10 society of nuclear medicine procedure guideline for brain death scintigraphy version 1 0 approved february 25 2003 suggested articles. Definition of irreversible coma jama 205 no. Report of the ad hoc committee of the harvard medical school to examine the definition of brain death.
Although ct plays a central role in the initial assessment of suspected intracranial injury planar brain scintigraphy provides valuable information regarding cerebral. In the united states approximately 1 7 million patients are treated annually for traumatic brain injury and cerebrovascular insults are the third leading cause of death. Goals the goal of this guideline is to describe some of the elements common to optimal performance of brain death.
The purpose of this guideline is to assist nuclear medicine practitioners in recommending performing inter preting and reporting the results of brain perfusion imaging to assist in confirming the diagnosis of brain death. The diagnosis of brain death is a clinical diagnosis that is sometimes confirmed with cerebral perfusion scintigraphy 1 2 it is important that all physicians be knowledgeable about the clinical requirements for the diagnosis of brain death especially the need to establish irreversible cessation of all function of the cerebrum. See also the snm guideline for general imaging.
This can be assessed by a number of modalities including ct mri ultrasound nuclear medicine examinations and catheter angiography. Most imaging tests for brain death rely on the absence of cerebral blood flow as a surrogate for brain death. In the delayed phase tracer accumulation is seen in the cerebral parenchyma.
In the flow phase tracer is seen in the common carotid arteries and anterior and middle cerebral arteries double and single arrows respectively. The below image is an example of a negative brain death scan using a brain specific tracer like tc 99m hmpao.
