Diagnostic Value of Perfusion MR Imaging as a Potential Ancillary Test for Brain Death

Measuring brain perfusion by CT or MR as ancillary tests for diagnosis of brain death: a systematic review and meta-analysis

Objectives

To gather and synthesize evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis.

Methods

A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by 3 reviewers. PubMed/MEDLINE, EMBASE and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies' quality. Meta-analysis was performed using univariate random-effects models.

Results

Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, n = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI, 89.5-98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI, 86.5-98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings.

Conclusions

The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre, and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters.

Advances in knowledge

Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area.

PROSPERO registration number

CRD42022336353.

Diagnostic Value of Magnetic Resonance Susceptibility-Weighted Imaging Scanning in Different Types of Early Prostate Cancer

To investigate the cost of MRI-sensitive imaging (SWI) for early-stage prostate cancer. In 2019, the research group included a total of 60 leukemia patients, all of whom were diagnosed with prostate-specific antigen (PSA). According to the range of PSA values, they were group A (18 cases), group A 0-44 mg/ml (18 cases), and group B 4-1010 mg/ml (26 cases). 10 mg/ml was divided into C group (16 cases). Another 60 patients with benign prostatic hyperplasia treated at the same time served as a control group. All patients underwent sensitive MRI scanning, followed by diagnostic and clinical evaluation of weighted MRI scanning to diagnose various types of prostate cancer. The results showed that there was no difference in Ve levels among the three groups (P > 0.05); the SUSE score and Ktrans and Kep levels of the patients in group C were higher in groups B, A, and A (P < 0.05). In patients with early leukemia, SUSE score was significantly correlated with Ktrans and Kep levels (P < 0.05), but not with Ve and P > 0.05 levels. Magnetic resonance imaging can be used to diagnose prostate cancer. It can differentiate and diagnose different types of prostate cancer early. This is important for evaluating the benefits of prostate cancer screening and treatment.