scholarly journals Computed tomography angiography (CTA) to prove circulatory arrest for the diagnosis of brain death in the context of organ transplantation

2011 ◽  
Author(s):  
A Rieke ◽  
B Regli ◽  
HP Mattle ◽  
C Brekenfeld ◽  
J Gralla ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Organ Transplantation ◽  
Computed Tomography Angiography ◽  
Circulatory Arrest

Computed tomography angiography accuracy in brain death diagnosis

2020 ◽  
Vol 133 (4) ◽  
pp. 1220-1228
Author(s):  
Sergio Brasil ◽  
Edson Bor-Seng-Shu ◽  
Marcelo de-Lima-Oliveira ◽  
Fabio Silvio Taccone ◽  
Gabriel Gattás ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Circulatory Arrest ◽  
Cerebral Veins ◽  
Clinical Trial Registration ◽  
Bilateral Absence ◽  
Internal Cerebral Veins ◽  
Cerebral Circulatory Arrest

OBJECTIVEThe present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest.METHODSA unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score ≤ 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally.RESULTSA total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS.CONCLUSIONSCTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.Clinical trial registration no.: 12500913400000068 (clinicaltrials.gov)

scholarly journals 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

2021 ◽  
Vol 10 (18) ◽  
pp. 4237
Author(s):  
Romuald Bohatyrewicz ◽  
Joanna Pastuszka ◽  
Wojciech Walas ◽  
Katarzyna Chamier-Cieminska ◽  
Wojciech Poncyljusz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Cerebral Blood Volume ◽  
New Technologies ◽  
Circulatory Arrest ◽  
Brain Regions ◽  
National Guidelines ◽  
Computed Tomography Perfusion ◽  
Cerebral Circulatory Arrest

Background: Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been conducted in order to unify clinical procedures and to validate and implement new technologies into a panel of ancillary tests. Recently evaluated computed tomography angiography and computed tomography perfusion (CTA/CTP) seem to be superior to traditionally used digital subtraction angiography (DSA), transcranial Doppler (TCD) and cerebral perfusion scintigraphy for diagnosis of cerebral circulatory arrest (CCA). In this narrative review, we would like to demonstrate scientific evidence supporting the implementation of CTA/CTP in Polish guidelines for BD/DNC diagnosis. Research and implementation process: In the first of our base studies concerning the potential usefulness of CTA/CTP for the confirmation of CCA during BD/DNC diagnosis procedures, we showed a sensitivity of 96.3% of CTA in a group of 82 patients. CTA was validated against DSA in this report. In the second study, CTA showed a sensitivity of 86% and CTP showed a sensitivity of 100% in a group of 50 patients. In this study, CTA and CTP were validated against clinical diagnosis of BD/DNC supported by TCD. Additionally, we propose our CCA criteria for CTP test, which are based on ascertainment of cerebral blood flow (CBF) < 10 mL/100 g/min and cerebral blood volume < 1 mL/100 g in regions of interest (ROIs) localized in all brain regions. Based on our research results, CTA/CTP methods were implemented in Polish BD/DNC criteria. To our knowledge, CTP was implemented for the first time in national guidelines. Conclusions: CTA and CTP-derived CTA might be in future the tests of choice for CCA diagnosis, proper and/or Doppler pretest might significantly increase sensitivity of CTA in CCA diagnosis procedures. Whole brain CTP might be decisive in some cases of inconclusive CTA. Implementation of CTA/CTP in the Polish BD/DNC diagnosis guidelines does not show any major obstacles. We believe that in next edition of “The World Brain Death Project” CTA and CTP will be recommended as ancillary tests of choice for CCA confirmation during BD/DNC diagnosis procedures.

Role of computed tomography angiography and perfusion tomography in diagnosing brain death: A systematic review

2016 ◽  
Vol 43 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Sérgio Brasil ◽  
Edson Bor-Seng-Shu ◽  
Marcelo de-Lima-Oliveira ◽  
Milena K. Azevedo ◽  
Manoel J. Teixeira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Brain Death ◽  
Computed Tomography Angiography

scholarly journals Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Petros Zampakis ◽  
Vasilios Panagiotopoulos ◽  
Christina Kalogeropoulou ◽  
Maria Karachaliou ◽  
Diamanto Aretha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
False Negative ◽  
Scoring Systems ◽  
Clinical Tests ◽  
Negative Results ◽  
Skull Defects

AbstractTo assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

scholarly journals Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death

Cureus ◽  
2017 ◽  
Author(s):  
Homa Sadeghian ◽  
Mohammad Ali Raeisi ◽  
Parviz Dolati ◽  
Rouzbeh Motiei-Langroudi
Keyword(s):  
Computed Tomography ◽  
Brain Death ◽  
Computed Tomography Angiography ◽  
Brain Computed Tomography ◽  
Ancillary Test
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