Scintigraphic confirmation of brain death

Area of Science:

• Neurology
• Nuclear Medicine
• Medical Imaging

Background:

• Brain death determination is crucial for ending futile interventions and facilitating organ transplantation.
• Variations exist in brain death definitions, diagnostic methodologies, and quality assurance practices across professional societies and legal statutes.

Purpose of the Study:

• To review the role of scintigraphy in evaluating brain death.
• To discuss the utility and limitations of different scintigraphic techniques, including planar imaging and SPECT.

Main Methods:

• Review of scintigraphic techniques for brain death evaluation.
• Discussion of tracers like Tc99m diethylene triamine pentaacetic acid and Tc99m hexamethylpropyleneamineoxime (HMPAO).
• Analysis of planar imaging, radionuclide angiography, and single-photon emission computed tomography (SPECT).

Main Results:

• Planar imaging with radionuclide angiography is the primary scintigraphic method for confirming brain death.
• Tc99m HMPAO enables evaluation of various brain regions via multiprojection static planar imaging.
• SPECT's role is currently supplemental for differentiating scalp from intracerebral activity, with its reliability for brainstem assessment unproven.

Conclusions:

• Scintigraphy, particularly planar imaging, is a key tool in brain death diagnosis.
• Further research is needed to validate the reliability of SPECT in assessing brainstem function for brain death confirmation.