Quesnel Christophe, Fulgencio Jean-Pierre, Adrie Christophe, Marro Béatrice, Payen Laurent, Lembert Nadège, El Metaoua Sonia, Bonnet Francis
Université Pierre & Marie Curie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Service d'Anesthésie-Réanimation, 4 rue de la Chine, 75970 Paris Cedex 20, France.
Intensive Care Med. 2007 Dec;33(12):2129-35. doi: 10.1007/s00134-007-0789-6. Epub 2007 Jul 21.
To evaluate the accuracy of cerebral computed tomographic angiography (CT-a) for the diagnosis of brain death (BD).
Prospective observational study in intensive care units.
Twenty-one clinically BD patients enrolled over 12 months.
All clinically BD patients were evaluated by electroencephalography (EEG) and CT-a after exclusion of hypothermia and drug intoxication. Data collected included: demographic characteristics, cause of BD, delay between in-hospital admission and BD diagnosis and between EEG and CT-a, occurrence of cardiac arrest, administration of vasoactive agents, results of EEG and CT-a. We evaluated the sensitivity of EEG and CT-a and their agreement. Groups were compared according to BD diagnosis by EEG and CT-a (E+C+), or only by EEG (E+C(-)). Statistical analysis were performed by Mann-Whitney test and Fisher's exact test. BD was confirmed by EEG in all cases (sensitivity 100%) whereas only 11 patients of 21 had no cerebral perfusion during CT-a (sensitivity 52.4%). No agreement was documented between EEG and CT-a for the diagnosis of BD (kappa = 0). Patients' characteristics did not differ between E+C+ and E+C(-) groups. In the E+C(-) group arterial opacification was observed in 100% of patients, but opacification of the internal cerebral veins was achieved in only 30%.
In clinically BD patients with no electroencephalographic activity CT-a documents opacification of the intracerebral vessels in a significant percentage of the cases. Therefore CT-a cannot be recommended as a means of BD diagnosis.
评估脑计算机断层血管造影（CT-a）诊断脑死亡（BD）的准确性。
在重症监护病房进行的前瞻性观察性研究。
在12个月内纳入的21例临床诊断为BD的患者。
所有临床诊断为BD的患者在排除体温过低和药物中毒后，均接受了脑电图（EEG）和CT-a检查。收集的数据包括：人口统计学特征、BD病因、入院至BD诊断之间以及EEG与CT-a之间的时间间隔、心脏骤停的发生情况、血管活性药物的使用情况、EEG和CT-a的结果。我们评估了EEG和CT-a的敏感性及其一致性。根据EEG和CT-a（E+C+）或仅根据EEG（E+C(-)）诊断BD对患者进行分组比较。采用Mann-Whitney检验和Fisher精确检验进行统计分析。所有病例均通过EEG确诊为BD（敏感性100%），而21例患者中只有11例在CT-a检查时无脑灌注（敏感性52.4%）。EEG和CT-a在BD诊断方面未发现一致性（kappa = 0）。E+C+组和E+C(-)组患者的特征无差异。在E+C(-)组中，100%的患者观察到动脉显影，但仅30%的患者实现了脑内静脉显影。
在临床上无脑电图活动的BD患者中，CT-a在相当比例的病例中显示脑内血管显影。因此，不推荐将CT-a作为BD的诊断方法。
