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Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
Published on: February 17, 2013
Measuring brain perfusion by CT or MR as ancillary tests for diagnosis of brain death: a systematic review and
João N Ramos1,2, Catarina Pinto3, Vera Cruz E Silva4
1Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental, Lisboa, 1349-019, Portugal.
Objectives:
To gather and synthesize evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis.
Methods:
A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by 3 reviewers. PubMed/MEDLINE, EMBASE and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies' quality. Meta-analysis was performed using univariate random-effects models.
Results:
Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, n = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI, 86.5-98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings.
Conclusions:
The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre, and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters.
Advances In Knowledge:
Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area.
Prospero Registration Number:
CRD42022336353.
Insights
Cerebral perfusion imaging using CT or MRI shows high accuracy for diagnosing brain death. Further prospective studies are needed to validate these promising findings.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Brain death (BD) diagnosis requires accurate confirmation of cessation of cerebral blood flow.
- Established methods like CT angiography (CTA) and transcranial Doppler (TCD) are used, but novel imaging techniques are being explored.
- Perfusion imaging, including CT perfusion (CTP) and MR perfusion (MRP), offers a potential alternative or adjunct for assessing cerebral blood flow.
Purpose of the Study:
- To systematically review and synthesize evidence on the diagnostic accuracy of CTP and MRP for diagnosing brain death.
- To evaluate the sensitivity and specificity of perfusion imaging in BD diagnosis compared to existing methods.
Main Methods:
- A systematic review and meta-analysis was conducted following PRISMA guidelines and registered with PROSPERO (CRD42022336353).
- Relevant studies were searched in PubMed/MEDLINE, EMBASE, and Cochrane databases.
- Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and meta-analysis used univariate random-effects models.
Main Results:
- Ten studies including 328 patients were analyzed.
- Perfusion imaging, predominantly CTP (8 studies), demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for diagnosing BD.
- Publication bias was identified, and other diagnostic metrics could not be calculated.
Conclusions:
- CTP or MRP show very high sensitivity for BD diagnosis, comparable to CTA and TCD.
- However, due to the retrospective nature and limitations of included studies, results should be interpreted cautiously.
- Prospective, multi-center studies with standardized parameters and control groups are essential for validating perfusion imaging in BD assessment.
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