ABR Diagnostic Radiology Maintenance
of Certification (MOC) Practice Exam
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 65-year-old man presents with painless hematuria. CT urography
shows a filling defect in the bladder. What is the most likely diagnosis?
A. Cystitis
B. Transitional cell carcinoma
C. Squamous cell carcinoma
D. Adenocarcinoma
Rationale: Transitional cell carcinoma is the most common bladder
malignancy in adults and typically presents with painless hematuria.
2. In evaluating acute stroke, which imaging modality is most sensitive in
the first few hours?
, A. CT without contrast
B. CT angiography
C. MRI with diffusion-weighted imaging
D. MR angiography
Rationale: Diffusion-weighted MRI is the most sensitive method for
detecting acute ischemic stroke within hours of onset.
3. Which imaging feature is characteristic of hepatocellular carcinoma
(HCC) on multiphasic CT?
A. Hypoenhancement in arterial phase
B. Isoenhancement in venous phase
C. Arterial phase hyperenhancement with washout in portal venous
phase
D. Delayed enhancement only
Rationale: HCC typically shows arterial hyperenhancement followed
by washout in portal venous or delayed phases, reflecting its vascular
supply.
4. What is the most appropriate initial imaging modality for suspected
pulmonary embolism in a patient with normal renal function?
A. Chest X-ray
B. CT pulmonary angiography (CTPA)
C. Ventilation-perfusion scan
D. MRI pulmonary angiography
, Rationale: CTPA is the first-line imaging for PE in patients with
normal renal function due to high sensitivity and specificity.
5. Which of the following is a hallmark finding of Alzheimer’s disease on
MRI?
A. Diffuse cortical swelling
B. Medial temporal lobe (hippocampal) atrophy
C. Basal ganglia calcification
D. Cerebellar tonsillar herniation
Rationale: Hippocampal atrophy is an early and characteristic MRI
finding in Alzheimer’s disease.
6. Which contrast agent is preferred in evaluating a patient with chronic
kidney disease undergoing MRI?
A. Gadolinium-based linear agent
B. Macrocyclic gadolinium-based agent
C. Iodinated CT contrast
D. Oral barium
Rationale: Macrocyclic gadolinium agents are more stable and carry
lower risk of nephrogenic systemic fibrosis in CKD patients.
7. On chest radiograph, a right paratracheal mass with loss of the aortic
knob contour suggests which pathology?
A. Pneumothorax
B. Mediastinal lymphadenopathy
C. Pleural effusion
, D. Pulmonary embolism
Rationale: Right paratracheal masses commonly represent enlarged
mediastinal lymph nodes, which can obscure normal mediastinal
contours.
8. Which imaging feature distinguishes a benign bone lesion from a
malignant one?
A. Periosteal reaction
B. Well-defined sclerotic margin
C. Cortical destruction
D. Soft tissue mass
Rationale: Benign bone lesions typically have well-defined sclerotic
margins, while malignant lesions often show cortical destruction and
soft tissue extension.
9. In pediatric patients, the preferred modality for evaluating
appendicitis is:
A. CT abdomen/pelvis
B. Ultrasound
C. MRI
D. Plain abdominal radiograph
Rationale: Ultrasound is preferred in children to avoid ionizing
radiation, and it is effective in detecting an inflamed appendix.
10. Which of the following is the best initial imaging study for
suspected aortic dissection?
of Certification (MOC) Practice Exam
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 65-year-old man presents with painless hematuria. CT urography
shows a filling defect in the bladder. What is the most likely diagnosis?
A. Cystitis
B. Transitional cell carcinoma
C. Squamous cell carcinoma
D. Adenocarcinoma
Rationale: Transitional cell carcinoma is the most common bladder
malignancy in adults and typically presents with painless hematuria.
2. In evaluating acute stroke, which imaging modality is most sensitive in
the first few hours?
, A. CT without contrast
B. CT angiography
C. MRI with diffusion-weighted imaging
D. MR angiography
Rationale: Diffusion-weighted MRI is the most sensitive method for
detecting acute ischemic stroke within hours of onset.
3. Which imaging feature is characteristic of hepatocellular carcinoma
(HCC) on multiphasic CT?
A. Hypoenhancement in arterial phase
B. Isoenhancement in venous phase
C. Arterial phase hyperenhancement with washout in portal venous
phase
D. Delayed enhancement only
Rationale: HCC typically shows arterial hyperenhancement followed
by washout in portal venous or delayed phases, reflecting its vascular
supply.
4. What is the most appropriate initial imaging modality for suspected
pulmonary embolism in a patient with normal renal function?
A. Chest X-ray
B. CT pulmonary angiography (CTPA)
C. Ventilation-perfusion scan
D. MRI pulmonary angiography
, Rationale: CTPA is the first-line imaging for PE in patients with
normal renal function due to high sensitivity and specificity.
5. Which of the following is a hallmark finding of Alzheimer’s disease on
MRI?
A. Diffuse cortical swelling
B. Medial temporal lobe (hippocampal) atrophy
C. Basal ganglia calcification
D. Cerebellar tonsillar herniation
Rationale: Hippocampal atrophy is an early and characteristic MRI
finding in Alzheimer’s disease.
6. Which contrast agent is preferred in evaluating a patient with chronic
kidney disease undergoing MRI?
A. Gadolinium-based linear agent
B. Macrocyclic gadolinium-based agent
C. Iodinated CT contrast
D. Oral barium
Rationale: Macrocyclic gadolinium agents are more stable and carry
lower risk of nephrogenic systemic fibrosis in CKD patients.
7. On chest radiograph, a right paratracheal mass with loss of the aortic
knob contour suggests which pathology?
A. Pneumothorax
B. Mediastinal lymphadenopathy
C. Pleural effusion
, D. Pulmonary embolism
Rationale: Right paratracheal masses commonly represent enlarged
mediastinal lymph nodes, which can obscure normal mediastinal
contours.
8. Which imaging feature distinguishes a benign bone lesion from a
malignant one?
A. Periosteal reaction
B. Well-defined sclerotic margin
C. Cortical destruction
D. Soft tissue mass
Rationale: Benign bone lesions typically have well-defined sclerotic
margins, while malignant lesions often show cortical destruction and
soft tissue extension.
9. In pediatric patients, the preferred modality for evaluating
appendicitis is:
A. CT abdomen/pelvis
B. Ultrasound
C. MRI
D. Plain abdominal radiograph
Rationale: Ultrasound is preferred in children to avoid ionizing
radiation, and it is effective in detecting an inflamed appendix.
10. Which of the following is the best initial imaging study for
suspected aortic dissection?
