{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:05:18Z","timestamp":1792670718352,"version":"4.5.0"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"Importance<\/jats:title>Accurate and timely confirmation of death by neurologic criteria (DNC) is essential for clinical decision-making and organ-donation processes, yet currently available ancillary tests have suboptimal diagnostic performance or limited validation.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To determine the diagnostic accuracy, interrater reliability, and safety of brain computed tomography (CT) perfusion and CT angiography as ancillary investigations for DNC.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Between April 25, 2017, and March 10, 2021, a prospective, multicenter, blinded diagnostic accuracy cohort study was conducted in 15 adult intensive care units across Canada. Consecutive, critically ill adults (aged \u226518 years) with a Glasgow Coma Scale score of 3 and no confounding factors who were at high risk of DNC were included. Data collection and analysis were performed from April 2021 to July 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Contrast-enhanced brain CT perfusion with CT angiography reconstructions performed within 2 hours of a blinded, standardized clinical DNC examination.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were the sensitivity and specificity of qualitative and quantitative brainstem CT perfusion for DNC determination, assessed by 2 independent neuroradiologists blinded to clinical findings; the prespecified validation threshold was greater than 98%. Secondary outcomes were the diagnostic accuracy of whole-brain CT perfusion and CT angiography, interrater reliability (Cohen \u03ba), and adverse events associated with imaging.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 282 patients (mean [SD] age, 57.8 [15.4] years; 133 [47%] female) completed the study protocol and were included in the primary analysis; 204 (72%) of these were ultimately declared deceased by standardized clinical criteria. Qualitative brainstem CT perfusion showed a sensitivity of 98.5% (95% CI, 95.8%-99.7%) and a specificity of 74.4% (95% CI, 63.2%-83.6%); quantitative brainstem CT perfusion was not diagnostically accurate. Qualitative whole-brain CT perfusion yielded a sensitivity of 93.6% (95% CI, 89.3%-96.6%) and a specificity of 92.3% (95% CI, 84.0%-97.1%). CT angiography sensitivity ranged from 75.5% (95% CI, 69.0%-81.2%) to 87.3% (95% CI, 81.9%-91.5%), and its specificity ranged from 89.7% (95% CI, 80.8%-95.5%) to 91.0% (95% CI, 82.4%-96.3%). Interrater reliability was excellent for all ancillary tests (\u03ba ranged from 0.81 [95% CI, 0.73-0.89] to 0.84 [95% CI, 0.78-0.91]). Fourteen patients (5%) experienced minor, self-limited adverse events; no serious adverse events occurred.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The observed sensitivity and specificity measures for CT perfusion and CT angiography as an ancillary test for DNC did not meet the prespecified validation threshold of greater than 98%. Clinical examination remains the cornerstone of DNC, and ancillary imaging should be interpreted cautiously within a comprehensive clinical assessment.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.2375","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T11:30:35Z","timestamp":1749814235000},"page":"932","source":"Crossref","is-referenced-by-count":10,"title":["Computed Tomography Perfusion and Angiography for Death by Neurologic Criteria"],"prefix":"10.1001","volume":"82","author":[{"given":"Micha\u00ebl","family":"Chass\u00e9","sequence":"first","affiliation":[{"name":"Department of Medicine, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Centre de Recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"School of Public Health, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai Jai Shiva","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Department of Human Anatomy and Cell Sciences, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean A.","family":"Fergusson","sequence":"additional","affiliation":[{"name":"Methodological and Implementation Research Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane W.","family":"English","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada"},{"name":"Acute Care Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"School 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