1
c) periventricular rCBF diminution with a normal global rCBF and MRI showing white matter hyperintensities, eg, "'micro- angiopathy" corresponding to the SPECT defects. Results: 94 (46.3%) were diagnosed with AD, and 6l (30%) were diagnosed with VaD of which 41/61 have white matter dis- ease on MRI and show posterior rCBF diminution similar to AD but without global hypoperfusion. These subjects demonstrated cognitive impairment less severe than patients with AD. 20/203 (9.85%) showed (AD-VaD) mixed pattern on SPECT and MRI. 8/203 (8.86%) showed frontal lobe diminution and 10/203 (4.95%) showed a pattern of pseudodementia of depression. Conclusion: SPECT and MRI can differentiate dementia due to AD, VaD, frontal lobe involvement, and pseudodementia of de- pression. A significant number of patients with VaD presents with microangiopathy on MRI and SPECT rCBF pattern mimick- ing AD. MRI correlation is therefore important. (P-12) Dextrocardia: The Right Way John W. Wu, MD Wake Forest University School of Medicine, Winston-Salem, NC, Thomas S. Harle, MD, Kerry M. Link, MD Congenital heart malformation is a complex subject that can be quite confusing. Complex embryological changes, inexact termi- nology, and complex anatomy combine to compound the difficul- ties of understanding a complex topic. In this poster, the authors will attempt to provide a conceptual framework to facilitate com- prehension of the different types of dextrocardia. A summary of the embryological development of a heart is presented along with a precise definition of the developmental anomalies based on the segmental anatomy of the heart. Examples of the major causes of dextrocardia are presented, including dextroposition, an'est of the D-bulbo ventricular loop, L-transposition of the great vessels, and situs inversus. (P-13) CT Manifestations of Hypovolemic Shock Vahid Yaghmai, MD Evanston Hospital, Evanston, IL, Gary G. Ghahremani, MD, Richard M. Gore, MD, Maria V. Graichen, MD, Elan M. Omessi, MD Abdominal CT examination should only performed on trauma patients who are hemodynamically stable. However, patients in hypovolemic shock may transiently maintain stable vital signs af- ter aggressive volume repletion and, therefore, be judged to be candidates for CT imaging by the trauma surgeon. This exhibit reviews manifestations of shock on the abdominal CT of these critically ill patients. These include intense renal enhancement ("shock kidney"), unusual pancreatic and adrenal enhancement, collapsed IVC, mad a small aorta. Other equally important find- ings include abnormal bowel enhancement and free intraperito- neal fluid. Examples of each finding will be shown and potential pitfalls in diagnosis will be discussed. A knowledge of these findings is crucial for the correct and expeditious management of these patients. (P-14) Clinical Utility of Embolization in the Management of Myomas V. Monique McCorvey, MD Bryn Mawr Hospital, Bryn Mawr, PA, Vikram S. Dravid, MD, Hung Q. Vu, MD, Roosevelt McCorvey, MD, Beverly R. Love, MD, Carolyn G. Dudley, MD Purpose: We attempt to describe the role and illustrate the tech- nique of uterine embolization in the management of myomas. Materials: We retrospectively reviewed cases in which emboliza- don was used either primarily or post-operatively in the manage- ment of myomas, with a view to estimate clinical feasibility and utility of the technique. Results: Embolization was used successfully in all cases attempted. Relief of symptoms (ie, menorrhagia and dysmenorrhea) was noted in all cases when embolization was the primary technique in man- agement. Complete cessation of hemorrhage was achieved when embolization was used in the postoperative setting. Conclusions: Embolization is feasible and of clinical utility in the primary and postoperative management of uterine myomas. Learning Objectives: 1 .To provide a pictoral display of the technique of uterine embolization in the management of uterine myomas. 2.To elucidate the role of embolotherapy in the man- agement of myomas. (P.15) Multimedia Content Production for Radiology Teach- ing and Presentation Brian J. Bartholmal, MD Wake Forest University School of Medi- cine, Winston-Salem, NC, Walter D. Liebkemann, MD, Daniel L. Schwarz, MD Purpose: Many of the imaging modalities used in radiology such as ultrasound, fluoroscopy, dynamic MRI, and some nuclear medicine studies may demonstrate findings which are best viewed using real-time or dynamic information display. We de- scribe an inexpensive and straightforward method for the incor- poration of multimedia and video into computer-based radiology teaching files and presentations. Materials and Methods: A PC-compatible personal computer and a MiroVideo DC-30 video capture card attached to an S-VHS video camera were utilized for digitization of video sequences. Editing and post-processing of the video as well as animation se- quences made from MRI, CT and nuclear medicine still images were performed using Adobe Premiere version 4.2 for Windows 95. Video compression was performed using Intel Indeo software version 5.06. Results: Multiple video sequences up to 8 minutes in length and animated sequences of MRI, CT, and nuclear medicine studies were produced and incorporated into a multimedia CD-ROM radi- ology teaching file which was distributed to first-year medical stu- dents as part of their radiographic anatomy course. Conclusion: Inexpensive modem hardware and software can be used to create computer-based video for incorporation into multi- media teaching files and presentations. (P-16) Complications of Central Vein Catheters: Radiologic Assessment and Management Saravanan Kasthuri, MD University of Tennessee, Memphis, TN, Matthew T. Graham, MD Radiologists have been actively involved in the diagnosis and man- agement of venous catheter-related complications. In this poster we will discuss the clinical findings, radiologic imag- ing and interventional management of the various complications as- sociated with central vein catheters. Complications are presented in three groups: malposition, occlusion and mechanical problems. Management is presented for each group. Our goal is to provide an update on diagnosis and management that will help to proactively prevent a number of these complications. (P-17) The Indications for and Variety of Venous Access Devices Matthew T. Graham, MD University of Tennessee, Memphis, TN, Saravanan Kasthuri, MD Purpose: Our presentation will educate radiology residents and medical students with the indications of venous access, the choices of venous access devices and how to select the appropriate device for a given patient. 628

(P-13) CT manifestations of hypovolemic shock

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Page 1: (P-13) CT manifestations of hypovolemic shock

c) per iventr icular rCBF d iminut ion with a normal global rCBF and MRI showing white mat ter hyper intensi t ies , eg, " 'micro- ang iopa thy" cor responding to the S P E C T defects.

Resu l t s : 94 (46.3%) were d iagnosed with AD, and 6 l (30%) were d iagnosed with Va D of wh ich 41/61 have whi te mat te r dis- ease on MRI and show poster ior rC B F d iminut ion s imilar to AD but wi thout global hypoper fus ion . These subjects demons t ra ted cogni t ive impa i rmen t less severe than pat ients with AD. 20/203 (9.85%) showed (AD-VaD) mi xed pat tern on S P E C T and MRI. 8/203 (8.86%) showed frontal lobe d iminut ion and 10/203 (4.95%) showed a pat tern o f p seudodemen t i a o f depress ion.

Conc lus ion: SPECT and M R I can differentiate demen t i a due to AD, VaD, frontal lobe involvement , and p seudodemen t i a o f de- pression. A s ignif icant n u m b e r o f pat ients with VaD presents with mic roang iopa thy on M R I and S P E C T rCBF pat tern mimick - ing AD. MRI correlat ion is therefore important .

(P-12) Dextrocardia: The Right Way John W. Wu, M D Wake Forest University School of Medicine, Winston-Salem, NC, T h o m a s S. Harle, MD, Kerry M. Link, M D

Congeni ta l hear t ma l fo rmat ion is a complex subject that can be qui te confus ing . C o m p l e x embryolog ica l changes , inexac t termi- nology, and complex ana t omy combi ne to c o m p o u n d the difficul- ties o f unders tand ing a c omp l ex topic. In this poster, the authors will a t tempt to provide a conceptua l f r amework to facilitate com- prehens ion o f the different types o f dextrocardia. A s u m m a r y of the embryologica l deve lopmen t o f a heart is presented along with a precise defini t ion o f the deve lopmenta l anomal ies based on the segmenta l ana tomy of the heart. Examples o f the major causes o f dextrocardia are presented, inc lud ing dextroposi t ion, an 'est o f the D-bulbo ventr icular loop, L- t ranspos i t ion o f the great vessels , and si tus inversus .

(P-13) CT Manifestations of Hypovolemic Shock Vahid Yaghmai , M D Evanston Hospital, Evanston, IL, Gary G. Ghahreman i , MD, Richard M. Gore, MD, Mar ia V. Graichen, MD, Elan M. Omess i , M D

A b d o m i n a l CT examina t ion should only pe r fo rmed on t r auma pat ients who are h e m o d y n a m i c a l l y stable. However , pat ients in hypovo lemic shock m a y t ransient ly main ta in stable vital s igns af- ter aggress ive vo lume replet ion and, therefore, be j udged to be candidates for C T imag ing by the t r auma surgeon. This exhibi t reviews mani fes ta t ions o f shock on the abdomina l C T of these crit ically ill pat ients . These inc lude intense renal e n h a n c e m e n t ( "shock kidney") , unusua l pancreat ic and adrenal enhancemen t , col lapsed IVC, mad a smal l aorta. Other equal ly impor tan t find- ings inc lude abnormal bowel e n h a n c e m e n t and free intraperito- neal fluid. Example s o f each f inding will be shown and potential pitfalls in d iagnos is will be d iscussed. A knowledge o f these f indings is crucial for the correct and expedi t ious m a n a g e m e n t o f these patients .

(P-14) Clinical Utility of Embolization in the Management of Myomas V. Mon ique McCorvey , M D Bryn Mawr Hospital, Bryn Mawr, PA, Vikram S. Dravid, MD, H u n g Q. Vu, MD, Rooseve l t McCorvey , MD, Bever ly R. Love, MD, Caro lyn G. Dudley, M D

P u r p o s e : W e a t tempt to descr ibe the role and illustrate the tech- n ique o f uter ine embol iza t ion in the m a n a g e m e n t o f m y o m a s .

Mate r i a l s : W e retrospectively reviewed cases in which emboliza- don was used either primarily or post-operatively in the manage- ment of myomas , with a view to est imate clinical feasibility and utility of the technique.

Resul t s : Embolization was used successful ly in all cases attempted. Rel ief o f symptoms (ie, menorrhagia and dysmenorrhea) was noted in all cases when embolizat ion was the primary technique in man- agement. Complete cessation of hemorrhage was achieved when embolization was used in the postoperative setting.

Conc lus ions : Embol iza t ion is feasible and o f clinical utility in the pr imary and postopera t ive m a n a g e m e n t o f uterine m y o m a s .

L e a r n i n g Ob jec t ive s : 1 .To provide a pictoral d isplay of the technique o f uterine embol iza t ion in the m a n a g e m e n t o f uter ine m y o m a s . 2.To elucidate the role o f embolo the rapy in the man- agemen t o f m y o m a s .

(P.15) Multimedia Content Production for Radiology Teach- ing and Presentation Brian J. Bartholmal, M D Wake Forest University School of Medi- cine, Winston-Salem, NC, Walter D. Liebkemann, MD, Daniel L. Schwarz, M D

P u r p o s e : M a n y of the imag ing modal i t ies used in radiology such as u l t rasound, f luoroscopy, dynamic MRI, and some nuclear medic ine s tudies may demons t ra te f indings which are best v iewed us ing rea l - t ime or dynamic informat ion display. W e de- scribe an inexpens ive and s t ra ightforward me thod for the incor- porat ion o f mul t imed ia and video into compute r -based radiology teaching files and presentat ions .

M a t e r i a l s a n d M e t h o d s : A PC-compat ib le personal compute r and a MiroVideo DC-30 video capture card attached to an S-VHS video camera were utilized for digitization o f video sequences. Edit ing and post -process ing o f the video as well as animat ion se- quences made f rom MRI, C T and nuclear medic ine still images were per formed us ing Adobe Premiere version 4.2 for W i n d o w s 95. Video compress ion was performed us ing Intel Indeo software vers ion 5.06.

Resul t s : Multiple video sequences up to 8 minutes in length and an imated sequences o f MRI, CT, and nuclear medic ine studies were produced and incorporated into a mul t imedia C D - R O M radi- ology teaching file which was distributed to f irst-year medical stu- dents as part o f their radiographic ana tomy course.

Conclus ion: Inexpens ive m o d e m hardware and software can be used to create computer -based video for incorporation into mult i- media teaching files and presentat ions.

(P-16) Complications of Central Vein Catheters: Radiologic Assessment and Management Saravanan Kasthuri , M D University of Tennessee, Memphis, TN, Mat thew T. Graham, M D

Radiologists have been actively involved in the diagnosis and man- agement of venous catheter-related complications.

In this poster we will discuss the clinical findings, radiologic imag- ing and interventional managemen t o f the various complications as- sociated with central vein catheters.

Complicat ions are presented in three groups: malposition, occlusion and mechanical problems. Managemen t is presented for each group.

Our goal is to provide an update on diagnosis and managemen t that will help to proactively prevent a number o f these complications.

(P-17) The Indications for and Variety of Venous Access Devices Matthew T. Graham, M D University of Tennessee, Memphis, TN, Saravanan Kasthuri , M D

P u r p o s e : Our presentat ion will educate radiology residents and medical students with the indications of venous access, the choices of venous access devices and how to select the appropriate device for a g iven patient.

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