Comparison of early- and late-phase CT angiography findings in brain death


ARSAVA E. M. , Cagan C. A. , GÜMELER E., PARLAK SAĞOL Ş., Oguz K. K. , TOPÇUOĞLU M. A.

JOURNAL OF NEUROLOGY, vol.269, no.11, pp.5973-5980, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 269 Issue: 11
  • Publication Date: 2022
  • Doi Number: 10.1007/s00415-022-11281-x
  • Journal Name: JOURNAL OF NEUROLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.5973-5980
  • Keywords: Brain death, Computed tomography angiography, Sensitivity and specificity, Cerebral arteries, Cerebral veins, COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CIRCULATORY ARREST, CONFIRMATORY TEST, DIAGNOSIS, PERFUSION, RELIABILITY, SENSITIVITY
  • Hacettepe University Affiliated: Yes

Abstract

Background Late-phase images on computed tomography angiography (CTA), traditionally used for assessing cerebral circulatory arrest in brain death, suffer from suboptimal diagnostic yield due to stasis filling. Herein, we assessed contrast filling in individual intracranial arteries and veins in the early and late phases of CTA in patients with clinically confirmed brain death. Methods Contrast opacification within 28 arterial/venous segments was evaluated in both phases of CTA in 79 patients. This information was combined with reports in the literature to calculate prevalence of contrast filling in different intracranial vessels. Additionally, diagnostic sensitivity of 4-point, 7-point, and 10-point scores defined for brain death were compared among ratings based on early, late, and both phases (arteries rated on early, veins rated on late phase) of imaging. Results The median (IQR) number of vessel segments with contrast opacification was 0 (0-2) in early phase and 6 (0-10) in late phase. All segments showed increased prevalence of opacification when evaluated in late phase (p < 0.05). The M4 segments of MCA, internal cerebral veins, and vein of Galen had the lowest percentage of opacification in both phases. The sensitivity of 4-, 7-, and 10-point scoring algorithms increased from 59-91% to 94-99% when ratings were performed using early-phase images rather than based solely on late-phase images. Conclusions The incorporation of early-phase images might be considered as a strategy to improve the sensitivity of CTA as an ancillary test in confirming brain death, especially in patients without missing or questionable elements in clinical examination.