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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

CTA findings in a 50-year-old man (patient no. 45) with traumatic brain injury (epidural hematoma in the right parietal region, massive intracerebral, and subarachnoid and intraventricular hemorrhage) and right sided craniectomy presented with signs of BD on clinical examination: a Ten millimeter maximum intensity projection (MIP) in sagittal plane. CTA shows opacification of the BA (thin arrow) and a trace of contrast in A2 segments of the ACAs (thick arrow). b Ten millimeter MIP in coronal plane. CTA shows opacification of the M1 segment of the left MCA (thin arrow) and the A1 segments of the ACAs (thick arrow); these findings exclude the diagnosis of BD according to the 10-point scale but confirm BD according to the 7- and 4-point scales. c Catheter angiography of the right VA performed 0.5 h later revealed delayed, residual filling of the BA (arrow) that occurred 21 s after injection. This result was interpreted as stasis filling consistent with the diagnosis of BD
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Fig3: CTA findings in a 50-year-old man (patient no. 45) with traumatic brain injury (epidural hematoma in the right parietal region, massive intracerebral, and subarachnoid and intraventricular hemorrhage) and right sided craniectomy presented with signs of BD on clinical examination: a Ten millimeter maximum intensity projection (MIP) in sagittal plane. CTA shows opacification of the BA (thin arrow) and a trace of contrast in A2 segments of the ACAs (thick arrow). b Ten millimeter MIP in coronal plane. CTA shows opacification of the M1 segment of the left MCA (thin arrow) and the A1 segments of the ACAs (thick arrow); these findings exclude the diagnosis of BD according to the 10-point scale but confirm BD according to the 7- and 4-point scales. c Catheter angiography of the right VA performed 0.5 h later revealed delayed, residual filling of the BA (arrow) that occurred 21 s after injection. This result was interpreted as stasis filling consistent with the diagnosis of BD

Mentions: According to the 10-point scale, 27 false negative CTA results were observed, see Fig. 3. With the 7-point scale, the number of false negative results decreased to 21, see Fig. 4. The 4-point scale provided three false negative results, see Fig. 5. A comparison of sensitivities for different CTA scales is presented in Fig. 6.Fig. 3


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)

CTA findings in a 50-year-old man (patient no. 45) with traumatic brain injury (epidural hematoma in the right parietal region, massive intracerebral, and subarachnoid and intraventricular hemorrhage) and right sided craniectomy presented with signs of BD on clinical examination: a Ten millimeter maximum intensity projection (MIP) in sagittal plane. CTA shows opacification of the BA (thin arrow) and a trace of contrast in A2 segments of the ACAs (thick arrow). b Ten millimeter MIP in coronal plane. CTA shows opacification of the M1 segment of the left MCA (thin arrow) and the A1 segments of the ACAs (thick arrow); these findings exclude the diagnosis of BD according to the 10-point scale but confirm BD according to the 7- and 4-point scales. c Catheter angiography of the right VA performed 0.5 h later revealed delayed, residual filling of the BA (arrow) that occurred 21 s after injection. This result was interpreted as stasis filling consistent with the diagnosis of BD
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: CTA findings in a 50-year-old man (patient no. 45) with traumatic brain injury (epidural hematoma in the right parietal region, massive intracerebral, and subarachnoid and intraventricular hemorrhage) and right sided craniectomy presented with signs of BD on clinical examination: a Ten millimeter maximum intensity projection (MIP) in sagittal plane. CTA shows opacification of the BA (thin arrow) and a trace of contrast in A2 segments of the ACAs (thick arrow). b Ten millimeter MIP in coronal plane. CTA shows opacification of the M1 segment of the left MCA (thin arrow) and the A1 segments of the ACAs (thick arrow); these findings exclude the diagnosis of BD according to the 10-point scale but confirm BD according to the 7- and 4-point scales. c Catheter angiography of the right VA performed 0.5 h later revealed delayed, residual filling of the BA (arrow) that occurred 21 s after injection. This result was interpreted as stasis filling consistent with the diagnosis of BD
Mentions: According to the 10-point scale, 27 false negative CTA results were observed, see Fig. 3. With the 7-point scale, the number of false negative results decreased to 21, see Fig. 4. The 4-point scale provided three false negative results, see Fig. 5. A comparison of sensitivities for different CTA scales is presented in Fig. 6.Fig. 3

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