The role of spiral CT for the assessment of the intracranial circulation in suspected brain-death

CT Angiography for Brain Death Diagnosis

“…One had an opacified cortical artery, but no venous return was noted. Leclerc et al 12 found similar results; and on the basis of their data, the sensitivity of the 4-point CTA score would have been 93.3%. Together with the present findings, this suggests that the absence of ICVs and bilateral cortical branches of the MCAs constitutes the best criterion of BD diagnosis by using CTA.…”

“…Whereas the cortical segments of the MCAs were assessable in all previous studies, 11,12 the excluded cerebral veins were deemed difficult to assess because of cerebral hemorrhage or edema. Strict comparison of unenhanced and enhanced images, additional sagittal and axial subtractions, is helpful for confirming lack of opacification.…”

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

“…Dupas (8,(16)(17)(18). Recently, Welschehold et al (19,20) proposed that analysis of arterial vasculature should be carried out in the arterial scanning phase and that of deep venous system in the venous phase, as employed in our study.…”

“…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).…”

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 …”