Radionuclide angiography as a confirmatory test for brain death: a review of 229 studies in 219 patients.
BACKGROUND
Radionuclide angiography (RA) has been used for many years to confirm the clinical diagnosis of brain death, but quantitative data regarding the technique are unavailable.


METHODS
We conducted a retrospective review of 229 RA procedures done in 219 patients.


RESULTS
Of 206 patients who had interpretable studies and met clinical criteria for brain death (profound coma, absent brain stem reflexes, and apnea), including 10 patients who had repeated studies, 203 (98.5% sensitivity) had positive studies, and 6 (2.9%) had negative studies. Of nine patients who had interpretable studies and did not meet the clinical criteria for brain death, five (56% specificity) had positive studies and four (44%) had negative studies.


CONCLUSIONS
Radionuclide angiography is a sensitive confirmatory test of brain death. The study does not evaluate the posterior fossa circulation, and an occasional patient may have residual brain stem function. The examination is most reliable when the patient is in a deep coma, has no brain stem reflexes, and has failed a formal apnea test.
Flowers
W M
WM
Department of Radiology, University of Mississippi Medical Center, Jackson 39216, USA.
Patel
B R
BR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001049:Apnea / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging*; D001926:Brain Death / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001933:Brain Stem / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002648:Child; D003128:Coma / Q000503:physiopathology; D004569:Electroencephalography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011875:Radionuclide Angiography; D019275:Radiopharmaceuticals; D012018:Reflex; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m
D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m