Intensive Care Medicine

, 24:911

99mTc-HMPAO SPECT in the diagnosis of brain death

  • E. Facco
  • P. Zucchetta
  • M. Munari
  • F. Baratto
  • A. U. Behr
  • M. Gregianin
  • A. Gerunda
  • F. Bui
  • M. Saladini
  • G. Giron
Original

DOI: 10.1007/s001340050689

Cite this article as:
Facco, E., Zucchetta, P., Munari, M. et al. Intensive Care Med (1998) 24: 911. doi:10.1007/s001340050689

Abstract

Objective

To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD).

Design

Prospective study in comatose and brain-dead patients.

Setting

Neurologic ICU.

Patients and methods

Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD.

]Interventions

Brain SPECT following i.v. injection of 99mTc-HMPAO (300–1100 MBq), using a 4-headed gamma-camera (20 min, 360 °, 88 images).

Measurements and results

All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7 %), clearly showing the arrest of brain perfusion (picture of “empty skull”); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later.

Conclusions

Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.

Key words

Brain deathSPECTCerebrovascular circulationBrain injuriesEEG

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • E. Facco
    • 1
  • P. Zucchetta
    • 2
  • M. Munari
    • 1
  • F. Baratto
    • 1
  • A. U. Behr
    • 1
  • M. Gregianin
    • 2
  • A. Gerunda
    • 1
  • F. Bui
    • 2
  • M. Saladini
    • 3
  • G. Giron
    • 1
  1. 1.Lab. Neurophysiology - Neuro ICU, Dept. of Anesthesiology and Intensive CareUniversity of PaduaPadovaItaly
  2. 2.Nuclear Medicine Service IUniversity of PaduaPadovaItaly
  3. 3.Dept. of NeurologyUniversity of PaduaPadovaItaly