Sérgio Brasil1, Edson Bor-Seng-Shu2, Marcelo de-Lima-Oliveira3, Milena K Azevedo3, Manoel J Teixeira3, Luca Bernardo4, Wanderley M Bernardo4. 1. University of São Paulo, School of Medicine, Hospital das Clínicas, Division of Neurological Surgery, São Paulo, Brazil. Electronic address: sbrasil@usp.br. 2. University of São Paulo, School of Medicine, Hospital das Clínicas, Division of Neurological Surgery, São Paulo, Brazil. Electronic address: edsonshu@hotmail.com. 3. University of São Paulo, School of Medicine, Hospital das Clínicas, Division of Neurological Surgery, São Paulo, Brazil. 4. University of São Paulo, School of Medicine, São Paulo, Brazil.
Abstract
BACKGROUND: Several complications make the diagnosis of brain death (BD) medically challenging and a complimentary method is needed for confirmation. In this context, computed tomography angiography (CTA) and computed tomography perfusion (CTP) could represent valuable alternatives; however, the reliability of CTA and CTP for confirming brain circulatory arrest remains unclear. METHODS: A systematic review was performed to identify relevant studies regarding the use of CTA and CTP as ancillary tests for BD confirmation. RESULTS: Three hundred twenty-two patients were eligible for the meta-analysis, which exhibited 87.5% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. CONCLUSIONS: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to provide radiologic confirmation. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide.
BACKGROUND: Several complications make the diagnosis of brain death (BD) medically challenging and a complimentary method is needed for confirmation. In this context, computed tomography angiography (CTA) and computed tomography perfusion (CTP) could represent valuable alternatives; however, the reliability of CTA and CTP for confirming brain circulatory arrest remains unclear. METHODS: A systematic review was performed to identify relevant studies regarding the use of CTA and CTP as ancillary tests for BD confirmation. RESULTS: Three hundred twenty-two patients were eligible for the meta-analysis, which exhibited 87.5% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. CONCLUSIONS: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to provide radiologic confirmation. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide.
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