Diagnostic Value of Computed Tomography Angiography in Confirmation of Brain Death

Abstract

Accurate and on-time confirmation of brain death (BD) is necessary to prevent unnecessary treatments and allow for well-timed organ harvesting for transplantation. While clinical criteria for BD are legally reliable in some countries, others may prefer complementary ancillary tests to assess the brain's electrical activity and/or blood circulation. This study aims to define the sensitivity and specificity of CT-Angiography based on four-, seven-, and ten-score tests compared to the clinical criteria and electroencephalography in patients with BD. A total of 32 patients with a confirmed diagnosis of BD according to their clinical criteria (cases) along with 18 patients with GCS=3 and absent brain stem and papillary reflexes who had spontaneous respiration (controls), all with blood pressure > 90 mmHg, diuresis > 100 ml/h, and CVP > 6-8 mmHg, underwent CT-angiography. The 4-, 6-, and 10-score criteria were used according to the opacity/lack of opacity of the brain vessels in CTA evaluation scales for the diagnosis of BD. The two groups were homogeneous in terms of age, gender distribution, and the etiology of coma. All patients in the control group received zero in 4-, 7-, and 10-scores; while, the average values for 4-score, 7-score, and 10-score in patients with confirmed BD were 3.75±0.67, 6.4±1.36, and 9.06±2.2, respectively. Of patients with BD, 28 (87.5%), 26 (81.25%), and 25 (78.12%) received full 4-, full 7-, and full 10-scores. The sensitivity and specificity as well as negative and positive predictive values for all three scores were found to be 100%. Also, the sensitivities for various cerebral vessels were as: ICV: 100%, GCV: 96.9%, P2: 90.6%, M4: 87.5%, BA: 84.4%, and A3: 84.4%. Also, the specificity of lack of opacification in all these vessels for the diagnosis of BD was 100%. According to our findings, the CTA-based four-point scoring system with 100% specificity can be used along with clinical examinations to confirm BD.