Abstract
Diagnosis of brain death is made on the basis of 3 essential findings: coma, absence of brain stem reflexes, and apnea. Although confirmatory tests are not mandatory in most situations, additional testing may be necessary to declare brain death in patients in whom results of specific components of clinical testing cannot be reliably evaluated. Recently, arterial spin-labeling has been incorporated as part of MR imaging to evaluate cerebral perfusion. Advantages of arterial spin-labeling include being completely noninvasive and providing information about absolute CBF. We retrospectively reviewed arterial spin-labeling findings according to the following modified criteria based on previously established confirmatory tests to determine brain death: 1) extremely decreased perfusion in the whole brain, 2) bright vessel signal intensity around the entry of the carotid artery to the skull, 3) patent external carotid circulation, and 4) "hollow skull sign" in a series of 5 patients. Arterial spin-labeling findings satisfied the criteria for brain death in all patients. Arterial spin-labeling imaging has the potential to be a completely noninvasive confirmatory test to provide additional information to assist in the diagnosis of brain death.
Highlights
Even though the patients were already diagnosed as being brain dead by clinical criteria, the physicians requested MR imaging to determine the irreversible cause of coma and to evaluate the features of brain parenchyma, intracranial arteries, and perfusion
After reviewing our radiology data base from June 2010 to April 2014, we identified 5 patients with clinically diagnosed brain death who underwent Arterial spin-labeling (ASL) MR imaging
The ASL findings used to assess the absence of intracranial blood flow were the following: 1) extremely decreased perfusion in the whole brain, 2) bright vessel signal intensity around the entry of the carotid artery to the skull suggesting flow stagnation, and 3) patent external carotid circulation corresponding to the findings of brain death on conventional angiography.[3]
Summary
Even though the patients were already diagnosed as being brain dead by clinical criteria, the physicians requested MR imaging to determine the irreversible cause of coma and to evaluate the features of brain parenchyma, intracranial arteries, and perfusion. After reviewing our radiology data base from June 2010 to April 2014, we identified 5 patients with clinically diagnosed brain death who underwent ASL MR imaging.
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