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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

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CT angiography for brain death diagnosis.

E Frampas¹, M Videcoq, E de Kerviler

¹Departments of Radiology and Medical Imaging, CHU Nantes Hôtel-Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, France. eric.frampas@chu-nantes.fr

AJNR. American Journal of Neuroradiology

|May 2, 2009

Summary

A simplified 4-point CT angiography score effectively confirms brain death by assessing lack of vessel opacification. This method shows high sensitivity and specificity for diagnosing brain death, improving upon older scoring systems.

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Area of Science:

Neurology
Radiology
Critical Care Medicine

Background:

Cerebral circulation absence is key for brain death confirmation.
Conventional angiography is standard, but CT angiography (CTA) is an emerging alternative.
France uses a 7-point CTA score for brain death diagnosis.

Purpose of the Study:

Validate the efficiency of the existing 7-point CTA score.
Evaluate the sensitivity of a novel 4-point CTA score for confirming brain death.

Main Methods:

Prospective multicenter study of 105 patients undergoing CTA for brain death confirmation.
Initial interpretation using a 7-point score (pericallosal/cortical MCAs, ICVs, great cerebral vein).
Second interpretation by expert radiologists using a novel 4-point score (cortical MCAs, ICVs).

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Main Results:

The 7-point score had 62.8% sensitivity.
The novel 4-point score achieved 85.7% sensitivity and 100% specificity.
Absence of internal cerebral vein opacification occurred in 98.1% of patients.

Conclusions:

Lack of opacification in middle cerebral arteries and internal cerebral veins on CTA is efficient and reliable for brain death confirmation.
The 4-point CTA score offers a more sensitive and specific method for diagnosing brain death.