Computed Tomography Angiography in the Diagnosis Of Brain Death: A Systematic Review and Meta-Analysis

Kramer, Andreas H.; Roberts, Derek J.

doi:10.1007/s12028-014-9997-4

Cited by 61 publications

(38 citation statements)

References 41 publications

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“…Sensitivity of our 4-point scale was close to the results of two recent meta-analyses (12,23). According to a meta-analysis of twelve studies involving 541 patients, the pooled sensitivity was 62% for venous phase and 84% for arterial phase, when complete lack of opacification of intracranial vessels was taken as the CT angiography criterion for brain death (23). Sensitivity was 85% (77%-93%) when the CT angiography criterion involved the lack of opacification of ICVs and distal MCA branches using the 4-point scale.…”

Section: Discussionsupporting

confidence: 86%

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Şahin¹,

Pekçevik²

2015

Diagn Interv Radiol

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Section: Discussionsupporting

confidence: 86%

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Şahin¹,

Pekçevik²

2015

Diagn Interv Radiol

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“…One of the advantages of CTP over more commonly used ancillary imaging test of CTA was the ability of CTP to demonstrate isolated brainstem death. While CTA is ubiquitously used and studied, [10][11][12][13][14]16,[19][20][21][22][23] it does not permit functional assessment of brainstem function. Radionuclide scan could, in principle, demonstrate the isolated brainstem death; however, the number of patients in our study was small and the poor spatial resolution of radionuclide scan could be a limitation.…”

Section: Discussionmentioning

confidence: 99%

The Role of Neuroimaging in the Determination of Brain Death

MacDonald

Stewart-Perrin

Shankar

2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSEBrain death determination (BDD) is primarily a clinical diagnosis, where death is defined as the permanent loss of brainstem function. In scenarios where clinical examinations are inaccurate, ancillary imaging tests are required. The choice of ancillary imaging test is variable, but the common denominator for all of them is to establish a lack of cerebral blood flow. The purpose of this study was to compare the diagnostic accuracy and interrater reliability of different ancillary imaging tests used for BDD.METHODSArchival data were retrospectively analyzed for all patients who underwent any ancillary imaging test for BDD at our institution. The results of ancillary imaging tests were compared with, the reference standard, the clinical checklist for declaration of brain death. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different ancillary imaging tests for BDD were performed. Interobserver agreement between two observers was measured using kappa statistics for each of the imaging modalities.RESULTSA total of 74 patients underwent 41 computer tomography perfusion (CTP), 54 CT angiogram, 15 radionuclide scans, 1 cerebral angiogram, 3 magnetic resonance imaging, and 71 nonenhanced CT (NECT) head for BDD. All ancillary tests (except NECT head) showed 100% specificity and PPV. CTP had the highest sensitivity and NPV. All ancillary imaging tests demonstrated very high interrater reliability.CONCLUSIONSThe uses of ancillary imaging tests for BDD are increasing. Within this study's limitations, CTP followed by radionuclide scan were found to be the most accurate and reliable ancillary imaging test for BDD.

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“…6). 68,69 Enhancement of more distal arterial branches is less common and opacification of the great cerebral or internal cerebral veins almost never occurs. It is likely that complete cessation of intracranial contrast opacification is a relatively late phenomenon in what should be regarded as a progressive process (►Fig.…”

Section: Ct Angiographymentioning

confidence: 99%

Ancillary Testing in Brain Death

Kramer

2015

Semin Neurol

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Despite worldwide acceptance of the concept of brain death, there is marked variability in the use of ancillary testing. In most countries, ancillary tests are used primarily when confounding factors interfere with reliable completion of a clinical assessment, or physiologic instability precludes performance of an apnea test. Alternatively, in some countries, confirmatory ancillary tests are routinely required before brain death can be diagnosed. Ancillary tests assess brain function (e.g., electroencephalography) or blood flow (e.g., cerebral angiography). Evaluation of blood flow is affected less by confounding clinical factors and is now preferred in most jurisdictions. With angiographic techniques, a significant proportion of patients meeting clinical criteria for brain death have some opacification of proximal intracranial arteries. Consequently, the sensitivity of angiography is strongly influenced by the particular criteria that are used to define intracranial circulatory arrest. Lack of enhancement of the great cerebral and internal cerebral veins has the highest sensitivity. Worldwide experience with newer tests, such as computed tomography and magnetic resonance angiography, is growing. Radionuclide imaging has the advantage of not requiring use of potentially nephrotoxic contrast material. Transcranial Doppler ultrasonography can be brought to the bedside to demonstrate lack of brain blood flow. The specificity of imaging techniques in the detection of intracranial circulatory arrest has not been as well studied as their sensitivity.

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Computed Tomography Angiography in the Diagnosis Of Brain Death: A Systematic Review and Meta-Analysis

Cited by 61 publications

References 41 publications

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

The Role of Neuroimaging in the Determination of Brain Death

Ancillary Testing in Brain Death

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