CT Angiography as a Confirmatory Test in Brain Death

Welschehold, Stefan; Boor, Stephan; Reuland, Katharina; Beyer, Christian; Kerz, Thomas; Reuland, Andre; Müller‐Forell, Wibke

doi:10.1007/978-3-7091-0956-4_60

Cited by 9 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The only remnant flow that was observed in a minority of patients was the filling of a short segment of the proximal intradural VA (proximal V4), which does not exclude BD. This finding is similar to intracranial non-filling observed in some other studies [ 2 , 5 - 6 , 19 ] and simulates the characteristic findings observed in conventional angiography [ 2 , 9 ]. This finding may yield to 100% specificity for the diagnosis of BD.…”

Section: Discussionsupporting

confidence: 92%

Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death

Sadeghian

Raeisi

Dolati³

et al. 2017

Cureus

View full text Add to dashboard Cite

IntroductionBrain death (BD) is the irreversible termination of the functioning of the brain. The diagnosis should be first made by clinical criteria and confirmed by using paraclinical confirmatory techniques (ancillary tests). While conventional brain angiography remains the standard method of choice, computed tomography angiography (CTA) has emerged as an alternative method. In this study, we tried to evaluate the accuracy of CTA for the diagnosis of BD.MethodsIn this study, we included nine patients with a clinical diagnosis of BD, confirmed by electroencephalography (EEG). CTA was then performed to compare the results.ResultsThe most frequent cause for BD was multiple trauma (7/9) in our patients, followed by aneurysm rupture and brain infarct. CTA examination in all patients showed opacification of extracranial arteries and major branches of external carotid artery (ECA), including superficial temporal arteries (STAs), while no opacification was observed in the internal carotid arteries (ICA) including and beyond the cavernous segment, middle cerebral arteries (MCAs), anterior cerebral arteries (ACAs), distal vertebral arteries (VAs), and basilar artery (BA). Moreover, no opacification was observed in the internal cerebral veins (ICVs) or great cerebral vein (GCV).ConclusionThe accuracy rate of CTA in the detection of intracranial circulatory arrest was 100%. CTA examinations confirmed BD diagnoses in all patients who had clinical and EEG BD diagnoses, and no confliction between CTA findings and clinical diagnoses was observed.

show abstract

Section: Discussionsupporting

confidence: 92%

Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death

Sadeghian

Raeisi

Dolati³

et al. 2017

Cureus

View full text Add to dashboard Cite

show abstract

“…The preliminary results of this study were presented on the 14th International Conference on Intracranial Pressure and Brain Monitoring (September 2010, Tuebingen, Germany) [12]. The preliminary results of this study were presented on the 14th International Conference on Intracranial Pressure and Brain Monitoring (September 2010, Tuebingen, Germany) [12].…”

Section: Introductionmentioning

confidence: 99%

“…We present our results on intracranial contrast enhancement in arterial and venous scanning series of cranial vascular territories in BD, compared to the well-established tests like electroencephalography (EEG) and Transcranial Doppler Ultrasonography (TCD) and propose a protocol to determine intracranial circulatory arrest in BD with CT-A, evaluating anterior as well as posterior circulation. The preliminary results of this study were presented on the 14th International Conference on Intracranial Pressure and Brain Monitoring (September 2010, Tuebingen, Germany) [12].…”

Section: Introductionmentioning

confidence: 99%

Detection of intracranial circulatory arrest in brain death using cranial CT‐angiography

Welschehold

Kerz

Boor

et al. 2012

Euro J of Neurology

View full text Add to dashboard Cite

CT-A is easily accessible in almost every hospital, offers a high spatio-temporal resolution, is operator independent and inexpensive. The results of CT-A are comparable to other established brain perfusion techniques in BD. An international consensus should be established to ascertain consistent parameters similar to fixed guidelines for other ancillary procedures to determine BD in order to prevent different scanning and evaluation protocols for detecting intracranial circulatory arrest.

show abstract

“…Multiple studies have attempted to show the reliability of CTA in demonstrating a lack of intracranial blood flow in the brain-dead patient. [1][2][3][5][6][7][8][9][10][12][13][14][15][17][18][19] However, these studies are highly heterogeneous in terms of the comparison studies they use as gold standards; some appropriately use clinical criteria alone, whereas others use a combination of clinical criteria and any one or a combination of the AAN-recommended ancillary tests. The use of ancillary tests other than CA as gold standards to compare with CTA is problematic, as many of these studies have a statistical performance similar to that of CTA.…”

mentioning

confidence: 99%

Computed tomography angiography as a confirmatory test for the diagnosis of brain death

Garrett¹,

Williamson²,

Bohl³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE For a diagnosis of brain death (BD), ancillary testing is performed if patient factors prohibit a complete clinical examination and apnea test. The American Academy of Neurology (AAN) guidelines identify cerebral angiography (CA), cerebral scintigraphy, electroencephalography, and transcranial Doppler ultrasonography as accepted ancillary tests. CA is widely considered the gold standard of these, as it provides the most reliable assessment of intracranial blood flow. CT angiography (CTA) is a noninvasive and widely available study that is also capable of identifying absent or severely diminished intracranial blood flow, but it is not included among the AAN's accepted ancillary tests because of insufficient evidence demonstrating its reliability. The objective of this study was to assess the statistical performance of CTA in diagnosing BD, using clinical criteria alone or clinical criteria plus CA as the gold-standard comparisons. METHODS The authors prospectively enrolled 22 adult patients undergoing workup for BD. All patients had cranial imaging and clinical examination results consistent with BD. In patients who met the AAN clinical criteria for BD, the authors performed CA and CTA so that both tests could be compared with the gold-standard clinical criteria. In cases that required ancillary testing, CA was performed as a confirmatory study, and CTA was then performed to compare against clinical criteria plus CA. Radiographic data were evaluated by an independent neuroradiologist. Test characteristics for CTA were calculated. RESULTS Four patients could not complete the standard BD workup and were excluded from analysis. Of the remaining 18 patients, 16 met AAN criteria for BD, 9 of whom required ancillary testing with CA. Of the 16 patients, 2 who also required CA ancillary testing were found to have persistent intracranial flow and were not declared brain dead at that time. These patients also underwent CTA; the results were concordant with the CA results. Six patients who were diagnosed with BD on the basis of clinical criteria alone also underwent CA, with 100% sensitivity. For all 18 patients included in the study, CTA had a sensitivity of 75%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 33%. CONCLUSIONS Clinical examination with or without CA remains the gold standard in BD testing. Studies assessing the statistical performance of CTA in BD testing should compare CTA to these gold standards. The statistical performance of CTA in BD testing is comparable to several of the nationally accepted ancillary tests. These data add to the growing medical literature supporting the use of CTA as a reliable ancillary test in BD testing.

show abstract

CT Angiography as a Confirmatory Test in Brain Death

Cited by 9 publications

References 29 publications

Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death

Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death

Detection of intracranial circulatory arrest in brain death using cranial CT‐angiography

Computed tomography angiography as a confirmatory test for the diagnosis of brain death

Contact Info

Product

Resources

About