PT - JOURNAL ARTICLE AU - Nishanta Baidya AU - Lance Hall TI - Brain death nuclear imaging using Tc-99m DTPA: does equivocal cerebral flow result really matter? A retrospective study DP - 2018 May 01 TA - Journal of Nuclear Medicine PG - 1705--1705 VI - 59 IP - supplement 1 4099 - http://jnm.snmjournals.org/content/59/supplement_1/1705.short 4100 - http://jnm.snmjournals.org/content/59/supplement_1/1705.full SO - J Nucl Med2018 May 01; 59 AB - 1705Objectives: To eliminate the “equivocal flow” group from cerebral flow studies with Tc-99m DTPA by demonstrating patients with equivocal flow will eventually follow in the brain death groups who have no flow. Methods: We retrospectively reviewed 100 consecutive patients with requested cerebral flow studies for confirmation of brain death at the University of Wisconsin from October 2009 to December 2017. Of those requests, 2 patients died before they could obtain the cerebral flow study, and 4 patients had duplicate medical record numbers or flow studies, leaving a total of 94 evaluable patients. Patients were categorized into 3 groups: no flow, equivocal flow, and definite flow. Equivocal flow was defined as any visual uptake of radiotracer in the superior sagittal sinus without uptake elsewhere or faint uptake elsewhere in an indeterminate location or pattern not typical of normal cerebral flow. Medical records were reviewed to determine if any patients with equivocal flow did actually survive or die. Results: Seventy patients had no flow, 16 patients had equivocal flow, and 8 patients had definite flow. All patients (94/94) in all 3 groups were clinically declared brain dead by the neurointensivist team during the same hospital admission. All 16 patients in the equivocal flow group were clinically declared brain dead within 24 hours of the cerebral flow studies. There was no difference in the final outcome among the no flow and equivocal flow groups. Conclusions: All patients with “equivocal flow” were ultimately declared brain dead and thus this equivocal flow category and clinical uncertainty associated with it can be eliminated, which has the potential to expedite organ harvesting. Furthermore, given the lack of any false negative studies with Tc-99m DTPA, we suggest more expensive and logistically challenging radiopharmaceuticals such as Tc-99m HMPAO and Tc-99m ECD may not be necessary to discriminate cases of equivocal flow.