Çinar Hasibe Gökçe, Ucan Berna, Bulut Hasan, Yılmaz Şükriye, Göncü Sultan, Gün Emrah, Özbudak Pınar, Üstün Canan, Üner Çiğdem
Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06170, Turkey.
Department of Pediatric İntensive Care, Ankara Etlik City Hospital, Ankara 06170, Turkey.
Tomography. 2025 Mar 8;11(3):30. doi: 10.3390/tomography11030030.
BACKGROUND/OBJECTIVES: While ancillary tests for brain death diagnosis are not routinely recommended in guidelines, they may be necessary in specific clinical scenarios. Computed tomography angiography (CTA) is particularly advantageous in pediatric patients due to its noninvasive nature, accessibility, and rapid provision of anatomical information. This study aims to assess the diagnostic sensitivity of a revised venous system (ICV-SPV) utilizing a 4-point scoring system in children clinically diagnosed with brain death.
A total of 43 pediatric patients clinically diagnosed with brain death who underwent CTA were retrospectively analyzed. Imaging was performed using a standardized brain death protocol. Three distinct 4-point scoring systems (A20-V60, A60-V60, ICV-SPV) were utilized to assess vessel opacification in different imaging phases. To evaluate age-dependent sensitivity, patients were categorized into three age groups: 26 days-1 year, 2-6 years, and 6-18 years. The sensitivity of each 4-point scoring system in diagnosing brain death was calculated for all age groups.
The revised venous scoring system (ICV-SPV) demonstrated the highest overall sensitivity in confirming brain death across all age groups, significantly outperforming the reference 4-point scoring systems. Furthermore, the ICV-SPV system exhibited the greatest sensitivity in patients with cranial defects.
The revised 4-point venous CTA scoring system, which relies on the absence of ICV and SPV opacification, is a reliable tool for confirming cerebral circulatory arrest in pediatric patients with clinical brain death.
背景/目的：虽然脑死亡诊断的辅助检查在指南中并非常规推荐，但在特定临床情况下可能是必要的。计算机断层血管造影（CTA）因其无创性、可及性以及能快速提供解剖信息，在儿科患者中具有特别的优势。本研究旨在评估一种经修订的静脉系统（ICV-SPV）利用4分评分系统对临床诊断为脑死亡的儿童的诊断敏感性。
对43例临床诊断为脑死亡并接受CTA检查的儿科患者进行回顾性分析。成像采用标准化的脑死亡方案。使用三种不同的4分评分系统（A20-V60、A60-V60、ICV-SPV）评估不同成像阶段的血管显影情况。为评估年龄依赖性敏感性，将患者分为三个年龄组：26天至1岁、2至6岁和6至18岁。计算所有年龄组中每个4分评分系统诊断脑死亡的敏感性。
修订后的静脉评分系统（ICV-SPV）在所有年龄组中确认脑死亡的总体敏感性最高，显著优于参考4分评分系统。此外，ICV-SPV系统在有颅骨缺损的患者中表现出最大的敏感性。
修订后的4分静脉CTA评分系统，基于ICV和SPV不显影，是确认临床脑死亡的儿科患者脑循环停止的可靠工具。
