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1. What percentage of blood is supplied to the liver through the portal vein?  

  •  75%

2. What is the transverse fissure on the visceral surface of the liver between the caudate and quadrate lobes?  

  • porta hepatis

3. Describe the portal veins within the liver.  

  • thick, bright walls; course within the liver segments

4. What landmark identifies the start of the proper hepatic artery from the common hepatic artery?  

  • gastroduodenal artery

5. What is the relationship between the MPV and the IVC?  

  • MPV is anterior to the IVC

6. What patient position offers excellent visualization of the porta hepatis?  

  • right coronal oblique

7. Which location should the portal vein diameter be measured?  

  •  where it crosses the inferior vena cava

8. Which transducer can be useful for assessing the liver surface nodularity?  

  • 7 to 9 MHz linear

9. What is the normal portal vein diameter with quiet respiration?  

  • 13 mm or less

10. Severe liver disease, presence of portosystemic collaterals, and size mismatch between a donor portal vein and native vein can all cause what type of flow in the portal vein?  

  • helical flow

11. What does an increase in caliber of less than 20% in the splenic vein during deep inspiration indicate?  

  • portal hypertension

12. What increases blood flow within the portal, splenic, and SMVs?  

  • expiration and ingestion of food

13. When assessing hepatic vein flow, the S and D waves should show blood flow toward which organ?  

  • heart

14. What is the normal RI in the hepatic artery?  

  • 0.5 to 0.7

15. What is the most common etiology for portal hypertension in North America?  

  • cirrhosis

16. What is the primary complication of portal hypertension?  

  • gastrointestinal bleeding

17. What is the most common portosystemic collateral shunt in the presence of portal hypertension? 

  •  coronary-gastroesophageal veins

18. What are the sonographic findings associated with portal hypertension?  

  • Splenomegaly and hepatofugal flow in the main portal vein

19. What type of flow may be seen in the portal vein when an arterioportal fistula is present?  

  • pulsatile hepatofugal flow

20. What is a treatment of portal hypertension that involves jugular vein cannulation with stent placement in the liver?  

  • TIPS

21. What are the normal findings in a transjugular portosystemic shunt?  

  • hepatopetal flow in the portal and splenic veins

22. Upon duplex evaluation of the portal system, the technologist visualizes increased portal vein caliber with no detectable flow by color, power, and spectral Doppler. 

Increased hepatic arterial flow is also documented. What do these findings suggest?  

  • portal vein thrombosis

23. Besides IVC dilatation, what distinct finding helps differentiate between congestive heart failure and portal hypertension?  

  •  increased pulsatility in both the portal and hepatic veins

24. What are the sonographic findings in Budd-Chiari syndrome?  

  •  portal hypertension

25. What are the clinical features of sinusoidal obstruction syndrome? 

  •  weight loss 

28. What are the limitations of contrast angiography?  

  • detailed anatomic information

- Renal System  

29. What is true regarding duplex ultrasound assessment of renal vasculature?  

  • provides anatomic information

  • provides hemodynamic infromation

  • painless and noninvasive

30. What is the normal length of the kidney?  

  • 10-12cm

31. Kidneys that are joined at the lower poles by an isthmus of tissue that lies anterior to the aorta is called what?  

  • Horseshoe kidneys

32. Why is the renal sinus normally brightly echogenic on a sonographic image?  

  • Fat and fibrous tissue in the sinus

33. What are the triangular-shaped structures within the inner portion of the kidney that carry urine from the cortex to the renal pelvis?  

  • Renal pyramids

34. What is the most common congenital anomaly of the urinary tract? 

  •  Duplication of the renal collecting system

35. The right renal artery courses where in relation to the aorta and IVC?  

  • Anterolateral, posterior

  • The right renal artery initially courses __________ from the aorta, then passes __________ to the inferior vena cava.

36. What vessel courses anterior to the aorta but posterior to the SMA and anterior to both renal arteries?  

  •  left renal vein

37. Which part of the renal artery segments does atherosclerotic disease in the renal artery typically occur?  

  • Origin to proximal third

38. Which patients would be suspected of fibromuscular dysplasia in the renal artery?  

  •  32 yr old female with poorly controlled hypertension

39. What is the most appropriate transducer for the evaluation of the renal arteries?  


40. At which level is a spectral Doppler waveform with peak systolic velocity needed from the aorta for use in the renal-aortic ratio?  

  • Proximal, at the level of the celiac and superior mesenteric arteries

41. To identify the renal ostia from a midline approach, an image is obtained from which location?  

42. Which of the ultrasound modality that has a low-angle dependence that may be helpful in identifying duplicate renal arteries?  

  • Power Doppler

43. Which angle of insonation are flow patterns within the kidney parenchyma typically obtained with spectral Doppler?  

  • 0 degrees

44. Comparing renal length of both kidneys, how much of a difference suggests compromised flow in the smaller kidney?  

45. What describes a normal spectral Doppler waveform characteristic in the renal artery?  

  • Low-resistance, high-diastolic flow with velocities in the range of 10 to 120 cm/s

46. A patient presents to the vascular lab with suspected acute tubular necrosis. Which findings on the renal artery duplex examination would be consistent with this condition?  

  • Renal artery velocities of 70 cm/s, EDR of 0.19

47. What is measured to determine acceleration time?  

  • Onset of systole to the early systolic peak

48. During a renal artery duplex examination, proximal aortic velocities of 100 cm/s, proximal right renal artery velocities of 200 cm/s, and proximal left renal artery velocities of 400 cm/s were found. Describe the findings.  

  • Right RAR = 2.0, less than 60% stenosis, left RAR = 4.0, more than 60% stenosis

49. During the renal artery duplex examination, as in the last question, for which renal artery would you expect to see post-stenotic turbulence?  

  • Left 

50. What may be the results of misinterpretation of the hilar acceleration time?  

  • All of the above (elevated renovascular resistance, systemic arterial stiffness, renal artery stenosis in the 60% to 79% range)

51. Under what conditions is the renal-to-aortic ratio likely inaccurate?  

  • The abdominal aortic velocities are over 100 cm/s or below 40 cm/s

52. During renal duplex evaluation, the left renal vein near the hilum is noted to have continuous, nonphasic low-velocity flow. What do these findings suggest?  

  • Proximal renal vein thrombosis



53. A patient presents to the vascular lab for follow-up after renal artery stent placement. Velocities within the distal segment of the stent reach 250 cm/s. At other follow-ups at 6 and 12 months, velocities in the distal stent remain 250 cm/s. What are these findings consistent with? 

  • Increased velocity because of size mismatch from the stent to native vessel 

54. What renal duplex findings demonstrate a high risk for renal atrophy and likely unsuccessful renal revascularization?  

  • renal artery LAB >400 cm/s and cortical EDV <5 cm/s

55. What is the most common vascular complication following renal transplantation?  

  • renal artery stenosis