Wednesday, July 5, 2006
SPECT as a 'gold standard' to determine Brain Death ?

Angiography has been considered the gold standard for diagnosis of Brain Death for decades. With arrival of new technologies, we try to move more and more towards non-invasive procedures.

Dr. Munari from Italy looked into 20 clinically brain dead patients. ( 99mTc-HMPAO) SPECT and four-vessel angiography were performed in the same session, with no time delay in between. Then, the results of SPECT and angiography were interpreted separately by a specialist in nuclear medicine and a neuroradiologist, respectively; both of them were blind to the results of the other investigation. Both angiography and SPECT confirmed BD in 19 of 20 patients: angiography showed the absence of filling of intracranial arteries, while SPECT showed a picture of empty skull. For one patient, angiography showed slight and late filling of vessels while SPECT showed faint traces of uptake.For this patient, the tests were repeated 48 hrs later, and both showed the arrest of intracranial circulation, thus confirming brain death.

SPECT = Single Photon Emission Computed Tomography


It was concluded by the authors that: SPECT is a good candidate for the gold standard of diagnosis as:

• It is noninvasive and, therefore, free from complications and can be repeated for patients who are not brain dead with no harm;
• It shows a clear-cut picture of empty skull, an image that can be easily understood by physicians and even by patient's relatives;
• It fully fits the definition of whole Brain death, showing the absence of whole brain perfusion, down to the foramen magnum.

See interesting Power point presentation on

Brain Death: The Neurologist's Perspective from Stephen T. Mernoff, MD, Clinical Assistant Professor of Neurology, Brown Medical School. Also see our neurology section for various related topics as
Brain death determination (Source MGH stroke service)
Pre-Apnea test checklist (sample from virginia.edu)
Post-Apnea test checklist (sample from virginia.edu)


References: click to get abstract/article

1. Confirmatory tests in the diagnosis of brain death: Comparison between SPECT and contrast angiography - Critical Care Medicine. 33(9):2068-2073, September 2005