Pitfalls in vascular imaging when brain death is suspected: multiparametric multidetector computed tomography as a complementary diagnostic tool.

Although multidetector computed tomography (MDCT) has not yet been adopted to confirm brain death in Brazil, international reports support the use of multiparametric techniques to properly evaluate the circulation of the brain. Proposed MDCT protocol consists of two acquisitions to assess the arterial and venous phases of brain circulation. The complete absence of intracranial vascular enhancement supports the diagnosis of brain death. However, delayed, weak and persistent opacification of the proximal segments of the cerebral arteries, termed "stasis filling," indicates the inability to perform brain perfusion and should be recognized as an important pitfall when computed tomography angiography (CTA) is analyzed. Computed tomography perfusion (CTP) is reliable in demonstrating the absence of brain perfusion and thereby confirming severe hemodynamic arrest (Figure).