Intensive Care Medicine

, Volume 33, Issue 12, pp 2129–2135 | Cite as

Limitations of computed tomographic angiography in the diagnosis of brain death

  • Christophe Quesnel
  • Jean-Pierre Fulgencio
  • Christophe Adrie
  • Béatrice Marro
  • Laurent Payen
  • Nadège Lembert
  • Sonia El Metaoua
  • Francis Bonnet
Original

Abstract

Objective

To evaluate the accuracy of cerebral computed tomographic angiography (CT-a) for the diagnosis of brain death (BD).

Design and setting

Prospective observational study in intensive care units.

Patients

Twenty-one clinically BD patients enrolled over 12 months.

Measurements and results

All clinically BD patients were evaluated by electroencephalography (EEG) and CT-a after exclusion of hypothermia and drug intoxication. Data collected included: demographic characteristics, cause of BD, delay between in-hospital admission and BD diagnosis and between EEG and CT-a, occurrence of cardiac arrest, administration of vasoactive agents, results of EEG and CT-a. We evaluated the sensitivity of EEG and CT-a and their agreement. Groups were compared according to BD diagnosis by EEG and CT-a (E+C+), or only by EEG (E+C). Statistical analysis were performed by Mann–Whitney test and Fisher's exact test. BD was confirmed by EEG in all cases (sensitivity 100%) whereas only 11 patients of 21 had no cerebral perfusion during CT-a (sensitivity 52.4%). No agreement was documented between EEG and CT-a for the diagnosis of BD (κ = 0). Patients' characteristics did not differ between E+C+ and E+C groups. In the E+C group arterial opacification was observed in 100% of patients, but opacification of the internal cerebral veins was achieved in only 30%.

Conclusions

In clinically BD patients with no electroencephalographic activity CT-a documents opacification of the intracerebral vessels in a significant percentage of the cases. Therefore CT-a cannot be recommended as a means of BD diagnosis.

Keywords

Brain death Cerebral computed tomographic angiography Electroencephalography Organ procurement 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Christophe Quesnel
    • 1
  • Jean-Pierre Fulgencio
    • 1
  • Christophe Adrie
    • 2
  • Béatrice Marro
    • 3
  • Laurent Payen
    • 4
  • Nadège Lembert
    • 1
  • Sonia El Metaoua
    • 1
  • Francis Bonnet
    • 1
  1. 1.Service d’Anesthésie-RéanimationUniversité Pierre & Marie Curie, Hôpital Tenon, Assistance Publique-Hôpitaux de ParisParis Cedex 20France
  2. 2.Service de Réanimation PolyvalenteHôpital DelafontaineSt. DenisFrance
  3. 3.Service de Radiologie, Hôpital TenonAssistance Publique-Hôpitaux de ParisParis Cedex 20France
  4. 4.Service de RadiologieHôpital DelafontaineSt-DenisFrance

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