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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.
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).
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.
