engleski

CT angiography as a method of brain death confirmation

After clinical diagnosis of brain death, Croatian legislature requires confirmation with one „paraclinical“ method (DSA, scintigraphy, TCD, evoked potentials, EEG). We explore the appropriateness of CT angiography, as a potential „paraclinical“ method. From December 2002, 18 patients in coma after traumatic brain injury or nontraumatic SAH, aged 23-46, were evaluated as possible organ donors. Brain death was diagnosed according to clinical criteria (fixed dilated pupils, absence of bulbar reflexes, negative apnoea-test). Only 9 patients were later candidates for CT angiography. Exams were performed on single-slice scanner. Ana rea from C1 to the lateral ventricle bodies was covered. Standard protocol was used: 100ml of nonionic contrast medium (370mg/ml) flow rate 4mL/s, 1mm slice thickness, pitch 1.5, scan delay up to 60s. No visualisation of great intracranial vessels and the absence of parenchymal attenuation increase after contrast administration due to cerebral circulatory arrest were criteria for brain death confirmation. In 7 patients there was no enhancement of wessels forming the Circle of Willis, and filling of ECAs and infraclinoid ICAs was shown. In 2 patients there was slight enhancement of anterior circulation vessels (MCAs and ACAs) and in agreement with clinicians ; exams were repeated 12 hours later when they were confirmatory. Eventually familiess allowed organ harvesting in 4 patients. Rapid diagnosis of absence of intracranial arterial circulation is important for identification of potential organ donors. Results of CT angiography are comparable to other radiological „paraclinical“ methods, but further comparison studies are needed.

computed ; tomography ; angiography ; brain ; death

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