title: Original Protocol Using Computed Tomographic Angiography for Diagnosis of Brain Death: A Better Alternative to Standard Two-Phase Technique?
abstract: BACKGROUND The application of computed tomographic angiography (CTA) for the diagnosis of brain death (BD) is limited because of the low sensitivity of the commonly used two-phase method consisting of assessing arterial and venous opacification at the 60th second after contrast injection. The hypothesis was that a reduction in the scanning delay might increase the sensitivity of the test. Therefore, an original technique using CTA was introduced and compared with catheter angiography as a reference. MATERIAL AND METHODS In a prospective multicenter trial, 84 clinically brain-dead patients were examined using CTA and catheter angiography. The sensitivities of original CTA technique, involving an arterial assessment at the 25th second and a venous assessment at the 40th second, and the standard CTA, involving an arterial and venous assessment at the 60th second, were compared to catheter angiography. RESULTS Catheter angiography results were consistent with the clinical diagnosis of BD in all cases. In comparison to catheter angiography, the sensitivity of original CTA technique was 0.93 (95%CI, 0.85-0.97; p<0.001) and 0.57 (95%CI, 0.46-0.68; p<0.001) for the standard protocol. The differences were statistically significant (p=0.03 for original CTA and p<0.001 for standard CTA). Decompressive craniectomy predisposes to a false-negative CTA result with a relative risk of 3.29 (95% CI, 1.76-5.81; p<0.001). CONCLUSIONS Our original technique using CTA for the assessment of the cerebral arteries during the arterial phase and the deep cerebral veins with a delay of 15 seconds is a highly sensitive test for the diagnosis of BD. This method may be a better alternative to the commonly used technique.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Sawicki
authors.affiliation: Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sołek-Pastuszka
authors.affiliation: Department of Radiology, Regional Joint Hospital, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Jurczyk
authors.affiliation: Department of Diagnostic Imaging, City Hospital, Poznań, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Skrzywanek
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wroclaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Guziński
authors.affiliation: Department of Anaesthesiology and Intensive Care, Regional Joint Hospital, Szczecin, Poland.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Czajkowski
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Poznań Medical University, Poznań, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Mańko
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Wrocław Medical University, Wroclaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Burzyńska
authors.affiliation: Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Safranow
authors.affiliation: Department of Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Poncyljusz
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Walecka
authors.affiliation: 2nd Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Olgierd
authors.initials: O
authors.lastname: Rowiński
authors.affiliation: The Centre of Postgraduate Medical Education, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Walecki
authors.affiliation: Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Romuald
authors.initials: R
authors.lastname: Bohatyrewicz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult