Imaging Findings of Brain Death on 3-Tesla MRI

Sohn, Chul‐Ho; Lee, Hwa-Pyung; Park, Jun‐Beom; Chang, Hyuk Won; Kim, Ealmaan; Kim, Eun‐Hee; Park, Ui Jun; Kim, Hyoung-Tae; Ku, Jeonghun

doi:10.3348/kjr.2012.13.5.541

Cited by 31 publications

(31 citation statements)

References 24 publications

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“…As with other forms of angiography, there may be some filling of proximal intracranial vessels. [101][102][103][104][105] One study performed MR venography, with the finding that brain dead patients sometimes had filling of the superior sagittal sinus, which was thought to be due to drainage from meningeal vessels. 104 In 2010, the AAN update concluded that there was still insufficient evidence to incorporate MRI as an ancillary test in the diagnosis of brain death.…”

Section: Other Potential Ancillary Testsmentioning

confidence: 99%

Ancillary Testing in Brain Death

Kramer

2015

Semin Neurol

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Despite worldwide acceptance of the concept of brain death, there is marked variability in the use of ancillary testing. In most countries, ancillary tests are used primarily when confounding factors interfere with reliable completion of a clinical assessment, or physiologic instability precludes performance of an apnea test. Alternatively, in some countries, confirmatory ancillary tests are routinely required before brain death can be diagnosed. Ancillary tests assess brain function (e.g., electroencephalography) or blood flow (e.g., cerebral angiography). Evaluation of blood flow is affected less by confounding clinical factors and is now preferred in most jurisdictions. With angiographic techniques, a significant proportion of patients meeting clinical criteria for brain death have some opacification of proximal intracranial arteries. Consequently, the sensitivity of angiography is strongly influenced by the particular criteria that are used to define intracranial circulatory arrest. Lack of enhancement of the great cerebral and internal cerebral veins has the highest sensitivity. Worldwide experience with newer tests, such as computed tomography and magnetic resonance angiography, is growing. Radionuclide imaging has the advantage of not requiring use of potentially nephrotoxic contrast material. Transcranial Doppler ultrasonography can be brought to the bedside to demonstrate lack of brain blood flow. The specificity of imaging techniques in the detection of intracranial circulatory arrest has not been as well studied as their sensitivity.

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Section: Other Potential Ancillary Testsmentioning

confidence: 99%

Ancillary Testing in Brain Death

Kramer

2015

Semin Neurol

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“…Ishii et al26 suggested first that absence of the cerebral blood flow above the supraclinoid portions of ICA and their intracranial branches on MR angiograms is specific to brain death. Karantanas et al27 and Sohn et al29 confirmed these findings using sophisticated time-of-flight (TOF) imaging techniques. TOF imaging has been increasingly accepted as a technique for the examination of the intracranial circulation.…”

Section: Discussionmentioning

confidence: 92%

Gadolinium-enhanced magnetic resonance angiography in brain death

Luchtmann

Beuing

Skalej

et al. 2014

Sci Rep

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Confirmatory tests for the diagnosis of brain death in addition to clinical findings may shorten observation time required in some countries and may add certainty to the diagnosis under specific circumstances. The practicability of Gadolinium-enhanced magnetic resonance angiography to confirm cerebral circulatory arrest was assessed after the diagnosis of brain death in 15 patients using a 1.5 Tesla MRI scanner. In all 15 patients extracranial blood flow distal to the external carotid arteries was undisturbed. In 14 patients no contrast medium was noted within intracerebral vessels above the proximal level of the intracerebral arteries. In one patient more distal segments of the anterior and middle cerebral arteries (A3 and M3) were filled with contrast medium. Gadolinium-enhanced MRA may be considered conclusive evidence of cerebral circulatory arrest, when major intracranial vessels fail to fill with contrast medium while extracranial vessels show normal blood flow.

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“…Regarding the DTA studies, one reviewer experienced in DTA studies selected eligible articles according to criteria established elsewhere ( 9 ) with additional confirmation by another DTA expert in cases of ambiguity. Of the initial 124 candidate articles, 63 articles ( 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 ) were finally included. Regarding the studies that analyzed reliability, eligible articles were chosen by consensus after review by two of four independent reviewers experienced in the relevant methodology.…”

Section: Methodsmentioning

confidence: 99%

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

et al. 2017

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ObjectiveTo evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test.Materials and MethodsSixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis.ResultsThirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies.ConclusionGreater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.

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Imaging Findings of Brain Death on 3-Tesla MRI

Cited by 31 publications

References 24 publications

Ancillary Testing in Brain Death

Ancillary Testing in Brain Death

Gadolinium-enhanced magnetic resonance angiography in brain death

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

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