Computed tomographic angiography as a useful adjunct in the diagnosis of brain death

Welschehold, Stefan; Kerz, Thomas; Boor, Stephan; Reuland, Katharina; Thömke, Frank; Reuland, Andre; Beyer, Christian; Tschan, Christoph A.; Wagner, W.; Müller‐Forell, Wibke; Giese, Alf

doi:10.1097/01586154-201305000-00014

Cited by 11 publications

(14 citation statements)

References 29 publications

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“…Additionally, we noticed (unpublished results) that if CTA tests were performed shortly after the appearance of brainstem areflexia, more widespread opacification of cerebral vessels, thus excluding CCA diagnosis, was recorded, which was also confirmed by the data published by Welschehold and Kerhuel [ 13 , 16 ]. The explanation for this phenomenon is quite simple: in this short period, the intracranial pressure (ICP) did not exceed the mean arterial pressure (MAP), leading to CCA.…”

Section: Early Research Into Using Cta/ctp For Diagnosing Bd/dnc In Polandsupporting

confidence: 77%

“…During initial attempts to implement CTA for CCA diagnosis, there was no consensus regarding the evaluation criteria, which have evolved as research progressed [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The most popular scoring systems (10, 7, 4 points), shown in Figure 1 , were based on analysis of the opacification of the following: Pericallosal segments of the right and left anterior cerebral artery (ACA-A3); Cortical segments of the right and left middle cerebral artery (MCA-M4); Cortical segments of the right and left posterior cerebral artery (PCA-P2); Basilar artery (BA); Right and left internal cerebral vein (ICV); Great cerebral vein (GCV)—the vein of Galen.…”

Section: Early Research Into Using Cta/ctp For Diagnosing Bd/dnc In Polandmentioning

confidence: 99%

“…Recently Lewis et al reviewed diagnostic requirements for ancillary testing for BD/DNC in 78 official national BD/DNC protocols and found that in 14 European countries CTA was included in to a panel of ancillary tests [ 17 ], but according to our knowledge this method was in detail described in national guidelines and relatively frequently used only in France, Germany and recently in Poland. French and Polish protocols and diagnostic criteria based on 4-point scale are similar while German protocol elaborated on the grounds of publication of Welschehold [ 13 ] is based on recognition of lack of opacification of 7 intracranial arteries in late arterial phase [ 18 ]. Comparison of these three diagnostic protocols is demonstrated in Table 1 .…”

Section: Comparison With the Other Instructions For Cca Confirmation By Cta Imagingmentioning

confidence: 99%

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Implementation of Computed Tomography Angiography (CTA) and Computed Tomography Perfusion (CTP) in Polish Guidelines for Determination of Cerebral Circulatory Arrest (CCA) during Brain Death/Death by Neurological Criteria (BD/DNC) Diagnosis Procedure

Bohatyrewicz

Pastuszka

Walas

et al. 2021

JCM

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Background: Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been conducted in order to unify clinical procedures and to validate and implement new technologies into a panel of ancillary tests. Recently evaluated computed tomography angiography and computed tomography perfusion (CTA/CTP) seem to be superior to traditionally used digital subtraction angiography (DSA), transcranial Doppler (TCD) and cerebral perfusion scintigraphy for diagnosis of cerebral circulatory arrest (CCA). In this narrative review, we would like to demonstrate scientific evidence supporting the implementation of CTA/CTP in Polish guidelines for BD/DNC diagnosis. Research and implementation process: In the first of our base studies concerning the potential usefulness of CTA/CTP for the confirmation of CCA during BD/DNC diagnosis procedures, we showed a sensitivity of 96.3% of CTA in a group of 82 patients. CTA was validated against DSA in this report. In the second study, CTA showed a sensitivity of 86% and CTP showed a sensitivity of 100% in a group of 50 patients. In this study, CTA and CTP were validated against clinical diagnosis of BD/DNC supported by TCD. Additionally, we propose our CCA criteria for CTP test, which are based on ascertainment of cerebral blood flow (CBF) < 10 mL/100 g/min and cerebral blood volume < 1 mL/100 g in regions of interest (ROIs) localized in all brain regions. Based on our research results, CTA/CTP methods were implemented in Polish BD/DNC criteria. To our knowledge, CTP was implemented for the first time in national guidelines. Conclusions: CTA and CTP-derived CTA might be in future the tests of choice for CCA diagnosis, proper and/or Doppler pretest might significantly increase sensitivity of CTA in CCA diagnosis procedures. Whole brain CTP might be decisive in some cases of inconclusive CTA. Implementation of CTA/CTP in the Polish BD/DNC diagnosis guidelines does not show any major obstacles. We believe that in next edition of “The World Brain Death Project” CTA and CTP will be recommended as ancillary tests of choice for CCA confirmation during BD/DNC diagnosis procedures.

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Section: Early Research Into Using Cta/ctp For Diagnosing Bd/dnc In Polandsupporting

confidence: 77%

Section: Early Research Into Using Cta/ctp For Diagnosing Bd/dnc In Polandmentioning

confidence: 99%

Section: Comparison With the Other Instructions For Cca Confirmation By Cta Imagingmentioning

confidence: 99%

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Implementation of Computed Tomography Angiography (CTA) and Computed Tomography Perfusion (CTP) in Polish Guidelines for Determination of Cerebral Circulatory Arrest (CCA) during Brain Death/Death by Neurological Criteria (BD/DNC) Diagnosis Procedure

Bohatyrewicz

Pastuszka

Walas

et al. 2021

JCM

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“…Recently, Welschehold et al (19,20) proposed that analysis of arterial vasculature should be carried out in the arterial scanning phase and that of deep venous system in the venous phase, as employed in our study. Besides those disparities, scanning time of arterial and venous phases also differ between studies.…”

Section: Discussionmentioning

confidence: 99%

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Şahin¹,

Pekçevik²

2015

Diagn Interv Radiol

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“…In addition, there are problems evaluating CT angiography scans that additionally contain a "venous" acquisition series. Therefore, as confirmed by studies by Welschehold et al [14], it is recommended to restrict information to be diagnostically used to the arterial phase in the case of this issue. In the case of contrast enhancement of the anterior cerebral artery, middle cerebral artery, posterior cerebral artery and basilar artery, the cessation of cerebral blood circulation is not definitively proven according to the currently valid guidelines [1].…”

mentioning

confidence: 99%

Imaging of Irreversible Loss of Brain Function

Lanfermann

Schober

2015

Fortschr Röntgenstr

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The updated guidelines for the determination of irreversible loss of brain function include a substantial innovation, i.?e., the use of CT angiography as a supplementary technical examination. Adherence to a standardized protocol is the prerequisite for the application of CT angiography. The guidelines for standardized execution of perfusion scintigraphy are unchanged and still valid. Requirements regarding the quality of examining physicians are specified. Key points: ??The guidelines for determining irreversible loss of brain function were updated. ??The approval of CT angiography as a supplementary examination method is a major innovation. ??CT angiography is to be performed to determine the cessation of cerebral blood circulation according to a standard protocol. ??The guidelines for the standardized implementation of perfusion scintigraphy continue to be valid. ??Quality requirements regarding examining physicians were specified. Citation Format: ??Lanfermann H, Schober O. Imaging of Irreversible Loss of Brain Function. Fortschr R?ntgenstr 2016; 188: 23???26

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Computed tomographic angiography as a useful adjunct in the diagnosis of brain death

Cited by 11 publications

References 29 publications

Implementation of Computed Tomography Angiography (CTA) and Computed Tomography Perfusion (CTP) in Polish Guidelines for Determination of Cerebral Circulatory Arrest (CCA) during Brain Death/Death by Neurological Criteria (BD/DNC) Diagnosis Procedure

Implementation of Computed Tomography Angiography (CTA) and Computed Tomography Perfusion (CTP) in Polish Guidelines for Determination of Cerebral Circulatory Arrest (CCA) during Brain Death/Death by Neurological Criteria (BD/DNC) Diagnosis Procedure

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Imaging of Irreversible Loss of Brain Function

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