Computed tomography angiography accuracy in brain death diagnosis

Area of Science:

• Neurology
• Radiology

Background:

• Systematic reviews indicate a lack of evidence supporting computed tomography angiography (CTA) for diagnosing brain death (BD).
• Concerns exist regarding the effectiveness and optimal criteria for using CTA in identifying intracranial circulatory arrest.

Purpose of the Study:

• To assess the diagnostic effectiveness of CTA in identifying brain death (BD).
• To define optimal tomographic criteria for diagnosing intracranial circulatory arrest using CTA.

Main Methods:

• A prospective, observational case-control study involving 106 comatose patients (Glasgow Coma Scale score ≤ 5).
• CTA and transcranial Doppler (TCD) were performed, with personnel blinded to results.
• BD diagnosis was determined neurologically, with CTA accuracy assessed using the 4-point score (4PS) and venous score (VS) criteria.

Main Results:

• CTA demonstrated 100% specificity in patients without BD.
• For patients with BD, the venous score (VS) achieved 87% sensitivity, compared to 61.1% for the 4-point score (4PS).
• CTA accuracy, particularly with VS, increased significantly when performed within 12 hours of neurological assessment, reaching 95.5% sensitivity.

Conclusions:

• CTA can reliably aid in the diagnosis of brain death (BD).
• The absence of deep venous opacification, evaluated by the VS criteria, effectively confirms cerebral circulatory arrest.
• The study provides validated criteria for using CTA in BD diagnosis.