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Computed tomographic angiography as a useful adjunct in the diagnosis of brain death

Welschehold, Stefan MD, MA; Kerz, Thomas MD; Boor, Stephan MD; Reuland, Katharina; Thömke, Frank MD, PhD; Reuland, Andre MD; Beyer, Christian MD; Tschan, Christoph MD, PhD; Wagner, Wolfgang MD, PhD; Müller-Forell, Wibke MD, PhD; Giese, Alf MD, PhD

Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0b013e31828c46ba
Original Articles
Abstract

BACKGROUND: Because of its widespread accessibly, computed tomographic angiography (CT-A) is a promising technique in the detection of intracranial circulatory arrest in brain death (BD). Several studies assessed this tool, but neither have standardized evaluation parameters been developed nor has information about specificity become available.

METHODS: We conducted a prospective study between January 2008 and April 2012. Thirty patients were admitted to our University Hospital (16 men and 14 women; age, 18–88 years) and underwent CT-A scanning at two occasions: immediately after the first signs of loss of brain stem reflexes and after definitive determination of brain. The results of CT-A were compared with transcranial Doppler ultrasonography and electroencephalogram.

RESULTS: In 3 of 30 patients, we observed a termination of contrast flow at the level of the skull base and foramen magnum in arterial scanning series before the clinical determination of BD. After the clinical determination of BD, the opacification of all vascular territories in arterial phase scanning was found in one case, but venous phase scanning revealed no blood return in internal cerebral veins. In all other cases, contrast filling ceased at level of skull base or below. The specificity of CT-A in the detection of intracranial circulatory arrest was 90%, and sensitivity was 97%.

CONCLUSION: CT-A is reliable and appropriate technical investigation to detect intracranial circulatory arrest in BD. The evaluation of contrast enhancement in arterial phase scanning seems to be more reliable than that in venous phase. An international consensus about a uniformly applied CT-A protocol for the evaluation of BD should be established.

LEVEL OF EVIDENCE: Diagnostic study, level V.

Author Information

From the Department of Neurosurgery (S.W, T.K., K.R., A.R., C.B., C.T., W.W., A.G.), Institute of Neuroradiology (S.B., W.M-F.), Department of Neurology(F.T.), Mainz; Department of Neurosurgery (C.T.), University Hospital Homburg/Saar, Homburg/Saar; and Department of Neurotraumatology and Neurosurgery(S.W., A.R.), Asklepios Hospital Weißenfels, Weißenfels, Germany.

Submitted: November 23, 2012; Revised: December 29, 2012; Accepted: January 2, 2013.

Address for reprints: Stefan Welschehold, MD, MA, Department of Neurotraumatologyand Neurosurgery, Asklepios Hospital Weißenfels, Naumburger Str. 76, 06667 Weißenfels, Germany; email: s.welschehold@asklepios.com.

© 2013 Lippincott Williams & Wilkins, Inc.