International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning

Objects: Our objective was to investigate the use of CT and its relationship to head injury severity and age. Method: The multi-center group International Study of Head Injury Project (ISHIP) serves as the administrative body for research design, data collection and analysis. This is a nonrandomized prospective study of longitudinal outcomes following examination and care in emergency department in five different countries. The subjects of our study were 4,690 children from birth to 15 years of age, all of whom were systematically evaluated. Each child was medically evaluated and categorized as to injury severity, mechanism of injury and findings on X-ray and CT scan. Follow-up interview and assessment was completed for comparison with the presenting clinical state. Results: CT scans were performed for674 (14.3%) of the children: 438 scans were normal and 236 were abnormal (P<0.001). Of the children with abnormal CT scans, 23.3% had mild head injuries, 42.7% had moderate injuries, and 33.8% had severe injuries, as determined by the GCS. By age, 10.5% of the positive CTs were in children aged 0–2 years, 56.3% in 3- to 9-year-olds, and 33% in 10- to 15-year-olds; only in 2% of cases were both CT and X-ray positive. Conclusions: The majority of children did not need significant medical intervention. Physicians ordered X-ray investigations more frequently than CT scanning. The use of X-ray to decide whether or not CT is ne- cessary is not warranted. The implications of positive CTs in mild or moderate injuries were most noteworthy, as were age-related interactions with positive CT findings. Received: 23 June 2000     

The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department

BACKGROUND: The purpose of neuroimaging of a patient with new onset of seizures is to demonstrate cause and explore the prognosis. It was recently recommended that emergency brain computed tomography (CT) be performed only in adult seizure patients with an increased likelihood of life-threatening lesions, i.e., those with new focal deficits, persistent altered mental status, fever, recent trauma, persistent headaches, history of cancer, history of anticoagulation, or suspicion of acquired immunodeficiency syndrome. The objective of this study was to determine the diagnostic utility of emergency brain CT in children who present to the emergency department with new onset of seizures. METHODS: A 1-year retrospective chart review of all children who presented to the emergency department of the Schneider Children's Hospital with a new onset of seizures and who underwent CT of the brain, excluding children with simple febrile seizures. RESULTS: Sixty-six patients, 34 boys and 32 girls with a mean age of 4.9 years, qualified for inclusion in the study. Fifty-two patients (78.8%) had normal CT results and 14 patients (21.2%) had abnormal CT results. Seizure cause was considered cryptogenic in 33 patients, of whom 2 (6%) had abnormal CT results; neither patient required intervention. Seizure cause was considered symptomatic in 20 patients, of whom 12 (60%) had abnormal CT results (p < 0.0001). In two patients with abnormal CT scans (both acute symptomatic), the imaging findings were of immediate therapeutic significance and were predictable from the clinical history and the physical examination. None of the 13 patients with complex febrile seizure cause had an abnormal CT scan. Patients with partial convulsive seizures were more likely to have abnormal CT scans than patients with generalized convulsive seizures, but the difference was not statistically significant. CONCLUSIONS: The routine practice in many pediatric emergency departments of obtaining brain CT scans for all patients with new onset of nonfebrile seizures is unjustified. History and physical examination are sufficient to identify those patients for whom such studies are likely to be appropriate. Emergent CT is not indicated for patients with no known seizure risk factors, normal neurological examinations, no acute symptomatic cause other than fever, and reliable neurological follow-up. For these patients, referral to a pediatric neurologist for further workup, including electroencephalography and the more diagnostically valuable magnetic resonance imaging, would be more appropriate.     

The diagnostic values of red flags in pediatric patients with headache

BackgroundHeadache is a common complaint in childhood and adolescence. Differentiating benign primary headaches from ominous secondary headaches is often difficult. Clinicians usually seek red flags to determine the need for neuroimaging. We aimed to evaluate the diagnostic values of red flags in pediatric headaches.MethodsWe retrospectively reviewed the medical records of 1510 pediatric patients (1470 with primary headache, 40 with secondary headache) presenting with headache and underwent neuroimaging from two centers between March 2010 and December 2019.ResultsThe secondary-headache group exhibited significantly higher frequencies of abnormal neurologic signs/symptoms (40.0% vs 6.8%, p < 0.001), Valsalva maneuver/exercise-induced headache (15.0% vs 4.9%, p = 0.004), headache with vomiting (35.0% vs 17.9%, p = 0.006), and onset under age 6 (25.0% vs 10.3%, p = 0.003) than the primary-headache group, with the following positive likelihood ratio (PLR): 5.88, 3.06, 1.96, and 2.42, respectively. The sensitivity values were as follows: abnormal neurologic signs/symptoms (16/40, 40.0%), headache with vomiting (14/40, 35.0%), onset under age 6 (10/40, 25.0%), and Valsalva maneuver/exercise-induced headache (6/40, 15.0%). The overall sensitivity for ominous secondary headaches requiring surgical treatment was 86.2% (25/29).ConclusionsCertain red flags, including abnormal neurologic signs/symptoms, Valsalva maneuver/exercise-induced headache, headache with vomiting, and onset under age 6, were more prevalent in the secondary-headache group; nonetheless, their sensitivity values and PLR were relatively low. Notwithstanding, considering these red flags’ high overall sensitivity for ominous secondary headaches, neuroimaging in patients presenting these red flags should rely on careful follow-up of symptom progression.     

脑动脉狭窄的CTA、DSA对比研究临床意义

目的以数字减影血管造影(DSA)为参照,比较电子计算机断层扫描血管成像(CTA)诊断脑动脉狭窄的准确性,评价其临床价值。方法对150例1月内进行CTA和DSA检查的可疑脑血管狭窄的患者进行对比,研究CTA对脑动脉狭窄的诊断价值。结果从所研究的总的病变部位来分析:CTA与DSA符合率为98.27%(454/462);CTA阴性而DSA阳性者为1.73%(8/462);CTA阳性而DSA阴性者为1.30%(6/462);以DSA作为"金标准";CTA诊断脑动脉狭窄的敏感性为99.57%(460/462),特异性为98.27%(454/462),假阳性为1.32%(6/454),假阴性为1.76%(8/454)。按不同部位分层分析:颈总动脉、颈内动脉起始段、大脑中动脉M1段、椎动脉开口、椎动脉V1、V2段的敏感性和特异性均为100%;颈内动脉岩段至终末端假阴性为10.26%(8/78),椎动脉V3、V4段和基底动脉假阳性为15.34%(6/39)。结论 CTA在诊断脑动脉狭窄方面的敏感性、特异性均很高,可以作为脑血管病的重要诊断和筛查方法。但对颈内动脉岩段至终末端和椎动脉V3、V4段还存在一定的漏诊和误诊率,对于在脑血管病的诊断和治疗方案的决定中还要结合DSA进行全面评价。     

The complementary role of angiography and CT in the diagnosis of cerebral sinovenous occlusion

Three patients with angiographic and CT findings of cerebral sinovenous occlusion are described. Filling defects within the venous pathways are well demonstrated by angiography. Some of the most characteristic CR signs are here described. Full evaluation, including the clinical history, angiography and computed tomography is essential.

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Sommario Vengono descritti tre pazienti con segni angiografici e tomodensitometrici di trombosi venosa del circolo intracranico. I difetti di ri empimento del circolo venoso son ben dimostrati dall'angiografia. Si decrivono alcuni degli aspetti tomodensitometrici più caratteristici. Viene sottolineata inoltre l'utilità di una completa valutazione clinica e neurocardiologica di questa patologia.

     

The symptom of headache in Emergency Departments. The experience of a neurology emergency department

Although the symptom of headache is a frequent cause of Emergency Department examinations, it is often considered to be of little clinical relevance in comparison with other emergencies and is usually treated only symptomatically. But how frequently does a simple headache mask a severe cerebral pathology? To answer this question, we studied a consecutive series of patients examined at the Neurology Emergency Department of Turin's Ospedale Molinette over a period of three months; the patients were then followed-up for more than two years in order to confirm the diagnoses.Of 215 cases of acute headache, 121 (56%) were essential and 94 (44%) symptomatic; of the latter, 18 (8.3%) were the only clinical manifestation of a severe cerebral pathology (10 hemorrhages, 2 ischemias, 6 tumours). In diagnosing these 18 cases, 72 EEG, 57 CT and 4 rachicentesis examinations were carried out and their diagnostic efficacy is here analysed. Our data show the importance of a careful evaluation of the symptom of headache in Emergency Departments and the need to send any doubtful cases to a facility specialised in coping with such emergencies.

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Sommario Il sintomo cefalea costituisce un frequente motivo di visita in Pronto Soccorso, spesso considerato di scarsa rilevanza clinica rispetto ad altre urgenze e per lo più trattato solo dal punto di vista sintomatico. Ma in quanti di questi casi una semplice cefalea nasconde una grave patologia cerebrale? A questo proposito abbiamo effettuato uno studio presso il Dipartimento di Emergenza di Neurologia dell'Ospedale Molinette di Torino su una serie consecutiva di pazienti che sono stati visitati per cefalea nell'arco di tre mesi, seguendoli quindi nel tempo con un follow-up di oltre due anni per la verifica diagnostica.Su 215 cefalee acute, le cefalee essenziali sono risultate 121 (56%), e quelle sintomatiche 94 (44%). Tra queste ultime, 18 (8,3%) erano l'unica manifestazione clinica di una grave patologia cerebrale (10 emorragie, 2 ischemie, 6 tumori). Per diagnosticare questi 18 casi sono stati eseguiti 72 EEG, 57 T.C e 4 rachicentesi; di questi esami viene quindi analizzata l'efficacia ai fini diagnostici. Da questi dati emerge quindi l'importanza di un'attenta valutazione del sintomo cefalea in Pronto Soccorso e la necessità di inviare, nei casi dubbi, il paziente in una struttura specializzata per queste emergenze.

     

Relevance of emergency head CT scan for fall in the elderly person

ObjectivesFall of the elderly person is a public health problem. The objectives of our study were to evaluate the relevance of systematically performing in emergency a computed tomography (CT) scan for fall in the elderly person, to identify specific criteria predicting the appearance of lesions.Material and methodsWe performed a retrospective analysis of 500 consecutive patients aged 65 and over, who underwent an emergency head CT scan for fall from their height. Outcome at the end of the acute care, clinico-biological data and delays between trauma an d CT were collected, and crossed with a detection of head lesion on the CT scan.ResultsOf 500 patients, 38 (7.6%) had traumatic lesions depicted on the CT scan and 267 (53.4%) were hospitalized after the CT scan. Three (0.6%) had been operated for urgent head surgery. Nine of the 38 (23.6%) patients with traumatic lesion returned home. Presence of a lesion depicted on the CT scan was not correlated with the orientation of the patient (P < 0.0001). Post-traumatic injury was significantly associated with male sex (RR = 2.19, P = 0.0217), consciousness impairment (RR = 1.56, P < 0.0001), focal neurological deficit (RR = 6.36, P = 0.0362) and past history of post-traumatic brain injury (RR = 7.17, P = 0.0027). Anticoagulant therapy was not associated with increased risk of traumatic lesions (P = 0.3315). ROC analysis determined that a 5-hours time-interval between head trauma and CT allowed optimal detection of lesions.ConclusionThe systematic indication of an emergency head CT scan for fall in elderly patients presents a low diagnostic and therapeutic yield and is not relevant. Male sex, consciousness impairment, focal neurological deficit, past history of post-traumatic brain injury and time-interval between head trauma and CT are statistically related to the presence of lesions and should therefore be taken into account.     

The value of the use of plasma B-type natriuretic peptide among acute ischemic stroke patients in a Chinese emergency department

Objective

To determine the value of the use of plasma B-type natriuretic peptide (BNP) among acute ischemic stroke patients in a Chinese emergency department (ED).

Materials and methods

In our ED, the emergency physicians prospectively assessed consecutive adult patients with acute phase of ischemic stroke and measured plasma BNP by Biosite Triage^®BNP POCT platform on admission, then followed up these patients. And the stroke neurologists evaluated patients’ functional outcome at hospital discharge, and also made discharge diagnosis and stroke etiologic subtypes according to TOAST criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-artery occlusion (SAO), stroke of other determined etiology (SOE) and stroke of other undetermined etiology (SUE).

Results

In this study, 142 of 238 acute ischemic stroke patients met the study criteria [mean age 70.84 ± 11.48 years, 74 (52.11%) female]. Of the 142 patients, 35.92% were diagnosed with LAA at discharge, 25.35% with CE, 27.46% with SAO, 11.27% with SOE or SUE. Age, previous cardiac disease, atrial fibrillation, the length of hospital stays, SSS score on admission ≤ 25 and mRS ≥ 3 or death at discharge were all significantly higher in the CE patients compared to other subtypes (p < 0.01). And the mean BNP concentration was significantly higher in the CE group than in other three subtypes (p < 0.001). The optimal cut-off concentration, sensitivity and specificity of the plasma BNP concentration suitable to distinguish CE from non-CE were 66.50 pg/ml, 75.0% and 88.7%, respectively.

Conclusions

Plasma BNP level is significantly higher in CE patients than in other TOAST subtypes, and by using Biosite Triage^®BNP POCT platform, emergency physicians should strongly consider CE subtype with the plasma BNP level of over 66.50 pg/ml. However, the single BNP biomarker panel cannot be used to confidently rule out or identify stroke subtypes as a diagnosis and must be taken in context with clinical assessment and judgment before making management decisions in the ED.     

Assessment of pretest probability of pulmonary embolism in the emergency department by physicians in training using the Wells model

INTRODUCTION: Assessment of pretest probability should be the initial step in investigation of patients with suspected pulmonary embolism (PE). In teaching hospitals physicians in training are often the first physicians to evaluate patients. OBJECTIVE: To evaluate the accuracy of pretest probability assessment of PE by physicians in training using the Wells clinical model and to assess the safety of a diagnostic strategy including pretest probability assessment. PATIENTS AND METHODS: 291 consecutive outpatients with clinical suspicion of PE were categorized as having a low, moderate or high pretest probability of PE by physicians in training who could take supervising physicians' advice when they deemed necessary. Then, patients were managed according to a sequential diagnostic algorithm including D-dimer testing, lung scan, leg compression ultrasonography and helical computed tomography. Patients in whom PE was deemed absent were followed up for 3 months. RESULTS: 34 patients (18%) had PE. Prevalence of PE in the low, moderate and high pretest probability groups categorized by physicians in training alone was 3% (95% confidence interval (CI): 1% to 9%), 31% (95% CI: 22% to 42%) and 100% (95% CI: 61% to 100%) respectively. One of the 152 untreated patients (0.7%, 95% CI: 0.1% to 3.6%) developed a thromboembolic event during the 3-month follow-up period. CONCLUSION: Physicians in training can use the Wells clinical model to determine pretest probability of PE. A diagnostic strategy including the use of this model by physicians in training with access to supervising physicians' advice appears to be safe.     

CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: Utility in evaluating aneurysm occlusion and WEB compression at one year

Background and purpose

The WEB is an innovative flow disruption device for cerebral aneurysm embolization with rapidly expanding indications. Our purpose was to evaluate the diagnostic performance of computed tomography angiography (CTA) at 1-year follow-up of aneurysms treated with the WEB.

Knowledge of TIA among general practitioners and emergency department physicians. A questionnaire survey in a French semi-rural area

Background and objective

Management of transient ischemic attacks (TIAs) is of vital importance in an attempt to prevent stroke. However, suboptimal management still raise concern among general practitioners (GPs) and emergency department (ED) physicians—the first medical contact of most TIA patients. This may relate to their poorly updated knowledge about TIA. The study was designed to assess knowledge of TIA among these non-neurologists.

Methods

The study was a post-mailed questionnaire survey among GPs and ED physicians. The questionnaire related to selective clinical aspects on TIA.

Results

There were a total of 85 respondents for analysis, mostly GPs (n = 64; 75.3%), out of 177 mailed physicians. Response rate was 52.7%. Many of these respondents were unaware of the newly proposed TIA definition (59%), unfamiliar with TIA mimics and predictors of post-TIA early stroke recurrence and therefore with the rationales underlying the need of emergency management of TIA. More than one third (39%) were unaware of the relevant national guidelines. Guidelines-aware respondents performed better in most part of the mailed questionnaire.

Conclusion

Our results show that poorly updated knowledge about TIA among non-neurologists represents a potential contributing factor to the persisting sub-optimal management of the disorder. Although further studies are needed to confirm this, improved continuous medical education of this group of health care professionals appears warranted.     

两种微创手术方法治疗基底节区中度脑出血临床疗效的比较研究

目的比较研究CT实时引导下软通道穿刺手术和小骨窗微创开颅手术治疗基底节区脑出血。方法选取266例出血量在20～40毫升的基底节区脑出血患者,其中208例采用CT实时引导下软通道穿刺血肿腔手术(穿刺组),58例患者行微创开颅手术(开颅组)。两组病人从住院天数、水肿期意识加深情况、再出血率及预后等方面进行比较。结果两组在平均住院天数(穿刺组11.53±0.418天VS开颅组11.30±0.778天)、入院3天GSC评分下降(穿刺组1.53±0.160分VS手术组1.48±0.232分)及再出血率(穿刺组1.92%VS开颅组1.72%)方面均无统计学差异(P0.05);而在出院时NIHSS评分提高方面,穿刺组较开颅组提高更显著(穿刺组2.98±0.247分VS开颅组2.05±0.186分,P 0.05)。结论对于基底节区中度脑出血患者,血肿腔穿刺手术和微创开颅手术比较,前者预后改善较后者明显。     

两种微创手术方法治疗基底节区中度脑出血临床疗效的比较研究

目的 比较研究CT实时引导下软通道穿刺手术和小骨窗微创开颅手术治疗基底节区脑出血。方法 选取266例出血量在20~40毫升的基底节区脑出血患者,其中208例采用CT实时引导下软通道穿刺血肿腔手术（穿刺组）,58例患者行微创开颅手术（开颅组）。两组病人从住院天数、水肿期意识加深情况、再出血率及预后等方面进行比较。结果 两组在平均住院天数（穿刺组11.53±0.418天VS开颅组11.30±0.778天）、入院3天GSC评分下降（穿刺组1.53±0.160分VS手术组1.48±0.232分）及再出血率（穿刺组1.92% VS开颅组1.72%）方面均无统计学差异（P>0.05）;而在出院时NIHSS评分提高方面,穿刺组较开颅组提高更显著（穿刺组2.98±0.247分VS开颅组2.05±0.186分,P<0.05）。结论 对于基底节区中度脑出血患者,血肿腔穿刺手术和微创开颅手术比较,前者预后改善较后者明显。     

Risk factors for calcification of the vertebrobasilar arteries in cardiovascular patients referred for a head CT,the SMART study

Background and purposeVertebrobasilar artery calcification (VBAC) has been associated with increased stroke occurrence. Little is known on VBAC risk factors, especially for patients with cardiovascular disease. We aimed to assess risk factors associated with VBAC in a cohort of cardiovascular patients referred for a head computed tomography (CT) scan.Materials and methodsAll patients who underwent a clinically indicated, unenhanced, thin slice head CT 6 months before or after inclusion in the SMART study were included. CTs were assessed for presence of VBAC (dichotomously). Relative risks of the associations of age, sex, diabetes mellitus (DM), obesity, body mass index, estimated glomerular filtration rate, hypertension, hyperlipidemia, use of lipid lowering medication, smoking status, high sensitivity C-reactive protein, ankle-brachial index (ABI; ≤ 0.90, ≥ 1.30, continuous), internal carotid artery stenosis ≥ 70%, and carotid intima-media thickness (IMT) with VBAC were estimated using Poisson regression analysis with robust standard errors, adjusted for age and sex.ResultsOf the 471 patients included (57% male, median age 58 [interquartile range 47–63]), 117 (24.8%) showed VBAC. Presence of VBAC was associated with older age (RR per 10 years = 1.70 [95%CI 1.46–1.99]), DM (RR = 1.45 [95%CI 1.03–2.06]), obesity (RR = 1.53 [95%CI 1.10–2.12]), ABI ≤ 0.90 (RR = 1.57 [95%CI 1.02–2.41]), and an increased carotid IMT (RR = 2.60 per mm [95%CI 1.20–5.62]). Other measurements were not associated with VBAC.ConclusionsWe identified several markers associated with VBAC in patients with cardiovascular disease referred for a head CT. Future investigation into the relationship between VBAC and stroke is warranted to determine the potential of VBAC in stroke prevention.     

The role of ECA transection in the development of masticatory lesions in the MCAO filament model

In the intraluminal suture model of middle cerebral artery occlusion (MCAO) in the rat, lesions of the masticator muscles associated with impaired functional outcome occur. We evaluated the role of external carotid artery (ECA) transection. We assessed whether isolated interruption of an arterial or a venous connection to the ECA territory was sufficient to induce masticatory hypoperfusion and lesions. We also evaluated a direct access to the common carotid artery (CCA) with subsequent vascular closure with regard to its feasibility, frequency of masticatory lesions, complications, and cerebral ischemia. Cerebral and masticatory lesions and perfusion deficits were assessed by in vivo magnetic resonance imaging (MRI). Vessel patency was evaluated using computerized tomography angiography and histology. An interruption of arterial blood flow led to masticatory hypoperfusion. Masticatory lesions occurred in 6% of the rats. Access to and closure of the CCA were feasible in all animals, leading to moderate or severe vessel stenosis in 20%, and intraarterial thrombosis in 25% of the rats. Reproducible cerebral infarctions were obtained in all animals. In 24% of the rats, hyperintense MRI signal changes were observed in the ipsilateral temporal muscle. Thus, the induction of masticatory hypoperfusion and lesions by arterial transection supports the role of the ECA in this context. Direct access to the CCA with subsequent vessel closure led to stenosis in most animals. Preservation of ECA continuity was not suitable to fully prevent masticatory lesions.     

Prospective diagnostic accuracy assessment of the HemosIL HS D-dimer to exclude pulmonary embolism in emergency department patients

Introduction

Chest pain and shortness of breath are among the most common symptoms requiring immediate evaluation. Testing for pulmonary embolism (PE) has become easier and widespread due to D-dimer blood tests. Safe use of these tests is only possible if sensitivity is high and they are used in non-high probability patients. We evaluated diagnostic performance of the HemosIL HS D-dimer, which despite FDA approval in 2005, has been minimally reported in prospective standard clinical care.

Materials and methods

We used a prospective observational study design to follow patients in a single center with the HemosIL HS ordered for symptoms of possible PE with positive test result if > 243 ng/ml. The outcome was PE or deep venous thrombosis (DVT) at the time of presentation or subsequent 45 days determined by structured evaluation of imaging tests, phone, or medical record follow-up in all patients.

Results

529 patients received a D-dimer and 4.7% were ultimately diagnosed with PE or DVT. The sensitivity of the HemosIL HS was 96.0% (95% CI; 79.6 to 99.9%) specificity was 65.7% (95% CI; 61.4 to 69.8%) and likelihood ratio negative was 0.06 (95% CI; 0.01 to 0.42). The probability of PE in patients with a negative D-dimer was 1/332 or 0.3% (95% CI; 0.01% to 1.67%). The receiver operator curve had an area under the curve of 0.87 and supported the current cut-point as optimal.

Conclusions

The HemosIL HS D-dimer had high sensitivity, very low negative post-test probability and is useful in excluding PE in the acute care setting.     

A pilot study utilizing whole body 18 F-FDG-PET/CT as a comprehensive screening strategy for occult malignancy in patients with unprovoked venous thromboembolism

Background

Approximately 7-10% of patients with unprovoked VTE will be diagnosed with cancer within 12 months. Although cancer screening has been proposed in these patients, the optimal strategy remains unclear. In a pilot study, we prospectively investigated the use of FDG-PET/CT to screen for occult malignancy in 40 patients with unprovoked VTE.

Materials/Methods

Patients were initially screened for occult malignancy with a focused history, physical, and laboratory evaluation. Patients underwent whole body FDG-PET/CT and were followed for up to two years for a new diagnosis of cancer. The total costs of using FDG-PET/CT as a comprehensive screening strategy were determined using 2010 Medicare reimbursement rates.

Results

Completion of FDG-PET/CT imaging was feasible and identified abnormal findings requiring additional evaluations in 62.5% of patients. Occult malignancy was evident in only one patient (cancer incidence 2.5%) and FDG-PET/CT imaging excluded malignancy in the remainder of patients. No patients with a negative FDG-PET/CT were diagnosed with malignancy during an average (± SD) follow-up of 449 (± 311) days. The use of FDG-PET/CT to screen for occult malignancy added $59,151 in total costs ($1,479 per patient). The majority of these costs were due to the cost of the FDG-PET/CT ($1,162 per patient or 78.5% of total per-patient costs).

Conclusions

FDG-PET/CT may have utility for excluding occult malignancy in patients with unprovoked VTE. The costs of this comprehensive screening strategy were comparable to other screening approaches. Larger studies are needed to further evaluate the utility and cost-effectiveness of FDG-PET/CT as a cancer screening strategy in patients with unprovoked VTE.     

TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中的对比研究

目的探讨彩色经颅多普勒（TCD）、脑电图（EEG）、脑干听觉诱发电位（BAEP）、CT在小儿脑性瘫痪诊断中各自的作用及与临床的关系。方法对2001～2006年采用TCD、EEG、BAEP、CT检查的资料数据完整的40例小儿脑性瘫痪病例,进行统计学处理及分析。结果TCD阳性率为72.5%、EEG为75.0%、BAEP为80.0%、CT为57.5%。TCD、EEG、BAEP之间相比无统计学意义P〉0.05。TCD、EEG、CT亦无统计学意义P〉0.05。仅BAEP阳性率与CT阳性率有统计学意义χ^2=4.1,P〈0.5。结论TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中各自均有一定的价值,对脑性瘫痪的诊断如采用多种检查,将起到相辅相成的作用,综合分析意义更大。