Abstract Details

Title Radionuclide Perfusion Scintigraphy in Diagnosis of Brain Death: A Retrospective Cohort Study

Topic Neuro Trauma and Critical Care

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 7-001

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.

Authors/Disclosures
Jonah Kaziyev, BS PRESENTER	Mr. Kaziyev has nothing to disclose.
Sheena Patel, Medical Student	Ms. Patel has nothing to disclose.
Carina Hou, BA	Ms. Hou has nothing to disclose.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. An immediate family member of Dr. Greer has or had stock in Vertex Pharmaceuticals. The institution of Dr. Greer has received research support from NINDS. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Ali Daneshmand, MD (Boston University School of Medicine)	Dr. Daneshmand has nothing to disclose.

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