Scintigraphic Confirmation of Brain Death

(A) Anterior projection dynamic images at one second per frame, obtained after the intravenous administration of 23.2 mCi (858 MBq) Tc99m HMPAO in a 17-year-old patient. The absence of perfusion in the anterior and middle cerebral artery territories is noted. (B) Planar static images in right lateral, anterior, and the left lateral projections demonstrate absence of tracer uptake in the cerebrum, basal ganglia thalami, and cerebellum.

(A) Anterior projection dynamic images at one second per frame, obtained after the intravenous administration of 8.6 mCi (318 MBq) Tc99m HMPAO in a 2-year-old patient. Because of the small size of the brain and narrower vascular lumen than in adults, interpretation of the dynamic images can be more challenging. (B) Planar images in anterior and right lateral projection demonstrate absence of tracer uptake in the cerebrum, cerebellum, and the basal ganglia.

SPECT imaging of the brain performed 60 minutes after the intravenous administration of 30.8 mCi (1140 MBq) Tc99m HMPAO. Clinical examination was consistent with brain death. No tracer uptake is noted in the cerebrum or cerebellum. Brainstem is not visualized, either. An incidental note is made of the SPECT equivalent of the “hot nose” sign.

SPECT imaging of the brain performed after intravenous administration of 23.5 mCi Tc99m ECD. The study was performed not to confirm brain death but as a part of an acetazolamide challenge test and is shown for comparison with Fig. 3. In this individual, SPECT was performed with the detector close to the patient and without the limitation of a cervical collar, the brainstem can be faintly visualized in the more caudal sections.