The role of cervical color Doppler ultrasound in the diagnosis of brain death

Alessandro Pedicelli, Margherita Bartocci, Emilio Lozupone, Francesco D’Argento, Andrea Alexandre, Giuseppe Garignano, Ciro D’Alò, Viola Giacobbe, Iacopo Valente, Cesare Colosimo

Research output: Contribution to journalArticle

Abstract

Purpose: Brain death (BD) is defined as the irreversible destruction of all brain functions. It is usually diagnosed through a clinical examination, but in certain circumstances, ancillary examinations (such as digital subtraction angiography (DSA), transcranial color Doppler (TCD), computed tomography angiography (CTA), magnetic resonance angiography (MRA), or radionuclide scanning) are required as confirmatory tests. In many countries, cervical color Doppler sonography (CCD) is not recognized as a valid test. The aim of our study is to assess its accuracy as a non-invasive, inexpensive, and easily available examination to determine cerebral circulatory arrest (CCA). Methods: We performed a retrospective study in which 123 patients with clinical diagnosis of BD underwent bedside cervical color Doppler as an additional examination for CCA assessment. We compared these cervical color Doppler findings with the results of validated ancillary tests such as CTA, TCD, and DSA. Results: Cervical color Doppler exams showed a sensitivity of 78% (96/123 patients) in detecting CCA compared to standard ancillary tests. Twenty-seven patients showed a persistent diastolic flow in one or two of the four arterial vessels examined and thus considered as false negatives. Conclusion: Our results show that cervical color Doppler may become a reliable and safe technique in detecting CCA, which can shorten the time for declaring brain death. In particular, in patients lacking good bone windows at transcranial color Doppler, cervical color Doppler of the cervical internal carotids and vertebral arteries could be recommended to increase the sensitivity of transcranial color Doppler, or as an alternative bedside examination.

Original languageEnglish
JournalNeuroradiology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Doppler Ultrasonography
Brain Death
Color
Digital Subtraction Angiography
Doppler Color Ultrasonography
Vertebral Artery
Magnetic Resonance Angiography
Internal Carotid Artery
Radioisotopes
Retrospective Studies
Bone and Bones

Keywords

  • Ancillary test
  • Brain death
  • Cerebral circulatory arrest
  • Cervical color Doppler
  • Transcranial color Doppler

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Pedicelli, A., Bartocci, M., Lozupone, E., D’Argento, F., Alexandre, A., Garignano, G., ... Colosimo, C. (Accepted/In press). The role of cervical color Doppler ultrasound in the diagnosis of brain death. Neuroradiology. https://doi.org/10.1007/s00234-018-2111-4

The role of cervical color Doppler ultrasound in the diagnosis of brain death. / Pedicelli, Alessandro; Bartocci, Margherita; Lozupone, Emilio; D’Argento, Francesco; Alexandre, Andrea; Garignano, Giuseppe; D’Alò, Ciro; Giacobbe, Viola; Valente, Iacopo; Colosimo, Cesare.

In: Neuroradiology, 01.01.2018.

Research output: Contribution to journalArticle

Pedicelli, A, Bartocci, M, Lozupone, E, D’Argento, F, Alexandre, A, Garignano, G, D’Alò, C, Giacobbe, V, Valente, I & Colosimo, C 2018, 'The role of cervical color Doppler ultrasound in the diagnosis of brain death', Neuroradiology. https://doi.org/10.1007/s00234-018-2111-4
Pedicelli A, Bartocci M, Lozupone E, D’Argento F, Alexandre A, Garignano G et al. The role of cervical color Doppler ultrasound in the diagnosis of brain death. Neuroradiology. 2018 Jan 1. https://doi.org/10.1007/s00234-018-2111-4
Pedicelli, Alessandro ; Bartocci, Margherita ; Lozupone, Emilio ; D’Argento, Francesco ; Alexandre, Andrea ; Garignano, Giuseppe ; D’Alò, Ciro ; Giacobbe, Viola ; Valente, Iacopo ; Colosimo, Cesare. / The role of cervical color Doppler ultrasound in the diagnosis of brain death. In: Neuroradiology. 2018.
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abstract = "Purpose: Brain death (BD) is defined as the irreversible destruction of all brain functions. It is usually diagnosed through a clinical examination, but in certain circumstances, ancillary examinations (such as digital subtraction angiography (DSA), transcranial color Doppler (TCD), computed tomography angiography (CTA), magnetic resonance angiography (MRA), or radionuclide scanning) are required as confirmatory tests. In many countries, cervical color Doppler sonography (CCD) is not recognized as a valid test. The aim of our study is to assess its accuracy as a non-invasive, inexpensive, and easily available examination to determine cerebral circulatory arrest (CCA). Methods: We performed a retrospective study in which 123 patients with clinical diagnosis of BD underwent bedside cervical color Doppler as an additional examination for CCA assessment. We compared these cervical color Doppler findings with the results of validated ancillary tests such as CTA, TCD, and DSA. Results: Cervical color Doppler exams showed a sensitivity of 78{\%} (96/123 patients) in detecting CCA compared to standard ancillary tests. Twenty-seven patients showed a persistent diastolic flow in one or two of the four arterial vessels examined and thus considered as false negatives. Conclusion: Our results show that cervical color Doppler may become a reliable and safe technique in detecting CCA, which can shorten the time for declaring brain death. In particular, in patients lacking good bone windows at transcranial color Doppler, cervical color Doppler of the cervical internal carotids and vertebral arteries could be recommended to increase the sensitivity of transcranial color Doppler, or as an alternative bedside examination.",
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AU - Alexandre, Andrea

AU - Garignano, Giuseppe

AU - D’Alò, Ciro

AU - Giacobbe, Viola

AU - Valente, Iacopo

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