CT perfusion for confirmation of brain death

Abstract

For pronouncing brain death, unlike CTP, the 2-phase CTA gives no functional information and is limited by inadvertent delay of the second acquisition, which may give false-negative results. The purpose of our study was to compare CTP and CTA derived from the CTP data with the Dupas and Frampas criteria for confirmation of brain death. A retrospective review of CTP in 11 consecutive patients for confirmation of brain death showed a sensitivity of 72.7% for 7- and 4-point scores, 81.8% for opacification of the ICV, and 100% for CTP scores in the brain stem. CTA obtained from the CTP data showed similar sensitivity in the diagnosis of brain death. This protocol also reduces the iodinated contrast dose and is less operator-dependent. The addition of the functional tools of CTP increased the sensitivity of CTA in the confirmation of brain death.

Fig 1.

Different phases of CTA images in a 63-year-old man who had intracranial hemorrhage after tPA treatment for a thrombosed iliac stent show opacification of cortical branches of the MCA, A2 segment of the ACA (A), and the ICV and VOG (E). CTP images show a matched defect in the brain stem and cerebellum on CBF (B–D) and CBV (F–H) maps. The perfusion was preserved in the supratentorial compartment.

Fig 2.

Different phases of CTA images in a 23-year-old woman who had hemorrhagic shock and cardiac arrest following a perforated innominate vein during central line insertion show opacification of the cortical branches of the MCA, A2 segment of the ACA (A), and the ICV and VOG (E). CTP images show a matched defect only in the brain stem on CBF (B–D) and CBV (F–H) maps. The perfusion was preserved in the cerebellum and supratentorial compartment.