Dept. of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Clinical Hospital No1, Unii Lubelskiej 1, 71252, Szczecin, Poland.
Clin Neuroradiol. 2019 Mar;29(1):101-108. doi: 10.1007/s00062-017-0631-7. Epub 2017 Nov 17.
In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. Because cerebral circulatory arrest commences at the capillary level, we hypothesized that computed tomography perfusion (CTP) would be a more sensitive approach than CTA; therefore, the aim of the study was to compare the sensitivities of CTP and CTA in the diagnosis of BD.
Whole brain CTP was performed in patients in the intensive care unit diagnosed with BD and CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. The CTP findings were interpreted as being consistent with a diagnosis of BD (positive) when CBF and CBV in all regions of interest (ROIs) were below 10 ml/100 g/min and 1.0 ml/100 g, respectively. The CTA findings were interpreted using a 4-point grading system.
A total of 50 patients were included in the study. The CTP results revealed CBF from 0.00 to 9.98 ml/100 g/min (mean, 1.98 ± 1.68 ml/100 g/min) and CBV from 0.00 to 0.99 ml/100 g (mean, 0.14 ± 0.12 ml/100 g) and were thus interpreted as positive in all 50 patients. In contrast, the CTA results suggested 7 negative cases, providing a sensitivity of 86%. The difference between the CTP and CTA sensitivity results for the diagnosis of BD was statistically significant (p = 0.006).
Whole brain CTP may potentially be a feasible and highly sensitive test for diagnosing BD: therefore, performing CTP in combination with CTA in cases when CTA results are negative for BD could increase the sensitivity of CTA.
在脑死亡（BD）的诊断中，计算机断层血管造影（CTA）的结果在某些情况下显示颅内充盈，导致诊断混淆。由于脑循环停止始于毛细血管水平，我们假设计算机断层灌注（CTP）比 CTA 更敏感；因此，本研究旨在比较 CTP 和 CTA 在 BD 诊断中的敏感性。
对重症监护病房中诊断为 BD 的患者进行全脑 CTP，从 CTP 数据集中得出 CTA。计算所有脑区的脑血流量（CBF）和脑血容量（CBV）。当所有感兴趣区（ROI）的 CBF 和 CBV 均低于 10 ml/100 g/min 和 1.0 ml/100 g 时，将 CTP 结果解释为符合 BD 诊断（阳性）。使用 4 分制评分系统解释 CTA 结果。
共有 50 例患者纳入研究。CTP 结果显示 CBF 为 0.00 至 9.98 ml/100 g/min（平均值 1.98 ± 1.68 ml/100 g/min），CBV 为 0.00 至 0.99 ml/100 g（平均值 0.14 ± 0.12 ml/100 g），因此所有 50 例患者的结果均为阳性。相比之下，CTA 结果提示 7 例为阴性病例，敏感性为 86%。CTP 和 CTA 对 BD 诊断的敏感性结果之间的差异具有统计学意义（p = 0.006）。
全脑 CTP 可能是一种可行且高度敏感的 BD 诊断测试：因此，在 CTA 结果为 BD 阴性时，结合 CTP 和 CTA 进行检查，可能会提高 CTA 的敏感性。
