Ramos João N, Pinto Catarina, Cruz E Silva Vera, Topriceanu Constantin-Cristian, Bisdas Sotirios
Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental, Lisboa, 1349-019, Portugal.
Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, United Kingdom.
BJR Open. 2024 Nov 4;6(1):tzae037. doi: 10.1093/bjro/tzae037. eCollection 2024 Jan.
To gather and synthesize evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis.
A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by 3 reviewers. PubMed/MEDLINE, EMBASE and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies' quality. Meta-analysis was performed using univariate random-effects models.
Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI, 86.5-98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings.
The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre, and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters.
Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area.
CRD42022336353.
收集并综合有关CT灌注成像（CTP）或MR灌注成像（MRP）用于脑死亡（BD）诊断的诊断准确性的证据。
一项系统评价和荟萃分析已在PROSPERO（CRD42022336353）上进行前瞻性注册，并按照PRISMA指南由3名审稿人独立进行。检索PubMed/MEDLINE、EMBASE和Cochrane数据库以查找相关研究。使用诊断准确性研究质量评估-2来评估研究质量。采用单变量随机效应模型进行荟萃分析。
纳入10项研究（328例患者）。灌注成像（最常见的是CTP，共8项研究）对BD显示出96.1%（95%CI，89.5-98.6）的高敏感性，在亚组分析中为95.5%（95%CI，86.5-98.6）且结果一致。遗憾的是，计算其他指标不可行。此外，在我们的研究结果中发现了发表偏倚的证据。
CTP或MRP用于BD诊断的敏感性非常高，与CTA和TCD相当。然而，考虑到大多数研究是回顾性的，并且在BD评估中缺乏对照组和明确的灌注成像标准，结果应谨慎解释。未来的研究，理想情况下是前瞻性、多中心且有对照组的研究对于验证这些方法至关重要，尤其是标准化技术参数。
使用CT或MRI的脑灌注成像在诊断BD方面显示出高敏感性，与CTA和TCD相当。该方法得到世界脑死亡小组的推荐，有望在该领域进行进一步研究。
PROSPERO注册号：CRD42022336353。
