Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function.
OBJECTIVE
To determine the usefulness of (Tc 99m) HM-PAO scan in supporting the clinical diagnosis of brain death.


METHODS
Retrospective review.


METHODS
Paediatric Intensive Care Unit.


METHODS
A total of 39 paediatric patients had HM-PAO scans conducted to confirm  the presence of brain death or to assess the degree of brain injury.


METHODS
All patients had (Tc 99m) HM-PAO injected before the scan was conducted.


RESULTS
Fifty-four scans were done in 39 patients. The majority of cerebral injury was as a result of closed head injury or asphyxia/anoxia.  There were 20 scans which demonstrated no cerebral blood flow (CBF); however, in 26 situations patients were clinically brain dead.  All of the patients who continued to have CBF in the presence of clinical brain death sustained asphyxial/anoxic injuries.


CONCLUSIONS
The HM-PAO scan is a useful non-invasive portable tool for supporting the diagnosis of brain death when there is absent CBF. However, continued flow may be present in asphyxial/anoxic injuries in the presence of clinical brain death.
Singh
N C
NC
Paediatric Critical Care Unit, Department of Paediatrics and Department of Nuclear Medicine, University of Western Ontario, Children's Hospital of Western Ontario, Canada.
Reid
R H
RH
Loft
J A
JA
Frewen
T C
TC
Parker
B L
BL
Dhillon
J S
JS
D000293:Adolescent; D001237:Asphyxia; D001783:Blood Flow Velocity; D001926:Brain Death / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002540:Cerebral Cortex / Q000098:blood supply; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015609:Organotechnetium Compounds; D010091:Oximes; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies