title: Computed tomographic angiography criteria in the diagnosis of brain death-comparison of sensitivity and interobserver reliability of different evaluation scales.
abstract: BACKGROUND
  The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD.
  
  
  METHODS
  Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.
  
  
  RESULTS
  Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p<0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37).
  
  
  CONCLUSIONS
  In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Clinical Hospital No1, Unii Lubelskiej 1, Szczecin, 71252, Poland, msaw@pum.edu.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Sawicki
authors.forename: R
authors.initials: R
authors.lastname: Bohatyrewicz
authors.forename: K
authors.initials: K
authors.lastname: Safranow
authors.forename: A
authors.initials: A
authors.lastname: Walecka
authors.forename: J
authors.initials: J
authors.lastname: Walecki
authors.forename: O
authors.initials: O
authors.lastname: Rowinski
authors.forename: J
authors.initials: J
authors.lastname: Solek-Pastuszka
authors.forename: Z
authors.initials: Z
authors.lastname: Czajkowski
authors.forename: M
authors.initials: M
authors.lastname: Guzinski
authors.forename: M
authors.initials: M
authors.lastname: Burzynska
authors.forename: J
authors.initials: J
authors.lastname: Wojczal
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult