SNM Practice Guideline for Brain Death Scintigraphy 2.0

Donohoe, Kevin J.; Agrawal, Garima; Frey, Kirk A.; Gerbaudo, Victor H.; Mariani, Giuliano; Nagel, James S.; Shulkin, Barry L.; Stabin, Michael G.; Stokes, Margaret

doi:10.2967/jnmt.112.105130

Cited by 60 publications

(48 citation statements)

References 23 publications

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“…Radionuclide CBF testing must be performed in accordance with guidelines established by the Society of Nuclear Medicine and the American College of Radiology. 49,50 EEG testing must be performed in accordance with standards established by the American Electroencephalographic Society. 51 Interpretation of ancillary studies requires the expertise of appropriately trained and qualified individuals who understand the limitations of these studies to avoid any potential misinterpretation.…”

Section: Ancillary Studies (Recommendations 5a-e Table 1)mentioning

confidence: 99%

“…A waiting period of 24 hours is recommended before further ancillary testing, using a radionuclide CBF study, is performed allowing adequate clearance of Tc-99m. 49,50 While no evidence exists for a recommended waiting period between EEG studies, a waiting period of 24 hours is reasonable and recommended before repeating this ancillary study.…”

Section: Repeating Ancillary Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa¹,

Ashwal²,

Mathur³

et al. 2011

Pediatrics

183

120

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OBJECTIVE: To review and revise the 1987 pediatric brain death guidelines. METHODS: Relevant literature was reviewed. Recommendations were developed using the GRADE system. CONCLUSIONS AND RECOMMENDATIONS: (1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline.

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Section: Ancillary Studies (Recommendations 5a-e Table 1)mentioning

confidence: 99%

Section: Repeating Ancillary Studiesmentioning

confidence: 99%

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa¹,

Ashwal²,

Mathur³

et al. 2011

Pediatrics

183

120

View full text Add to dashboard Cite

show abstract

“…Radionuclide techniques do not require the withdrawal of medical therapy and are especially useful in the settings of hypothermia, drug overdose, shock, or an inconclusive physical examination (2,4). This study is often a critical and decisive step for the patient's family to give their consent to withdraw care and harvest organs.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, use of these radiopharmaceuticals makes dynamic imaging a noncritical step in image acquisition (2,4,5). Additionally, they allow for imaging with suboptimal patient positioning, which is often the case because of the presence of life support equipment.…”

Section: Discussionmentioning

confidence: 99%

The Role of Scintigraphy in Confirmation of Suspected Brain Death

Jolepalem

Balon

2013

Journal of Nuclear Medicine Technology

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We present a case illustrating how cerebral perfusion scintigraphy can be used to assist in crucial medical decision making in the intensive care setting for patients who are maintained on life support but are clinically suspected to have brain death. Cerebral perfusion scintigraphy can confirm brain death but cannot be used to diagnose it. 99m Tc-HMPAO and 99m Tc-ethylcysteinate dimer are the preferred imaging agents since they cross the blood-brain barrier. Thi s case report illustrates how cerebral perfusion scintigraphy can be used to assist in crucial medical decision making in the intensive care setting for patients who are maintained on life support but are clinically suspected to have brain death. The choice of radiotracers, imaging findings, and appropriate-use criteria will be discussed. The residents' familiarity with interpretation criteria is critical, as these studies may have to be performed at any time of the day or night, and usually in an emotionally stressful situation. CASE REPORTA 3-y-old girl with a history of congenital adrenal hyperplasia presented with status epilepticus, hypoglycemia, and acute respiratory failure requiring mechanical ventilation after she had been found unresponsive by her parents. CT scanning on admission (Fig. 1) showed diffuse cerebral edema and loss of gray matter-white matter differentiation. Subsequent brain MR perfusion imaging (Fig. 2) demonstrated decreased perfusion in the thalami and basal ganglia and diffusely decreased perfusion in the cerebral cortex. MR spectroscopy demonstrated diffusely decreased N-acetylaspartic acid, indicating decreased neuronal activity; elevation of choline, indicating increased cell turnover; and the presence of lactate, indicating hypoxia (1). These findings were compatible with hypoxic brain injury. Follow-up CT performed 2 d later demonstrated impending transtentorial herniation (Fig. 3). Despite several interventions, the patient eventually showed no brain stem reflexes and had an isoelectric electroencephalogram. A scintigraphic cerebral perfusion study was ordered to confirm brain death before preparing for organ donation and discontinuation of life support. SPECT images of the head were obtained 20 min after intravenous injection of 407 MBq (11 mCi) of 99m Tchexamethylpropyleneamine oxime (HMPAO). The images did not demonstrate any evidence of cerebral perfusion, whereas radiotracer activity was seen in the scalp, lacrimal glands, and salivary glands (Fig. 4). The patient was subsequently declared deceased.

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“…Reviews of the current medical literature periodically appear (13)(14)(15)(16), and updated guidelines have been issued by professional societies (17)(18)(19)(20)(21). Despite these resources, surveys have repeatedly shown that many physicians exhibit a poor understanding of the underlying concepts (22,23) and that even carefully formulated practice guidelines are inconsistently adopted (7,(24)(25)(26), indicating a persistent gap in knowledge and training (27,28).…”

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confidence: 99%

Radionuclide Evaluation of Brain Death in the Post-McMath Era

Zuckier

2016

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to (1) relate the diagnostic protocols and recommendations regarding the clinical diagnosis of brain death; (2) list the relative advantages and disadvantages of lipophilic and nonlipophilic blood flow radiopharmaceuticals for brain blood flow studies; and (3) consider how the nuclear medicine blood flow study could assist the clinician in making the difficult diagnosis of brain death.Financial Disclosure: The author of this article has indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through October 2019.The pronouncement of death is a determination of paramount social, legal, and ethical import. The novel construct of "brain death" was introduced 50 years ago, yet there persist gaps in understanding regarding this diagnosis on the part of medical caregivers and families. The tragic, much-publicized case of Jahi McMath typifies potential problems that can be encountered with this diagnosis and serves as an effective point of departure for discussion. This article recapitulates the historical development of brain death and the evolution of scintigraphic examinations as ancillary or confirmatory studies, emphasizing updated clinical and imaging practice guidelines and the current role of scintigraphy. The limitations of clinical and radionuclide studies are then reviewed. Finally, the article examines whether radionuclide examinations might be able to play an expanded role in the determination of brain death by improving accuracy and facilitating effective communication with family members.

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SNM Practice Guideline for Brain Death Scintigraphy 2.0

Cited by 60 publications

References 23 publications

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

The Role of Scintigraphy in Confirmation of Suspected Brain Death

Radionuclide Evaluation of Brain Death in the Post-McMath Era

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