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99mTc HM-PAO brain perfusion SPECT in brain death
M G Bonetti1, P Ciritella, G Valle
1Department of Diagnostic Imaging, IRCCS Casa Sollievo della Sofferenza Hospital, Italy.
Neuroradiology
|July 1, 1995
Summary
Diagnosing brain death requires certainty for organ donation. Technetium-99m HM-PAO SPECT reliably confirms irreversible cessation of brain stem function by detecting absent intracranial blood flow, even with suboptimal clinical assessments.
Area of Science:
- Neurology
- Nuclear Medicine
- Radiology
Background:
- Accurate brain death diagnosis is critical for organ transplantation and ventilator withdrawal.
- Clinical and electrophysiological assessments can be confounded by factors like drug intoxication, hypothermia, or technical artifacts.
- Reliable confirmatory tests are needed when clinical evaluation is suboptimal to demonstrate absent intracranial blood flow.
Purpose of the Study:
- To evaluate the utility of 99mTc HM-PAO SPECT as an early confirmatory test for brain death.
- To assess the feasibility of performing and interpreting 99mTc HM-PAO SPECT without interrupting patient therapy.
- To determine if 99mTc HM-PAO SPECT can improve the assessment of brain injury extent compared to CT scans.
Main Methods:
- A consecutive series of 40 comatose patients with brain damage underwent 99mTc HM-PAO SPECT.
- The procedure was performed without discontinuing ongoing patient therapy.
- Brain death was diagnosed based on the absence of intracranial radionuclide uptake, indicating no brain perfusion.
Main Results:
- 99mTc HM-PAO SPECT was easily performed and interpreted in all 40 patients.
- Brain death was diagnosed in 7 patients due to the absence of intracranial uptake.
- In patients with detectable perfusion, SPECT provided a more accurate assessment of injury extent than CT scans.
Conclusions:
- 99mTc HM-PAO SPECT is a reliable, non-invasive tool for confirming brain death by demonstrating absent intracranial blood flow.
- This technique can be safely performed without interrupting patient care, offering valuable diagnostic information.
- SPECT imaging provides a superior assessment of brain injury severity compared to CT in comatose patients.