title: CT angiography for brain death diagnosis.
abstract: OBJECTIVE
  Lack of cerebral circulation is an important confirmatory test for brain death (BD). Conventional angiography remains the standard imaging method, but CT angiography (CTA) is emerging as an alternative. France accepts BD diagnoses relying on a score based on lack of opacification of 7 intracerebral vessels in CTA images. The purpose of this study was to validate the efficiency of this score and to evaluate the sensitivity of a novel 4-point CTA score in confirming BD.
  
  
  METHODS
  A prospective multicentric study was conducted during 12 months with 105 patients referred for CTA to confirm a clinical diagnosis of BD. Clinical data were recorded. CTA images were interpreted first by local radiologists at the referent center, resulting in a 7-point score based on lack of opacification of the pericallosal and cortical segments of the middle cerebral arteries (MCAs), internal cerebral veins (ICVs), and 1 great cerebral vein per patient and, second, by a consensus panel of 3 expert radiologists, blinded to the initial scores, resulting in novel 4-point scores based on the lack of opacification of the cortical segments of the MCAs and ICVs.
  
  
  RESULTS
  Injection of contrast medium did not alter renal function. With the initial 7-point score, sensitivity was 62.8%. With the simplified 4-point score, sensitivity was 85.7% and specificity was 100%. Opacification of ICVs was absent in 98.1% of patients.
  
  
  CONCLUSIONS
  Lack of opacification in the cortical segments of the MCAs and internal veins in CTA is efficient and reliable for confirming BD.
authors.affiliation: Departments of Radiology and Medical Imaging, CHU Nantes Hôtel-Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, France. eric.frampas@chu-nantes.fr
authors.forename: E
authors.initials: E
authors.lastname: Frampas
authors.forename: M
authors.initials: M
authors.lastname: Videcoq
authors.forename: E
authors.initials: E
authors.lastname: de Kerviler
authors.forename: F
authors.initials: F
authors.lastname: Ricolfi
authors.forename: V
authors.initials: V
authors.lastname: Kuoch
authors.forename: F
authors.initials: F
authors.lastname: Mourey
authors.forename: A
authors.initials: A
authors.lastname: Tenaillon
authors.forename: B
authors.initials: B
authors.lastname: Dupas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002550:Cerebral Veins / Q000000981:diagnostic imaging*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult