title: Computed tomographic angiography as a useful adjunct in the diagnosis of brain death.
abstract: BACKGROUND
  Because of its widespread accessibly, computed tomographic angiography (CT-A) is a promising technique in the detection of intracranial circulatory arrest in brain death (BD). Several studies assessed this tool, but neither have standardized evaluation parameters been developed nor has information about specificity become available.
  
  
  METHODS
  We conducted a prospective study between January 2008 and April 2012. Thirty patients were admitted to our University Hospital (16 men and 14 women; age, 18-88 years) and underwent CT-A scanning at two occasions: immediately after the first signs of loss of brain stem reflexes and after definitive determination of brain. The results of CT-A were compared with transcranial Doppler ultrasonography and electroencephalogram.
  
  
  RESULTS
  In 3 of 30 patients, we observed a termination of contrast flow at the level of the skull base and foramen magnum in arterial scanning series before the clinical determination of BD. After the clinical determination of BD, the opacification of all vascular territories in arterial phase scanning was found in one case, but venous phase scanning revealed no blood return in internal cerebral veins. In all other cases, contrast filling ceased at level of skull base or below. The specificity of CT-A in the detection of intracranial circulatory arrest was 90%, and sensitivity was 97%.
  
  
  CONCLUSIONS
  CT-A is reliable and appropriate technical investigation to detect intracranial circulatory arrest in BD. The evaluation of contrast enhancement in arterial phase scanning seems to be more reliable than that in venous phase. An international consensus about a uniformly applied CT-A protocol for the evaluation of BD should be established.
authors.affiliation: Department of Neurotraumatology and Neurosurgery, Asklepios Hospital Weißenfels, Weißenfels, Germany. s.welschehold@asklepios.com
authors.forename: Stefan
authors.initials: S
authors.lastname: Welschehold
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerz
authors.forename: Stephan
authors.initials: S
authors.lastname: Boor
authors.forename: Katharina
authors.initials: K
authors.lastname: Reuland
authors.forename: Frank
authors.initials: F
authors.lastname: Thömke
authors.forename: Andre
authors.initials: A
authors.lastname: Reuland
authors.forename: Christian
authors.initials: C
authors.lastname: Beyer
authors.forename: Christoph
authors.initials: C
authors.lastname: Tschan
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.forename: Wibke
authors.initials: W
authors.lastname: Müller-Forell
authors.forename: Alf
authors.initials: A
authors.lastname: Giese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001926:Brain Death / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods*; D004453:Echoencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult