• E Facco, P Zucchetta, M Munari, F Baratto, A U Behr, M Gregianin, A Gerunda, F Bui, M Saladini, and G Giron.
• Dept. of Anesthesiology and Intensive Care, University of Padua, Italy. efacco@uxl.unipd.it
• Intensive Care Med. 1998 Sep 1; 24 (9): 911917911-7.

ObjectiveTo evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD).DesignProspective study in comatose and brain-dead patients.SettingNeurologic ICU.Patients And MethodsFifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD.InterventionsBrain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360 degrees, 88 images).Measurements And ResultsAll patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of "empty skull"); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later.ConclusionsOur results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.

20 keywords...

hide…