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Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death. | LitMetric

AI Article Synopsis

  • Computed tomography angiography (CTA) is commonly used in Europe to help diagnose brain death but has lower sensitivity, especially in patients with a history of decompressive craniectomy.
  • A study involving 76 patients assessed a new four-point venous CTA score that included non-opacification of specific veins, showing improved sensitivity (95%) for confirming brain death compared to the older reference score (88%).
  • This revised score proved particularly effective in patients who had undergone decompressive craniectomy, achieving a sensitivity of 100%, indicating it is a better diagnostic tool overall.

Article Abstract

Background: Computed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death.

Methods: A preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score.

Results: The revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score.

Conclusion: Compared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020015PMC
http://dx.doi.org/10.1186/s13613-016-0188-7DOI Listing

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