Computed Tomography Perfusion is a\xa0Useful Adjunct to Computed Tomography Angiography in the Diagnosis of Brain Death

M Sawicki,J Walecki,J Sołek-Pastuszka,A Walecka,K Chamier-Ciemińska,R Bohatyrewicz

doi:10.1007/s00062-017-0631-7

Abstract

BackgroundIn the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. Because cerebral circulatory arrest commences at the capillary level, we hypothesized that computed tomography perfusion (CTP) would be a more sensitive approach than CTA; therefore, the aim of the study was to compare the sensitivities of CTP and CTA in the diagnosis of BD.Material and MethodsWhole brain CTP was performed in patients in the intensive care unit diagnosed with BD and CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. The CTP findings were interpreted as being consistent with a diagnosis of BD (positive) when CBF and CBV in all regions of interest (ROIs) were below 10 ml/100 g/min and 1.0 ml/100 g, respectively. The CTA findings were interpreted using a 4-point grading system.ResultsA total of 50 patients were included in the study. The CTP results revealed CBF from 0.00 to 9.98 ml/100 g/min (mean, 1.98 ± 1.68 ml/100 g/min) and CBV from 0.00 to 0.99 ml/100 g (mean, 0.14 ± 0.12 ml/100 g) and were thus interpreted as positive in all 50 patients. In contrast, the CTA results suggested 7 negative cases, providing a sensitivity of 86%. The difference between the CTP and CTA sensitivity results for the diagnosis of BD was statistically significant (p = 0.006).ConclusionWhole brain CTP may potentially be a feasible and highly sensitive test for diagnosing BD: therefore, performing CTP in combination with CTA in cases when CTA results are negative for BD could increase the sensitivity of CTA.

Highlights

In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion
Brain death (BD) diagnosis first relies on a clinical examination and the study of brainstem function [1]; there are some situations in which clinical examinations are unreliable or cannot be completed because of confounding factors (e. g. neurodepressive agents, metabolic disorder, facial or brainstem damage, infants and children)
Because cerebral circulatory arrest commences at the capillary level, we hypothesized that the addition of whole brain computed tomography perfusion (CTP) to the commonly used CTA approach would reduce the frequency of negative findings obtained using CTA alone, increasing the sensitivity of the test for the confirmation of BD

Summary

Introduction

In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. In recent years computed tomography angiography (CTA) became the most commonly used ancillary test for the determination of BD; radiologists sometimes become confused when interpreting CTA findings about whether to confirm or reject a diagnosis of BD in deeply comatose patients with areflexia. This diagnostic confusion is caused by the preserved filling of the cortical branches K

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