

topography could often be well defined by 

non-invasive procedures.

D.    Catheter angiography remains 

important in the visualisation of the 

exact gastroduodenal artery pathology 

measurement of artery width and presence 

of arteriovenous fistula. It is an invasive 

procedure, but can also allow treatment of 

the pseudoaneurysm at the same time.

10. Identify one false statement.

A.    The Medical Imaging Society of South 

Africa (MISA) and member companies 

Siemens Healthcare, GE Healthcare, Philips 

Medical Systems and AEC Amersham have 

announced a sponsorship of R20 000.

B.    The sponsorship will be applied in the form 

of a refund of R1 000 to each of up to 20 

registrars who incur long-distance travel 

and accommodation expenses in attending 

RSSA congresses and workshops.

C.    The terms of the sponsorship are that the 

first 20 registrars who register and pay their 

registration fees by the ‘early bird’ deadline 

will receive a refund of R1 000 after the 

course ends.

D.    Awarding the sponsorships depends on the 

course location and where the participants 

come from. For the congress in Sandton, 

for example, Gauteng registrars will be 

included. This is to ensure that recipients 

are those who have to pay for their spouses, 

children or girlfriends.

A.    Ultrasound evaluation of appendicitis was 

first described by Puylaert in 1968.

B.    In a meta-analysis conducted between 1986 

and 1994, Orr et al. reported a sensitivity of 

95% and a specificity of 82% among adult 

and paediatric populations.

C.    Sonography has the advantage of being 

quick to perform without any need for 

patient preparation.

D.    Ultrasound of the appendix is not operator 

dependent and the appendix is readily 

visualised.

4.  Which of the following 
statements regarding ultrasound 
of appendicitis is true? See previous page for 

CPD instructions.

CPD dec 08.indd   104 12/5/08   11:26:19 AM