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Computed tomographic angiography as a useful adjunct in the diagnosis of brain death
Stefan Welschehold1, Thomas Kerz, Stephan Boor
1Department of Neurotraumatology and Neurosurgery, Asklepios Hospital Weißenfels, Weißenfels, Germany. s.welschehold@asklepios.com
Insights
Computed tomographic angiography (CT-A) reliably detects intracranial circulatory arrest in brain death (BD). Arterial phase scanning is more accurate than venous phase for confirming BD.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Computed tomographic angiography (CT-A) is accessible for detecting intracranial circulatory arrest in brain death (BD).
- Standardized parameters and specificity data for CT-A in BD diagnosis are lacking.
- Existing studies highlight CT-A's potential but require further validation.
Purpose of the Study:
- To evaluate the reliability and accuracy of CT-A in diagnosing intracranial circulatory arrest in patients with brain death (BD).
- To compare CT-A findings with established methods like transcranial Doppler ultrasonography and electroencephalogram.
- To determine the specificity and sensitivity of CT-A for BD confirmation.
Main Methods:
- A prospective study involving 30 patients diagnosed with brain death (BD) between January 2008 and April 2012.
- CT-A scans were performed twice: post-brainstem reflex loss and post-definitive BD determination.
- Results were cross-referenced with transcranial Doppler ultrasonography and electroencephalogram findings.
Main Results:
- CT-A showed cessation of contrast flow at the skull base or foramen magnum in 3 patients before definitive BD diagnosis.
- In one case, arterial phase showed opacification, but venous phase revealed no cerebral venous return.
- CT-A demonstrated 90% specificity and 97% sensitivity for detecting intracranial circulatory arrest.
Conclusions:
- CT-A is a reliable diagnostic tool for identifying intracranial circulatory arrest in brain death (BD).
- Arterial phase contrast enhancement evaluation in CT-A is more indicative of BD than venous phase.
- An international consensus on a standardized CT-A protocol for BD evaluation is recommended.
Background:
Because of its widespread accessibly, computed tomographic angiography (CT-A) is a promising technique in the detection of intracranial circulatory arrest in brain death (BD). Several studies assessed this tool, but neither have standardized evaluation parameters been developed nor has information about specificity become available.
Methods:
We conducted a prospective study between January 2008 and April 2012. Thirty patients were admitted to our University Hospital (16 men and 14 women; age, 18-88 years) and underwent CT-A scanning at two occasions: immediately after the first signs of loss of brain stem reflexes and after definitive determination of brain. The results of CT-A were compared with transcranial Doppler ultrasonography and electroencephalogram.
Results:
In 3 of 30 patients, we observed a termination of contrast flow at the level of the skull base and foramen magnum in arterial scanning series before the clinical determination of BD. After the clinical determination of BD, the opacification of all vascular territories in arterial phase scanning was found in one case, but venous phase scanning revealed no blood return in internal cerebral veins. In all other cases, contrast filling ceased at level of skull base or below. The specificity of CT-A in the detection of intracranial circulatory arrest was 90%, and sensitivity was 97%.
Conclusion:
CT-A is reliable and appropriate technical investigation to detect intracranial circulatory arrest in BD. The evaluation of contrast enhancement in arterial phase scanning seems to be more reliable than that in venous phase. An international consensus about a uniformly applied CT-A protocol for the evaluation of BD should be established.
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