Şahin Hilal, Pekçevik Yeliz
Department of Radiology, Tepecik Training and Research Hospital, Izmir, Turkey.
Diagn Interv Radiol. 2015 Mar-Apr;21(2):177-83. doi: 10.5152/dir.2014.14241.
Computed tomography (CT) angiography emerges as a viable alternative technique for confirmation of brain death. However, evaluation criteria are not well established for demonstration of cerebral circulatory arrest. This retrospective study aimed to evaluate CT angiography scoring systems in diagnosis of brain death, review the literature, and compare interobserver agreement between different scales for the diagnosis of brain death.
CT angiography examinations of 25 patients with a clinical diagnosis of brain death were reevaluated according to 10-, 7-, and 4-point scales. Exams were performed with a 64-slice CT scanner including unenhanced, arterial (20 s) and venous phase (60 s) scans. Subtraction images of both phases were obtained. Interobserver agreement was evaluated for the assessment of vessel opacification and diagnosis of brain death.
According to 10-, 7-, and 4-point scales; 13, 16, and 22 of 25 patients had full score, respectively. Using the clinical exam as the reference standard, sensitivities obtained for 10-, 7-, and 4-point scales were 52%, 64%, and 88%, respectively. Percent agreement between readers was 100% for 10- and 7-point scales and 88% for 4-point scale. Percent agreement for opacification of scale vessels was equally high for all three scales (93.6%, 93.7%, 91% for 10-, 7-, and 4-point scales, respectively).
The 4-point scale appears to be more sensitive than the 10- and 7-point scales in CT angiography evaluation for brain death. Interobserver agreement is high for all three scales when subtraction images are used.
计算机断层扫描（CT）血管造影术已成为确认脑死亡的一种可行替代技术。然而，对于脑循环停止的显示，评估标准尚未完全确立。本回顾性研究旨在评估CT血管造影评分系统在脑死亡诊断中的作用，回顾相关文献，并比较不同评分系统在脑死亡诊断中观察者间的一致性。
根据10分制、7分制和4分制对25例临床诊断为脑死亡患者的CT血管造影检查进行重新评估。检查使用64层CT扫描仪进行，包括平扫、动脉期（20秒）和静脉期（60秒）扫描。获取两期的减影图像。评估观察者间在血管显影评估和脑死亡诊断方面的一致性。
根据10分制、7分制和4分制；25例患者中分别有13例、16例和22例获得满分。以临床检查作为参考标准，10分制、7分制和4分制的敏感性分别为52%、64%和88%。10分制和7分制读者间的一致性百分比为100%，4分制为88%。所有三种评分系统在主要血管显影方面的一致性百分比同样很高（10分制、7分制和4分制分别为93.6%、93.7%、91%）。
在CT血管造影评估脑死亡方面，4分制似乎比10分制和7分制更敏感。当使用减影图像时，所有三种评分系统的观察者间一致性都很高。
