Neuroimaging: Moyamoya disease: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: Moyamoya disease

Sample item

A child with recurrent transient ischaemic attacks has angiography showing progressive stenosis of the terminal internal carotid arteries with a hazy network of collaterals at the base of the brain. What is the angiographic sign?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Puff of smoke appearance of Moyamoya disease

In moyamoya disease (Japanese for puff of smoke), chronic stenosis of the supraclinoid ICA and proximal anterior and middle cerebral arteries leads to a network of fine lenticulostriate collaterals. Revascularisation surgery is the treatment. Fibromuscular dysplasia shows a string of beads in the cervical ICA.

Option by option

  • A. Pearls and strings of vasculitis

    Alternating stenoses and dilations suggest vasculitis, not a basal network.

  • B. Rat-tail sign of arterial dissection

    Dissection produces a tapered flame-like narrowing.

  • C. String of beads in fibromuscular dysplasia

    String of beads is seen in fibromuscular dysplasia.

  • D. Puff of smoke appearance of Moyamoya disease (correct)

    Correct. The collateral network gives the puff of smoke appearance.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Puff of smoke appearance of Moyamoya disease. In moyamoya disease (Japanese for puff of smoke), chronic stenosis of the supraclinoid ICA and proximal anterior and middle cerebral arteries leads to a network of fine lenticulostriate collaterals.

Why is "Pearls and strings of vasculitis" not the answer?

Alternating stenoses and dilations suggest vasculitis, not a basal network.

Why is "Rat-tail sign of arterial dissection" not the answer?

Dissection produces a tapered flame-like narrowing.

Why is "String of beads in fibromuscular dysplasia" not the answer?

String of beads is seen in fibromuscular dysplasia.

What concept does this question test?

It tests Neuroimaging: Moyamoya disease in Radiology. Revascularisation surgery is the treatment. Fibromuscular dysplasia shows a string of beads in the cervical ICA.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: Moyamoya disease?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.