Reliability of computed tomographic angiography in the diagnosis of brain death

Area of Science:

• Neurology
• Radiology
• Forensic Medicine

Background:

• Diagnosing brain death (BD) requires confirmation of cessation of cerebral blood flow.
• Conventional cerebral angiography is the gold standard but is invasive.
• Cerebral computed tomographic (CT) angiography offers a less invasive alternative for assessing cerebral perfusion.

Purpose of the Study:

• To evaluate the diagnostic accuracy of cerebral CT angiography in comparison to conventional cerebral angiography for confirming brain death.
• To identify specific cerebral arteries and venous structures where discrepancies in CT angiography findings are most prominent.

Main Methods:

• A prospective, monocentric study involving 43 adult patients meeting clinical criteria for BD.
• All patients underwent both cerebral CT angiography and conventional cerebral angiography.
• Diagnostic criteria for BD on CT angiography included absence of perfusion in specific anterior, middle, and posterior cerebral artery segments, basilar artery, and cerebral veins.

Main Results:

• Brain death was confirmed by both methods in 30 patients.
• Cerebral angiography confirmed BD in 13 patients where CT angiography still indicated cerebral perfusion, resulting in a 30.2% divergence rate.
• The divergence was most significant concerning the proximal A2 anterior cerebral artery segments.

Conclusions:

• Cerebral CT angiography is a potentially valuable tool for diagnosing brain death.
• Significant discrepancies between CT angiography and conventional angiography, especially in proximal vessels, require further investigation.
• Establishing international consensus on CT angiography interpretation criteria is crucial for its widespread adoption as a complementary diagnostic tool for brain death.