Diagnosing brain death by CT perfusion and multislice CT angiography
| Autor: | J. Otero, L. Cofiño, Ricardo Roger, Pedro Vega, Guillermo M. Albaiceta, Eduardo Murias, Armando Blanco, Francisco Taboada, Lara Marqués, Dolores Escudero, Diego Parra, Angela Meilán, JA Gonzalo |
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| Rok vydání: | 2009 |
| Předmět: |
Aortic arch
Adult Male medicine.medical_specialty Brain Death Neurology Ultrasonography Doppler Transcranial medicine.medical_treatment Perfusion scanning Critical Care and Intensive Care Medicine Young Adult medicine.artery Medicine Humans Multislice Evoked Potentials Aged medicine.diagnostic_test business.industry Brain Electroencephalography Middle Aged Cerebral Angiography Alpha Rhythm Cerebral blood flow Cerebrovascular Circulation Angiography Decompressive craniectomy Female Neurology (clinical) Radiology Internal carotid artery business Tomography X-Ray Computed Blood Flow Velocity |
| Zdroj: | Neurocritical care. 11(2) |
| ISSN: | 1541-6933 |
| Popis: | Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD. Prospective observational study in 27 BD patients. All patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead. The radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography. |
| Databáze: | OpenAIRE |
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