Confirmation of Brain Death with Positron Emission Tomography

Özdemir, Semra; Tan, Yusuf Ziya; Öztürk, Fulya Koç; Battal, Fatih

doi:10.1055/s-0039-1696652

Cited by 4 publications

(5 citation statements)

References 8 publications

(11 reference statements)

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“…The absence of brainstem reflexes is considered to be one of the diagnostic criteria for brain death in human patients (4,5). In addition, the absence of FDG uptake in intracranial structures, an indicator also used on the FDG-PET scans of brain-dead human patients, was identified in this canine patient (1,6,7). A previous study reported that extremely low FDG uptake was identified in the brain in human patients with metastatic neuroblastomas; however, no neurological symptoms were observed in those patients (10).…”

Section: Discussionmentioning

confidence: 93%

“…However, to the author's knowledge, there have been no reports of brain death in canine patients due to diagnostic limitations. Scintigraphy is an inexpensive and non-invasive examination used to determine brain death in human patients ( 1 , 5 ). Ozdemir suggested that FDG-PET/CT could be used for the confirmation of brain death because it has higher spatial resolution compared to other nuclear scans, such as gamma camera and single-photon emission computed tomography ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Scintigraphy is an inexpensive and non-invasive examination used to determine brain death in human patients ( 1 , 5 ). Ozdemir suggested that FDG-PET/CT could be used for the confirmation of brain death because it has higher spatial resolution compared to other nuclear scans, such as gamma camera and single-photon emission computed tomography ( 1 ). In this comatose canine patient without spontaneous breathing, we suspected brain death due to the absence of brainstem reflexes including the pupillary light reflex, oculocephalic reflex, corneal reflex, facial muscle movement to noxious stimulus, and pharyngeal and tracheal reflex.…”

Section: Discussionmentioning

confidence: 99%

“…Brain death is defined as the irreversible and complete loss of all activities of the brain, brainstem, and cerebellum resulting from the cessation of cerebral perfusion caused by increased intracranial pressure ( 1 ). The diagnosis of brain death is primarily clinical; that is, it involves a single apnea test and two assessments of brainstem reflexes ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…Human patients diagnosed with brain death using a fluorodeoxyglucose-positron emission tomography (FDG-PET) scan, which is a nuclear scan, have been reported ( 1 , 6 , 7 ). A hallmark of the FDG-PET scan for brain death is the absence of tracer residues within the brain and brainstem, indicating the absence of brain metabolism ( 1 , 6 , 7 ). Furthermore, in a study using brain-dead experimental animals, FDG-PET was used to confirm brain death ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

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Case report: Absent fluorodeoxyglucose uptake in a dog with unexpected brain death

Koo

Yun

et al. 2022

Front. Vet. Sci.

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A 5-year-old male Maltese dog was presented with generalized tonic seizures and hypermetria. Multiple nodular subcortical cerebellar enhancements and meningeal enhancement were observed on magnetic resonance imaging. Fluorodeoxyglucose-positron emission tomography/computed tomography was performed due to suspicion of neoplastic disease, and no fluorodeoxyglucose uptake was observed in the intracranial structures. In PET images of this dog, absent fluorodeoxyglucose uptake was identified in the brain indicating no cerebral metabolism, strongly suggested brain death. The dog had no spontaneous breathing and no brainstem reflexes for more than 24 h after the termination of anesthesia. Through these results, this dog was diagnosed with unexpected brain death, and it is presumed that the cause was anesthesia. We report herein a case of brain death in a dog diagnosed using fluorodeoxyglucose-positron emission tomography/computed tomography.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Case report: Absent fluorodeoxyglucose uptake in a dog with unexpected brain death

Koo

Yun

et al. 2022

Front. Vet. Sci.

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Diagnostic value of PET imaging in clinically unresponsive patients

Farg,

Elnakib,

Gebreil

et al. 2023

British Journal of Radiology

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Rapid advancements in the critical care management of acute brain injuries have facilitated the survival of numerous patients who may have otherwise succumbed to their injuries. The probability of conscious recovery hinges on the extent of structural brain damage and the level of metabolic and functional cerebral impairment, which remain challenging to assess via laboratory, clinical, or functional tests. Current research settings and guidelines highlight the potential value of fluorodeoxyglucose-PET (FDG-PET) for diagnostic and prognostic purposes, emphasizing its capacity to consistently illustrate a metabolic reduction in cerebral glucose uptake across various disorders of consciousness. Crucially, FDG-PET might be a pivotal tool for differentiating between patients in the minimally conscious state and those in the unresponsive wakefulness syndrome, a persistent clinical challenge. In patients with disorders of consciousness, PET offers utility in evaluating the degree and spread of functional disruption, as well as identifying irreversible neural damage. Further, studies that capture responses to external stimuli can shed light on residual or revived brain functioning. Nevertheless, the validity of these findings in predicting clinical outcomes calls for additional long-term studies with larger patient cohorts suffering from consciousness impairment. Misdiagnosis of conscious illnesses during bedside clinical assessments remains a significant concern. Based on the clinical research settings, current clinical guidelines recommend PET for diagnostic and/or prognostic purposes. This review article discusses the clinical categories of conscious disorders and the diagnostic and prognostic value of PET imaging in clinically unresponsive patients, considering the known limitations of PET imaging in such contexts.

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Absent 18F-FDG Uptake in the Brain—Unsuspected Brain Death

Pedersen

Jensen-Fangel²,

Nielsen

et al. 2020

Clin Nucl Med

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Brain death is the complete, irreversible cessation of brain function, including the capacity for brainstem, respiratory, and vegetative activities. It is a clinical diagnosis that can be supplemented with brain perfusion imaging. Absent cerebral blood flow can be visualized with CT angiography or perfusion scintigraphy. 18F-FDG PET/CT, visualizing glucose uptake, is another approach that has been shown to indicate brain death in small case series. We here present a case with unsuspected absent 18F-FDG uptake and thus no metabolic activity, in the brain. The patient was declared brain dead later the same day.

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Confirmation of Brain Death with Positron Emission Tomography

Cited by 4 publications

References 8 publications

Case report: Absent fluorodeoxyglucose uptake in a dog with unexpected brain death

Case report: Absent fluorodeoxyglucose uptake in a dog with unexpected brain death

Diagnostic value of PET imaging in clinically unresponsive patients

Absent 18F-FDG Uptake in the Brain—Unsuspected Brain Death

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