Clinical use of technetium-99m HM-PAO for determination of brain death

We report our clinical experience with the use of [99mTc]hexamethyl propyleneamine oxime (HM-PAO) in establishing a diagnosis of brain death in 11 patients following trauma to the head and four patients who suffered atraumatic injuries. In 9/15 studies there was no intracranial flow present and brain death was then confirmed by standard criteria. Of the remaining 6/15 studies which showed evidence of cerebral perfusion, 3/6 patients underwent a subsequent HM-PAO study which showed cessation of perfusion. One additional patient died of pneumonia and two patients survived. Thus, in all cases where there was no flow present the diagnosis of brain death was later confirmed whereas three patients clinically thought to be brain dead showed significant perfusion and survived the cerebral trauma. HM-PAO may be useful in determination of brain death because it provides unequivocal results, can be performed by planar imaging at the bedside, and does not require withdrawal of medical therapy, thus allowing a diagnosis to be established more rapidly.