title: Diagnosing brain death by CT perfusion and multislice CT angiography.
abstract: BACKGROUND
  Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD.
  
  
  METHODS
  Prospective observational study in 27 BD patients.
  
  
  RESULTS
  All patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead.
  
  
  CONCLUSIONS
  The radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography.
authors: Department of Intensive Care Medicine, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, Spain. dolores.escudero@sespa.princast.es
authors: Dolores
authors: D
authors: Escudero
authors: Jesús
authors: J
authors: Otero
authors: Lara
authors: L
authors: Marqués
authors: Diego
authors: D
authors: Parra
authors: José Antonio
authors: JA
authors: Gonzalo
authors: Guillermo M
authors: GM
authors: Albaiceta
authors: Luis
authors: L
authors: Cofiño
authors: Armando
authors: A
authors: Blanco
authors: Pedro
authors: P
authors: Vega
authors: Eduardo
authors: E
authors: Murias
authors: Angela
authors: A
authors: Meilan
authors: Ricardo López
authors: RL
authors: Roger
authors: Francisco
authors: F
authors: Taboada
mesh_terms: D000328:Adult; D000368:Aged; D000513:Alpha Rhythm; D001783:Blood Flow Velocity; D001921:Brain / Q000000981:diagnostic imaging*; D001926:Brain Death / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D055815:Young Adult