P.088 Computed tomography angiography for diagnosis of brain death; a technical review

Abstract

Background: Brain death is defined as an irreversible cessation of all brain activity. Ancillary tests are an objective way to support an initial diagnosis of brain death. Computed tomography angiography (CTA) is an imaging modality utilized as an ancillary mean to assist clinicians with such diagnosis. Different criteria and scoring systems have been proposed, however clear criteria are yet to be recognized to demonstrate full brain circulatory arrest. We aim to discuss different scoring systems presented in the literature and make evidence-based recommendations. Methods: A literature search using titles and key terms was conducted for articles containing brain death ancillary testing diagnosis, and CTA as primary focus. Results: CTA has the benefits of being non-invasive, fast, readily and widely available and it is especially useful in unstable patients. It is essential, however, to confirm intravascular injection of contrast injection by checking opacification of External Carotid Artery branches on CTA to prevent false diagnoses. Conclusions: When faced with the challenging decision to declare brain death in a patient, radiologists often face great apprehension and concern for the large responsibility bestowed upon them. It is critical for radiologist to understand that the final diagnosis of brain death is based on clinical criteria.