Radionuclide angiography as a confirmatory test for brain death : A review of 229 studies in 219 patients

Radionuclide angiography (RA) has been used for many years to confirm the clinical diagnosis of brain death, but quantitative data regarding the technique are unavailable. We conducted a retrospective review of 229 RA procedures done in 219 patients. Of 206 patients who had interpretable studies and met clinical criteria for brain death (profound coma, absent brain stem reflexes, and apnea), including 10 patients who had repeated studies, 203 (98.5% sensitivity) had positive studies, and 6 (2.9%) had negative studies. Of nine patients who had interpretable studies and did not meet the clinical criteria for brain death, five (56% specificity) had positive studies and four (44%) had negative studies. Radionuclide angiography is a sensitive confirmatory test of brain death. The study does not evaluate the posterior fossa circulation, and an occasional patient may have residual brain stem function. The examination is most reliable when the patient is in a deep coma, has no brain stem reflexes, and has failed a formal apnea test.