• Dolores Escudero, Jesús Otero, Lara Marqués, Diego Parra, José Antonio Gonzalo, Guillermo M Albaiceta, Luis Cofiño, Armando Blanco, Pedro Vega, Eduardo Murias, Angela Meilan, Ricardo López Roger, and Francisco Taboada.
• Department of Intensive Care Medicine, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, Spain. dolores.escudero@sespa.princast.es
• Neurocrit Care. 2009 Jan 1;11(2):261-71.

IntroductionAlthough the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD.MethodsProspective observational study in 27 BD patients.ResultsAll patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead.ConclusionsThe radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography.

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