Radionuclide Perfusion Scintigraphy in Diagnosis of Brain Death: A Retrospective Cohort Study
Jonah Kaziyev1, Sheena Patel1, Carina Hou1, David Greer1, Ali Daneshmand1
1Boston University School of Medicine
Objective:
To systematically investigate the use of Nuclear Medicine Single Photon Emission Computed Tomography (NM-SPECT) for ancillary testing in brain death/death by neurologic criteria (BD/DNC).
Background:
BD/DNC is the permanent loss of all brain function, including the brainstem. Ancillary tests help establish the diagnosis of BD/DNC when complete clinical testing is not feasible or safe. Specifically, the NM-SPECT evaluates cerebral perfusion.
Design/Methods:
Using an established multi-center retrospective cohort from the IRB-approved New England Brain Death Project, we identified and extracted data from all patients who underwent NM-SPECT for BD/DNC determination between 2012 and 2023, noting whether the results were congruent with absent cerebral blood flow.
Results:
Of the 74 patients who underwent NM-SPECT, 70 (94.6%) had results consistent with BD/DNC, and 4 (5.4%) did not. For those with consistent results, 50 (71.4%) were male; mean age was 42.1 years. The most common primary diagnoses were hypoxic-ischemic brain injury (57.1%), traumatic brain injury (22.9%) and subarachnoid hemorrhage (12.9%). The most common reasons for ancillary testing were positive urine toxicology (34.3%) and hemodynamic instability (14.3%). In patients with NM-SPECT consistent with BD/DNC, four (5.7%) had undergone craniectomy and thirteen (18.6%) had other skull defects, whereas in the group with non-consistent findings, 3 of 4 patients had undergone craniectomy. Fifty-three (75.7%) with NM-SPECT consistent with BD/DNC underwent CT imaging within 48 hours of clinical brain death examination, versus one (25%) patient in the group with non-consistent NM-SPECT. Fifty-five (78.6%) in the consistent group had NM-SPECT within 48 hours of most recent CT, versus one (25%) in the non-consistent group.
Conclusions:
Our study highlights the limitations of NM-SPECT, particularly its risk of showing possible preserved cerebral blood flow in patients with skull defects. Future prospective studies comparing NM-SPECT to a gold standard ancillary test are required to establish its sensitivity and specificity in patients with skull defects.
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