PMID- 23609279
OWN - NLM
STAT- MEDLINE
DCOM- 20130708
LR  - 20161125
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 74
IP  - 5
DP  - 2013 May
TI  - Computed tomographic angiography as a useful adjunct in the diagnosis of brain 
      death.
PG  - 1279-85
LID - 10.1097/TA.0b013e31828c46ba [doi]
AB  - BACKGROUND: Because of its widespread accessibly, computed tomographic 
      angiography (CT-A) is a promising technique in the detection of intracranial 
      circulatory arrest in brain death (BD). Several studies assessed this tool, but 
      neither have standardized evaluation parameters been developed nor has 
      information about specificity become available. METHODS: We conducted a 
      prospective study between January 2008 and April 2012. Thirty patients were 
      admitted to our University Hospital (16 men and 14 women; age, 18-88 years) and 
      underwent CT-A scanning at two occasions: immediately after the first signs of 
      loss of brain stem reflexes and after definitive determination of brain. The 
      results of CT-A were compared with transcranial Doppler ultrasonography and 
      electroencephalogram. RESULTS: In 3 of 30 patients, we observed a termination of 
      contrast flow at the level of the skull base and foramen magnum in arterial 
      scanning series before the clinical determination of BD. After the clinical 
      determination of BD, the opacification of all vascular territories in arterial 
      phase scanning was found in one case, but venous phase scanning revealed no blood 
      return in internal cerebral veins. In all other cases, contrast filling ceased at 
      level of skull base or below. The specificity of CT-A in the detection of 
      intracranial circulatory arrest was 90%, and sensitivity was 97%. CONCLUSION: 
      CT-A is reliable and appropriate technical investigation to detect intracranial 
      circulatory arrest in BD. The evaluation of contrast enhancement in arterial 
      phase scanning seems to be more reliable than that in venous phase. An 
      international consensus about a uniformly applied CT-A protocol for the 
      evaluation of BD should be established.
FAU - Welschehold, Stefan
AU  - Welschehold S
AD  - Department of Neurotraumatology and Neurosurgery, Asklepios Hospital Weissenfels, 
      Weissenfels, Germany. s.welschehold@asklepios.com
FAU - Kerz, Thomas
AU  - Kerz T
FAU - Boor, Stephan
AU  - Boor S
FAU - Reuland, Katharina
AU  - Reuland K
FAU - Thomke, Frank
AU  - Thomke F
FAU - Reuland, Andre
AU  - Reuland A
FAU - Beyer, Christian
AU  - Beyer C
FAU - Tschan, Christoph
AU  - Tschan C
FAU - Wagner, Wolfgang
AU  - Wagner W
FAU - Muller-Forell, Wibke
AU  - Muller-Forell W
FAU - Giese, Alf
AU  - Giese A
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Brain/*blood supply/diagnostic imaging/physiopathology
MH  - Brain Death/*diagnosis
MH  - Cerebral Angiography/*methods
MH  - Echoencephalography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Sensitivity and Specificity
MH  - Tomography, X-Ray Computed/*methods
MH  - Ultrasonography, Doppler, Transcranial
MH  - Young Adult
EDAT- 2013/04/24 06:00
MHDA- 2013/07/09 06:00
CRDT- 2013/04/24 06:00
PHST- 2013/04/24 06:00 [entrez]
PHST- 2013/04/24 06:00 [pubmed]
PHST- 2013/07/09 06:00 [medline]
AID - 01586154-201305000-00014 [pii]
AID - 10.1097/TA.0b013e31828c46ba [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2013 May;74(5):1279-85. doi: 
      10.1097/TA.0b013e31828c46ba.