Contribution of MRI and MR angiography in early diagnosis of brain death.

The objective of this study was to investigate whether the findings of MR imaging and MR angiography could accurately and early diagnose brain death in comatose patients. Thirty comatose patients were studied with MRI and MR arteriography. In 20 patients (group A) presenting with a Glasgow coma scale (GCS) 3-6, the final clinical diagnosis was brain death. In ten comatose patients with a GCS 4-6 and no clinical signs of brain death (group B), the clinical follow-up did not reveal brain death in a period of 12 months. The MRI examination consisted of turbo fluid-attenuated inversion recovery and T2 turbo spin-echo pulse sequences. The MR arteriography was performed with a 3D inflow pulse sequence. In 12 patients with brain death and 5 patients with no signs of brain death, a 3D phase contrast MR venography was also applied. Magnetic resonance imaging in all patients showed variable edema with swelling of the cerebral gyri, small ventricular system, and basilar subarachnoid spaces. In group A, MRI in addition showed tonsillar herniation. In group A, MR arteriography revealed no arterial flow in the intracranial circulation, whereas MR venography showed in 9 patients no opacification of the sagittal and straight sinuses or visualization of intracranial veins. In contrast, MR angiography showed intact intracranial vessels in patients of group B. In conclusion, MR imaging and MR angiography may be reliable ancillary tests for use in early diagnosis of brain death and further work is required to validate its utility.