Abstract
It is significantly important to define brain death with greater precision in terms of timing and accuracy. While in the past determination of brain death is simply based on conventional angiography, now with major technological advances the Diffusion-weighted MRI is a new method sensitive to cerebral ischemia which gives on the molecular level the deeply ischemic nature of the changes. Its value in brain death has been shown in various studies. In our study, we did a comparative overview of diffusion-weighted imaging (DWI) with and magnetic resonance angiography (MRA) considering the contribution of ADC measurements from brain parenchyma, in the patients diagnosed with brain death by clinical criteria. We studied 16 brain deaths in serial studies, in which there is a prominent difference between the white and gray matter ADC values on diffusion MRI. In the postmortem brains, ADC values comparing with the normal brain parenchyma, were reduced 65% in white matter and 42% in gray matter. Also, the patients’ ADC values of gray and white matter were significantly lower than those of irreversible brain-ischemia patients’ in ADC values. In comparison to most of the other studies, in our study population studied is large, in which is a comprehensive study that results consistent with the literature. As a result we propose that in the definition of brain death Diffusion MRI and ADC measurements are reliable to show diffuse ishemic changes of brain parenchyma.
Highlights
It even takes places in the old writings that the brain is the first organ that will lose its viability after the death
Apparent diffusion coefficient (ADC) values in the normal brain parenchyma were calculated in ten patients who were examined with cranial MRI for various reason without any known neural parenchymal pathology
MRI imaging of the brain performed in patients with clinical suspicion of the brain death within 3 - 24 hours after apnea test was done
Summary
It even takes places in the old writings that the brain is the first organ that will lose its viability after the death. With increasing demand of solid-organ transplantations, brain death criteria was established. Pathophysiological changes that leads irreversible loss of functioning of the whole brain is accepted as the sole criterion of brain death. Since 1968, a brain-based definition of death was proposed by Harvard Medical School and named as Harvard criteria [1] that became widely accepted. Various studies have been undertaken to determine which distinct signs are needed to call “brain death” on the basis of both clinical and confirmatory tests. Supportive testing is not required to help diagnosis in situations in which the clinical determination is inadequate. Today it is used to the diagnosis of brain death quicker
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