Neurocritical Care

, Volume 11, Issue 2, pp 261–271

Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

Authors

    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Jesús Otero
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Lara Marqués
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Diego Parra
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • José Antonio Gonzalo
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Guillermo M. Albaiceta
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Luis Cofiño
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Armando Blanco
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
  • Pedro Vega
    • Neuroradiology Section, Radiology UnitHospital Universitario Central de Asturias
  • Eduardo Murias
    • Neuroradiology Section, Radiology UnitHospital Universitario Central de Asturias
  • Ángela Meilan
    • Neuroradiology Section, Radiology UnitHospital Universitario Central de Asturias
  • Ricardo López Roger
    • Neuroradiology Section, Radiology UnitHospital Universitario Central de Asturias
  • Francisco Taboada
    • Department of Intensive Care MedicineHospital Universitario Central de Asturias
Original Article

DOI: 10.1007/s12028-009-9243-7

Cite this article as:
Escudero, D., Otero, J., Marqués, L. et al. Neurocrit Care (2009) 11: 261. doi:10.1007/s12028-009-9243-7

Abstract

Introduction

Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD.

Methods

Prospective observational study in 27 BD patients.

Results

All patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead.

Conclusions

The radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography.

Keywords

Brain deathCerebral circulatory arrestCerebral computed tomographic angiographyCerebral computed perfusionOrgan donor

Abbreviations

BAEP

Brainstem auditory-evoked potentials

BD

Brain death

BH

Brain hemorrhage

CBF

Cerebral blood flow

CBV

Cerebral blood volume

CTA

Computed tomographic angiography

CTP

Computed tomography perfusion

EEG

Electroencephalogram

GCS

Glasgow coma scale

ICP

Intracranial pressure

MCA

Middle cerebral artery

MIP

Maximum intensity projection

MTT

Mean transit time

ROI

Region of interest

SAH

Subarachnoid hemorrhage

SEP

Somatosensory-evoked potentials

SLST

Superior longitudinal sinus thrombosis

TBI

Traumatic brain injury

TCD

Transcranial Doppler ultrasonography

Tc99-HMPAO

Tecnecium 99-hexamethylpropylene amine oxime

VR

Volume rendering

Copyright information

© Humana Press Inc. 2009