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Comparative Study
. 2019 Mar;29(1):101-108.
doi: 10.1007/s00062-017-0631-7. Epub 2017 Nov 17.

Computed Tomography Perfusion is a Useful Adjunct to Computed Tomography Angiography in the Diagnosis of Brain Death

M Sawicki  1 , J Sołek-Pastuszka  2 , K Chamier-Ciemińska  1 , A Walecka  1 , J Walecki  3 , R Bohatyrewicz  4
Affiliations
Comparative Study

Computed Tomography Perfusion is a Useful Adjunct to Computed Tomography Angiography in the Diagnosis of Brain Death

M Sawicki et al. Clin Neuroradiol. 2019 Mar.

Abstract

Background: In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. Because cerebral circulatory arrest commences at the capillary level, we hypothesized that computed tomography perfusion (CTP) would be a more sensitive approach than CTA; therefore, the aim of the study was to compare the sensitivities of CTP and CTA in the diagnosis of BD.

Material and methods: Whole brain CTP was performed in patients in the intensive care unit diagnosed with BD and CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. The CTP findings were interpreted as being consistent with a diagnosis of BD (positive) when CBF and CBV in all regions of interest (ROIs) were below 10 ml/100 g/min and 1.0 ml/100 g, respectively. The CTA findings were interpreted using a 4-point grading system.

Results: A total of 50 patients were included in the study. The CTP results revealed CBF from 0.00 to 9.98 ml/100 g/min (mean, 1.98 ± 1.68 ml/100 g/min) and CBV from 0.00 to 0.99 ml/100 g (mean, 0.14 ± 0.12 ml/100 g) and were thus interpreted as positive in all 50 patients. In contrast, the CTA results suggested 7 negative cases, providing a sensitivity of 86%. The difference between the CTP and CTA sensitivity results for the diagnosis of BD was statistically significant (p = 0.006).

Conclusion: Whole brain CTP may potentially be a feasible and highly sensitive test for diagnosing BD: therefore, performing CTP in combination with CTA in cases when CTA results are negative for BD could increase the sensitivity of CTA.

Keywords: Brain death; Four-dimensional computed tomography; Multidetector computed tomography; Perfusion imaging.

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Conflict of interest statement

M. Sawicki, J. Sołek-Pastuszka, K. Chamier-Ciemińska, A. Walecka, J. Walecki and R. Bohatyrewicz declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram (CTP computed tomography perfusion, CTA computed tomography angiography, MAP mean arterial blood pressure)
Fig. 2
Fig. 2
The distribution of CBF (a) and CBV (b) in 50 patients diagnosed with BD. Box plots present values obtained from 66 ROIs for each patient covering all brain regions. Data are presented as medians, 25–75% interquartile ranges, minimums and maximums. In all cases, the perfusion values are below the thresholds for nonviable tissue
Fig. 3
Fig. 3
Results of CTA (a) and CTP (b) in the patient diagnosed with brain death. The CTA shows absence of filling of intracranial arteries and veins and was classified as positive, i. e. consistent with the diagnosis of BD. CTP reveals perfusion values below the thresholds for non-viable tissue and, like CTA, was interpreted as positive, i. e. confirming the diagnosis of BD
Fig. 4
Fig. 4
Results of CTA (a) and CTP (b) in the patient diagnosed with brain death. CTA shows filling of cortical branches of the right and left MCA (arrows) and was classified as negative, i. e. inconsistent with the diagnosis of BD. CTP reveals perfusion values below the thresholds for non-viable tissue and, contrary to CTA was interpreted as positive, i. e. consistent with the diagnosis of BD
See this image and copyright information in PMC

Comment in

References

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