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Comparison of early- and late-phase CT angiography findings in brain death

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Abstract

Background

Late-phase images on computed tomography angiography (CTA), traditionally used for assessing cerebral circulatory arrest in brain death, suffer from suboptimal diagnostic yield due to stasis filling. Herein, we assessed contrast filling in individual intracranial arteries and veins in the early and late phases of CTA in patients with clinically confirmed brain death.

Methods

Contrast opacification within 28 arterial/venous segments was evaluated in both phases of CTA in 79 patients. This information was combined with reports in the literature to calculate prevalence of contrast filling in different intracranial vessels. Additionally, diagnostic sensitivity of 4-point, 7-point, and 10-point scores defined for brain death were compared among ratings based on early, late, and both phases (arteries rated on early, veins rated on late phase) of imaging.

Results

The median (IQR) number of vessel segments with contrast opacification was 0 (0–2) in early phase and 6 (0–10) in late phase. All segments showed increased prevalence of opacification when evaluated in late phase (p < 0.05). The M4 segments of MCA, internal cerebral veins, and vein of Galen had the lowest percentage of opacification in both phases. The sensitivity of 4-, 7-, and 10-point scoring algorithms increased from 59–91% to 94–99% when ratings were performed using early-phase images rather than based solely on late-phase images.

Conclusions

The incorporation of early-phase images might be considered as a strategy to improve the sensitivity of CTA as an ancillary test in confirming brain death, especially in patients without missing or questionable elements in clinical examination.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ethem Murat Arsava, Cansu Ayvacioglu Cagan & Mehmet Akif Topcuoglu

  2. Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ekim Gumeler, Safak Parlak & Kader Karli Oguz

Authors
  1. Ethem Murat Arsava
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  2. Cansu Ayvacioglu Cagan
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  3. Ekim Gumeler
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  4. Safak Parlak
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  5. Kader Karli Oguz
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  6. Mehmet Akif Topcuoglu
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Corresponding author

Correspondence to Ethem Murat Arsava.

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Conflicts of interest

EMA receives honoraria from Fresenius Kabi, Bayer AG, Daiichi-Sankyo, Pfizer, Sanofi, Abbott, and Nutricia. He serves on the advisory boards of Abbott, Daiichi-Sankyo, Bayer AG, Pfizer, Fresenius Kabi, and Nutricia. MAT receives honoraria from Fresenius Kabi, Daiichi-Sankyo, Sanofi, and Abbott. He serves on the advisory boards for Abbott, Fresenius Kabi, Daiichi-Sankyo, and Pfizer. CAC, EG, SP, and KKO report no conflicts of interest.

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Arsava, E.M., Ayvacioglu Cagan, C., Gumeler, E. et al. Comparison of early- and late-phase CT angiography findings in brain death. J Neurol 269, 5973–5980 (2022). https://doi.org/10.1007/s00415-022-11281-x

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  • DOI: https://doi.org/10.1007/s00415-022-11281-x

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