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20 May 2010

Computed Tomographic Angiography in the diagnosis of brain death

Marcin Sawicki, Anna Walecka, Romuald Bohatyrewicz, Wojciech Poncyljusz, Janusz Kordowski

Med Sci Monit 2010; 16(1): 28-32 :: ID: 880579

Abstract

Two neurophysiological methods can demonstrate the cessation of brain function: electroencephalography (EEG) and brain-stem auditory-evoked potentials. Conventional angiography of the 4 cerebral arterial axes are the reference standard for imaging brain death. Thus, it is an invasive examination that needs an experienced neuroradiologist, and the availability of an angiography suite. The use of a computed tomographic (CT) scan to diagnose brain death (BD) was proposed in 1978. This examination developed widely these last years thanks to a new generation of multirow CT, which allows visualization of opacified cerebral vessels. This study sought to determine the accuracy of CT, for confirmation of BD.
We examined 15 patients with suspicion of BD according to clinical criteria defined by law. CT scan was performed with and without injection of contrast material, followed by cerebral angiography. In our material, CT angiography showed opacification of A2-ACA and M2 or M3-MCA in 10 patients. In our patients, results of CT angiography fulfill the criteria proposed by the French Society of Neuroradiology: absence of perfusion of M4 middle cerebral artery segments (M4-MCA) and deep cerebral veins. In conventional angiography, 2 patients showed, at the level of the anterior and middle cerebral artery, a phenomenon already described as stasis filling.
CT angiography is a promising radiologic examination in diagnosing BD. When confirmatory examinations are required among BD patients for whom the clinical diagnosis remains essential, it may be an interesting alternative to conventional cerebral angiography, which is more invasive and constraining, and when EEG is unavailable or inadequate.

Keywords: Brain Death, conventional angiography, CT, Angiography

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750