Document Detail

99mTc-HMPAO SPECT in the diagnosis of brain death.
MedLine Citation:
PMID:  9803326     Owner:  NLM     Status:  MEDLINE    
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 degrees, 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.
E Facco; P Zucchetta; M Munari; F Baratto; A U Behr; M Gregianin; A Gerunda; F Bui; M Saladini; G Giron
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  24     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1999-01-19     Completed Date:  1999-01-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  911-7     Citation Subset:  IM    
Dept. of Anesthesiology and Intensive Care, University of Padua, Italy.
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MeSH Terms
Brain Death / diagnosis*,  radionuclide imaging
Child, Preschool
Infant, Newborn
Middle Aged
Predictive Value of Tests
Prospective Studies
Radiopharmaceuticals / diagnostic use*
Technetium Tc 99m Exametazime / diagnostic use*
Tomography, Emission-Computed, Single-Photon*
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime
Comment In:
Intensive Care Med. 1998 Sep;24(9):895-7   [PMID:  9803324 ]

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