Reliability of computed tomographic angiography in the diagnosis of brain death
Reliability of computed tomographic angiography in the diagnosis of brain death
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DOI：
10.1016/j.transproceed.2006.10.204
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发表时间：
2007-01-01
影响因子：
0.9
通讯作者：
Freysz, M.
中科院分区：
文献类型：
--
作者：
Combes, J-C.;Chomel, A.;Freysz, M.
客观的。本研究探讨了与传统脑血管造影相比，脑计算机断层扫描 (CT) 血管造影在诊断脑死亡 (BD) 中的有效性。这项前瞻性、单中心研究持续了 24 个月，纳入了 43 名年龄至少 18 岁、符合 BD 临床标准的患者。所有患者均先行脑CT血管造影，然后再行脑血管造影。为了确诊BD，CT扫描必须显示A2大脑前动脉段（A2-ACA）、M4大脑中动脉段（W-MCA）、P2大脑后动脉段（P2-PCA）、基底动脉、大脑内静脉以及最后的大脑大静脉缺乏灌注。脑血管造影显示后循环枕骨大孔水平脑血流停滞，前循环颈动脉虹吸水平。结果。 30 名患者通过两次检查均确诊为 BD。 13例患者脑血管造影证实BD，而CT血管造影仍显示脑灌注；分歧率为30.2%。结论。 CT 血管造影似乎是一种很有前景的 BD 确诊检查。然而，脑血管造影的差异显着，主要涉及近端的 M2-ACA。可能仅使用 W-NICA、P2-PCA、基底动脉和静脉血回流不透明的情况来保持符合法国法律。无论如何，国际医学界应该就 CT 血管造影的解释达成共识，将其广泛用作 BID 的补充检查。
Objective. This study examined the validity of cerebral computed tomographic (CT) angiography in the diagnosis of brain death (BD) compared with conventional cerebral angiography.Methods. This prospective, monocentric study was performed over a 24-month period and included 43 patients, at least 18 years of age, with clinical criteria of BD. All patients underwent cerebral CT angiography and then cerebral angiography. To confirm BD, the CT scan had to show the absence of perfusion of A2 anterior cerebral artery segments (A2-ACA), M4 middle cerebral artery segments (W-MCA), P2 posterior cerebral artery segments (P2-PCA), basilar artery, internal cerebral veins, and finally the great cerebral vein. Cerebral angiography showed cerebral blood flow arrest at the level of the foramen magnum for posterior circulation and carotid siphon for anterior circulation.Results. For 30 patients, BD was confirmed by both examinations. For 13 patients, cerebral angiography confirmed BD, whereas CT angiography still showed cerebral perfusion; the divergence rate was 30.2%.Conclusions. CT angiography seems to be a promising exam to confirm BD. However, the divergence with cerebral angiography is significant mainly concerning M2-ACA, which are proximal. It may be possible to only use the absence of opacification of W-NICA, P2-PCA, basilar artery, and venous blood return to remain in conformity with the French law. In all cases, the international medical community should obtain a consensus for the interpretation of CT angiography to use it extensively as a complementary exam for BID.