Evaluation of the Efficacy of Computed Tomography Angiography in Brain Death

Objective: Brain death is defined as the complete and irreversible loss of all brain functions including the brain stem. Three major findings used for the diagnosis of brain death are coma, absence of the brain stem reflexes and apnea. The diagnosis of brain death has become more important with the increasing number of patients waiting for transplantation. The objective of this study was to determine the efficacy of computed tomography angiography in confirming brain death.

Material & Methods: Clinical brain death was reported in total 21 patients hospitalized in critical care unit of our hospital between October 2015 and June 2018. One of these patients was excluded since he underwent magnetic resonance angiography. CTA findings of the remaining patients were retrospectively evaluated. Patients were aged between 25 and 75 years with a mean age of 45 ± 1 years. CTA evaluations were performed using a 64 detector device. 100 mL contrast agent was delivered with a double head automated pump at a rate of 3.5 – 4 cc/sec as 350-375 mg/mL. When the region of interest reached to 90-100 HU cut off value, the images were acquired at 15-20 sec intervals on the axial plan. CTA findings were interpreted using 10- point scale.

Results: Causes of death were reported as intracranial hemorrhage in eight patients, ischemic cerebrovascular events in four patients, hemorrhage after craniotomy in three patients, cardiac arrest in two patients, post-traumatic contusio cerebri in one patient, and metabolic reasons in two patients.

Contrast filling was “0” in the ACA, PCA, MCA distal, and ICA supraclinoid branches of all 20 patients. Suspected contrast filling was found in MCA proximal in eight patients and unilateral ACA proximal in two patients. Each loss of opacification in the intracranial brancges was scored as 1 point. Accordingly, all patients were scored as 10 points.

Conclusion: According to our results, CTA is an effective and sensitive method for the diagnosis of brain death which is obligated by regulations.