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.
Paediatric Critical Care Unit, Department of Paediatrics and Department of Nuclear Medicine, University of Western Ontario, Children's Hospital of Western Ontario, Canada.
N C
NC
Singh
R H
RH
Reid
J A
JA
Loft
T C
TC
Frewen
B L
BL
Parker
J S
JS
Dhillon
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