gms | German Medical Science

Objective: Due to its widespread accessibly and high resolution, CT-Angiography (CT-A) is a new promising method to detect intracranial circulatory arrest in brain death (BD). Several studies assessed this tool but neither standardised evaluation parameters have been developed nor has information about specificity become available.

Method: We conducted a prospective study between January 2008 and January 2012. Thirty patients were admitted to our University Hospital (16 male, 14 female, age 18-88 years, mean age 54 ± 18.9 years) and underwent CT-A scanning on two occasions: immediately after the first signs of loss of brain stem reflexes and after definitive determination of brain death by clinical examination. The results of CT-A were compared to transcranial Doppler ultrasonography (TCD) and electroencephalography (EEG).

Results: In 3 out 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 clinical determination of brain death. After clinical determination of BD, opacification of all vascular territories in arterial scanning series was found in one case, but venous scanning series revealed no blood return in internal cerebral veins (ICV). In all other cases, contrast filling ceased at level of skull base or below. Specificity of CT-A to detect intracranial circulatory arrest was 90% and sensitivity was 97%.

Conclusions: CT-A is a promising and appropriate technical investigation to detect intracranial circulatory arrest in BD. Evaluation of contrast enhancement in arterial scanning series seems to be more reliable than in venous scanning series. CT-A is able to substitute conventional angiography and could be appropriate endorsement of the german guidelines for determination of brain death.