title: Clinical utility of arterial spin-labeling as a confirmatory test for suspected brain death.
abstract: Diagnosis of brain death is made on the basis of 3 essential findings: coma, absence of brain stem reflexes, and apnea. Although confirmatory tests are not mandatory in most situations, additional testing may be necessary to declare brain death in patients in whom results of specific components of clinical testing cannot be reliably evaluated. Recently, arterial spin-labeling has been incorporated as part of MR imaging to evaluate cerebral perfusion. Advantages of arterial spin-labeling include being completely noninvasive and providing information about absolute CBF. We retrospectively reviewed arterial spin-labeling findings according to the following modified criteria based on previously established confirmatory tests to determine brain death: 1) extremely decreased perfusion in the whole brain, 2) bright vessel signal intensity around the entry of the carotid artery to the skull, 3) patent external carotid circulation, and 4) "hollow skull sign" in a series of 5 patients. Arterial spin-labeling findings satisfied the criteria for brain death in all patients. Arterial spin-labeling imaging has the potential to be a completely noninvasive confirmatory test to provide additional information to assist in the diagnosis of brain death.
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.).
authors.forename: K M
authors.initials: KM
authors.lastname: Kang
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.) radiologyyun@gmail.com.
authors.forename: T J
authors.initials: TJ
authors.lastname: Yun
authors.affiliation: Neurology (B.-W.Y., B.S.J.) Clinical Research Center for Stroke (B.-W.Y., B.S.J.), Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: B-W
authors.initials: BW
authors.lastname: Yoon
authors.affiliation: Neurology (B.-W.Y., B.S.J.) Clinical Research Center for Stroke (B.-W.Y., B.S.J.), Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: B S
authors.initials: BS
authors.lastname: Jeon
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.).
authors.forename: S H
authors.initials: SH
authors.lastname: Choi
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.).
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Neurosurgery (J.E.K.).
authors.forename: J E
authors.initials: JE
authors.lastname: Kim
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.).
authors.forename: C-H
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: From the Institute of Radiation Medicine (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea Departments of Radiology (K.M.K., T.J.Y., S.H.C., J.-h.K., C.-H.S., M.H.H.).
authors.forename: M H
authors.initials: MH
authors.lastname: Han
mesh_terms: D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D013113:Spin Labels