Analysis of the use of computerized angiotomography for diagnosis of brain death: A Systematic Review
DOI:
https://doi.org/10.34119/bjhrv8n5-196Keywords:
brain death, CT angiography, ancillary tests, systematic reviewAbstract
Background: Brain death (BD) can be described as a complete and irreversible loss of brain function caused by the cessation of both brain and spinal cord activity. The diagnosis of this condition is mainly clinical, although it can be used with ancillary tests such as Computed Tomography Angiography (CTA) to increase the accuracy of the diagnosis. Also, the countries’ protocol of BD diagnosis vary regarding the ancillary tests, and there is no consensus on this topic in literature. Objective: The aim of this study is to answer the question if CTA is a sensitive ancillary test for the diagnosis of brain death. Methods: In this systematic review, we evaluate the articles published on PubMed/MEDLINE until July 16, 2024. Data of brain death causes, accordance percentage of CTA corroborating BD and the clinical BD diagnosis, CTA scores and which arteries and vein had lack of opacification were analyzed. Methodological quality was assessed by QUADAS-2. Results: The searches retrieved 2187 records, of which 30 publications were selected for full-text screening. 6 studies were included, with 1346 patients evaluated. The accordance percentage of CTA corroborating BD and the clinical BD diagnosis varied from 100% (3 studies), 97% (1 study), 94,2% (1 study) and 1 study divided in 52,4% confirming BD diagnosis with 47,6% indicating BD diagnosis. Conclusion: CTA is a promising method for BD diagnosis, nevertheless there are disagreements regarding its use, and still more studies are needed.
References
A E, TEKELI; H, DEMIRKIRAN; DEATH, ARSLAN H. Evaluation of Computed Tomography Angiography as an Ancillary Test to Reduce Confusion After Clinical Diagnosis of Brain Death. Transplantation Procedures. 53(2):596-601. 2020.
A, LEWIS; J, LIEBMAN; E, KREIGER-BENSON; A, KUMPFBECK; A, BAKKAR; AL, SHEMIE SD et. Ancillary Testing for Determination of Death by Neurologic Criteria Around the World. Neurocritical Care. 34(2):473-484. 2020.
AJ, MARCHAND; P, SEGUIN; Y, MALLEDANT; M, TALEB; H, RAOULT; JY, GAUVRIT. Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death. Annals of Intensive Care 6(1):88. 2016.
B, DUPAS; M, GAYET-DELACROIX; D, VILLERS; D, ANTONIOLI; MF, VECCHERINI; JP, Soulillou. Diagnosis of brain death using two-phase spiral CT. AJNR American Journal of Neuroradiology 19:641–47 1998.
C, QUESNEL; JP, FULGENCIO; C, ADRIE; B, MARRO; L, PAYEN; N, LEMBERT; AL, et. Limitations of computed tomographic angiography in the diagnosis of brain death. Intensive Care Medicine 33(12):2129-35. 2007.
DM, GREER D; MP, KIRSCHEN; A, LEWIS; GS, GRONSETH; A, ERA-GRANT; S, ASHWAL; AL, et. Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM . Neurology. 101(24):1112-1132. 2023.
E, FRAMPAS; M, VIDECOQ; E, DE KERVILER; F, RICOLFI; V, KUOCH; F, MOUREY; AL, et. CT angiography for brain death diagnosis. American Journal of Neuroradiology. 30(8):1566-70. 2009
G, CITERIO.; CRIPPA; I.A.; BRONCO; A. VARGIOLU A, SMITH M. Variability in Brain Death Determination in Europe: Looking for a Solution. Neurocritical Care. 21(3):376-82. 2014..
EF, Wijdicks. 2002 Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 58(1):20-5. .
G, SCHWARZ; M, ERRATH; PA, DELGADO; U, WIEßPEINER; H, VOIT-AUGUSTIN; R, Grims; AL, et. Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death. Life. 12(10):1551. 2022.
GA, WESTPHAL; VC, VEIGA; BRAZIL, Franke CA Diagnosis of brain death in. Revista Brasileira de Terapia Intensiva 31(3):403-409. 2019.
H, SADEGHIAN; MA, RAEISI; P, DOLATI; R, MOTIEI-LANGROUDI. Brain Computed Tomography Angiography as an Ancillary Test in the Confirmation of Brain Death. Cureus. 9(7):e1491. 2017.
HC, CHUA; TK, KWEK; H, MORIHARA; D, GAO. Brain death: the Asian perspective. Seminars in Neurology 35(2):152-61. 2015.
H SAHIN; PEKCEVIK, HY. CT angiography as a confirmatory test in diagnosis of brain death: Comparison between three scoring systems. Diagnostic and Interventional Radiology. 21(2):177-83. 2015.
JC, COMBES; A, CHOMEL; F, RICOLFI; P, D’ATHIS; M, FREYSZ. Reliability of Computed Tomographic Angiography in the Diagnosis of Brain Death. Transplant Procedure. 39(1):16-20. 2007.
K, KARAKUŞ; S, DEMIRCI; AY, CENGIZ; MH, ATALAR. Confirming the brain death diagnosis using brain CT angiography: experience in Tokat State Hospital. Internal Journal of Clinical and Experimental Medicine 7:1747-51 2014.
M, SAWICKI; J, SOŁEK-PASTUSZKA; K, CHAMIER-CIEMINSKA; A, WALECKA; R, BOHATYREWICZ. Accuracy of computed tomographic perfusion in diagnosis of brain death: A prospective cohort study. Medical Science Monitor 4:24:2777-2785. 2018.
MA, Koenig; DEATH, Kaplan PW Brain. Handbook of Clinical Neurology 161:89-102. 2019.
MH, YOSHIKAWA; NN, RABELO; LC, WELLING; JPM, TELLES; EG, Figueiredo. Brain death and management of the potential donor. Neurology Sciences. 42(9):3541-3552. 2021.
O, HOFFMANN; F, SALIH; GERMANY, MASUHR F Computed tomography angiography in the diagnosis of brain death: Implementation and results in. European Journal of Neurology. 31(4):e16209. 2024.
P, ZAMPAKIS; V, PANAGIOTOPOULOS; C, KALOGEROPOULOU; M, KARACHALIOU; D, ARETHA; N, SIOULAS; AL, et. Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death. Scientific Reports. 11(1):15081. 2021.
PF, WHITING; AWS, RUTJES; ME, WESTWOOD; S, MALLET; JJ, DEEKS; JB, REITSMA; AL, et. QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Ann Internal Medicine. 155(8):529-36. 2011.
R, BOHATYREWICZ; M, SAWICKI; A, WALECKA; J, WALECKI; O, ROWINSKI; A, BOHATYREWICZ; AL, et. Computed Tomographic Angiography and Perfusion in the Diagnosis of Brain Death. Transplant Procidures. 42(10):3941-6. 2010.
R, JOHNSTON; C, KALIAPERUMAL; G, WYSE; G, KAAR. Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation. BMJ Case Reports. 8:2013:bcr2012007754. 2013.
S, WAHLSTER; EF, WIJDICKS; PV, PATEL; DM, GREER; J, CLAUDE HEMPHILL 3RD; AL, CARONE M et. Brain death declaration: Practices and perceptions worldwide. Neurology 84(18):1870-9. 2015.
S, WELSCHEHOLD; T, KERZ; S, BOOR; K, REULAND; F, THÖMKE; A, REULAND; AL, et. Computed tomographic angiography as a useful adjunct in the diagnosis of brain death. Journal of Trauma and Acute Care Surgiry. 74(5):1279-85. 2013.


