{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:56Z","timestamp":1787027936821,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","award":["512648189"],"award-info":[{"award-number":["512648189"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Open Access Publication Fund of the Thueringer Universitaets-und Landesbibliothek Jena, Germany","award":["FSU040THUL-10554:2025"],"award-info":[{"award-number":["FSU040THUL-10554:2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: In addition to clinical examinations, confirmatory investigations are frequently performed to determine brain death (BD). Among other perfusion tests, brain perfusion scintigraphy (BPS) has been shown to be a reliable tool for the detection of brain circulatory arrest, particularly in cases with inconclusive clinical status or potential pharmacological interactions. Methods: Evaluation for brain death included standardized clinical examinations by two experienced neuro-intensive medicine specialists, followed by ancillary brain perfusion tests. BPS with the lipophilic tracer 99mTc-hexamethylpropyleneamine oxime (HMPAO) was performed according to a standardized protocol. Imaging results, additional confirmatory test results, as well as clinical parameters were prospectively recorded. Results: BPS was performed in 30 patients (18 male, 12 female; median age 55.5 years, range 0.1\u201379.8 years). Eight patients underwent decompressive craniectomy (DC) prior to BD evaluation, three patients were supported by veno-arterial extracorporeal membrane oxygenation (vaECMO), and one patient by a left ventricular assist device (LVAD). The median interval between the initial brain-damaging event and BPS was 4.0 days (range 1\u201318 days). BPS demonstrated brain perfusion cessation in all patients. A concomitant single-photon emission computed tomography (SPECT) was required in one patient. There were no technical failures requiring a re-examination. Conclusions: BPS is a feasible, safe, and technically robust confirmatory test in BD diagnosis. BPS yielded unambiguous results, particularly in cases with inconclusive results of other ancillary tests, in neonates, young children and patients after DC. It is applicable to patients supported by LVAD and vaECMO.<\/jats:p>","DOI":"10.3390\/diagnostics15212734","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:29:34Z","timestamp":1761661774000},"page":"2734","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Brain Perfusion Scintigraphy in the Diagnostic Toolbox for the Confirmation of Brain Death: Practical Aspects and Examination Protocol"],"prefix":"10.3390","volume":"15","author":[{"given":"Albrecht","family":"G\u00fcnther","sequence":"first","affiliation":[{"name":"Department of Neurology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Gunkel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9859-581X","authenticated-orcid":false,"given":"Christian","family":"Geis","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Br\u00e4mer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-9448","authenticated-orcid":false,"given":"Martin","family":"Brauer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Doerfel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Intensive Care Medicine and Neonatology, Jena University Hospital, 07747 Jena,  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fritzenwanger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6462-3851","authenticated-orcid":false,"given":"Martin","family":"Freesmeyer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8958-4801","authenticated-orcid":false,"given":"Thomas","family":"Winkens","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Drescher","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref_1","first-page":"393","article-title":"The Prolongation of Life","volume":"4","author":"Pius","year":"1958","journal-title":"Pope Speak."},{"key":"ref_2","unstructured":"Federal Medical Association Germany (Bundes\u00e4rztekammer) (2022). 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