The role of spiral CT for the assessment of the intracranial circulation in suspected brain-death

Abstract

Background and purpose: The aim of this study was to assess the role of spiral CT for the diagnosis of brain death.

Methods: Over a 12-month period, 15 patients that fulfilled the clinical criteria of brain death were referred from the intensive care unit to evaluate remaining intracranial blood flow by spiral CT. The clinical diagnosis was confirmed by an apnea test in all cases. Two phases of spiral CT were performed at 20 and 60 seconds after the start of contrast media injection. Qualitative analysis included the evaluation of vessel opacification (arteries and veins) by two radiologists in consensus.

Results: The cortical segments of the middle cerebral artery (MCA) were assessable in all patients, whereas the internal cerebral veins could not be evaluated in five patients due to artifacts or intracranial hemorrhage. Opacification of the major branches of the circle of Willis was observed in seven cases. Unilateral opacification of cortical branches of the MCA occurred in one. We did not observe bilateral enhancement of cortical MCA branches. The internal cerebral veins did not enhance in brain death.

Conclusion: The absence of internal cerebral vein opacification and the absence of bilateral enhancement of cortical MCA branches constituted the best criteria of brain death by contrast enhanced spiral CT.