Akdogan Asli I, Sahin Hilal, Pekcevik Yeliz, Uluer Hatice
Department of Radiology, Buca Women Birth and Child Diseases Hospital, Izmir, Turkey.
Department of Radiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
Pol J Radiol. 2020 Nov 25;85:e636-e642. doi: 10.5114/pjr.2020.101482. eCollection 2020.
To assess the utility of brain parenchyma density measurement on unenhanced computed tomography (CT) in predicting brain death (BD), in order to evaluate the added value of CT perfusion (CTP).
A total of 77 patients who were clinically diagnosed as BD and had both CT angiography (CTA) and CTP imaging in the same session were retrospectively reviewed. On unenhanced phase of CTA, density measurement was performed from 23 regions of interests (ROIs) which were located in the following areas: level of basal ganglia (caudate nucleus, putamen, corpus callosum, posterior limb of internal capsule), level of brainstem, grey- white matters on levels of centrum semiovale (CS), high convexity (HC), and cerebellum. CTP images were evaluated qualitatively and independently. Grey matter (GM), white matter (WM), density, and GM/WM density ratio of BD patients were compared with control subjects.
Comparing with the normal control group, the GM and WM density at each level and GM/WM density ratio of CS, HC, and cerebellum level were significantly lower in brain-dead patients ( = 0.019 for HC-WM, < 0.001 for other areas). Using ROC analysis, the highest value of area under curve (AUC) for the GM/WM density ratio was found at the HC level (AUC = 0.907). The sensitivity of the GM/WM density ratio at the HC level was found to be 90% when the cut-off value of 1.25 was identified. Evaluating the GM/WM density ratio together with the CTP results increased the sensitivity further to 98%.
The GM/WM density ratio at the HC level on unenhanced CT may be a useful finding to predict BD. Also, the addition of CTP increases the sensitivity of this method.
评估在未增强计算机断层扫描（CT）上测量脑实质密度对预测脑死亡（BD）的效用，以评估CT灌注（CTP）的附加值。
回顾性分析77例临床诊断为BD且在同一时间段内同时进行CT血管造影（CTA）和CTP成像的患者。在CTA的未增强期，从位于以下区域的23个感兴趣区（ROI）进行密度测量：基底节水平（尾状核、壳核、胼胝体、内囊后肢）、脑干水平、半卵圆中心（CS）、高凸面（HC）和小脑水平的灰质和白质。对CTP图像进行定性和独立评估。比较BD患者与对照组的灰质（GM）、白质（WM）密度以及GM/WM密度比。
与正常对照组相比，脑死亡患者各水平的GM和WM密度以及CS、HC和小脑水平的GM/WM密度比均显著降低（HC-WM为P = 0.019，其他区域P < 0.001）。使用ROC分析，发现GM/WM密度比在HC水平的曲线下面积（AUC）最高（AUC = 0.907）。当确定截断值为1.25时，HC水平的GM/WM密度比敏感性为90%。将GM/WM密度比与CTP结果一起评估可使敏感性进一步提高至98%。
未增强CT上HC水平的GM/WM密度比可能是预测BD的有用指标。此外，增加CTP可提高该方法的敏感性。
