ORIGINAL ARTICLE Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography Dolores Escudero Æ Jesu ´s Otero Æ Lara Marque ´s Æ Diego Parra Æ Jose ´ Antonio Gonzalo Æ Guillermo M. Albaiceta Æ Luis Cofin ˜o Æ Armando Blanco Æ Pedro Vega Æ Eduardo Murias Æ A ´ ngela Meilan Æ Ricardo Lo ´pez Roger Æ Francisco Taboada Published online: 30 June 2009 Ó Humana Press Inc. 2009 Abstract Introduction Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD. Methods Prospective observational study in 27 BD patients. Results All patients were diagnosed as BD based on clin- ical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclu- sively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroenceph- alogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead. D. Escudero (&) Á J. Otero Á L. Marque ´s Á D. Parra Á J. A. Gonzalo Á G. M. Albaiceta Á L. Cofin ˜o Á A. Blanco Á F. Taboada Department of Intensive Care Medicine, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, Spain e-mail: dolores.escudero@sespa.princast.es; lolaescudero@telefonica.net J. Otero e-mail: jesus.otero@sespa.princast.es L. Marque ´s e-mail: lmacngs@yahoo.es D. Parra e-mail: dparruiz@yahoo.es J. A. Gonzalo e-mail: jagonzalo@yahoo.es G. M. Albaiceta e-mail: galbaiceta@gmail.com L. Cofin ˜o e-mail: warrior@lacofi.org A. Blanco e-mail: armando.blanco@sespa.princast.es F. Taboada e-mail: taboada@uniovi.es P. Vega Á E. Murias Á A ´ . Meilan Á R. L. Roger Neuroradiology Section, Radiology Unit, Hospital Universitario Central de Asturias, C/Celestino Villamil s/n, 33006 Oviedo, Spain e-mail: peveval@yahoo.es E. Murias e-mail: emuriass@hotmail.com A ´ . Meilan e-mail: anmeil@hotmail.com R. L. Roger e-mail: mjreyp@yahoo.es Neurocrit Care (2009) 11:261–271 DOI 10.1007/s12028-009-9243-7