Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography

Abstract

Diagnostic study, level II.

Computed tomography angiography as a confirmatory test for the diagnosis of brain death

“…13 Because tests of cerebral perfusion such as CTA are actually tests of cerebral circulatory arrest, these are the most appropriate tests to use when attempting to clarify an ambiguous diagnosis of BD, as they tend to have the smallest falsepositive rates. 2,14,18 Our data support these claims, as CTA maintained a specificity of 100% and a sensitivity of 75% in our test population. Test sensitivity in this context refers to the number of patients who meet the gold-standard criteria for BD but have CTA findings that do not meet the stated criteria for BD (opacification above the level of the petrous ICAs, intradural VAs, or ICVs).…”

“…9,15 Furthermore, the statistical performance of CTA reported in the literature is similar to that of EEG and TCD, 2 AAN-approved ancillary tests. 2,9,14,15,18 Numerous radiological criteria exist for interpreting CTA results in patients suspected of being brain dead, with widely varying sensitivities resulting from how many and which vessels are included in a given criteria. In 2009, Frampas et al 6 compared the standard French 7-vessel criteria (nonopacification of pericallosal and cortical segments of the MCAs, ICVs, and great cerebral vein) with a 4-vessel criteria (nonopacification of cortical segments of MCAs and ICVs) and found that, by using the 4-vessel criteria, sensitivity was improved from 62.8% to 85.7% while maintaining a specificity of 100%.…”

“…In 2009, Frampas et al 6 compared the standard French 7-vessel criteria (nonopacification of pericallosal and cortical segments of the MCAs, ICVs, and great cerebral vein) with a 4-vessel criteria (nonopacification of cortical segments of MCAs and ICVs) and found that, by using the 4-vessel criteria, sensitivity was improved from 62.8% to 85.7% while maintaining a specificity of 100%. Furthermore, Suarez-Kelly et al 14 found that performing quantitative analysis of vessel opacity on CTA could increase the sensitivity of CTA to 97% while maintaining 100% specificity. Other authors have attempted to further elucidate the sensitivity and specificity of CTA by comparing it to TCD and EEG.…”

“…Multiple studies have attempted to show the reliability of CTA in demonstrating a lack of intracranial blood flow in the brain-dead patient. [1][2][3][5][6][7][8][9][10][12][13][14][15][17][18][19] However, these studies are highly heterogeneous in terms of the comparison studies they use as gold standards; some appropriately use clinical criteria alone, whereas others use a combination of clinical criteria and any one or a combination of the AAN-recommended ancillary tests. The use of ancillary tests other than CA as gold standards to compare with CTA is problematic, as many of these studies have a statistical performance similar to that of CTA.…”

CT-Angiographie zum Nachweis des zerebralen Zirkulationsstillstandes: Aktualisierung der Kriterien

“…Suarez-Kelly et al. [ 8 ] hatten als Studienergebnis mitgeteilt, dass ein intraarterieller Schwellenwert von 80 Hounsfield Units (HU) für die Unterscheidung von erhaltener Hirndurchblutung und sistierender zerebraler Zirkulation (Stasis filling) geeignet sei. Ein in dieser Größenordnung gelegener Schwellenwert war auch von Welschehold et al.…”