title: Limitations of computed tomographic angiography in the diagnosis of brain death.
abstract: OBJECTIVE
  To evaluate the accuracy of cerebral computed tomographic angiography (CT-a) for the diagnosis of brain death (BD).
  
  
  METHODS
  Prospective observational study in intensive care units.
  
  
  METHODS
  Twenty-one clinically BD patients enrolled over 12 months.
  
  
  RESULTS
  All clinically BD patients were evaluated by electroencephalography (EEG) and CT-a after exclusion of hypothermia and drug intoxication. Data collected included: demographic characteristics, cause of BD, delay between in-hospital admission and BD diagnosis and between EEG and CT-a, occurrence of cardiac arrest, administration of vasoactive agents, results of EEG and CT-a. We evaluated the sensitivity of EEG and CT-a and their agreement. Groups were compared according to BD diagnosis by EEG and CT-a (E+C+), or only by EEG (E+C(-)). Statistical analysis were performed by Mann-Whitney test and Fisher's exact test. BD was confirmed by EEG in all cases (sensitivity 100%) whereas only 11 patients of 21 had no cerebral perfusion during CT-a (sensitivity 52.4%). No agreement was documented between EEG and CT-a for the diagnosis of BD (kappa = 0). Patients' characteristics did not differ between E+C+ and E+C(-) groups. In the E+C(-) group arterial opacification was observed in 100% of patients, but opacification of the internal cerebral veins was achieved in only 30%.
  
  
  CONCLUSIONS
  In clinically BD patients with no electroencephalographic activity CT-a documents opacification of the intracerebral vessels in a significant percentage of the cases. Therefore CT-a cannot be recommended as a means of BD diagnosis.
authors.affiliation: Université Pierre & Marie Curie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Service d'Anesthésie-Réanimation, 4 rue de la Chine, 75970 Paris Cedex 20, France. christophe.quesnel@tnn.aphp.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Quesnel
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fulgencio
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Béatrice
authors.initials: B
authors.lastname: Marro
authors.forename: Laurent
authors.initials: L
authors.lastname: Payen
authors.forename: Nadège
authors.initials: N
authors.lastname: Lembert
authors.forename: Sonia
authors.initials: S
authors.lastname: El Metaoua
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D002533:Cerebral Angiography; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed