BRANT: Chapter 47: Adrenal Glands and Kidneys

Question 1

The adrenal glands are composed of an outer cortex and an inner medulla that are functionally independent and anatomically distinct. The ____ secretes steroid hormones including cortisol, aldosterone, androgens, and estrogens. The ____ produces catecholamines.

Answer 1

Cortex, medulla

Question 2

True of the adrenal glands, except:
a.The adrenal glands lie within the perirenal space surrounded by fat.
b. The right adrenal gland is located posterior to the inferior vena cava (IVC) at the level where the IVC enters the liver.
c. The right adrenal gland is between the right lobe of the liver and the right crus of the diaphragm just above the upper pole of the right kidney.
d. All of the above are true

Answer 2

d. All of the above are true

Question 3

T/F: The left adrenal gland lies just medial and anterior to the upper pole of the left kidney, posterior to the pancreas and splenic vessels, and lateral to the left crus of the diaphragm.

Answer 3

True

Question 4

The limbs of the adrenals are ____ in length and ____ in thickness.

Answer 4

4 to 5 cm, 5 to 7 mm

In diffuse hyperplasia, the limbs of the adrenal glands are longer than 5 cm and exceed 10 mm thickness.

Question 5

a. On MR, the normal adrenal is ____, about equal to striated muscle, on T1WI.
b. On T1WI and T2WI, the adrenals are ____ compared with the liver

Answer 5

a. Hypointense
b. Isointense or slightly hypointense

Question 6

In adenomas, percentage washout measurements are made on images taken at a. ____ following the onset of intravenous contrast injection (enhanced attenuation).

Delayed attenuation measurements are made on images obtained at b. ____ following contrast injection.

Answer 6

a. 60 to 75 seconds
b. 10 or 15 minutes

The 60% APW and 40% RPW criteria are easier to remember and seem to work effectively using either 10- or 15-minute delayed images.

Question 7

For cases of Cushing syndrome, MR of which part of the body is recommended?

Answer 7

MR of the sella turcica is recommended for suspected pituitary adenomas.

Question 8

Phases of CT urogram: In this phase, the renal cortex enhances before the renal medulla.

Answer 8

Corticomedullary phase

Question 9

Phases of CT urogram: At approximately 120 seconds following onset of contrast injection the renal parenchyma is normally uniformly enhanced

Answer 9

Nephrogram phase

Question 10

Phases of CT urogram: At 3 to 5 minutes shows contrast filling of the collecting system and ureters.

Answer 10

Pyelogram phase

Question 11

This is essential in MR urogram for recognition of low-grade enhancement.

Answer 11

Subtraction images

Question 12

T/F: Excretory phase T2WI images are obtained of the collecting system, ureters, and bladder as gadolinium is excreted into the urine.

Answer 12

False

Excretory phase T1WI images are obtained of the collecting system, ureters, and bladder as gadolinium is excreted into the urine.

Gadolinium shortens the T1 relaxation time of urine making it bright as gadolinium initially mixes in the urine. However, as the gadolinium concentration increases T2-star effects reduce signal intensity and the urine darkens impairing the quality of the study

Oral hydration, diuretics, and use of low-dose gadolinium agents minimize this effect.

Question 13

The kidney is made up of lobes that consist of a pyramid-shaped medulla surrounded by cortex except at the ____

Answer 13

Apex of the pyramid

Question 14

The peripheral cortex is immediately beneath the renal capsule, and the septal cortex extends down between the pyramids as the

Answer 14

Columns of Bertin

Question 15

T/F: The kidneys gradually increase in size from birth to age 18.

Answer 15

False

20

Question 16

Renal length is relatively stable at ____ from ages 20 to 50 and gradually decreases thereafter

Answer 16

9 to 13 cm

Question 17

True of renal calyces, except:
a. Simple calyces are cup-shaped structures that drain one renal lobe. Compound calyces drain several renal lobes and are more complex in shape.
b. Compound calyces are more common at the poles of the kidney and are more prone to intrarenal reflux.
c. The shape of each calyx is determined by the shape of the papilla. Disease of the papilla is reflected in the appearance of the calyx.
d. The minor calyces join to form major calyces (infundibula), which drain into the renal pelvis and then into the ureter.
e. All of the above are true

Answer 17

e. All of the above are true

Intrarenal reflux, usually most prominent at the UPPER pole

Question 18

The normal kidney is equal in length to between ____ vertebral bodies.

Answer 18

Three and four

Question 19

Phase and timing

Answer 19

Pyelogram phase
3-5 min after IV administration

Question 20

True of the renal artery and veins, except:
a. The right renal artery courses posterior to the IVC, whereas the left renal artery courses posterior to the left renal vein.
b. The main renal artery divides into ventral and dorsal branches as it enters the renal hilum.
c. Segmental arteries supply separate portions of the kidney, each being an end artery without anastomoses.
d. Interlobar arteries arise from segmental arteries and course in the columns of Bertin.
e. Arcuate arteries are continuations of the interlobar arteries and course parallel to the renal capsule at the corticomedullary junction. Arcuate arteries give rise to intralobular arteries.
f. All of the above are true

Answer 20

f. All of the above are true

Question 21

T/F: Perirenal fat continues into the renal sinus, outlining blood vessels and the collecting system.

Answer 21

True

Question 22

Horseshoe kidney is the most common renal fusion anomaly. Which of the following is true?
a. The midpoles of the kidneys are joined across the midline by a fibrous or parenchymal band.
b. As a result of fusion, the kidneys are malrotated, with the renal pelvises directed more medially and the lower pole calyces directed inferiorly.
c. The fused kidney is low in position in the abdomen because normal ascent is prevented by renal tissue encountering the inferior mesenteric vein in the midline
d. Renal arteries are frequently multiple and ectopic in origin.

Answer 22

d. Renal arteries are frequently multiple and ectopic in origin.

a. LOWER POLES
b. Renal pelvises directed more ANTERIORLY, lower pole calyces directed more medially
c. IMA
d. True

Question 23

The characteristic India ink artifact in angiomyolipoma is seen in which MR sequence?

Answer 23

Chemical shift MR

Chemical shift MR may demonstrate the characteristic India ink artifact at the interface between fat within the tumor and renal parenchyma