Download PDF
Rofo 2016; 188(01): 23-26
DOI: 10.1055/s-0041-108202
Review
© Georg Thieme Verlag KG Stuttgart · New York

Imaging of Irreversible Loss of Brain Function

Bildgebende Verfahren zur Diagnostik des irreversiblen Hirnfunktionsausfalles
H. Lanfermann
1   Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany
,
O. Schober
2   Department of Nuclear Medicine, University Hospital Münster, Germany
› Author Affiliations
Further Information

Publication History

14 July 2015

25 September 2015

Publication Date:
01 December 2015 (online)

Also available at
   Permissions and Reprints

Abstract

The updated guidelines for the determination of irreversible loss of brain function include a substantial innovation, i. e., the use of CT angiography as a supplementary technical examination. Adherence to a standardized protocol is the prerequisite for the application of CT angiography. The guidelines for standardized execution of perfusion scintigraphy are unchanged and still valid. Requirements regarding the quality of examining physicians are specified.

Key points:

• The guidelines for determining irreversible loss of brain function were updated.

• The approval of CT angiography as a supplementary examination method is a major innovation.

• CT angiography is to be performed to determine the cessation of cerebral blood circulation according to a standard protocol.

• The guidelines for the standardized implementation of perfusion scintigraphy continue to be valid.

• Quality requirements regarding examining physicians were specified.

Citation Format:

• Lanfermann H, Schober O. Imaging of Irreversible Loss of Brain Function. Fortschr Röntgenstr 2016; 188: 23 – 26

Zusammenfassung

In den aktualisierten Richtlinien zur Feststellung des irreversiblen Hirnfunktionsausfalles wird als wesentliche Neuerung die CT-Angiografie als ergänzendes apparatives Untersuchungsverfahren zugelassen. Voraussetzung für den Einsatz der CT-Angiografie ist die Einhaltung eines Standardprotokolls. Die Richtlinien zur standardisierten Durchführung der Perfusionsszintigrafie sind unverändert fortgeschrieben. Die Qualitätsanforderungen der untersuchenden Ärzte werden präzisiert.

Key words

brain death - brain perfusion - scintigraphy - quality control - CT angiography

Deutscher Artikel/German Article

 

  • References

  • 1 Beschluss der Bundesärztekammer über die Richtlinie gemäß § 16 Abs. 1 S. 1 Nr. 1 TPG für die Regeln zur Feststellung des Todes nach § 3 Abs. 1 S. 1 Nr. 2 TPG und die Verfahrensregeln zur Feststellung des endgültigen, nicht behebbaren Ausfalls der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms nach § 3 Abs. 2 Nr. 2 TPG, Vierte Fortschreibung. Dtsch Arztebl 2015; 112: A-1256/B-1052/C-1024
    PubMedGoogle Scholar
  • 2 Richtlinien zur Feststellung des Hirntodes. Dritte Fortschreibung 1997 mit Ergänzungen gemäß Transplantationsgesetz (TPG). Deutsches Ärzteblatt 1998; 95: A-1861
    PubMedGoogle Scholar
  • 3 Dupas B, Gayet-Delacroix M, Villers D et al. Diagnosis of brain death using two-phase spiral CT. Am J Neuroradiol 1998; 19: 641-647
    PubMedGoogle Scholar
  • 4 Berenguer CM, Davis FE, Howington JU. Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan. J Trauma 2010; 68: 553-559
    CrossrefPubMedGoogle Scholar
  • 5 Bohatyrewicz R, Sawicki M, Walecka A et al. Computed tomographic angiography and perfusion in the diagnosis of brain death. Transplant Proc 2010; 42: 3941-3946
    CrossrefPubMedGoogle Scholar
  • 6 Combes JC, Chomel A, Ricolfi F et al. Reliability of computed tomographic angiography in the diagnosis of brain death. Transplant Proc 2007; 39: 16-20
    CrossrefPubMedGoogle Scholar
  • 7 Frampas E, Videcoq M, de Kerviler E et al. CT angiography for brain death diagnosis. Am J Neuroradiol 2009; 30: 1566-1570
    CrossrefPubMedGoogle Scholar
  • 8 Escudero D, Otero J, Marques L et al. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocrit Care 2009; 11: 261-271
    CrossrefPubMedGoogle Scholar
  • 9 Leclerc X, Taschner CA, Vidal A et al. The role of spiral CT for the assessment of the intracranial circulation in suspected brain-death. J Neuroradiol 2006; 33: 90-95
    CrossrefPubMedGoogle Scholar
  • 10 Qureshi AI, Kirmani JF, Xavier AR et al. Computed tomographic angiography for diagnosis of brain death. Neurology 2004; 62: 652-653
    CrossrefPubMedGoogle Scholar
  • 11 Rieke A, Regli B, Mattle HP et al. Computed tomography angiography (CTA) to prove circulatory arrest for the diagnosis of brain death in the context of organ transplantation. Swiss Med Wkly 2011; 141: w13261
    PubMedGoogle Scholar
  • 12 Welschehold S, Boor S, Reuland K et al. Technical aids in the diagnosis of brain death-a comparison of SEP, AEP, EEG, TCD and CT angiography. Dtsch Arztebl Int 2012; 109: 624-630
    PubMedGoogle Scholar
  • 13 Welschehold S, Kerz T, Boor S et al. Detection of intracranial circulatory arrest in brain death using cranial CT-angiography. Eur J Neurol 2013; 20: 173-179
    CrossrefPubMedGoogle Scholar
  • 14 Welschehold S, Kerz T, Boor S et al. A. Computed tomographic angiography as a useful adjunct in the diagnosis of brain death. J Trauma Acute Care Surg 2013; 7: 1279-1285
    PubMedGoogle Scholar
  • 15 Taylor T, Dineen RA, Gardiner DC et al. Computed tomography (CT) angiography for confirmation of the clinical diagnosis of brain death. Cochrane Database SystRev 2014; 3: CD009694
    PubMedGoogle Scholar
  • 16 Berkhemer OA, Fransen PS, Beumer D. MR CLEAN Investigators et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20
    CrossrefPubMedGoogle Scholar
  • 17 Saver JL, Goyal M, Bonafe A. SWIFT PRIME Investigators et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N Engl J Med 2015; 372: 2285-2295
    CrossrefPubMedGoogle Scholar
  • 18 ACR Practice Guideline for the performance of single photon emission computed tomography (SPECT) brain perfusion and brain death studies. ACR Practice Guidelines and Technical Standards. Res 2007; 21: 823-828
    PubMedGoogle Scholar
  • 19 Bender A, Jox RJ, Grill E et al. Persistent vegetative state and minimal conscious stae. Dtsch Arztebl Int 2015; 112: 235-242
    PubMedGoogle Scholar
  • 20 Bertagna F, Barozzi O, Puta E et al. Residual brain viability, evaluated by (99m)Tc-ECD SPECT, in patients with suspected brain death and with confounding clinical factors. Nucl Med Commun 2009; 30: 815-821
    CrossrefPubMedGoogle Scholar
  • 21 Donohoe KJ, Agrawal G, Frey KA et al. SNM practice guideline for brain death scintigraphy 2.0. J Nucl Med Technol 2012; 40: 198-203
    CrossrefPubMedGoogle Scholar
  • 22 Galaske RG, Schober O, Heyer R. Tc-99m-HM-PAO and I-123-amphetamine cerebral scintigraphy: a new noninvasive method in determination of brain death in children. Eur J Nucl Med 1988; 14: 446-452
    CrossrefPubMedGoogle Scholar
  • 23 Kim AC, Colletti PM. Perfusion „brain death“ scintigraphy in traumatic and hypoxic cerebral insults: correlation with CT. Clin Nucl Med 2012; 37: 880-888
    CrossrefPubMedGoogle Scholar
  • 24 Schober O, Galaske RG, Heyer R. Determination of brain death mit 123IMP and 99mTc-HM-PAO. Neurosurg Rev 1987; 10: 19-22
    CrossrefPubMedGoogle Scholar
  • 25 Sinha P, Conrad GR. Scintigraphic confirmation of brain death. Semin Nucl Med 2012; 42: 27-32
    CrossrefPubMedGoogle Scholar
  • 26 Weckesser M, Schober O. Brain death revisited: utility confirmed for nuclear medicine. Eur J Nucl Med 1999; 26: 1387-1391
    CrossrefPubMedGoogle Scholar