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Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

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Abstract

Introduction

Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD.

Methods

Prospective observational study in 27 BD patients.

Results

All patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead.

Conclusions

The radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography.

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Abbreviations

BAEP:

Brainstem auditory-evoked potentials

BD:

Brain death

BH:

Brain hemorrhage

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

CTA:

Computed tomographic angiography

CTP:

Computed tomography perfusion

EEG:

Electroencephalogram

GCS:

Glasgow coma scale

ICP:

Intracranial pressure

MCA:

Middle cerebral artery

MIP:

Maximum intensity projection

MTT:

Mean transit time

ROI:

Region of interest

SAH:

Subarachnoid hemorrhage

SEP:

Somatosensory-evoked potentials

SLST:

Superior longitudinal sinus thrombosis

TBI:

Traumatic brain injury

TCD:

Transcranial Doppler ultrasonography

Tc99-HMPAO:

Tecnecium 99-hexamethylpropylene amine oxime

VR:

Volume rendering

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Acknowledgments

The authors thank the medical and technical staff of the Radiology and Intensive Care Medicine units of the Hospital Universitario Central de Asturias, Oviedo, Spain for their help in managing the patients. The study was conceived by DE, who along with JO participated in its design and coordination and helped draft the manuscript. LM, DP, JA, GA, LC, AB and FC helped manage the brain-dead patients and also contributed to drafting and critically revising the manuscript. The images were acquired, processed and interpreted by PV, EM, AM and RL. All the authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006, Oviedo, Spain

    Dolores Escudero, Jesús Otero, Lara Marqués, Diego Parra, José Antonio Gonzalo, Guillermo M. Albaiceta, Luis Cofiño, Armando Blanco & Francisco Taboada

  2. Neuroradiology Section, Radiology Unit, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006, Oviedo, Spain

    Pedro Vega, Eduardo Murias, Ángela Meilan & Ricardo López Roger

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  1. Dolores Escudero
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  2. Jesús Otero
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  5. José Antonio Gonzalo
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  9. Pedro Vega
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  12. Ricardo López Roger
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  13. Francisco Taboada
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Correspondence to Dolores Escudero.

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Escudero, D., Otero, J., Marqués, L. et al. Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography. Neurocrit Care 11, 261–271 (2009). https://doi.org/10.1007/s12028-009-9243-7

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  • DOI: https://doi.org/10.1007/s12028-009-9243-7

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