Computed Tomography Perfusion and Angiography for Death by Neurologic Criteria

Area of Science:

• Neurology
• Radiology
• Critical Care Medicine

Background:

• Accurate confirmation of death by neurologic criteria (DNC) is crucial for clinical decisions and organ donation.
• Current ancillary tests for DNC have limitations in diagnostic performance and validation.

Purpose of the Study:

• To evaluate the diagnostic accuracy, interrater reliability, and safety of brain CT perfusion and CT angiography for DNC.
• To compare these imaging techniques against a prespecified validation threshold.

Main Methods:

• A prospective, multicenter, blinded diagnostic accuracy cohort study.
• Included critically ill adults with a Glasgow Coma Scale score of 3.
• Contrast-enhanced brain CT perfusion and CT angiography were performed within 2 hours of clinical DNC examination.

Main Results:

• Qualitative brainstem CT perfusion had 98.5% sensitivity but 74.4% specificity.
• Whole-brain CT perfusion showed 93.6% sensitivity and 92.3% specificity.
• CT angiography demonstrated good interrater reliability but did not meet the primary accuracy threshold.

Conclusions:

• Brain CT perfusion and CT angiography did not meet the >98% validation threshold for DNC.
• Clinical examination remains the primary method for DNC confirmation.
• Ancillary imaging should be used cautiously within a comprehensive clinical evaluation.