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Computed tomographic angiography criteria in the diagnosis of brain death-comparison of sensitivity and interobserver reliability of different evaluation scales.

Sawicki M, Bohatyrewicz R, Safranow K, Walecka A, Walecki J, Rowinski O, Solek-Pastuszka J, Czajkowski Z, Guzinski M, Burzynska M, Wojczal J - Neuroradiology (2014)

Bottom Line: CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37).In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Clinical Hospital No1, Unii Lubelskiej 1, Szczecin, 71252, Poland, msaw@pum.edu.pl.

ABSTRACT

Introduction: The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD.

Methods: Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.

Results: Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p<0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37).

Conclusions: In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.

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Related in: MedlinePlus

Different criteria for the diagnosis of BD by CTA: a Positive result in the 10-point scale (score = 10) confirming the diagnosis of BD was recorded when the following vessels were not opacified: the bilateral PCA-P2, the BA, the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 9 were classified as negative results excluding the diagnosis of BD; b In the 7-point scale, positive result (score = 7) was recorded with a lack of opacification of the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 6 were classified as negative results; c Positive result in the 4-point scale (score = 4) was recorded when the bilateral MCA-M4 and the bilateral ICV were not opacified. Scores from 0 to 3 were classified as negative results
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Fig1: Different criteria for the diagnosis of BD by CTA: a Positive result in the 10-point scale (score = 10) confirming the diagnosis of BD was recorded when the following vessels were not opacified: the bilateral PCA-P2, the BA, the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 9 were classified as negative results excluding the diagnosis of BD; b In the 7-point scale, positive result (score = 7) was recorded with a lack of opacification of the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 6 were classified as negative results; c Positive result in the 4-point scale (score = 4) was recorded when the bilateral MCA-M4 and the bilateral ICV were not opacified. Scores from 0 to 3 were classified as negative results

Mentions: A point was given for each vessel without opacification, resulting in scores between 0 and 10. Diagnosis of BD was established according to the three previously used evaluation systems: 10-, 7-, and 4-point scales—see Fig. 1. Positive result in each scale confirming the diagnosis of BD was noted with scores 10, 7, and 4, respectively.Fig. 1


Computed tomographic angiography criteria in the diagnosis of brain death-comparison of sensitivity and interobserver reliability of different evaluation scales.

Sawicki M, Bohatyrewicz R, Safranow K, Walecka A, Walecki J, Rowinski O, Solek-Pastuszka J, Czajkowski Z, Guzinski M, Burzynska M, Wojczal J - Neuroradiology (2014)

Different criteria for the diagnosis of BD by CTA: a Positive result in the 10-point scale (score = 10) confirming the diagnosis of BD was recorded when the following vessels were not opacified: the bilateral PCA-P2, the BA, the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 9 were classified as negative results excluding the diagnosis of BD; b In the 7-point scale, positive result (score = 7) was recorded with a lack of opacification of the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 6 were classified as negative results; c Positive result in the 4-point scale (score = 4) was recorded when the bilateral MCA-M4 and the bilateral ICV were not opacified. Scores from 0 to 3 were classified as negative results
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4125746&req=5

Fig1: Different criteria for the diagnosis of BD by CTA: a Positive result in the 10-point scale (score = 10) confirming the diagnosis of BD was recorded when the following vessels were not opacified: the bilateral PCA-P2, the BA, the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 9 were classified as negative results excluding the diagnosis of BD; b In the 7-point scale, positive result (score = 7) was recorded with a lack of opacification of the bilateral ACA-A3, the bilateral MCA-M4, the bilateral ICV, and the GCV. Scores from 0 to 6 were classified as negative results; c Positive result in the 4-point scale (score = 4) was recorded when the bilateral MCA-M4 and the bilateral ICV were not opacified. Scores from 0 to 3 were classified as negative results
Mentions: A point was given for each vessel without opacification, resulting in scores between 0 and 10. Diagnosis of BD was established according to the three previously used evaluation systems: 10-, 7-, and 4-point scales—see Fig. 1. Positive result in each scale confirming the diagnosis of BD was noted with scores 10, 7, and 4, respectively.Fig. 1

Bottom Line: CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37).In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Clinical Hospital No1, Unii Lubelskiej 1, Szczecin, 71252, Poland, msaw@pum.edu.pl.

ABSTRACT

Introduction: The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD.

Methods: Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales.

Results: Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p<0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p=0.37).

Conclusions: In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability.

Show MeSH
Related in: MedlinePlus