Original Protocol Using Computed Tomographic Angiography for Diagnosis of Brain Death: A Better Alternative to Standard Two-Phase Technique?
Marcin Sawicki, Joanna Sołek-Pastuszka, Krzysztof Jurczyk, Piotr Skrzywanek, Maciej Guziński, Zenon Czajkowski, Witold Mańko, Małgorzata Burzyńska, Krzysztof Safranow, Wojciech Poncyljusz, Anna Walecka, Olgierd Rowiński, Jerzy Walecki, Romuald Bohatyrewicz
Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
Ann Transplant 2015; 20:449-460
Available online: 2015-08-06
The application of computed tomographic angiography (CTA) for the diagnosis of brain death (BD) is limited because of the low sensitivity of the commonly used two-phase method consisting of assessing arterial and venous opacification at the 60th second after contrast injection. The hypothesis was that a reduction in the scanning delay might increase the sensitivity of the test. Therefore, an original technique using CTA was introduced and compared with catheter angiography as a reference.
MATERIAL AND METHODS: In a prospective multicenter trial, 84 clinically brain-dead patients were examined using CTA and catheter angiography. The sensitivities of original CTA technique, involving an arterial assessment at the 25th second and a venous assessment at the 40th second, and the standard CTA, involving an arterial and venous assessment at the 60th second, were compared to catheter angiography.
RESULTS: Catheter angiography results were consistent with the clinical diagnosis of BD in all cases. In comparison to catheter angiography, the sensitivity of original CTA technique was 0.93 (95%CI, 0.85–0.97; p<0.001) and 0.57 (95%CI, 0.46–0.68; p<0.001) for the standard protocol. The differences were statistically significant (p=0.03 for original CTA and p<0.001 for standard CTA). Decompressive craniectomy predisposes to a false-negative CTA result with a relative risk of 3.29 (95% CI, 1.76–5.81; p<0.001).
CONCLUSIONS: Our original technique using CTA for the assessment of the cerebral arteries during the arterial phase and the deep cerebral veins with a delay of 15 seconds is a highly sensitive test for the diagnosis of BD. This method may be a better alternative to the commonly used technique.
Keywords: Angiography, Digital Subtraction, Brain Death, Cerebral Angiography, decompressive craniectomy, Intracranial Hypertension, multidetector computed tomography