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Comparison of early- and late-phase CT angiography findings in brain death
Ethem Murat Arsava1, Cansu Ayvacioglu Cagan2, Ekim Gumeler3
1Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. arsavaem@hotmail.com.
Insights
Early computed tomography angiography (CTA) images improve brain death diagnosis sensitivity. Incorporating early-phase CTA enhances contrast filling assessment in intracranial arteries and veins, aiding confirmation.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Late-phase computed tomography angiography (CTA) has limited diagnostic value for brain death due to contrast stasis.
- Assessing contrast filling in early and late CTA phases can improve diagnostic accuracy.
Purpose of the Study:
- To evaluate contrast filling in intracranial arteries and veins during early and late CTA phases.
- To compare the diagnostic sensitivity of different CTA scoring systems for brain death.
Main Methods:
- Contrast opacification was assessed in 79 patients across 28 arterial/venous segments in early and late CTA phases.
- Diagnostic sensitivity of 4-, 7-, and 10-point scoring algorithms was compared using different CTA phase combinations.
Main Results:
- Late-phase CTA showed significantly increased contrast opacification across all segments compared to early-phase (p < 0.05).
- Sensitivity of scoring algorithms increased from 59-91% to 94-99% when early-phase images were included.
Conclusions:
- Early-phase CTA images can enhance the sensitivity of computed tomography angiography for confirming brain death.
- Integrating early-phase CTA may improve diagnostic confidence, particularly in clear clinical cases.
Background:
Late-phase images on computed tomography angiography (CTA), traditionally used for assessing cerebral circulatory arrest in brain death, suffer from suboptimal diagnostic yield due to stasis filling. Herein, we assessed contrast filling in individual intracranial arteries and veins in the early and late phases of CTA in patients with clinically confirmed brain death.
Methods:
Contrast opacification within 28 arterial/venous segments was evaluated in both phases of CTA in 79 patients. This information was combined with reports in the literature to calculate prevalence of contrast filling in different intracranial vessels. Additionally, diagnostic sensitivity of 4-point, 7-point, and 10-point scores defined for brain death were compared among ratings based on early, late, and both phases (arteries rated on early, veins rated on late phase) of imaging.
Results:
The median (IQR) number of vessel segments with contrast opacification was 0 (0-2) in early phase and 6 (0-10) in late phase. All segments showed increased prevalence of opacification when evaluated in late phase (p < 0.05). The M4 segments of MCA, internal cerebral veins, and vein of Galen had the lowest percentage of opacification in both phases. The sensitivity of 4-, 7-, and 10-point scoring algorithms increased from 59-91% to 94-99% when ratings were performed using early-phase images rather than based solely on late-phase images.
Conclusions:
The incorporation of early-phase images might be considered as a strategy to improve the sensitivity of CTA as an ancillary test in confirming brain death, especially in patients without missing or questionable elements in clinical examination.
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