TY - JOUR
T1 -
99mTc-HMPAO SPECT in the diagnosis of brain death
AU - Facco, E.
AU - Zucchetta, P.
AU - Munari, M.
AU - Baratto, F.
AU - Behr, A. U.
AU - Gregianin, M.
AU - Gerunda, A.
AU - Bui, F.
AU - Saladini, M.
AU - Giron, G.
PY - 1998
Y1 - 1998
N2 - Objective: To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD). Design: Prospective study in comatose and brain-dead patients. Setting: Neurologic ICU. Patients and methods: Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD. Interventions: Brain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360°, 88 images). Measurements and results: All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of 'empty skull'); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later. Conclusions: Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.
AB - Objective: To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD). Design: Prospective study in comatose and brain-dead patients. Setting: Neurologic ICU. Patients and methods: Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD. Interventions: Brain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360°, 88 images). Measurements and results: All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of 'empty skull'); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later. Conclusions: Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.
KW - Brain death
KW - Brain injuries
KW - Cerebrovascular circulation
KW - EEG
KW - SPECT
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U2 - 10.1007/s001340050689
DO - 10.1007/s001340050689
M3 - Article
C2 - 9803326
AN - SCOPUS:0031593901
VL - 24
SP - 911
EP - 917
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 9
ER -