Frampas E, Videcoq M, de Kerviler E, Ricolfi F, Kuoch V, Mourey F, Tenaillon A, Dupas B
Departments of Radiology and Medical Imaging, CHU Nantes Hôtel-Dieu, 1 place Alexis Ricordeau, Nantes Cedex 1, France.
AJNR Am J Neuroradiol. 2009 Sep;30(8):1566-70. doi: 10.3174/ajnr.A1614. Epub 2009 Apr 30.
Lack of cerebral circulation is an important confirmatory test for brain death (BD). Conventional angiography remains the standard imaging method, but CT angiography (CTA) is emerging as an alternative. France accepts BD diagnoses relying on a score based on lack of opacification of 7 intracerebral vessels in CTA images. The purpose of this study was to validate the efficiency of this score and to evaluate the sensitivity of a novel 4-point CTA score in confirming BD.
A prospective multicentric study was conducted during 12 months with 105 patients referred for CTA to confirm a clinical diagnosis of BD. Clinical data were recorded. CTA images were interpreted first by local radiologists at the referent center, resulting in a 7-point score based on lack of opacification of the pericallosal and cortical segments of the middle cerebral arteries (MCAs), internal cerebral veins (ICVs), and 1 great cerebral vein per patient and, second, by a consensus panel of 3 expert radiologists, blinded to the initial scores, resulting in novel 4-point scores based on the lack of opacification of the cortical segments of the MCAs and ICVs.
Injection of contrast medium did not alter renal function. With the initial 7-point score, sensitivity was 62.8%. With the simplified 4-point score, sensitivity was 85.7% and specificity was 100%. Opacification of ICVs was absent in 98.1% of patients.
Lack of opacification in the cortical segments of the MCAs and internal veins in CTA is efficient and reliable for confirming BD.
脑循环缺失是脑死亡（BD）的一项重要确诊检查。传统血管造影术仍是标准的成像方法，但CT血管造影（CTA）正逐渐成为一种替代方法。法国接受基于CTA图像中7条脑内血管不显影的评分来诊断BD。本研究的目的是验证该评分的有效性，并评估一种新的4分CTA评分在确诊BD中的敏感性。
在12个月内进行了一项前瞻性多中心研究，纳入105例因CTA前来确诊临床BD诊断的患者。记录临床数据。CTA图像首先由转诊中心的当地放射科医生解读，根据大脑中动脉（MCA）的胼周段和皮质段、大脑内静脉（ICV）以及每位患者的1条大脑大静脉不显影情况得出7分评分，其次由3名专家放射科医生组成的共识小组在不知晓初始评分的情况下进行解读，根据MCA和ICV皮质段不显影情况得出新的4分评分。
注射造影剂未改变肾功能。采用初始的7分评分时，敏感性为62.8%。采用简化的4分评分时，敏感性为85.7%，特异性为100%。98.1%的患者ICV不显影。
CTA中MCA和脑内静脉皮质段不显影在确诊BD方面有效且可靠。
