Al-Shammri S, Al-Feeli M
Department of Medicine, Faculty of Medicine, Kuwait University.
Med Princ Pract. 2004 Sep-Oct;13(5):267-72. doi: 10.1159/000079525.
To determine the reliability of radionuclide cerebral blood perfusion imaging in confirming brain death irrespective of continued heartbeat.
Twenty-eight patients (19 male and 9 female, aged 17-63 years) with severe brain injury and fully supported until the final cardiac asystole were included in the study. Two sets of clinical tests aimed at ascertaining brain death in each subject were performed separately for each case within an interval of 24 h. Dynamic, planar and single photon emission computed tomographic (SPECT) brain scintigraphy were also performed after intravenous administration of 550 MBq (15 mCi) technetium-99m hexamethyl propyleneamine oxime.
Following the clinical diagnosis of brain death, none of the patients was withdrawn from cardiopulmonary support or had any organ harvested. Dynamic, planar and SPECT imaging performed thereafter did not reveal any intracranial cerebral perfusion in any of the subjects, except in 1 patient where the initial scan showed posterior fossa activity that ceased, in a subsequent scan obtained after 24 h. All of the patients were declared dead only after the emergence of cardiac asystole.
The findings indicate that radionuclide brain perfusion imaging is reliable, reproducible, noninvasive and simple to perform for the confirmation of brain death and as such we recommend it as an alternative to exhaustive neurophysiological tests and invasive catheter angiography.
确定放射性核素脑血流灌注成像在不论心跳是否持续的情况下确认脑死亡的可靠性。
纳入28例（19例男性，9例女性，年龄17 - 63岁）严重脑损伤患者，在最终心跳停止前均给予充分支持治疗。对每例患者在24小时内分别进行两组旨在确定脑死亡的临床检查。静脉注射550MBq（15mCi）锝-99m六甲基丙烯胺肟后，还进行了动态、平面及单光子发射计算机断层扫描（SPECT）脑闪烁显像。
在临床诊断脑死亡后，没有患者停止心肺支持或进行任何器官摘取。此后进行的动态、平面及SPECT成像在所有受试者中均未显示任何颅内脑灌注，仅有1例患者在初始扫描时显示后颅窝有活性，但在24小时后的后续扫描中该活性消失。所有患者均在心跳停止后才被宣布死亡。
研究结果表明，放射性核素脑灌注成像在确认脑死亡方面具有可靠、可重复、无创且操作简便的特点，因此我们推荐将其作为全面神经生理学检查和有创导管血管造影的替代方法。
