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Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction (mMCAI) with bedside electroencephalography (EEG). Methods Thirty-five patients with massive hemispheric infarction (MHI) underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio (OR) of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators (infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [RAWOD]pattern, and absence of EEG reactivity), clinical parameters (nausea accompanied with vomiting), and imaging parameters (the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum) between the 2 groups (P < 0. 05). Of those, the risk of mMCAI was the highest in patients with disintegration of occipital a rhythm on the contralateral side of infarction (P = 22. 67, 95% CI 3. 89-132. 10). The sensitivity of predicting mMCAI was 85. 0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80. 0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical and imaging parameters.

7.Evaluation of CT-guided biopsy in diagnosing space-occupying lesions of the pancreas

Weixin WU ; Huita WU ; Xin WANG ; An SU ; Xia Lü

Journal of Interventional Radiology 2009;18(11):831-833

Objective To assess the diagnostic value of CT-gnided pereutaneous fine-needle aspiration biopsy (FANB) for the space-occupying lesions of the pancreas. Methods The authors retrospectively reviewed the medical records of 68 patients with pancreatic lesions who underwent CT-guided percutaneous fine-needle aspiration biopsy. The lesions were located at the pancreatic head (n = 49), body (n = 12) or tail (n = 7). The maximum diameter of the 68 lesions ranged from 2 cm to 7 cm. The lesion's diameter was < 3 cm in 10 cases and was ≥ 3 cm in 58 cases. A 20-gauge fine-needle was used to puncture and to make the aspiration in all patients. Both plain and contrast-enhanced abdominal CT scanning were performed before the biopsy procedure. The technical key points of aspiration biopsy included selection of the appropriate cross-section, the entry of the needle, and multiple insertions in fan-like fashion with fast manipulation of puncture and aspiration. All biopsy specimens were sent for pathologic evaluation. Results All the lesions were safely and successfully punctured through the anterior approach without major complications. The technical success of needle puncturing was 100%. Of 68 patients, the pathological results obtained from the biopsy included malignant tumor in 46, benign lesion in 17 and no abnormal finding in 5, of which follow-up observation found no abnormality in 2 and malignant process was eventually confirmed in remaining three. The overall accuracy, specificity and sensitivity of the biopsy were 96%, 95% and 100%, respectively. The accuracy of CT-guided biopsy for malignant and benign lesions was 94% and 100% respectively (P > 0.05). The diagnostic accuracy for lesions larger than 3.0 cm (97%) or located at the pancreatic tail (100%) was a little higher than that for lesions smaller than 3.0 cm (90%) or located at the pancreatic head (96%) or body (92%), although the difference was not statistically significant (P > 0.05). No serious complications occurred in our series. Conclusion CT-guided percutaneous fine-needle aspiration biopsy is a safe and effective technique for the diagnosis and differentiation of the space-occupying lesions of the pancreas.