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AJNR - American Journal of Neuroradiology

Published ahead of print on April 30, 2009
doi: 10.3174/ajnr.A1614

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American Journal of Neuroradiology 30:1566-1570, September 2009
© 2009 American Society of Neuroradiology

BRAIN

CT Angiography for Brain Death Diagnosis

E. Frampas^a, M. Videcoq^b, E. de Kerviler^c, F. Ricolfi^e, V. Kuoch^f, F. Mourey^d, A. Tenaillon^g and B. Dupas^a

^aFrom the Departments of Radiology and Medical Imaging (E.F., B.D.), CHU Nantes Hôtel-Dieu, Nantes, France
^bDepartment of Anesthesiology and Reanimation (M.V.), Hôpital Mère et Enfants, Nantes, France
^cDepartments of Radiology (E.d.K.)
^dAnesthesiology and Reanimation (F.M.), Hôpital Saint-Louis, Paris, France
^eDepartment of Medical Imaging (F.R.), Hôpital Général, Dijon Cedex, France
^fDepartment of Interventional Radiology (V.K.), CH Sud Francilien, Evry-Courcouronnes, France
^gDepartment of Medical and Scientific Management (A.T.), Transplantation Strategy Center, Biomedecine Agency, Saint-Denis-La-Plaine Cedex, France.

Please address correspondence to Eric Frampas, MD, and Benoit Dupas, MD, PhD, Radiology and Medical Imaging, CHU Nantes Hôtel-Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, 44093 France; e-mail: eric.frampas{at}chu-nantes.fr

BACKGROUND AND PURPOSE: Lack of cerebral circulation is an important confirmatory test for brain death (BD). Conventional angiography remains the standard imaging method, but CT angiography (CTA) is emerging as an alternative. France accepts BD diagnoses relying on a score based on lack of opacification of 7 intracerebral vessels in CTA images. The purpose of this study was to validate the efficiency of this score and to evaluate the sensitivity of a novel 4-point CTA score in confirming BD.

MATERIALS AND METHODS: A prospective multicentric study was conducted during 12 months with 105 patients referred for CTA to confirm a clinical diagnosis of BD. Clinical data were recorded. CTA images were interpreted first by local radiologists at the referent center, resulting in a 7-point score based on lack of opacification of the pericallosal and cortical segments of the middle cerebral arteries (MCAs), internal cerebral veins (ICVs), and 1 great cerebral vein per patient and, second, by a consensus panel of 3 expert radiologists, blinded to the initial scores, resulting in novel 4-point scores based on the lack of opacification of the cortical segments of the MCAs and ICVs.

RESULTS: Injection of contrast medium did not alter renal function. With the initial 7-point score, sensitivity was 62.8%. With the simplified 4-point score, sensitivity was 85.7% and specificity was 100%. Opacification of ICVs was absent in 98.1% of patients.

CONCLUSIONS: Lack of opacification in the cortical segments of the MCAs and internal veins in CTA is efficient and reliable for confirming BD.