死还是活？利用计算机断层血管造影定量分析的新型确证试验。

Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography.

作者信息

Suarez-Kelly Lorena P, Patel Dhruv A, Britt Peter M, Clayton Eric J, Bromberg William J, McCain Christina M, Howington Jay U, Davis Frank E

机构信息

From the Departments of Surgery (L.P.S.-K., W.J.B., F.E.D.), and Radiology (D.A.P., P.M.B.), and The Curtis and Elizabeth Anderson Cancer Institute (E.J.C.), Memorial University Medical Center; Department of Surgery (W.J.B., F.E.D.), Mercer University School of Medicine; and Neurologic Institute of Savannah & Center for Spine (J.U.H.), Savannah; and Department of Surgery (C.M.M.), Liberty Regional Medical Center, Hinesville, Georgia.

出版信息

J Trauma Acute Care Surg. 2015 Dec;79(6):995-1003; discussion 1003. doi: 10.1097/TA.0000000000000831.

DOI:10.1097/TA.0000000000000831

PMID:26680139

Abstract

BACKGROUND

When clinical examination is not reliable for brain death (BD) diagnosis, the preferred confirmatory test at our institution is nuclear medicine perfusion test (NMPT). Computed tomographic angiography (CTA) has been described as an alternative for BD confirmation. This study was designed to quantitatively analyze CTA, assess its accuracy compared with NMPT, and define set parameters for BD confirmation.

METHODS

This is a prospective clinical study, from 2007 to 2014, evaluating a consecutive series of clinically BD patients (n = 60) and randomly selected control group with normal CTA findings (n = 20). NMPT, used as the reference standard, was performed on all study patients followed immediately by CTA. Assessment of NMPT and quantitative CTA Hounsfield units of the horizontal segment of middle cerebral artery (M1), precommunicating segment of anterior cerebral artery (A1), and basilar artery (BA) was performed.

RESULTS

In the study cohort, 88% demonstrated absence of cerebral blood flow (CBF) on NMPT; however, only 50% demonstrated absence on CTA. Together, 50% had no CBF on NMPT and CTA (Group 1), 38% had no CBF on NMPT but persistent CBF on CTA (Group 2), 12% had persistent CBF on both NMPT and CTA (Group 3). Analysis of variance demonstrated that all groups varied significantly for M1, A1, and BA (p < 0.001). We were able to establish criteria that differentiate persistent CBF on CTA as either preserved cerebral perfusion or stasis filling.

CONCLUSION

We propose that a CTA Hounsfield units less than 80 in M1, A1, and BA is concordant with no CBF on NMPT, therefore indicative of a lack of physiologic cerebral perfusion, and thus allows the confirmation of BD with 97% sensitivity and 100% specificity.

LEVEL OF EVIDENCE

Diagnostic study, level II.

摘要

背景

当临床检查对脑死亡（BD）诊断不可靠时，我院首选的确诊检查是核医学灌注试验（NMPT）。计算机断层血管造影（CTA）已被描述为BD确诊的一种替代方法。本研究旨在对CTA进行定量分析，评估其与NMPT相比的准确性，并确定BD确诊的设定参数。

方法

这是一项前瞻性临床研究，时间跨度为2007年至2014年，评估一系列连续的临床脑死亡患者（n = 60）以及随机选择的CTA结果正常的对照组（n = 20）。以NMPT作为参考标准，对所有研究患者先进行NMPT，随后立即进行CTA。对大脑中动脉水平段（M1）、大脑前动脉交通前段（A1）和基底动脉（BA）的NMPT及CTA的定量亨氏单位进行评估。

结果

在研究队列中，88%的患者在NMPT上显示无脑血流（CBF）；然而，只有50%的患者在CTA上显示无脑血流。总体而言，50%的患者在NMPT和CTA上均无CBF（第1组），38%的患者在NMPT上无CBF但在CTA上有持续的CBF（第2组），12%的患者在NMPT和CTA上均有持续的CBF（第3组）。方差分析表明，所有组在M1、A1和BA上均有显著差异（p < 0.001）。我们能够建立标准来区分CTA上持续的CBF是保留的脑灌注还是淤滞性充盈。