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. 2024 Nov 4;6(1):tzae037.
doi: 10.1093/bjro/tzae037. eCollection 2024 Jan.

Measuring brain perfusion by CT or MR as ancillary tests for diagnosis of brain death: a systematic review and meta-analysis

João N Ramos  1   2 , Catarina Pinto  3 , Vera Cruz E Silva  4 , Constantin-Cristian Topriceanu  5   6 , Sotirios Bisdas  2   6
Affiliations

Measuring brain perfusion by CT or MR as ancillary tests for diagnosis of brain death: a systematic review and meta-analysis

João N Ramos et al. BJR Open. .

Abstract

Objectives: To gather and synthesize evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis.

Methods: A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by 3 reviewers. PubMed/MEDLINE, EMBASE and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies' quality. Meta-analysis was performed using univariate random-effects models.

Results: Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, n = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI, 86.5-98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings.

Conclusions: The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre, and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters.

Advances in knowledge: Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area.

Prospero registration number: CRD42022336353.

Keywords: CT; MR; arterial spin labelling; brain death; perfusion.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Flowchart of study selection across all stages.
Figure 2.
Figure 2.
Quality assessment of studies included using QUADAS-2.
Figure 3.
Figure 3.
Forest plot of sensitivity of perfusion imaging by CT or MR in BD diagnosis across all studies included and after applying univariate random-effect model.
Figure 4.
Figure 4.
Forest plot of sensitivity sub-analysis using studies including at least 30 patients.
Figure 5.
Figure 5.
Funnel plot of the included studies.
See this image and copyright information in PMC

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References

    1. Greer DM, Shemie SD, Lewis A, et al.Determination of brain death/death by neurologic criteria. JAMA. 2020;324(11):1078-1097. 10.1001/jama.2020.11586 - DOI - PubMed
    1. Nolan JP, Sandroni C, Böttiger BW, et al.European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369-421. 10.1007/s00134-021-06368-4 - DOI - PMC - PubMed
    1. Greer DM. Determination of brain death. N Engl J Med. 2021;385(27):2554-2561. 10.1056/NEJMcp2025326 - DOI - PubMed
    1. Greer DM, Kirschen MP, Lewis A, et al.Pediatric and adult brain death/death by neurologic criteria consensus guideline. Neurology. 2023;101(24):1112-1132. 10.1212/WNL.0000000000207740 - DOI - PMC - PubMed
    1. Bohatyrewicz R, Pastuszka J, Walas W, et al.Implementation of computed tomography angiography (CTA) and computed tomography perfusion (CTP) in Polish guidelines for determination of cerebral circulatory arrest (CCA) during brain death/death by neurological criteria (BD/DNC) diagnosis procedure. J Clin Med. 2021;10(18):4237. 10.3390/jcm10184237 - DOI - PMC - PubMed

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