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

  • Diagnostic Neuroradiology
  • Published:
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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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Authors and Affiliations

  1. UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Alessandro Pedicelli, Emilio Lozupone, Francesco D’Argento, Andrea Alexandre, Iacopo Valente & Cesare Colosimo

  2. UO Radiologia, Dipartimento di radiologia e diagnostica per immagini, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

    Margherita Bartocci

  3. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy

    Giuseppe Garignano & Cesare Colosimo

  4. UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Ciro D’Alò

  5. Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy

    Ciro D’Alò

  6. Medical Science Division, Guerbet, Villepinte, France

    Viola Giacobbe

Authors
  1. Alessandro Pedicelli
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  2. Margherita Bartocci
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  3. Emilio Lozupone
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  4. Francesco D’Argento
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  5. Andrea Alexandre
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  6. Giuseppe Garignano
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  7. Ciro D’Alò
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  8. Viola Giacobbe
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  9. Iacopo Valente
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  10. Cesare Colosimo
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Corresponding author

Correspondence to Iacopo Valente.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Pedicelli, A., Bartocci, M., Lozupone, E. et al. The role of cervical color Doppler ultrasound in the diagnosis of brain death. Neuroradiology 61, 137–145 (2019). https://doi.org/10.1007/s00234-018-2111-4

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  • DOI: https://doi.org/10.1007/s00234-018-2111-4

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