+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography

, : Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography. Journal of Trauma and Acute Care Surgery 79(6): 995-1003; Discussion 1003

When clinical examination is not reliable for brain death (BD) diagnosis, the preferred confirmatory test at our institution is nuclear medicine perfusion test (NMPT). Computed tomographic angiography (CTA) has been described as an alternative for BD confirmation. This study was designed to quantitatively analyze CTA, assess its accuracy compared with NMPT, and define set parameters for BD confirmation. This is a prospective clinical study, from 2007 to 2014, evaluating a consecutive series of clinically BD patients (n = 60) and randomly selected control group with normal CTA findings (n = 20). NMPT, used as the reference standard, was performed on all study patients followed immediately by CTA. Assessment of NMPT and quantitative CTA Hounsfield units of the horizontal segment of middle cerebral artery (M1), precommunicating segment of anterior cerebral artery (A1), and basilar artery (BA) was performed. In the study cohort, 88% demonstrated absence of cerebral blood flow (CBF) on NMPT; however, only 50% demonstrated absence on CTA. Together, 50% had no CBF on NMPT and CTA (Group 1), 38% had no CBF on NMPT but persistent CBF on CTA (Group 2), 12% had persistent CBF on both NMPT and CTA (Group 3). Analysis of variance demonstrated that all groups varied significantly for M1, A1, and BA (p < 0.001). We were able to establish criteria that differentiate persistent CBF on CTA as either preserved cerebral perfusion or stasis filling. We propose that a CTA Hounsfield units less than 80 in M1, A1, and BA is concordant with no CBF on NMPT, therefore indicative of a lack of physiologic cerebral perfusion, and thus allows the confirmation of BD with 97% sensitivity and 100% specificity. Diagnostic study, level II.


PMID: 26680139

DOI: 10.1097/TA.0000000000000831

Other references

Scholz Christopher H., 1988: Mechanisms of seismic quiescences. In the past decade there have been major advances in understanding the seismic cycle in terms of the recognition of characteristic patterns of seismicity over the entire tectonic loading cycle. The most distinctive types of patterns are seismic qu...

Adams, M.H.; Forrest, A.; Wilton, J.H.; Mcmahon, F.G.; Longstreth, J.A., 1994: Effect of age on the steady-state pharmacokinetics of oxaprozin and piroxicam. Pharmaceutical Research (New York) 11(10 SUPPL ): S101

Kovac, M.; Mosner, M.; Miller, S.; Hanna, E.K.; Dichter, G.S., 2017: Experience Sampling of Positive Affect in Adolescents with Autism: Feasibility and Preliminary Findings. Experience sampling is a powerful method for obtaining ecologically valid data from research participants in real-world contexts. Given the urgent need for innovative and sensitive outcome measures in autism spectrum disorder (ASD) research, the p...

Jiang, Y.; Wang, W.; Wang, J.; Lu, Y.; Chen, Y.; Jin, L.; Lin, D.; He, F.; Wang, H., 2012: Functional regulatory variants of MCL1 contribute to enhanced promoter activity and reduced risk of lung cancer in nonsmokers: implications for context-dependent phenotype of an antiapoptotic and antiproliferative gene in solid tumor. Dysfunction of molecules that regulate both apoptosis and proliferation is involved in tumorigenesis. A common insertional polymorphism in promoter of MCL1, a member of BCL2 family gene with the dual regulatory functions, has been shown to be func...

Muller, J.E.; Maroko, P.R.; Braunwald, E., 1975: Evaluation of precordial electrocardiographic mapping as a means of assessing changes in myocardial ischemic injury. Precordial electrocardiographic mapping has been proposed as a method for evaluating the extent of myocardial injury in patients with acute myocardial infarction. To assess the relationship between direct measures of myocardial cell damage and fin...

Elstein, M.; Morris, S.E.; Groom, G.V.; Jenner, D.A.; Scarisbrick, J.J.; Cameron, E.H., 1976: Studies on low-dose oral contraceptives: cervical mucus and plasma hormone changes in relation to circulating D-norgestrel and 17alpha ethynyl-estradiol concentrations. A study was undertaken to determine the effects of a low-dose oral contraceptive comprising 150 mug of D-norgestrel and 30 mug of 17alpha-ethynyl estradiol (Microgynon) on the plasma levels of follicle-stimulating hormone (FSH), luteinizing hormon...

Gaba Z.; Zimak J., 1988: Palygorskite from Supikovice, northern Moravia. Casopis Slezskeho Muzea v Opave A: Vedy Prirodni. 37; 1, Pages 59-61. 1988.

Andersen, N.H.; Christensen, N.Johan.; Lassen, P.R.; Freedman, T.B.N.; Nafie, L.A.; Strømgaard, K.; Hemmingsen, L., 2010: Structure and absolute configuration of ginkgolide B characterized by IR- and VCD spectroscopy. Experimental and calculated (B3LYP/6-31G(d)) vibrational circular dichroism (VCD) and IR spectra are compared, illustrating that the structure and absolute configuration of ginkgolide B (GB) may be characterized directly in solution. A conformatio...

Poiré, R.; Feuillet, C.; Degraeve, M.; Stoianoff-Nenoff, S.; Beck, L., 1967: Electrographic organization of spontaneous night sleep after pre-frontal lobotomy. Electroencephalography and Clinical Neurophysiology 23(3): 286-287

Youdim, M.B., 1983: In vivo, noradrenaline is a substrate for rat brain monoamine oxidase A and B. In vivo clorgyline (5 mg/kg) and (-)-deprenyl (5 mg/kg) selectively inhibit monoamine oxidase (MAO) type A and B activities in rat brain hypothalamus and caudate nucleus using 5-hydroxytryptamine (5-HT), noradrenaline (NA), and beta-phenylethylami...