CT Perfusion for Confirmation of Brain Death

Abstract

SUMMARY:For pronouncing brain death, unlike CTP, the 2-phase CTA gives no functional information and is limited by inadvertent delay of the second acquisition, which may give false-negative results. The purpose of our study was to compare CTP and CTA derived from the CTP data with the Dupas and Frampas criteria for confirmation of brain death. A retrospective review of CTP in 11 consecutive patients for confirmation of brain death showed a sensitivity of 72.7% for 7-and 4-point scores, 81.8% for opacification of the ICV, and 100% for CTP scores in the brain stem. CTA obtained from the CTP data showed similar sensitivity in the diagnosis of brain death. This protocol also reduces the iodinated contrast dose and is less operator-dependent. The addition of the functional tools of CTP increased the sensitivity of CTA in the confirmation of brain death. ABBREVIATIONS:ACA ϭ anterior cerebral artery; ICU ϭ intensive care unit; ICV ϭ internal cerebral vein; STA ϭ superficial temporal artery; VOG ϭ great cerebral

Cerebral perfusion measurement in brain death with intravoxel incoherent motion imaging

“…The demonstration of a lack of cerebral circulation can be used as a marker of cerebral death, in addition to neurologic examination. Although cerebral angiography is considered the standard method, CT-angiography [7] and CT perfusion [2] have also been proposed. IVIM might be of additional interest, because it generates essentially local perfusion maps of microvascular origin, (i.e.…”

“…Nevertheless, additional non-invasive quantitative methods to assess brain tissue viability are of interest, in particular in critically ill patients under anesthesia, in whom clinical assessment is difficult. In this context, perfusion imaging is of particular interest [2].…”

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

“…Following the introduction of (22) reported the sensitivity of CT perfusion and CT angiography as 72.7% for 7-and 4-point scales. In our study, the sensitivity of 7-and 4-point scales was determined as 64% and 88%, respectively, which is slightly higher than the sensitivity rates of Frampas et The strength of agreement is worse than expected by chance alone.…”

Pitfalls in vascular imaging when brain death is suspected: multiparametric multidetector computed tomography as a complementary diagnostic tool

“…However, delayed, weak and persistent opacification of the proximal segments of the cerebral arteries, termed "stasis filling," indicates the inability to perform brain perfusion and should be recognized as an important pitfall when computed tomography angiography (CTA) is analyzed 2,3 . Computed tomography perfusion (CTP) is reliable in demonstrating the absence of brain perfusion and thereby confirming severe hemodynamic arrest 4,5 (Figure). The second acquisition showed "stasis filling" (arrowheads) of enhanced proximal cerebral arteries (B).…”