Final Report of the Polish Multicentre Study for Evaluation of Computed Tomographic Angiography in the Diagnosis of Brain Death

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IntroductionAccording to Polish brain death (BD) criteria instituted in 2007, confirmatory tests should be used in specific situations such as intoxication, infratentorial processes, extensive facial damage, in children up to one year of age and any case when clinical examination seems to be inadequate. These tests are often unavailable due to insufficient access to proper equipment and qualified specialists. Therefore, finding a confirmatory test, which would be widely available, simple to perform and easy to interpret became of fundamental importance. Computed tomographic angiography (CTA) seemed to be the test of choice for this purpose because new generation of CT scanners became widely available. The method is simple and relatively cheap. Despite of this fact, CTA was not included in Polish BD criteria in 2007 because of limited expertise and lack of generally accepted criteria. In this situation, after approval of Bioethical Committee we organized Polish national multicentre trial for evaluation of CTA in the diagnosis of BD.MethodsIn 7 cooperating centres, we examined 119 patients, which fulfilled standard clinical BD criteria. In all cases two-phase CTA was performed with assessment of intracranial vessels at 60 sec. after contrast administration. Cerebral circulatory arrest in CTA was defined as the absence of opacification of M4 segments of the middle cerebral artery (M4-MCA) and deep cerebral veins, the same as in criteria of French Society of Neuroradiology [1].ResultsIn 107 patients, CTA revealed the absence of opacification of M4-MCA segments and deep cerebral veins. This met the French diagnostic criteria of cerebral circulatory arrest. This gave the sensitivity of 90% (95% CI 83-94%) for CTA in the diagnosis of BD. Additionally we identified potential points of pitfalls, which will be mentioned in currently elaborated Polish instruction.Conclusions1. CTA is a valuable confirmatory test for BD diagnosis. 2. Polish instruction will be compatible with French protocol published in 2011.Reference:1. Societe Francaise de Neuroradiologie, Societe Francaise de Radiologie, Agence de la Biomedecine. [Recommendations on diagnostic criteria of brain death by the technique of CT angiography]. J Neuroradiol. 2011;38(1):36–39.

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