Role of computed tomography angiography and perfusion tomography in diagnosing brain death: A systematic review

Brasil, Sérgio; Bor‐Seng‐Shu, Edson; Oliveira, Marcelo de Lima; Azevedo, Milena Krajnyk de; Teixeira, Manoel Jacobsen; Bernardo, Luca; Bernardo, Wanderley Marques

doi:10.1016/j.neurad.2015.07.006

Cited by 28 publications

(23 citation statements)

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“…13 Because tests of cerebral perfusion such as CTA are actually tests of cerebral circulatory arrest, these are the most appropriate tests to use when attempting to clarify an ambiguous diagnosis of BD, as they tend to have the smallest falsepositive rates. 2,14,18 Our data support these claims, as CTA maintained a specificity of 100% and a sensitivity of 75% in our test population. Test sensitivity in this context refers to the number of patients who meet the gold-standard criteria for BD but have CTA findings that do not meet the stated criteria for BD (opacification above the level of the petrous ICAs, intradural VAs, or ICVs).…”

Section: Discussionsupporting

confidence: 84%

“…9,15 Furthermore, the statistical performance of CTA reported in the literature is similar to that of EEG and TCD, 2 AAN-approved ancillary tests. 2,9,14,15,18 Numerous radiological criteria exist for interpreting CTA results in patients suspected of being brain dead, with widely varying sensitivities resulting from how many and which vessels are included in a given criteria. In 2009, Frampas et al 6 compared the standard French 7-vessel criteria (nonopacification of pericallosal and cortical segments of the MCAs, ICVs, and great cerebral vein) with a 4-vessel criteria (nonopacification of cortical segments of MCAs and ICVs) and found that, by using the 4-vessel criteria, sensitivity was improved from 62.8% to 85.7% while maintaining a specificity of 100%.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

Garrett¹,

Williamson²,

Bohl³

et al. 2018

Journal of Neurosurgery

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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.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Garrett¹,

Williamson²,

Bohl³

et al. 2018

Journal of Neurosurgery

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“…( 53 ) Two recent systematic reviews concluded that CTA might be used as an auxiliary to clinical examination for the diagnosis of brain death (B) . ( 54 , 55 )…”

Section: Part 2: Diagnosis Of Brain Deathmentioning

confidence: 99%

Guidelines for the assessment and acceptance of potential brain-dead organ donors

Westphal¹,

Garcı́a²,

Souza³

et al. 2016

Revista Brasileira De Terapia Intensiva

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Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

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“…The authors concluded that statistical performance of CTA was comparable with many confirmatory tests. In a meta-analysis by Brasil et al in 2015, results of 122 studies including 322 patients and evaluating the use of CTA for the diagnosis of brain death were reviewed (15). The mean sensitivity of CTA was reported as 87.5%.…”

Section: Cause Of Death N %mentioning

confidence: 99%

Evaluation of the Efficacy of Computed Tomography Angiography in the Diagnosis of Brain Death

Yurdaışık¹

2019

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Amaç: Beyin ölümü, beyin sapı dahil olmak üzere beynin bütün fonksiyonlarının tam ve geri dönüşsüz bir şekilde kaybı olarak tanımlanmaktadır. Beyin ölümü tanısında kullanılan üç esas bulgu koma, beyin sapı reflekslerinin yokluğu ve apnedir. Organ nakli bekleyen hastaların sayısındaki artış ile birlikte beyin ölümü tanısı daha da önemli bir hal almıştır. Bu çalışmada bilgisayarlı tomografi anjiyografinin (BTA) beyin ölümü tanısındaki etkinliğinin belirlenmesi amaçlanmıştır. Hastalar ve Yöntem: Ekim 2015 ile Haziran 2018 arasında hastanemizin yoğun bakım ünitesinde yatan toplam 21 hastanın beyin ölümünün gerçekleştiği klinik olarak bildirilmiştir. Bu hastalardan birine manyetik rezonans anjiyografi (MRA) uygulandığı için çalışma dışı bırakılmıştır. Geriye kalan ve BTA sonuçları mevcut olan toplam 20 hastanın bulguları retrospektif olarak yeniden değerlendirilmiştir. Hastaların yaşları 25-75 arasında değişmekte olup, ortalama yaş 45±1 yıldır. BTA değerlendirmeleri 64 dedektör sıralı, döngü başına 128 kesit alan ve 384 kesite kadar yükseltilebilen bir cihaz ile yapılmıştır. 100 ml kontrast madde, çift başlı bir otomatik pompa ile 350-375 mg/ml olacak şekilde 3.5-4 cc/sn hızında verilmiştir. Kontrast madde vermeye başladıktan sonra ilgili bölge (ROI) eşik değer olan 90-100 HU'ya ulaşınca aksiyel planda 15-20 sn aralığında tarama yapılmıştır. BTA bulguları 10 puanlı skala üzerinden değerlendirilmiştir. Bulgular: Çalışmaya alınan ve BTA uygulanan 20 hastanın ölüm nedenleri olarak sekiz hastada intrakranial hemoraji, dört hastada iskemik serebrovasküler olay (SVO), üç hastada kraniotomi sonrası hemoraji, iki hastada kardiyak arrest, bir hastada travma sonrası kontüzyo serebri ve iki hastada metabolik nedenler olarak bildirilmiştir. Toplam 20 hastada ACA, PCA, MCA distal ve ICA supraklinoid dallarında kontrast dolumu "0" iken, 8 hastada ise MCA proksimal dallarında kontrast dolumu saptanmıştır. İki hastada tek taraflı ACA proksimalinde şüpheli bir kontrast dolumu belirlenmiştir. Intrakraniyal dalların her birindeki opasifikasyon kaybına 1 puan verilmiştir. Buna göre 20 hastanın tümü toplam 10 puan almıştır. Sonuç: Organ nakilleri için yasalarla gerekliliği belirlenmiş beyin ölümü tanısı için BTA'nın etkin ve geçerli bir doğrulayıcı yöntem olduğunu düşünmekteyiz. Anahtar Kelimeler: Bilgisayarlı tomografi anjiyografi, beyin ölümü, organ nakli, görüntüleme Aim: Brain death is defined as the complete and irreversible loss of all brain functions including the brain stem. Three major findings used for the diagnosis of brain death are coma, absence of brain stem reflexes and apnea. The diagnosis of brain death has become more important with the increasing number of patients waiting for transplantation. The objective of this study was to determine the efficacy of computed tomography angiography (CTA) in confirming brain death. Patients and Methods: Clinical brain death was reported in total 21 patients hospitalized in the critical care unit of our hospital between October 2015 and June 2018. One of these patients was excluded sin...

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Role of computed tomography angiography and perfusion tomography in diagnosing brain death: A systematic review

Cited by 28 publications

References 35 publications

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

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

Guidelines for the assessment and acceptance of potential brain-dead organ donors

Evaluation of the Efficacy of Computed Tomography Angiography in the Diagnosis of Brain Death

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