Abstract

BackgroundComputed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death.MethodsA preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score.ResultsThe revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score.ConclusionCompared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.

Highlights

  • Computed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death

  • The aim of this study was to assess the diagnostic performance of a revised four-point brain death computed tomography angiography (CTA) score that relies on the non-opacification of both the internal cerebral vein (ICV) and infratentorial superior petrosal vein (SPV) compared with the previous reference CTA score

  • A second CTA was performed six hours after the first for seven of the 76 included patients because the first CTA did not confirm brain death according to the reference four-point CTA score

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Summary

Introduction

Computed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. Most of them explore only cortex, notably computed tomography angiography (CTA) when used as preconized. This is a critical issue when clinical diagnosis is uncertain [4, 5]. The first type analyses brain functions and includes EEG, auditory-evoked potentials, and somatosensory-evoked potentials. These tests present the same limitations as clinical examinations in cases of drug impregnation or hypothermia [6]. The tools required to perform and analyse cerebral functions are limited to the largest centres [7]

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