Perfusion Brain Death Scintigraphy in Traumatic and Hypoxic Cerebral Insults: Correlation With CT

Kim, Andrew Chae MD; Colletti, Patrick M. MD

doi: 10.1097/RLU.0b013e318262c799
Interesting Images

Abstract: In the United States, approximately 1.7 million patients are treated annually for traumatic brain injury, and cerebrovascular insults are the third leading cause of death. Although CT plays a central role in the initial assessment of suspected intracranial injury, planar brain scintigraphy provides valuable information regarding cerebral perfusion, function, and brain death. An understanding of the complexity of injuries is helpful in scintigraphic image interpretation. To illustrate potential scintigraphic confounders, we present 8 suspected brain death cases with correlative CT. Even with negative brain death studies, severe brain injury by CT portends grave outcomes.

From the Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA.

Received for publication April 9, 2012; revision accepted May 30, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Andrew Chae Kim, MD, Department of Radiology, University of Southern California, D+T Room 3D321, Los Angeles, CA 90033. E-mail:

Article Outline
Back to Top | Article Outline


1. Hijaz TA, Cento EA, Walker MT. Imaging of head trauma. Radiol Clin North Am. 2011; 49: 81–103.
2. Mettler FA, Guiberteau MJ. Essentials of Nuclear Medicine Imaging. Philadelphia, PA: Saunders Elsevier; 2006: 54–57.
3. Zuckier LS, Kolano J. Radionuclide studies in the determination of brain death: criteria, concepts, and controversies. Semin Nucl Med. 2008; 38: 262–273.
4. van Dyck CH, Lin CH, Smith EO, et al.. Comparison of technetium-99m-HMPAO and technetium-99m-ECD cerebral SPECT images in Alzheimer’s disease. J Nucl Med. 1996; 37: 1749–1755.
5. Han BK, Towbin RB, De Courten-Myers G, et al.. Reversal sign on CT: effect of anoxic-ischemic cerebral injury in children. AJR Am J Roentgenol. 1990; 154: 361–368.
6. Wijdicks E. The diagnosis of brain death. N Engl J Med. 2001; 344: 1215–1221.
7. Conrad GR, Sinha P. Scintigraphy as a confirmatory test of brain death. Semin Nucl Med. 2003; 33: 312–323.
8. Huang AH. The hot nose sign. Radiology. 2005; 235: 216–217.
9. Mishkin FS, Dyken ML. Increased early radionuclide activity in the nasopharyngeal area in patients with internal carotid artery obstruction: “hot nose.” Radiology. 1970; 96: 77–80.
10. Appelt EA, Song WS, Phillips WT, et al.. The hot nose sign on brain death nuclear scintigraphy: where does the flow really go? Clin Nucl Med. 2008; 22: 55–57.

brain death; cerebral perfusion; cerebral trauma; cerebral hypoxia; hot nose sign; CT

© 2012 Lippincott Williams & Wilkins, Inc.