engleski

Brain Perfusion Scintigraphy As Confirmation Test Of Absent Cerebral Blood Flow

The aim of this study is to evaluate the effectiveness of single photon emission tomography (SPECT) with Tc-99m HMPAO in the diagnosis of brain death (BD). It is widely accepted that BD is a clinical diagnosis, but sometimes confirmatory tests are recommended when clinical testing cannot be evaluated reliably. In our study we compared the outcome of planar brain scintigraphy with Tc-99m pertechnetate, with Tc-99m HMPAO brain SPECT for the assessment of brain blood flow in patients suspected of BD. Methods and Materials: In a period of five years (2012-2107) 36 patients with a clinical diagnose of BD (22 men and 14 women, age 6-86 y) were referred to our department for the confirmation of a clinical diagnosis of BD. We performed planar brain scintigraphy with Tc-99m pertechnetate 21 times, and Tc-99m HMPAO brain SPECT 20 times in patients. In 4 of 36 patients brain scintigraphy were performed few times because of doubtful findings. Flow images are acquired at the time of the injection of 1110 MBq of selected radiopharmaceutical with one-second dynamic images for a period of 60 seconds. Anterior, posterior and both lateral static images were obtained within 5 minutes after dynamic images, and than late static images when we use pertechnetate as a radiopharmaceutical. When we use Tc-99m HMPAO, brain SPECT images were obtained in addition to flow and early static images. Results: In 21 planar brain scintigraphy with Tc- 99m pertechnetate we confirmed a clinical diagnose of BD in 10 patients (47, 6%) while in 11 of them (52, 4%) we found different signs of cerebral blood flow. In 2 of them we performed a brain SPECT with Tc-99m HMPAO in few days and found the absence of brain perfusion. In 20 brain SPECT with Tc-99m HMPAO we confirm a clinical diagnose of BD in 15 patients (75%), while 5 cases (25%) were not consistent with BD. Conclusions: Our results suggest that Tc- 99m HMPAO brain SPECT is a non-invasive procedure, more sensitive in confirmation of clinical diagnosis of brain death than planar scintigraphy. SPECT also could facilitate the interpretation of doubtful planar images. So, we propose cerebral perfusion SPECT with Tc-99m HMPAO as a reference standard in the diagnosis of brain death wherever is possible, considering patient conditions and organization possibilities to perform it.

Tc-99m-HMPAO ; brain scintigraphy ; blood flow

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