CLINICAL REPORT BRAIN CT Perfusion for Confirmation of Brain Death

SUMMARY: For pronouncing brain death, unlike CTP, the 2-phase CTA gives no functional information and is limited by inadvertent delay of the second acquisition, which may give false-negative results. The purpose of our study was to compare CTP and CTA derived from the CTP data with the Dupas and Frampas criteria for confirmation of brain death. A retrospective review of CTP in 11 consecutive patients for confirmation of brain death showed a sensitivity of 72.7% for 7and 4-point scores, 81.8% for opacification of the ICV, and 100% for CTP scores in the brain stem. CTA obtained from the CTP data showed similar sensitivity in the diagnosis of brain death. This protocol also reduces the iodinated contrast dose and is less operator-dependent. The addition of the functional tools of CTP increased the sensitivity of CTA in the confirmation of brain death. ABBREVIATIONS: ACA anterior cerebral artery; ICU intensive care unit; ICV internal cerebral vein; STA superficial temporal artery; VOG great cerebral vein of Galen The diagnosis of brain death must comply with the medicolegal and ethical guidelines of each institution and should also be determined as accurately and as early as possible to avoid unnecessary treatment and allow organ harvesting for transplantation. Often, the diagnosis of brain death is made on the basis of clinical findings and neurologic examination. However for patients in the ICU with medication causing CNS depression, the clinical criteria of brain death, deep coma and the absence of brain stem reflexes, may be difficult to evaluate. In these cases, ancillary tests such as electroencephalography, cerebral angiography, nuclear scan, transcranial Doppler, CTA, and MR imaging/MRA are currently used in adults to pronounce brain death. Although cerebral angiography is considered the criterion standard, CTA has been accepted as one of the ancillary tests for confirmation of brain death. The protocol for CTA for the confirmation of brain death can vary considerably among different centers; this variation makes it difficult for it to be accepted as the criterion standard test. The most acceptable study, which used 2 acquisitions of CTA after a single bolus of contrast injection, had a variation between the 2 acquisitions from 54 to 61 seconds. Inadvertent further delay of the second acquisition may lead to diffusion of contrast into the distal cortical branches, causing false-negative results on CTA. Moreover CTA provides only anatomic and no functional information of the brain. The functional and the anatomic information about the brain can be obtained on