Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death.
BACKGROUND
Computed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death.


METHODS
A preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score.


RESULTS
The revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score.


CONCLUSIONS
Compared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.
Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France. antoine.marchand@chu-rennes.fr.
Antoine J
AJ
Marchand
Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.|Université Rennes 1, Rennes, France.|Inserm U991, Rennes, France.
Philippe
P
Seguin
Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.|Université Rennes 1, Rennes, France.|Inserm U991, Rennes, France.
Yannick
Y
Malledant
Service d'Anesthésie Réanimation 1, CHU Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.
Marion
M
Taleb
Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.
Hélène
H
Raoult
Department of Radiology and Medical Imaging, University and Regional Hospital Center (CHRU) of Rennes, 2 rue Henri Le Guillou, 35000, Rennes, France.|Université Rennes 1, Rennes, France.
Jean Yves
JY
Gauvrit
Brain death diagnosis; Computed tomography angiography; Confirmatory test; Revised four-point venous score