Measuring brain perfusion by CT or MR as ancillary tests for diagnosis of brain death: a systematic review and meta-analysis.
| Autor: | Ramos JN; Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental, Lisboa, 1349-019, Portugal.; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, United Kingdom., Pinto C; Department of Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, 4050-342, Portugal., Cruz E Silva V; Medical Image Analysis Center (MIAC AG), Basel, 4051, Switzerland., Topriceanu CC; Institute of Cardiovascular Science, University College London, London, WC1E 6DD, United Kingdom.; Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom., Bisdas S; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, United Kingdom.; Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom. |
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| Jazyk: | angličtina |
| Zdroj: | BJR open [BJR Open] 2024 Nov 04; Vol. 6 (1), pp. tzae037. Date of Electronic Publication: 2024 Nov 04 (Print Publication: 2024). |
| DOI: | 10.1093/bjro/tzae037 |
| Abstrakt: | Objectives: To gather and synthesize evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis. Methods: A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by 3 reviewers. PubMed/MEDLINE, EMBASE and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies' quality. Meta-analysis was performed using univariate random-effects models. Results: Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, n = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI, 86.5-98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings. Conclusions: The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre, and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters. Advances in Knowledge: Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area. Prospero Registration Number: CRD42022336353. Competing Interests: None declared. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.) |
| Databáze: | MEDLINE |
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