Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
Department of Radiology, University of Manitoba, Winnipeg, MB R3C 2C1, Canada.
Tomography. 2024 Jul 16;10(7):1139-1147. doi: 10.3390/tomography10070086.
The determination of death by neurological criteria (DNC) stands as a pivotal aspect of medical practice, involving a nuanced clinical diagnosis. Typically, it comes into play following a devastating brain injury, signalling the irreversible cessation of brain function, marked by the absence of consciousness, brainstem reflexes, and the ability to breathe autonomously. Accurate DNC diagnosis is paramount for adhering to the 'Dead donor rule', which permits organ donation solely from deceased individuals. However, complexities inherent in conducting a comprehensive DNC examination may impede reaching a definitive diagnosis. To address this challenge, ancillary testing such as computed tomography angiography (CTA) has emerged as a valuable tool. The aim of our study is to review the technique and interpretation of CTA for DNC diagnoses. CTA, a readily available imaging technique, enables visualization of the cerebral vasculature, offering insights into blood flow to the brain. While various criteria and scoring systems have been proposed, a universally accepted standard for demonstrating full brain circulatory arrest remains elusive. Nonetheless, leveraging CTA as an ancillary test in DNC assessments holds promise, facilitating organ donation and curbing healthcare costs. It is crucial to emphasize that DNC diagnosis should be exclusively entrusted to trained physicians with specialized DNC evaluation training, underscoring the importance of expertise in this intricate medical domain.
通过神经学标准确定死亡（DNC）是医学实践的一个关键方面，涉及到细致的临床诊断。通常情况下，它是在严重的脑损伤后出现的，标志着脑功能不可逆转地停止，表现为意识丧失、脑干反射消失以及自主呼吸能力丧失。准确的 DNC 诊断对于遵守“死亡供体规则”至关重要，该规则仅允许从已故个体中进行器官捐献。然而，进行全面 DNC 检查所固有的复杂性可能会阻碍明确诊断的达成。为了解决这一挑战，辅助测试如计算机断层血管造影（CTA）已成为一种有价值的工具。我们的研究旨在回顾 CTA 在 DNC 诊断中的技术和解释。CTA 是一种现成的成像技术，可用于可视化脑血管，提供有关大脑血流的信息。虽然已经提出了各种标准和评分系统，但证明全脑循环停止的通用标准仍难以确定。尽管如此，将 CTA 作为 DNC 评估的辅助测试具有很大的潜力，可以促进器官捐献并控制医疗保健成本。需要强调的是， DNC 诊断应仅由接受过专门 DNC 评估培训的训练有素的医生进行，这突显了在这个复杂的医学领域中专业知识的重要性。
