CT angiography used in the diagnosis of brain death
Conventional cerebral angiography has, prior to organ donation, been used to confirm that the blood flow to the brain has ceased in patients with clinical signs compatible with brain death. Conventional angiography has been replaced by newer imaging methods, like CT angiography, in a small number of hospitals in Norway. It is therefore of interest to evaluate whether CT angiography should replace conventional angiography in the diagnosis of brain death.
We identified an updated guideline from the American Academy of Neurology published in 2010 (literature search in May 2009) which concluded that, based on available research, it is not possible to decide whether new methods such as CT angiography can diagnose cessation of cerebral blood flow with high diagnostic accuracy.
We also performed an updated search for literature published after May 2009, and included one study that showed:
- Low sensitivity (0,38 %) of cerebral CT angiography compared to conventional cerebral angiography in patients with clinical signs of brain death.
A decision to change practice through replacing conventional angiography by CT angiography, therefore, must rely not only on research, but also on the experience of the clinical experts and an evaluation of what is considered to be realistic in clinical practice.