University Institute of Diagnostic and Interventional Neuroradiology, University of Bern / Inselspital, Freiburgstrasse, CH.
Swiss Med Wkly. 2011 Oct 4;141:w13261. doi: 10.4414/smw.2011.13261. eCollection 2011.
For the determination of brain death (BD) in potential organ donors, confirmatory tests that show cessation of cerebral circulation are used in many countries. Conventional angiography is considered the golden standard among these ancillary examinations. In recent years other angiographic techniques such as CT angiography (CTA) have been increasingly employed to establish the diagnosis of BD. We report our experience with CTA in this setting.
From 2007 to 2010, 29 patients were examined in order to determine BD using CTA. The studies consisted of an unenhanced head scan, a CT angiogram of the brain supplying vessels in the head and neck and a second head scan 80 seconds after contrast injection (venous phase). The studies were retrospectively re-evaluated by two experienced neuroradiologists according to the criteria accepted by the Swiss Academy of Medical Sciences.
In 22 patients, cessation of cerebral circulation was confirmed in the venous phase CT. In seven patients, cessation of brain circulation was not confirmed due to residual contrast enhancement in the relevant cerebral vessels, i.e. the M4-segments of the middle cerebral artery and/or the internal cerebral veins. In these patients, clinical re-evaluation after a minimum of six hours confirmed the diagnosis of BD. Using the clinical examination as the "golden standard," CTA achieved a sensitivity of 75.9%.
CTA is a useful additional tool for the confirmation of the diagnosis of brain death. Pooling of contrast in the relevant cerebral vessels, however, can be detected in up to 25% of CTAs in clinically brain dead patients.
在潜在器官捐献者中确定脑死亡（BD）时，许多国家使用显示脑循环停止的确认性试验。在这些辅助检查中，传统血管造影被认为是金标准。近年来，其他血管造影技术，如 CT 血管造影（CTA），已越来越多地用于建立 BD 的诊断。我们报告了我们在这种情况下使用 CTA 的经验。
从 2007 年到 2010 年，我们对 29 名患者进行了 CTA 检查以确定 BD。这些研究包括未增强的头部扫描、头部和颈部脑供血血管的 CT 血管造影以及对比剂注射后 80 秒的第二次头部扫描（静脉期）。两名经验丰富的神经放射科医生根据瑞士医学科学院接受的标准对研究进行了回顾性重新评估。
在 22 名患者中，在静脉期 CT 上确认了脑循环停止。在 7 名患者中，由于相关脑血管中的对比剂残留增强，即大脑中动脉的 M4 段和/或大脑内静脉，未确认脑循环停止。在这些患者中，至少 6 小时后的临床重新评估确认了 BD 的诊断。使用临床检查作为“金标准”，CTA 的灵敏度为 75.9%。
CTA 是确认脑死亡诊断的有用辅助工具。然而，在临床脑死亡患者中，多达 25%的 CTA 可以检测到相关脑血管中的对比剂积聚。
