Bohatyrewicz R, Sawicki M, Walecka A, Walecki J, Rowinski O, Bohatyrewicz A, Kanski A, Czajkowski Z, Krzysztalowski A, Solek-Pastuszka J, Zukowski M, Marzec-Lewenstein E, Wojtaszek M
Pomeranian Medical University Szczecin, Poland.
Transplant Proc. 2010 Dec;42(10):3941-6. doi: 10.1016/j.transproceed.2010.09.143.
According to Polish brain death (BD) criteria, instrumental confirmatory tests should be used in certain clinical situations, particularly any case for which clinical examinations seem inadequate. Electrophysiological tests are often unavailable. Therefore, cerebral perfusion testing is the method of choice with four-vessel digital subtraction angiography (DSA), the gold standard. Unfortunately, DSA is an expensive and invasive examination that requires an experienced neuroradiologist and the availability of an angiography suite. Recently, multirow computed tomographic devices became available, even in smaller hospitals in Poland. Despite this fact, computed tomographic angiography (CTA) and computed tomographic perfusion (CTP) are not accepted in BD diagnosis protocols in Poland because of limited experience and a lack of widely accepted criteria. In this situation, we started a multicenter trial to determine the accuracy of CTA and CTP to confirm BD.
We examined 24 patients who fulfilled standard clinical BD criteria. We recognized the absence of brain perfusion in CTA examination following the criteria proposed by the French Society of Neuroradiology, namely, the absence of opacification of M4 middle cerebral artery segments (M4-MCA) and of deep cerebral veins.
In all of our patients, CTA showed absence of opacification of M4 segments and of deep cerebral veins. In addition, three patients had CTA showing weak opacification of A2 segments of the anterior cerebral artery (A2-ACA) and M2 or M3-MCA. Opacification of the basilar artery or of the posterior cerebral arteries was not noted in any case. In all patients, CTP revealed zero values of regional cerebral blood volume and regional cerebral blood flow. Conventional angiography confirmed cerebral circulatory arrest in all 24 cases.
CTA and CTP seem to be promising radiological examinations for the diagnosis of BD. They may be noninvasive alternatives to conventional cerebral angiography, and to the other instrumental confirmatory tests, that are unavailable or inadequate.
根据波兰脑死亡（BD）标准，在某些临床情况下应使用仪器确认性检查，特别是在临床检查似乎不充分的任何病例中。电生理检查通常无法进行。因此，脑灌注测试是首选方法，四血管数字减影血管造影（DSA）是金标准。不幸的是，DSA是一种昂贵且有创的检查，需要经验丰富的神经放射科医生以及血管造影设备。最近，即使在波兰的较小医院也配备了多排计算机断层扫描设备。尽管如此，由于经验有限且缺乏广泛接受的标准，计算机断层血管造影（CTA）和计算机断层灌注（CTP）在波兰的BD诊断方案中未被接受。在这种情况下，我们启动了一项多中心试验，以确定CTA和CTP用于确认BD的准确性。
我们检查了24例符合标准临床BD标准的患者。根据法国神经放射学会提出的标准，我们在CTA检查中确认脑灌注缺失，即大脑中动脉M4段（M4-MCA）和大脑深静脉无造影剂充盈。
在我们所有的患者中，CTA显示M4段和大脑深静脉无造影剂充盈。此外，3例患者的CTA显示大脑前动脉A2段（A2-ACA）以及M2或M3-MCA有微弱造影剂充盈。在任何情况下均未发现基底动脉或大脑后动脉有造影剂充盈。在所有患者中，CTP显示局部脑血容量和局部脑血流量值为零。传统血管造影证实所有24例患者均存在脑循环停止。
CTA和CTP似乎是用于BD诊断的有前景的放射学检查。它们可能是传统脑血管造影以及其他无法获得或不充分的仪器确认性检查的非侵入性替代方法。
