Brain Death: Confirmation by Radionuclide Cerebral Angiography

Detection of intracranial circulatory arrest in brain death using cranial CT‐angiography

“…On the contrary, evaluation of opacification in the sagittal or transverse sinus was insensitive to confirm BD. We observed residual opacification of the SSS in 43 of our 63 patients, but residual opacification in the superficial veins in BD has also been confirmed by scintigraphy techniques [25][26][27][28], by conventional angiographic [29] and CT-A studies [30] as a phenomenon which may obscure the examination. These findings can sufficiently be explained as scalp blood flow of external carotid artery via bridging veins into the sagittal sinus, which does not contradict the diagnosis of BD [26,31].…”

Confirmatory tests in the diagnosis of brain death: Comparison between SPECT and contrast angiography

“…It is fast, safe, noninvasive, widely available, and easy to do at the patient's bedside with a portable ␥-camera. However, studies performed with intravascular tracers, such as Tc-pertechnetate or Tc-albumin (4,(25)(26)(27), may yield doubtful results, mainly when the absence of intracranial arterial flow is associated with activity in the sagittal sinus: even though this pattern is not incompatible with BD (28), it gives rise to some uncertainty. Furthermore, dynamic radionuclide cerebral angiography cannot image the posterior fossa well, and its capability of checking low-flow states is poor (29), sometimes leading to equivocal results (30), with a reported falsepositive rate of 0.4% (4,26).…”

Determination of Death by Neurological Criteria

“…As with the cerebral angiogram, it is a positive test that confirms the diagnosis of brain death by demonstrating failure of uptake in the brain consistent with absent cerebral perfusion. Unlike other tests such as EEG, it is rarely equivocal, and coma and medications such as the barbiturates phenobarbital and thiopental do not alter the scintigraphic findings [29][30][31][32][33]. The procedure involves an intravenous injection of a radiopharmaceutical agent and brain imaging to evaluate brain perfusion.…”