Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

Abstract

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.

CT Perfusion for Confirmation of Brain Death

“…These patients possibly have shown false-negativity in previous studies. A similar case was described by Escudero et al 10 The CTA in our study showed similar sensitivity on a 7-point scale but lower sensitivity on a 4-point scale compared with the study of Frampas et al 6 The lower sensitivity of the 4-point scale can be explained simply by a smaller number of patients in our study. Opacification of the ICV was absent in 81.8% of patients.…”

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

“…Preserved opacification of intracranial vessels in brain-dead patients with skull defects, such as craniectomy or skull fractures, is a known phenomenon which is reported by several authors previously (8,9,21,24). In case of pressure relieving defect, intracranial pressure does not exceed the cerebral perfusion pressure (9). This can cause diagnostic problems in patients with skull defects, particularly craniectomy, leading to false negative results.…”

“…Besides those disparities, scanning time of arterial and venous phases also differ between studies. Most studies initiated the arterial phase scan 20 s after contrast injection (1,8,18), while bolus triggering technique was used in others (9,21). Timing of the venous phase also ranged between 54 s and 80 s after contrast injection (1, 21).…”

“…This can cause diagnostic problems in patients with skull defects, particularly craniectomy, leading to false negative results. In the literature, craniectomy frequencies of 19%-32% were reported (9,21,24). Frampas et al (8) proposed that CT angiography does not appear to be efficient for patients with craniectomy.…”

Einsatz der CT-Angiographie zur Feststellung des zerebralen Zirkulationsstillstandes

“…Nachweis eines zerebralen Zirkulationsstillstandes durch fehlende Kontrastierung der intrakavernösen A. carotis interna beidseits (offener Pfeil) und der übrigen intraduralen Arterien bei guter Kontrastierung der A. temporalis superficialis beidseits und weiterer Externa-Äste (Pfeile). Die CTA wurde bisher ausschließlich für die Feststellung des zerebralen Zirkulationsstillstandes bei Erwachsenen validiert [3][4][5][6][7][8][9][10][11][12][13][14]. Bei klinischen Zeichen des irreversiblen Hirnfunktionsausfalles dürfte jedoch auch bei Kindern nach dem ersten Lebensjahr (geschlossene Fontanellen) der Nachweis des zerebralen Zirkulationsstillstandes mittels CTA ein relevanter prognostischer Indikator sein …”