Interventional Radiology Practice Questions

Q: Transjugular intrahepatic portosystemic shunt (TIPS) is contraindicated in which of the following conditions?

Portal vein thrombosis. **Explanation:** **Transjugular Intrahepatic Portosystemic Shunt (TIPS)** is an interventional procedure where a shunt is created between the hepatic vein and the portal vein to reduce portal hypertension. **Why Portal Vein Thrombosis (PVT) is the correct answer:** The success of a TIPS procedure depends on the ability to access and pass a wire through the portal vein to establish the shunt. In cases of **extensive or cavernous portal vein thrombosis**, the target vessel is either occluded or replaced by small collateral vessels, making the procedure technically impossible or highly hazardous. While partial PVT is sometimes managed by experienced interventionists, complete PVT remains a classic **absolute contraindication** in standard practice. **Analysis of Incorrect Options:** * **Post-shunt encephalopathy (A):** This is a common **complication** of TIPS, not a contraindication for the initial procedure. However, pre-existing severe hepatic encephalopathy is a relative contraindication. * **Cirrhosis (B):** Cirrhosis with portal hypertension is the **primary indication** for TIPS (specifically for refractory ascites or variceal bleeding). * **Variceal bleeding (D):** This is a **major indication** for TIPS, especially when bleeding is refractory to endoscopic management (Rescue TIPS). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Severe congestive heart failure (R-sided), severe pulmonary hypertension, and multiple hepatic cysts/polycystic liver disease. * **Relative Contraindications:** Active systemic infection, severe coagulopathy, and rapidly progressing hepatoma. * **MELD Score:** A MELD score >18 is associated with higher mortality post-TIPS. * **Mechanism:** TIPS bypasses the liver parenchyma, effectively converting sinusoidal portal hypertension into a side-to-side portocaval shunt.

Q: Uterine artery embolisation is done by using which of the following agents?

Polyvinyl alcohol. **Explanation:** **Uterine Artery Embolization (UAE)** is a minimally invasive interventional radiology procedure primarily used for the treatment of symptomatic uterine fibroids and adenomyosis, as well as for controlling life-threatening postpartum hemorrhage. **Why Polyvinyl Alcohol (PVA) is correct:** The goal of UAE is to achieve permanent or semi-permanent occlusion of the small vessels supplying the fibroid, leading to ischemic necrosis while preserving the normal myometrium. **Polyvinyl Alcohol (PVA) particles** (typically 300–700 μm) are the gold standard embolic agents for this procedure. They are non-absorbable, biocompatible, and cause a mechanical block that triggers an inflammatory response and subsequent permanent vascular thrombosis. **Analysis of Incorrect Options:** * **Thrombin:** This is a potent procoagulant used primarily for the percutaneous treatment of **pseudoaneurysms** (e.g., femoral artery pseudoaneurysm) via direct injection. It is not used for distal embolization in UAE. * **Vitamin K:** This is a systemic medication used to reverse the effects of warfarin or treat Vitamin K deficiency. It has no role as a physical embolic agent in interventional radiology. * **Iodine:** Iodine is a component of **contrast media** used to visualize vessels during fluoroscopy. While essential for the procedure to guide the catheter, it does not possess embolic properties. **High-Yield Clinical Pearls for NEET-PG:** * **Access Site:** Usually the common femoral artery (trans-radial access is an emerging alternative). * **Other Embolic Agents:** Besides PVA, **Tris-acryl gelatin microspheres** are also commonly used. * **Temporary Embolization:** **Gelfoam** (absorbable gelatin sponge) is used when only temporary occlusion is needed, such as in acute trauma or certain cases of postpartum hemorrhage. * **Absolute Contraindications:** Pregnancy, active pelvic infection, and suspected uterine malignancy.

Q: Which of the following statements is FALSE regarding Transjugular Intrahepatic Portosystemic Shunts (TIPS)?

Shunt thrombosis is more common than shunt stenosis.. **Explanation:** **1. Why Option A is False (The Correct Answer):** In the context of TIPS, **shunt stenosis** is significantly more common than acute shunt thrombosis. Stenosis typically occurs due to **pseudointimal hyperplasia** (accumulation of collagen and fibroblasts) within the stent or at the outflow hepatic vein. While the use of PTFE-covered stents (e.g., Viatorr) has drastically reduced these rates compared to bare-metal stents, stenosis remains the primary cause of long-term shunt dysfunction. **2. Analysis of Other Options:** * **Option B:** Hepatic encephalopathy (HE) occurs in approximately 20–30% of patients. By diverting portal blood directly into the systemic circulation, the liver’s "first-pass" detoxification of ammonia is bypassed, leading to neurotoxicity. * **Option C:** TIPS reduces portal pressure, which addresses the underlying pathophysiology of refractory ascites and hepatic hydrothorax, often leading to significant clinical improvement. * **Option D:** Clinical trials consistently show that TIPS is superior to endoscopic variceal ligation (EVL) and pharmacological therapy in preventing re-bleeding, although it carries a higher risk of HE. **3. High-Yield Clinical Pearls for NEET-PG:** * **Primary Indication:** Refractory variceal bleeding and refractory ascites. * **Anatomy:** The shunt is most commonly created between the **Right Hepatic Vein** and the **Right Portal Vein**. * **Absolute Contraindications:** Severe congestive heart failure (due to sudden increase in venous return), severe pulmonary hypertension, and polycystic liver disease. * **MELD Score:** A high MELD score (>18) is a predictor of poor prognosis post-TIPS.

Q: Therapeutic embolisation is indicated in all except?

Aneurysms. **Explanation:** The core principle of **therapeutic embolization** is the intentional occlusion of a blood vessel to stop hemorrhage, devitalize a tumor, or eliminate an abnormal vascular communication. **Why Aneurysms is the correct answer (The "Except"):** While interventional radiology is used to treat aneurysms, the goal is **exclusion** or **filling** of the aneurysmal sac (e.g., via endovascular coiling or flow-diverter stents) rather than "embolization" of the parent artery itself. Embolizing (blocking) the main artery supplying an aneurysm would lead to distal ischemia and infarction of the organ or tissue it supplies. Therefore, while "coiling" is a form of endovascular treatment, traditional therapeutic embolization is generally contraindicated for the parent vessel of an aneurysm. **Analysis of Incorrect Options:** * **Hemangioma:** Embolization is used to reduce the size of symptomatic or giant hemangiomas and to minimize intraoperative blood loss before surgical excision. * **Renal Cell Carcinoma (RCC):** Pre-operative embolization is a standard practice for large, vascular RCCs. It reduces intraoperative blood loss and "devitalizes" the tumor by cutting off its primary blood supply (usually the renal artery). * **AV Fistula:** Embolization is the treatment of choice for abnormal communications between arteries and veins. Agents like coils, glues (cyanoacrylate), or plugs are used to close the fistula tract directly. **NEET-PG High-Yield Pearls:** * **Common Embolizing Agents:** Gelfoam (temporary), Coils/Plugs (permanent), Polyvinyl Alcohol (PVA) particles, and Absolute Alcohol (sclerosant). * **Absolute Alcohol** is the agent of choice for **Arteriovenous Malformations (AVMs)**. * **Post-embolization Syndrome:** A common triad of pain, fever, and leukocytosis occurring after the procedure due to tissue ischemia/necrosis.

Question 1

Which of the following is NOT a contraindication to MR-guided focused ultrasound (MRgFUS) for uterine fibroids?

Accepted Answer

Highly vascular myomas

Answer

Myoma size greater than 10 cm

Answer

Uterine size equivalent to greater than 24 weeks gestation

Answer

Abdominal wall scars

Question 2

Transjugular intrahepatic portosystemic shunt (TIPS) is contraindicated in which of the following conditions?

Accepted Answer

Portal vein thrombosis

Answer

Post-shunt encephalopathy

Answer

Cirrhosis

Answer

Variceal bleeding

Question 3

Uterine artery embolisation is done by using which of the following agents?

Accepted Answer

Polyvinyl alcohol

Answer

Thrombin

Answer

Vitamin K

Answer

Iodine

Question 4

Which of the following statements is FALSE regarding Transjugular Intrahepatic Portosystemic Shunts (TIPS)?

Accepted Answer

Shunt thrombosis is more common than shunt stenosis.

Answer

Hepatic encephalopathy is a common complication.

Answer

TIPS can improve ascites and hydrothorax.

Answer

TIPS is more effective than variceal ligation for controlling bleeding.

Question 5

Therapeutic embolisation is indicated in all except?

Accepted Answer

Aneurysms

Answer

Hemangioma

Answer

Renal cell carcinoma

Answer

AV fistula

Interventional Radiology — MCQs

Interventional Radiology — MCQs

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