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Impact of skull defects on the role of CTA for brain death confirmation

American Journal of Neuroradiology Jul 14, 2019

Nunes DM, et al. - Through a series of consecutive patients with a clinical diagnosis of brain death who underwent CTA (case group) and patients with acute ischemic stroke in the same period (control group), the researchers assessed the influence of a skull defect and the interpretation criteria of images on CTA as a diagnostic test. Cases were scaled as a sound skull, craniotomy, and craniectomy. The sensitivity of CTA to confirm brain death was 95.5%, 87.5% and 60% in patients with an intact skull, with craniotomy, and with craniectomy, respectively, in the case group. False-negative diagnoses of brain death were observed in 15.6%, related to stasis filling in 71.4%. However, the sensitivity of CTA in order to verify brain death was 100%, 93.8% and 80% in patients with an intact skull, with craniotomy, and with craniectomy, respectively according to “modified Frampas criteria”. False-negative diagnoses of brain death were seen in 6.2% of subjects with no stasis filling. CTA exhibited 100% specificity in the control group. No disagreements amongst observers was noted. Hence, to verify brain death in subjects with an intact skull, CTA had great diagnostic accuracy and reproducibility. Especially in patients with a skull defect, the modified Frampas criteria increased the sensitivity of CTA. Moreover, to verify brain death, a concurrent skull defect, particularly craniectomy, could reduce the sensitivity of CTA.
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