Bohatyrewicz Romuald, Pastuszka Joanna, Walas Wojciech, Chamier-Cieminska Katarzyna, Poncyljusz Wojciech, Dabrowski Wojciech, Wojczal Joanna, Luchowski Piotr, Guzinski Maciej, Jurkiewicz Elzbieta, Bekiesinska-Figatowska Monika, Owczuk Radoslaw, Walecki Jerzy, Rowinski Olgierd, Zukowski Maciej, Kusza Krzysztof, Piechota Mariusz, Piotrowski Andrzej, Migdal Marek, Zielinska Marzena, Sawicki Marcin
Department of Anesthesiology and Intensive Therapy, Pomeranian Medical University, 70-204 Szczecin, Poland.
Pediatric and Neonatal Intensive Care Unit, Institute of Medical Science, University of Opole, 45-040 Opole, Poland.
J Clin Med. 2021 Sep 18;10(18):4237. doi: 10.3390/jcm10184237.
Brain death/death by neurologic criteria (BD/DNC) guidelines are routinely analyzed, compared and updated in the majority of countries and are later implemented as national criteria. At the same time, extensive works have been conducted in order to unify clinical procedures and to validate and implement new technologies into a panel of ancillary tests. Recently evaluated computed tomography angiography and computed tomography perfusion (CTA/CTP) seem to be superior to traditionally used digital subtraction angiography (DSA), transcranial Doppler (TCD) and cerebral perfusion scintigraphy for diagnosis of cerebral circulatory arrest (CCA). In this narrative review, we would like to demonstrate scientific evidence supporting the implementation of CTA/CTP in Polish guidelines for BD/DNC diagnosis. Research and implementation process: In the first of our base studies concerning the potential usefulness of CTA/CTP for the confirmation of CCA during BD/DNC diagnosis procedures, we showed a sensitivity of 96.3% of CTA in a group of 82 patients. CTA was validated against DSA in this report. In the second study, CTA showed a sensitivity of 86% and CTP showed a sensitivity of 100% in a group of 50 patients. In this study, CTA and CTP were validated against clinical diagnosis of BD/DNC supported by TCD. Additionally, we propose our CCA criteria for CTP test, which are based on ascertainment of cerebral blood flow (CBF) < 10 mL/100 g/min and cerebral blood volume < 1 mL/100 g in regions of interest (ROIs) localized in all brain regions. Based on our research results, CTA/CTP methods were implemented in Polish BD/DNC criteria. To our knowledge, CTP was implemented for the first time in national guidelines.
CTA and CTP-derived CTA might be in future the tests of choice for CCA diagnosis, proper and/or Doppler pretest might significantly increase sensitivity of CTA in CCA diagnosis procedures. Whole brain CTP might be decisive in some cases of inconclusive CTA. Implementation of CTA/CTP in the Polish BD/DNC diagnosis guidelines does not show any major obstacles. We believe that in next edition of "The World Brain Death Project" CTA and CTP will be recommended as ancillary tests of choice for CCA confirmation during BD/DNC diagnosis procedures.
大多数国家会定期分析、比较和更新脑死亡/神经学标准判定的死亡（BD/DNC）指南，随后将其作为国家标准实施。与此同时，人们开展了大量工作，以统一临床程序，并将新技术验证和应用于一系列辅助检查中。最近评估的计算机断层扫描血管造影和计算机断层扫描灌注（CTA/CTP）在诊断脑循环停止（CCA）方面似乎优于传统使用的数字减影血管造影（DSA）、经颅多普勒（TCD）和脑灌注闪烁显像。在这篇叙述性综述中，我们希望展示支持在波兰BD/DNC诊断指南中实施CTA/CTP的科学证据。研究与实施过程：在我们关于CTA/CTP在BD/DNC诊断程序中确认CCA的潜在用途的首批基础研究中，我们在一组82例患者中显示CTA的敏感性为96.3%。在本报告中，CTA与DSA进行了对照验证。在第二项研究中，在一组50例患者中，CTA显示敏感性为86%，CTP显示敏感性为100%。在这项研究中，CTA和CTP与由TCD支持的BD/DNC临床诊断进行了对照验证。此外，我们提出了CTP检查的CCA标准，该标准基于确定所有脑区感兴趣区域（ROI）的脑血流量（CBF）<10 mL/100 g/min和脑血容量<1 mL/100 g。基于我们的研究结果，CTA/CTP方法被纳入波兰BD/DNC标准。据我们所知，CTP首次被纳入国家指南。
CTA以及CTP衍生的CTA未来可能会成为CCA诊断的首选检查，适当的和/或多普勒预检查可能会显著提高CTA在CCA诊断程序中的敏感性。在某些CTA结果不确定的情况下，全脑CTP可能起决定性作用。在波兰BD/DNC诊断指南中实施CTA/CTP没有显示出任何重大障碍。我们相信，在《世界脑死亡项目》的下一版中，CTA和CTP将被推荐为BD/DNC诊断程序中确认CCA的首选辅助检查。
